Posts Tagged ‘Medical Error’

Forensic Nursing in Correctional Facilities, comment

February 9, 2009
I’m sure this is a hot topic among may people. I have to admit as an ER nurse who has seen children who have been physically and sexually abused the thought of having to provide humane care to these animals disgusts me. However, as a nurse we are taught we must heal and teach. I try to treat all patients with dignity no matter what they may have done, but I also believe that with any nursing position you shouldn’t go into it for the money but because it is an area you enjoy. I am not a pysch nurse. I don’t believe in all of the mumbo jumbo, but I do love forensics in trying to determine how a crime was committed and discovering the “who dunnit”. The individuals who work with the criminally insane and the prisioners have to be special people because of the horrible things they see and hear that these prisoners have done. It is a “right” I suppose that all individuals receive adequate healthcare but I have to wonder if were able to subject these criminals to an ounce of the pain that they caused some of their victims would we have less crime?

Original Post:
February 2, 2009
Forensic nursing in Correctional Facilities, comment
I have worked in a Forensic Mental Hospital. I am sure your are speaking about other correctional facilities.
In the Forensic Mental Hospital all of the patients are monitored differently that other patients with very strict rules. Only large strong young men can be the attendants because often the patients are “taken down’ But again this is because they are mentally ill criminals who have a history of hurting even killing people.
One of the forensic mentally ill patients was out in the community. A brutally mean child predator who was given large amts of Depo Provera to chemically castrate him. He could not achieve an erection but state he could not get the idea of hurting young girls out of his mind. He was readmitted to the hospital because he took a razor blade to his penis and testicles.  My job was to change the dressings once a day I had to have two strong young men with me when I was with this patient.  Even though people are locked up maybe the reasons they are criminals are not resolved.

I also applied at the State Prison. While I was waiting for my interview I saw young men hand cuffed through a bench. (i.e. one side of the hand cuff was on the patient and the other through the bench holding the prisoner on the bench)
I decided not to apply because the environment was scary. I agree with the article of Forensic nursing in Correctional facilities but feel it is a dream or fantasy to think that nursing can be like this.
These men and women are in a locked house without normal privileges; sometimes they are fighting for their life.  It is good to treat them normally but there is always the underlying ‘roar’ that they may be trying to get something more than they need. After all a large amount of criminals have sociopathic personalities
 
I work in a poor family clinic in a large city. I often have people who have gotten out of prison come to my clinic because they usually do not have money for health care.
It seems that more often then not, these patients continue their pre prison activities.  They come to us with infected needle lesions. They cry that they just cannot stop. They plead and cry for narcotics, show attitude, and sometimes are mean.
I agree we should treat them with dignity but so should show us respect also.  
I try to remember that most of them are in prison because they do not have people skills and have learned how to ‘play’ people to get what they need. How can a small clinic ‘provide nursing care that is free of bias and judgment’s when the patient (a previous criminal) has showed anger and attitude in the clinic. When I have to spend more than 15 minutes with this patient because he/she needs more help and expects it.
My company had to put a break proof piece of glass between the receptionist and the patient because one of these patients threatened the intake person. Now all the patients have to speak on a phone to the intake person.
It seems that even in a correctional facility they have rules and monitors to decrease the roots of violence. Now when the criminals are let out some of them continue the attitude and continue to cause problems.
Where does it end?

Original Post:
December 30, 2008
Forensic nursing in Correctional Facilities
This chapter started with a wonderful summary of some of the issues that forensic nurses had to contend with in correctional facilities. These nurses are not concerned about the crime that was committed because that has nothing to do with how the patient is to be treated. The same holds true for a psychiatric patient. The ED seems to be the only area where the entire story of the person is portrayed; for better or for worse. The text succinctly summarized the tasks of the correctional nurse: a. Consult and advocate on human rights issues b. Perform medicolegal examinations (not where employed) c. Teach and perform detailed, unbiased documentation d. Provide nursing care that is free of bias and judgment e. Advocate for healthcare and healthcare education f. Inspire health-care for offenders g. Assist nursing and other professionals in creating protocols with the highest ethical standards h. Assist in providing an impartial and secure environment for offenders and staff i. Develop and implement initiatives that decrease the roots of violence. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

Technorati Tags: , , , ,

Forensic nursing in Correctional Facilities, comment

February 2, 2009
I have worked in a Forensic Mental Hospital. I am sure your are speaking about other correctional facilities.
In the Forensic Mental Hospital all of the patients are monitored differently that other patients with very strict rules. Only large strong young men can be the attendants because often the patients are “taken down’ But again this is because they are mentally ill criminals who have a history of hurting even killing people.
One of the forensic mentally ill patients was out in the community. A brutally mean child predator who was given large amts of Depo Provera to chemically castrate him. He could not achieve an erection but state he could not get the idea of hurting young girls out of his mind. He was readmitted to the hospital because he took a razor blade to his penis and testicles.  My job was to change the dressings once a day I had to have two strong young men with me when I was with this patient.  Even though people are locked up maybe the reasons they are criminals are not resolved.

