Nursing Path

CARING is the essence of NURSING. -Jean Watson

Nursing Path

Knowing is not enough, we must APPLY. Willing is not enough, we must DO. -Bruce Lee

Nursing Path

Treat the patient as a whole, not just the hole in the patient.

Nursing Path

Success is not final. Failure is not fatal. It is the courage to continue that counts. -Winston Churchill

Nursing Path

A problem is a chance for you to do your best. -Duke Ellington

Interview: Covid-19 pandemic concerns for UK’s Indian nurses

A new and more transmissible version of Covid-19, first identified in India and recently named the Delta variant, has understandably raised anxieties among Indian nurses working in the UK, fearful for their home country and loved ones. Asha Day, vice chair of the British Indian…

The post Interview: Covid-19 pandemic concerns for UK’s Indian nurses appeared first on Nursing Times.



Funding boost for wellbeing of Scottish NHS and social care staff

An £8m funding package designed to support the wellbeing of health and social care staff, including those working in primary care, has been announced by the Scottish Government. It said the money would help fund a number of “immediate recovery actions” and ultimately lead to…

The post Funding boost for wellbeing of Scottish NHS and social care staff appeared first on Nursing Times.



Analysis: ‘Real shift’ is seen in practice for LGBTQ+ nurses

A group of nurses and health professionals have spoken to Nursing Times about the progress made in ensuring NHS staff from the LGBTQ+ community feel safe and supported at work. Discrimination and inequalities do still exist, and it is important to “shine a light” on…

The post Analysis: ‘Real shift’ is seen in practice for LGBTQ+ nurses appeared first on Nursing Times.



NMC chief sets out steps regulator is taking to tackle discrimination in nursing

The head of the Nursing and Midwifery Council has said she recognises the “really important role” the regulator has to play in rooting out discrimination – and that the first step is to acknowledge there is a problem in the profession. In an interview with…

The post NMC chief sets out steps regulator is taking to tackle discrimination in nursing appeared first on Nursing Times.



Analysis: Where is nursing on its journey towards race equality?

Nursing has started on a journey towards race equality but progress must accelerate to prevent nurses quitting their jobs in droves post pandemic, the profession’s diversity leaders have warned. In the second of what will now become an annual ‘stocktake’ of how the health and…

The post Analysis: Where is nursing on its journey towards race equality? appeared first on Nursing Times.



Warning after pre-reg nurse targeted by scammers impersonating NMC

Nursing leaders are calling for vigilance following reports of a scam in which fraudsters are pretending to be the Nursing and Midwifery Council in an attempt to steal money and personal information. The scammers had targeted a pre-registration nurse and had asked for payment of…

The post Warning after pre-reg nurse targeted by scammers impersonating NMC appeared first on Nursing Times.



Lift nurse morale by awarding ‘decent’ pay rise, new health secretary urged

Health unions have written to new health and social care secretary Sajid Javid to stress the importance of NHS workers receiving a “decent” wage rise in the current pay round. Mr Javid takes up the role at a time when tension over pay is high…

The post Lift nurse morale by awarding ‘decent’ pay rise, new health secretary urged appeared first on Nursing Times.



Standard surgical masks may be ‘insufficient’ for nurses on Covid-19 wards

The risk of hospital nurses contracting Covid-19 from patients can be “effectively mitigated” by giving staff higher-grade face masks, a trial at a hospital in Cambridge has suggested. Addenbrooke’s Hospital changed its approach after discovering that staff working on its Covid-19 wards were 47 times…

The post Standard surgical masks may be ‘insufficient’ for nurses on Covid-19 wards appeared first on Nursing Times.



NHS nurses gain more flexible working rights under new agreement

A range of restrictions on NHS flexible working requests are to be scrapped, following an agreement between health service employers and unions aimed at boosting work-life balance and staff retention. Under the deal, nurses working in the health service will be able to make an…

The post NHS nurses gain more flexible working rights under new agreement appeared first on Nursing Times.



All women should do pelvic floor muscle training, advises NICE

Women of all ages should be encouraged to do pelvic floor muscle training to help prevent the symptoms of pelvic floor dysfunction, according to draft guidance for the NHS. The National Institute for Health and Care Excellence has today published a draft guideline for consultation…

The post All women should do pelvic floor muscle training, advises NICE appeared first on Nursing Times.



Boost for pioneering nurse role helping younger people with dementia

A specialist nursing role that supports younger adults with dementia or Huntington’s disease has been further enhanced, thanks to charity support. The role of clinical co-ordinator for the cognitive disorders service, developed at University Hospital Southampton NHS Foundation Trust, is unique in the UK and combines…

The post Boost for pioneering nurse role helping younger people with dementia appeared first on Nursing Times.



Diabetes charity offers free wellbeing course to primary care nurses

A new training programme has been launched with the aim of helping nurses and other primary care staff to provide better emotional and psychological support to patients with diabetes. The free, online continuing professional development (CPD) training module has been launched by Diabetes UK and…

The post Diabetes charity offers free wellbeing course to primary care nurses appeared first on Nursing Times.



Continuity of community nursing care ‘improves patient outcomes’

Having the same community nurse for home health visits may prevent readmission for patients with dementia, according to US researchers. They found people with dementia receiving home health care visits were less likely to be readmitted to the hospital when there was consistency in nursing…

The post Continuity of community nursing care ‘improves patient outcomes’ appeared first on Nursing Times.



Calls for Javid to prioritise NHS workforce pressures and nurse pay

NHS workforce pressures and nurse pay need to be among the top priorities for new health secretary Sajid Javid, along with the Covid-19 pandemic, health sector leaders have warned. Unions and organisations representing the NHS were quick to respond to the appointment of the former…

The post Calls for Javid to prioritise NHS workforce pressures and nurse pay appeared first on Nursing Times.



Scale of long Covid requires ‘huge investment’ in nursing

The high prevalence of long Covid across the UK is placing further demand on an already “finite nursing resource” and reinforces the need for urgent investment in the workforce, leaders in the profession have urged. The warning follows two new research studies which suggest as…

The post Scale of long Covid requires ‘huge investment’ in nursing appeared first on Nursing Times.



Government commitment to supporting nursing research welcomed

Supporting nurse involvement in research is part of a new £64m government plan to "propel UK clinical research into the future". Nursing leaders have welcomed the funding and the commitment to the profession which has historically been underrepresented in clinical research roles. Related articles  Professor signals…

The post Government commitment to supporting nursing research welcomed appeared first on Nursing Times.



Charity launches campaign to double community end-of-life nursing team

A hospice charity based in West Essex and East Hertfordshire is striving to double its at-home registered nursing team, in the wake of increased complex care demands and an over-reliance on district nurses in the area. St Clare Hospice has launched its ‘Nurses are Needed’…

The post Charity launches campaign to double community end-of-life nursing team appeared first on Nursing Times.



Inspection uncovers bullying culture in trust’s maternity department

A “poor culture” in a London maternity department, with multiple instances of bullying and staff shouting at both each other and their patients, has sparked serious concerns from regulators. The Care Quality Commission described the situation that it found in the maternity department at Northwick…

The post Inspection uncovers bullying culture in trust’s maternity department appeared first on Nursing Times.



Nurse sacked over weekend working to have case reviewed after appeal

A nurse who was dismissed for not agreeing to work weekends is to have her case reviewed again after she successfully appealed the decision. North Cumbria Integrated Care NHS Trust dismissed community nurse Gemma Dobson in 2016 after she refused to take weekend shifts in…

The post Nurse sacked over weekend working to have case reviewed after appeal appeared first on Nursing Times.



Health service unions in Wales make joint plea to minister for ‘fair pay’

Nine trade unions, including those representing nurses and midwives, have collectively called on the Welsh Government to give NHS staff an “urgent, significant and well-earned” pay rise. Staffside members of the Welsh Partnership Forum have sent an open letter to ministers, arguing that there has…

The post Health service unions in Wales make joint plea to minister for ‘fair pay’ appeared first on Nursing Times.



Head of nursing research hub receives international mentorship award

A leading academic in Sunderland has received an international award in recognition of her excellence in mentoring nurses and other health researchers. Dr Yitka Graham, head of the Helen McArdle Nursing and Care Research Institute at the University of Sunderland, has been awarded the Interdisciplinary…

The post Head of nursing research hub receives international mentorship award appeared first on Nursing Times.



Standards launched to bolster community learning disability nursing

A set of voluntary standards to help support and encourage community learning disability nurse education and practice across the UK have been launched by leading nursing charities. The new document comes against a background of an increasing policy focus on improving care for people with…

The post Standards launched to bolster community learning disability nursing appeared first on Nursing Times.



HEE launches virtual training for NHS on loneliness and social isolation

Staff across the NHS and care sectors can now access a range of evidence-based interventions and information on how to refer or signpost people who may be at risk of loneliness and social isolation. A new e-learning resource has been developed by Health Education England (HEE)…

The post HEE launches virtual training for NHS on loneliness and social isolation appeared first on Nursing Times.



RCN escalates row over Scottish nurse pay rise to ‘trade dispute’

The Royal College of Nursing in Scotland has today formally notified the Scottish Government and NHS Scotland employers that they are in a “trade dispute” over pay. In a letter to health and care secretary Humza Yousaf, the RCN said it was calling on the…

The post RCN escalates row over Scottish nurse pay rise to ‘trade dispute’ appeared first on Nursing Times.



New app supports nurses to provide bladder and bowel continence care

A free app that could boost nurses’ success in managing patients with bladder or bowel incontinence was launched on Monday, marking the beginning of World Continence Week. Those behind the new app said it was a result of a “genuine desire to help people with…

The post New app supports nurses to provide bladder and bowel continence care appeared first on Nursing Times.



Research fellowships open to newly qualified nurses in East Midlands

Newly qualified nurses will have the opportunity to spend one day week on research and personal development under a new fellowship scheme being launched in Leicestershire. The programme, set up by Leicestershire Partnership NHS Trust and open to band 5 nurses, is part of a…

The post Research fellowships open to newly qualified nurses in East Midlands appeared first on Nursing Times.



Care home nurse ‘puts smiles on faces’ by painting staff caricatures

An artistic nurse has given her care home colleagues something to smile about by depicting them as superheroes in a series of light-hearted pictures that have raised spirits among residents and staff. Lynn Bell, who works in Parksprings care home in Motherwell, has created caricatures…

The post Care home nurse ‘puts smiles on faces’ by painting staff caricatures appeared first on Nursing Times.



Cancer trust nursing leader to swap Manchester for Liverpool

A specialist cancer trust has appointed a new chief nurse to its leadership team during what it described as a “pivotal time” for the organisation. Julie Gray will join The Clatterbridge Cancer Centre NHS Foundation Trust – which provides cancer care for the 2.4m people…

The post Cancer trust nursing leader to swap Manchester for Liverpool appeared first on Nursing Times.



CNO hails ongoing contribution of overseas nurses on Windrush Day

Nurses from all over the world have made an “important contribution to the NHS workforce” and international recruitment of nurses and other healthcare workers should remain a priority, according to England’s top nurse. Ruth May, CNO for England, marked the fourth annual Windrush Day by…

The post CNO hails ongoing contribution of overseas nurses on Windrush Day appeared first on Nursing Times.



First CNO social care award goes to founder of leading home care firm

A woman who set up a domiciliary care provider that is currently rated as ‘outstanding’ has become the first recipient of an award designed to showcase members of the profession making a difference in social care. Camille Leavold, the co-founder and managing director of a…

The post First CNO social care award goes to founder of leading home care firm appeared first on Nursing Times.



Reducing smoking to become business of all hospital nurses in region

Offering support to quit smoking is set to become a routine part of patient care for all hospital nurses in South Yorkshire and Bassetlaw, where a groundbreaking stop-smoking initiative is being rolled out. Nursing staff will undergo training to support the launch of the QUIT…

The post Reducing smoking to become business of all hospital nurses in region appeared first on Nursing Times.



Fresh commitments needed to fixing learning disability nurse shortages, warns RCN

The Royal College of Nursing is urging the government to "re-double" its efforts to address the "dire" shortages of learning disability nurses, which it says are leaving vulnerable patients at risk of harm. In a new report – Connecting for Change: for the future of…

The post Fresh commitments needed to fixing learning disability nurse shortages, warns RCN appeared first on Nursing Times.



Colorectal Cancer

 Description of Colorectal Cancer

  • Adenocarcinoma is the most common type of colon cancer and may spread by direct extension through the walls of the intestine or through the lymphatic or circulatory system. Metastasis is most often to the liver.
Duke’s Classification of Colorectal Cancer
  • Stage A: confined to bowel mucosa, 80-90 % 5 years survival rate
  • Stage B: invading muscle wall
  • Stage C; Lymph node involvement
  • Stage D: Metastases or locally unresectable tumor, less than 5% , 5 years survival rate.
Causes/ Risk Factors

Modifiable
  • Diet: Whether diet plays a role in developing colon cancer remains under debate. The belief that a high-fiber, low-fat diet could help prevent colon cancer has been questioned. Studies do indicate that exercise and a diet rich in fruits and vegetables can help prevent colon cancer.
  • Obesity: Obesity has been identified as a risk factor for colon cancer.
  • Smoking: Cigarette smoking has been definitely linked to a higher risk for colon cancer.
  • Drug effects: Recent studies have suggested that estrogen replacement therapy and nonsteroidal anti-inflammatory drugs such as aspirin may reduce colorectal cancer risk.
Non-Modifiable

Most colorectal cancers arise from adenomatous polyps-clusters of abnormal cells in the glands covering the inner wall of the colon. Over time, these abnormal growths enlarge and ultimately degenerate to become adenocarcinomas.

People with any of several conditions known as adenomatous polyposis syndromes have a greater-than-normal risk of     colorectal cancer.

  • In these conditions, numerous adenomatous polyps develop in the colon, ultimately leading to colon cancer.
  • The cancer usually occurs before age 40 years.
  • Adenomatous polyposis syndromes tend to run in families. Such cases are referred to as familial adenomatous polyposis (FAP). Celecoxib (Celebrex) has been FDA approved for FAP. After 6 months, celecoxib reduced the mean number of rectal and colon polyps by 28% compared to placebo (sugar pill) 5%.

Another group of colon cancer syndromes, termed hereditary nonpolyposis colorectal cancer (HNPCC) syndromes, also run in families. In these syndromes, colon cancer develops without the precursor polyps.

  • HNPCC syndromes are associated with a genetic abnormality. This abnormality has been identified, and a test is available. People at risk can be identified through genetic screening.
  • Once identified as carriers of the abnormal gene, these people require counseling and regular screening to detect precancerous and cancerous tumors.
  • HNPCC syndromes are sometimes linked to tumors in other parts of the body.

Also at high risk for developing colon cancers are people with any of the following:

  • Ulcerative colitis or Crohn colitis (Crohn disease)
  • Breast, uterine, or ovarian cancer now or in the past
  • A family history of colon cancer
  • The risk of colon cancer increases 2-3 times for people with a first-degree relative (parent or sibling) with colon cancer. The risk increases more if you have more than one affected family member, especially if the cancer was diagnosed at a young age.
Assessment
Ascending (Right) Colon Cancer
  • Occult blood blood in stool
  • Anemia
  • Anorexia and weight loss
  • Abdominal pain above umbilicus
  • Palpable mass
Distal Colon/ Rectal Cancer
  • Rectal bleeding
  • Change bowel habits
  • Constipation or diarrhea
  • Pencil or ribbon shaped stool
  • Tenesmus
  • Sensation of incomplete
Diagnostic Evaluation
  • Fecal occult blood test (FOBT) – checks for hidden blood in the stool. Sometimes cancers or polyps can bleed and this test is used to pick up small amounts of bleeding. Have this test every year.
  • Flexible sigmoidoscopy – an exam where a health care provider looks at the rectum and the lower part of the colon using a sigmoidoscope, a tube with a light on the end. Have this test every 5 years.
  • Colonoscopy – an exam when a health care provider looks at the rectum and the entire colon using a colonoscope, an instrument with a light on the end. If polyps are found, they can be removed. Have this test every 5 to 10 years.
  • Double contrast barium enema (DCBE) – a series of x-rays of the colon and rectum. You are first given an enema with barium in it, which outlines the colon and rectum on the x-rays. Have this test every 5 to 10 years (only if not having a colonoscopy every 10 years).
  • Digital rectal exam – a health care provider inserts a lubricated, gloved finger into the rectum to feel for any problem areas. Have this test every 5 to 10 years at the time of other screening tests (flexible sigmoidoscopy, colonoscopy, or DCBE).
Primary Nursing Diagnosis
  • Pain related to tissue injury from tumor invasion and the surgical incision
Therapeutic Intervention / Medical Management

Treatment of cancer depends on stage of disease and related complications. Obstruction is treated with intravenous  fluids and nasogastric suction and with blood therapy if bleeding is significant. Supportive therapy and adjuvant therapy (e.g., chemotherapy, radiation therapy, immuno therapy) are included.

Surgical Management
  • Surgery is the primary treatment for most colon and rectal cancers ; the type of surgery depends on the location and size of tumor, and it may be curative or palliative.
  • Cancers limited to one site can be removed to a colonoscope
  • Laparoscopy colostomy with polypectomy.
  • Neodymium-yttrium-aluminum-garnet (Nd:YAG) laser is effective in some lesions
  • Bowel resection with anastomosis and possible temporary or permanent colostomy or illeostomy ( less than 1/3 of patients) or coloanal resevoir (colonic J pouch).
Pharmacologic Intervention
  • Narcotic analgesic is often administered as patient-controlled anesthesia to manages surgical pain or pain from metastasis
Nursing Intervention
  • Administer chemotherapy agents as ordered, provide care for the client receiving chemotherapy.
  • Provide care for the client receiving radiation therapy.
  • Provide care for the client with bowel surgery.
Documentation Guidelines
  • Response to diagnosis of colorectal cancer, diagnostic tests, and treatment regimen
  • Description of all dressings, wounds, and drainage collection devices: Location of drains; color and amount of drainage; appearance of the incision; color of the ostomy stoma; presence, amount, and consistency of ostomy effluent
Discharge and Home Healthcare Guidelines

PATIENT TEACHING

  • Teach the patient the care related to the abdominal incision and any perineal wounds. Give instructions about when to notify the physician (if the wound separates or if any redness, bleeding, purulent drainage, unusual odor, or excessive pain is present).
  • Advise the patient not to perform any heavy lifting (􏰀10 lbs), pushing, or pulling for 6 weeks after surgery.
  • If the patient has a perineal incision, instruct her or him not to sit for long periods of time and to use a soft or “waffle” pillow rather than a rubber ring whenever in the sitting position.
  • Teach the patient colostomy care and colostomy irrigation.
  • Give the following instructions for care of skin in the external radiation field: Tell the patient to wash the skin gently with mild soap, rinse with warm water, and pat the skin dry each day; not to wash off the dark ink marking that outlines the radiation field; to avoid applying any lotions, perfumes, deodorants, and powder to the treatment area; to wear nonrestrictive soft cotton clothing directly over the treatment area; and to protect skin from sunlight and extreme cold.
  • Explain the purpose, action, dosage, and side effects of all medications prescribed by the physician.

FOLLOW-UP

  • Stress the need to maintain a schedule for follow-up visits recommended by the physician. Encourage patients with early-stage disease and complete healing of the bowel to eat a diet consisting of a low-fat and high-fiber content with cruciferous vegetables (Brussels sprouts, cauliflower, broccoli, cabbage). Most colorectal tumors grow undetected as symptoms slowly develop. Survival rates are best when the disease is discovered in the early stages and when the patient is asymptomatic. Unfortunately,50% of patients have positive lymph node involvement at the time of diagnosis. Participation in procedures for the early detection of colorectal cancer needs to be encouraged. Suggest follow-up involvement with community resources such as the United Ostomy Association and the American Cancer Society.

Nursing Care Plan

Nursing Diagnosis

Diarrhea related to inflammation, irritation, intestinal malabsorption or partial narrowing of the intestinal lumen, secondary to the process of intestinal malignancy.

Characterized by:

  • Increased bowel sounds / peristaltic
  • Improved liquid defecation
  • Stool color changes
  • Pain / cramping abdominal

Imbalanced Nutrition Less Than Body Requirements related to impaired absorption of nutrients, hypermetabolic state, secondary to the process of intestinal malignancy.

Characterized by:

  • Weight loss, decreased subcutaneous fat / muscle mass, poor muscle tone
  • Increased bowel sounds
  • Pale conjunctiva and mucous membranes
  • Nausea, vomiting, diarrhea

Anxiety (describe level) related to psychological factors (the threat of changes in health status, socio-economic status, functions, roles, interaction patterns) and sympathetic stimulation (neoplastic process)

Characterized by:

  • Acute phase of disease exacerbation
  • Increased tension, distress, fear
  • iritabel
  • Narrows the focus of attention

Ineffective individual coping related to the intensity and repetition stesor adaptive threshold exceeded (chronic illness, death threats, the vulnerability of individuals, severe pain, no adequate support system)

Characterized by:

  • Declare an inability to face problems, hopelessness, anxiety
  • Declared worthless
  • Depression and dependence

Knowledge Deficit: about condition, prognosis and treatment needs related to less exposure and or misinterpretation of information.

Characterized by:

  • Ask questions, request information or a statement of the concept of fault
  • Does not accurately follow the instructions
  • Complications / exacerbations can be prevented.
QUIZ

Q. 1. A patient received surgery and chemotherapy for colon cancer, completing therapy 3 months previously, and she is now in remission. At a follow-up appointment, she complains of fatigue following activity and difficulty with concentration at her weekly bridge games. Which of the following explanations could account for her symptoms?
A. The patient may be immunosuppressed.
B. The patient may be dehydrated.
C. The patient may be depressed.
D. The symptoms may be the result of anemia caused by chemotherapy.

        Correct Answer:  D. 

Explanation: 

Three months after surgery and chemotherapy the patient is likely to be feeling the after-effects, which often includes anemia because of bone-marrow suppression. There is no evidence that the patient is immunosuppressed, and fatigue is not a typical symptom of immunosuppression. The information given does not indicate that depression or dehydration is a cause of her symptoms.

Q.2.  Which of the follow statements provides accurate information regarding cancer of the colon and rectum?
A. Cancer of the colon and rectum is the second most common type of internal cancer in the United States.
B. Rectal cancer affects more than twice as many people as colon cancer.
C. There is no hereditary component to colon cancer.
D. The incidence of colon and rectal cancer decreases with age.
 

 

Correct Answer: A 
Explanation: Cancer of the colon and rectum is the second most common type of internal cancer in the United States.

Q. 3. Before discharge, the nurse scheduled the client who had a colostomy for colorectal cancer for discharge instruction about resuming activities. The nurse should plan to help the client understands that:
A. With counseling and medical guidance, a near normal lifestyle, including complete sexual function is possible.
B. Activities of daily living should be resumed as quickly as possible to avoid depression and further dependency.
C. Most sports activities, except for swimming, can be resumed based on the client’s overall physical condition.
D. After surgery, changes in activities must be made to accommodate for the physiologic changes caused by the operation.

 

Correct Answer: A
Explanation: There are few physical restraints on activity postoperatively, but the client may have emotional problems resulting from the body image changes.


Q. 4.A temporary colostomy is performed on the client with colon cancer. The nurse is aware that the proximal end of a double barrel colostomy:

A. Is the opening on the client’s left side

B. Is the opening on the distal right side

C. Is the opening on the distal end on the client’s left side

D. Is the opening on the client’s right side

Correct Answer: D 
Explanation: The proximal end of the double-barrel colostomy is the end toward the small intestines. This end is on the client’s right side.





 



NMC appoints knighted diplomat as new chair of council

A diplomat who formerly served as the British ambassador to Japan has been appointed as the new chair of the Nursing and Midwifery Council. Sir David Warren will lead the regulator’s governing council, which sets the strategic direction and budget for the NMC and is…

The post NMC appoints knighted diplomat as new chair of council appeared first on Nursing Times.



Charity shares concerning data on nurse suicide attempts during Covid-19

More than 220 nurses across the UK tried to end their life during the first year of the coronavirus pandemic, concerning data obtained by a mental health charity suggests. The Laura Hyde Foundation said that, according to its own investigations, at least 226 nurses across…

The post Charity shares concerning data on nurse suicide attempts during Covid-19 appeared first on Nursing Times.



Vital role of health visitor flagged in report backed by duchess

The high caseloads and other workforce pressures often faced by health visitors in the UK have been highlighted in a new report on early childhood, endorsed by the Duchess of Cambridge. It flagged the need for a “strong early years workforce” to support children and…

The post Vital role of health visitor flagged in report backed by duchess appeared first on Nursing Times.



DEVELOPMENT IN CURRENT NURSING PRACTICE

 The profession of nursing is dynamic and ever changing. Nursing roles evolve and develop in response to societal needs.

Forensic Nursing

It is a newly emerging field that forms an alliance between nursing, law enforcement and the forensic means anything belonging to or pertaining to, the law.

An Emerging Discipline 

Forensic nursing as defined by the International Association of Forensic Nurses (IAFN). is "the application of nursing science to public or legal proceedings, the application of the forensic aspects of healthcare combined with bio psycho social education of the registered nurse in the scientific investigation and treatment of trauma and death of victim and perpetrators of abuse, violence, criminal activity and traumatic accidents". Nurses, particularly emergency room nurses, have long provided care to victims of domestic violence, rape and other injuries resulting from criminal acts. They have collected, preserved and documented legal evidence without any formal training. It was not until 1992 that the term forensic nursing was coined. IAFN group includes legal nurse consultants, forensic nurse death investigators, forensic psychiatric nurses, as well as forensic correctional nurses. Forensic nurses specializes in several diverse roles and are beginning to find employment in variety of setting, these roles include the Sexual Assault Nurse Examiner (SANE), the forensic nurse death investigator, the forensic correctional nurse, and the legal nurse consultant.

Legal Nurse Consultant 

The legal nurse consultant is a licensed registered nurse who critically evaluates and analyzes health care issues in medically related law suits. They work in collaboration with attorneys and other legal and health care professional. They may have independent practices, work in the hospital setting in risk management or be employed by law firms or health insurance companies.

Medical Examiner Nurse 

Death Investigator

The roles of the death investigator is to advocate for the deceased. A death investigator is a professional with experiential and scientific knowledge who can accurately determine the cause of death. At the death scene, the forensic nurse death examiner examines the body, pronounces death, and takes tissue and blood samples. They take picture of the body and evidence at the scene. They are responsible for record keeping and arrange for the transport of the body to the morgue for autopsy of further examination. She works with the forensic pathologist to collect evidence in the lab during the autopsy.

Forensic Psychiatric Nurse

They work with individual who have mental health needs and who have entered the legal system. These nurses generally practice in state psychiatric institutions, jails and prisons. 

Forensic Correctional Nurse

The nurses provide health care for inmates in correctional facilities such as juvenile centers, jails and prisons. They manage acute and chronic illness, develop health care plans, dispense medications, perform health screenings and health education. 

Nurse Entrepreneur  

A nurse entrepreneur starts a business by combining nursing experience and knowledge with business knowledge. They can include nurse attorneys, nurse case managers, nurse educators, nurse death investigator, nurse midwives, psychiatric nurses and sexual assault nurses.

Case Management 

A Care Co-ordinator 

Nurse case managers act as advocates for clients and their families by coordinating care and linking the client with the physician, other members of health care team, resources and the payer. The goal of the nurse is to help the client obtain high quality, cost effective care while decreasing the duplication and fragmentation of care.  

Bioterrorism 

An Acute Health Issue 

Bioterrorism is the use of microorganism with the deliberate intent of causing infection to achieve political goals. The use of microorganisms is particularly effective because their release can go undetected for an extended period of time because their effects are not immediate. This allows for person to person spread before they are detected. 

Early Recognition 

The key to an effective response is training in the early recognition of a bioterrorist attack. 

Clinical Presentation 

One of the first indications of a biological attack will be an increase in the number of individuals seeking care from primary care providers and emergency rooms. Hospitals, doctors, nurses and public health professionals will be on the front lines of any attack.

Biological Agents 

The centers for disease control (CDC) developed a list of biological agents that are considered the most likely to be used in a bioterrorist attack. Ineffective agents were included based on their ability to produce widely disseminated infections, high mortality rates, potential for major health impact, ability to cause panic and social disruption. 

Effect Response

Identification and management 

Once appropriate notifications have been made, nurses will use their skills of clinical evaluation and history taking to identify the infective organism, mode of transmission, and source of exposure. In addition, nurses play a critical role in managing post exposure prophylaxis and its complications, as well as psychological and mental health problems brought on by event.

Response Training

Included was the recommendation that all basic nurse education programs include information on how to respond to mass casualty events. The task force includes self study modules and other specialty programs developed for ER nurses on detection and management of bioterrorism. 

Activation and Development 

In the event that the president declares a bioterrorism state of disaster, the National Nurses Response Team (NNRT) will be activated to respond by providing mass immunization or chemoprophylaxis to a population at risk. The NNRT under the auspices of the Department of Health and Human Services, will be quickly deployed in response to a major national event. 

Disaster Nursing

A disaster is a catastrophic event that leads to major loss. The American Red Cross defines a disaster as "an occurrence such as hurricane, tornado, storm, flood, high water, wind driven water, tidal wave, earthquake, drought, blizzard, pestilence, famine, fire, explosion, building collapse, commercial transportation wreck, or other situation that cause human suffering or create human needs that the victims cannot alleviate without substantial assistance". The disaster nurses have various short term and long term goals ranging from providing emergency medical assistance as well as mobilisation of necessary resource such as food, water, shelter, medication and water till providing assistance with resettlement programs and psychological, economic and legal needs.

Conclusion 

Florence Nightingale wrote in 1859 that "no man", not even a doctor, ever gives any other definition of what a nurse should be than this "devoted and obedient". This definition would do just as well for a porter. It might even do for a horsel!" nursing is constantly evolving and defining itself as it strives to include expanded roles of practice. Of the many new and exciting roles for nurses forensic, bioterrorism, disaster, entrepreneur, case management, and legal consultant have developed in response to the needs of the society.

Although nurses have practices in these areas for many years, they are only now beginning to be recognized for the unique skills and qualities they bring to these roles. As more nurses seek the specialised training that is now available for many of these roles and obtain nationally recognized certification as a demonstration of their knowledge, they will gain acceptance as highly qualified and valuable members of these specialized health care teams.



 

20 WAYS TO PREVENT INFECTION WITHOUT ANTIBIOTICS

 Many of us overuse antibiotics postoperatively, which can lead to side effects, such as vomiting and diarrhea, and antibiotic resistance in out patients.

There are, however, many other ways to reduce the infection rate in surgical patients. In human surgery, such practices have enabled a 25% reduction in nosocomial infections, also called hospital-acquired infections.

Beyond antibiotics, there are a number of ways to prevent infections.

  1. Oxygenation good oxygenation of the patient allows killing of bacteria via oxidative processes. Preoxygenation and short-term postoperative oxygenation can therefore be beneficial to fight surgical site infection.
  2. Control body temperatures many studies show that hypothermia is a common cause of infection. Hypothermia causes peripheral vasoconstriction and therefore poor local oxygenation. Hypothermia also decreases the patient's immunity, among other deleterious effects.
  3. Control blood sugar hyperglycemia can also potentiate infections. Glycemia should therefore be monitored closely, especially in poorly regulated diabetic patients, which are at increased risk of infection.
  4. Reduce anesthesia time duration of anesthesia is statistically correlated to the infection rate.
  5. Prevent licking or chewing of surgical incisions using an Elizabethan collar or Bite-Not collar.
  6. Perform sterile IV catheter placement, conscientious patient clipping (i.e. wide enough) and meticulous scrubbing technique.
  7. Improve the nutritional status of debilitated patients.
  8. Have constant awareness of asepsis during scrubbing, gowning, gloving and throughout surgery. Actually wearing a gown, cap and mask happens to be standard protocol, just like actually wearing clothes! wearing booties could be considered optional, if not debatable.
  9. Convert contaminated wounds into "clean contaminated" or cleaner wounds as soon as possible.
  10. Avoid elective surgery on immuno-suppressed or immuno-deficient patients.
  11. Use gentle tissue manipulation and careful tissue apposition to decrease the risk of hematomas or seromas.
  12. Treat distant infections such as dermatitis, otitis externa or tooth abscesses if possible before elective surgery.
  13. Change gloves whenever they are contaminated or perforated. The first step is to be honest with yourself.
  14. Avoid clipping the patient too long before surgery. Microtrauma by the clippers facilitates entry of bacteria into the skin and triples the risk of incisional infection.
  15. Limit the use propofol, which has been associated with a four-fold increase in surgical site infection.
  16. Avoid dental prophylaxis on the same day as an elective surgery.
  17. Meticulously clean the operating room, including the surgical lights and the table. Some veterinarians hide silver dollars in conspicuous places as an incentive!
  18. Use sharp, good quality, sterile instruments
  19. Establish a comprehensive plan to prevent nosocomial diseases, starting with frequent hand washing, especially after treating each patient.
  20. The standard for most elective procedures is to give an intravenous antibiotic such as cefazolin 30 minutes before the skin incision and every 90 minutes under anesthesia.



Petition calling for legal protection of ‘nurse’ title passes key milestone

A new petition calling on the government to protect the job title "nurse" in UK law has gained more than 10,000 signatures already, meaning ministers must respond with a statement. The petition was launched just five days ago on Monday and calls for the title…

The post Petition calling for legal protection of ‘nurse’ title passes key milestone appeared first on Nursing Times.



Exclusive: Further delay confirmed to process for new nurse pay deal

The timeline for a new pay deal being agreed for nurses in the NHS has fallen even further behind schedule, Nursing Times has learnt. The NHS Pay Review Body had been asked by the health and social care secretary to provide a report to government…

The post Exclusive: Further delay confirmed to process for new nurse pay deal appeared first on Nursing Times.



Hampshire council looking to cut 47 nursing staff to meet ‘saving obligations’

Plans to cut almost 50 public health nursing posts in Hampshire would have a “very detrimental impact” on health visiting and school nursing services in the area, the union Unite has warned. Hampshire County Council has this week opened a consultation which outlines plans to…

The post Hampshire council looking to cut 47 nursing staff to meet ‘saving obligations’ appeared first on Nursing Times.



Nurses ‘feel pressure’ from patients to prescribe unnecessary antibiotics

Many nurse prescribers feel under pressure from patients to give unnecessary antibiotics for upper respiratory tract infections, sometimes leading them to do so against their better judgement, according to UK researchers. They highlighted that the number of nurse prescribers was increasing, but said that little…

The post Nurses ‘feel pressure’ from patients to prescribe unnecessary antibiotics appeared first on Nursing Times.



Nurse leads call for better psychological support for young cancer patients

The problems that young cancer patients are facing in accessing specialist mental health support is “not good enough”, the chief nurse at Teenage Cancer Trust has warned. Dr Louise Soanes spoke out as a new survey by the charity found that more a third (35%)…

The post Nurse leads call for better psychological support for young cancer patients appeared first on Nursing Times.