I also applied at the State Prison. While I was waiting for my interview I saw young men hand cuffed through a bench. (i.e. one side of the hand cuff was on the patient and the other through the bench holding the prisoner on the bench)
I decided not to apply because the environment was scary. I agree with the article of Forensic nursing in Correctional facilities but feel it is a dream or fantasy to think that nursing can be like this.
These men and women are in a locked house without normal privileges; sometimes they are fighting for their life.  It is good to treat them normally but there is always the underlying ‘roar’ that they may be trying to get something more than they need. After all a large amount of criminals have sociopathic personalities
 
I work in a poor family clinic in a large city. I often have people who have gotten out of prison come to my clinic because they usually do not have money for health care.
It seems that more often then not, these patients continue their pre prison activities.  They come to us with infected needle lesions. They cry that they just cannot stop. They plead and cry for narcotics, show attitude, and sometimes are mean.
I agree we should treat them with dignity but so should show us respect also.  
I try to remember that most of them are in prison because they do not have people skills and have learned how to ‘play’ people to get what they need. How can a small clinic ‘provide nursing care that is free of bias and judgment’s when the patient (a previous criminal) has showed anger and attitude in the clinic. When I have to spend more than 15 minutes with this patient because he/she needs more help and expects it.
My company had to put a break proof piece of glass between the receptionist and the patient because one of these patients threatened the intake person. Now all the patients have to speak on a phone to the intake person.
It seems that even in a correctional facility they have rules and monitors to decrease the roots of violence. Now when the criminals are let out some of them continue the attitude and continue to cause problems.
Where does it end?

Original Post:
December 30, 2008
Forensic nursing in Correctional Facilities
This chapter started with a wonderful summary of some of the issues that forensic nurses had to contend with in correctional facilities. These nurses are not concerned about the crime that was committed because that has nothing to do with how the patient is to be treated. The same holds true for a psychiatric patient. The ED seems to be the only area where the entire story of the person is portrayed; for better or for worse. The text succinctly summarized the tasks of the correctional nurse: a. Consult and advocate on human rights issues b. Perform medicolegal examinations (not where employed) c. Teach and perform detailed, unbiased documentation d. Provide nursing care that is free of bias and judgment e. Advocate for healthcare and healthcare education f. Inspire health-care for offenders g. Assist nursing and other professionals in creating protocols with the highest ethical standards h. Assist in providing an impartial and secure environment for offenders and staff i. Develop and implement initiatives that decrease the roots of violence. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

Technorati Tags: , , ,

Emergency Department Environment

February 2, 2009
I am a Clinician at a small community hospital.  I was covering the ED during an illness of a coworker and received a phone call asking for assistance. I went to the department to find that an intubated patient was not responding well to Propofol and the MD did not want to titrate higher but wanted to add a paralytic agent instead. I requested trying pressor support first with increased titration of the Propofol, but was shot down. I inquired as to the paralytic agent and the MD wanted to utilize Norcuron, even though our hospital had an order set for Cisatracurium, complete with titration tables, assessment guidelines, etc.  I worked with the primary nurse who then began to argue with me regarding using Norcuron.  We utilize the Gahart IV Medication book as our resource and any med that is listed within Gahart is on our formulary and therefore usable. I worked closely with the primary nurse on the titration tables and had one other nurse double check our math. It required much coaxing on my part to finally get the primary RN to hang the Nimbex and begin titrating the drug.  It took several minutes to do this, meanwhile the patient is biting, pulling, bucking, you name it. At this point he did not require any pressor agents because whatever anxiety he was feeling was causing HTN and tachycardia. After performing baseline neuro testing, we finally hung the med with effect. I am still baffled at the stance of the RN in regards to using this medication. She stated that she did not feel comfortable with the work required to mix, titrate and then monitor for effect. I stood slack-jawed for a few minutes, but did get some satisfaction because in the end there was a positive outcome for the patient.  Working with nurses is difficult, but in the ED environment, lack of trust in oneself can lead to disaster.

Technorati Tags: , , ,


%d bloggers like this: