Examining the Core Concepts of Forensic Nursing

Examining the Core Concepts of Forensic Nursing Nursing is a profession which works on the core concepts of empathy, communication, caring, trust, advocacy, and leadership. Every area of nursing uses these concepts and beyond to provide care to clients at times when they need it the most. Forensic Nursing too uses these concepts; however, it places more concentration on scientific objectivity rather than patient support. This is not to say, that they to provide patient support, but it is the practice that by being objective in evidence collection, they ensure successful results in trauma investigations. Forensic Nursing is defined as the application of forensics with the biopsychosocial interventions of the registered nurse in the scientific investigation and treatment of trauma and/or death related medical-legal issues (Wecht, C.H., Rago, J.T., 2006). It used to be that forensic medical interventions including lifesaving interventions were withheld until a Forensic medical examiner (FME) until they arrived to the emergency department and had collected evidence (Pyrek, K., 2006). Often times, clients were even transferred to other cities which offered forensic clinical services, and even then no interventions could be provided so as not to disturb the forensic evidence (Pyrek, k., 2006). However, If a Forensic Nurse Examiner (FNE) is available at the clinical site, they are able to secure the important forensic evidence requiring timely recovery and preservation without withholding medical interventions, i.e. in sexual assault cases (pyrek, K. 2006). It was in 1991 that the American Society of Forensic Nurses first to recognized and accepted Forensic Nursing as a specialty (Bader, D.M, Gabriel, L.S.,). Then in 1992, 72 primary sexual assault nurse examiners formed the International Association of Forensic Nurses (IAFN) (International Association of Forensic Nurses, 2006). The aim of the IAFN was to promote the education of forensic nurses. In 1997 the IAFN went on to develop the Forensic Nursing Code of Ethics and the Scope and Standards of Nursing Practice (Bader, D.M, Gabriel, L.S., 2009). Forensic Nursing is a specialty that is still new and needs to continue developing so forensic nurses can provide the appropriate responses in trauma cases, provide a more holistic care to their clients, and advocate in an unbiased and scientifically objective manner. Where it has been that it is the emergency nurses who have been the first to come in contact with clients involved in trauma cases, emergency nurses are trained in the legal complexities that are characteristic of trauma cases, and who may not consult with the hospital legal team when such cases are presented, before going ahead and providing the necessary interventions that the client needs resulting in loss of critical evidence (pyrek, k., 2006). Forensic nurses can provide appropriate health care response in the event that they are presented with either a victim or a perpetrator of a traumatic case. They are trained in identifying injuries, their patterns, documenting statements and injuries through written and photographic accounts, and collecting and preserving physical evidence. Linda McCracken in the forensic nurses states that health care and the law often become enmeshed during critical moments when patient care supersedes the concern for social justice. (Pyrek, K., 2006). Most nurses and institutions are not trained to recognize the importance of physical evidence, so in the process of providing care to the patient, key physical evidence may be lost i.e. through discardment of victims clothing, or cleansing of the wounds. When most trauma cases are presented to the Emergency department, the Emergency nurse is most often the first person to see and talk to the patient, the first to know the situation, first to deal with the family, first to deal with the patient property, and as result first to deal with the specimen and evidence (pyrek, K., 2006). In these situations, the evidence and the manner and the time in which they are collected, saved, and documented can have an impact on the turn out in the analysis and legal proceedings (Ledray, L., 2010). Forensic nurses provide a more holistic care to their clients by including the forensic aspect within their care plan (Pyrek, k., 2006). A forensic nurse has many of the same role as any other registered nurse such as patient advocacy, however, they also have to fulfill they also work closely with the legal system, so they are active members of the investigation, are liaisons for law enforcement and facility staff, they identify, collect, and preserve the evidence, provide accurate documentation, and act as expert witnesses in courts (Bader, D.M., Gabriel, L.S., 2009). The forensic nurse practice models include sociology, criminology, clinical and criminal investigation, and education (Hammer, R.M., Pagliaro, E.M., 2006). The forensic nurse besides being an advocate for the client, is an advocate for truth and justice, and The first priority of a forensic nurse is to ensure the safety of the living victim and the dead victims body, collecting and preserving evidence from the body, performing a forensic examination with the intention of identifying and collecting evidence that may have transferred from the victim, collect evidence from without bias and without causing physical and psychological stress to the living or dead victim, and documenting all evidence (Bader, D.M., Gabriel, L.S., 2009). They are also responsible for conducting interviews on the victim, suspected victimizer, convicted victimizer; family, friends, and witnesses (Bader, D.M., Gabriel, L.S., 2009).They have to pay attention to collect any physical evidence i.e. dirt, and paint c hips, biological evidence i.e. saliva, and insects, and physical material i.e. fabric (Bader, D.M., Gabriel, L.S., 2009). Lastly the documentation which is perhaps the most important piece of evidence in an investigation should be accurate, descriptive, and without personal judgements. Forensic nurses have to be unbiased and scientifically objective. Forensic nurses dont come only in contact with victims of violence, but also with the victimizers. While many nurses when faced with a suspect or accused of a crime may be more concentrated on finding out why the suspected or accused perpetrator may have committed the act. While the question may be important, forgetting to concentrate on the evidence can be perilous. As forensic nurses they need to concentrate on what they are seeing, and what needs to be collected for the purposes of analysis. According to Janet Baber, MSN, FN, in the beginning forensic nursing was based on helping people in needNow forensic nursing has evolved to where we must compartmentalize our desire to nurture, console any nurse would do that because caring for and protecting human being is instinctive (pyrek, K., 2006). The advocacy component is not unique to forensic nursingthe forensic nurse cannot be get overtly involved in advocacy. This n urse must stay within an objective, scientific framework, because if a nurse allows advocacy to supersede concern about the evidence, he or she will become diverted from the purpose of forensic nursing (Pyrek, K., P. 29, 2006). Concentrating on the evidence will help more in uncovering the truth of the crime and revering justice than being embroiled in emotions of the case and the client. This is what will help the forensic nurse when it comes time for them to provide the evidence in court, where they are going to have prove that they were objective in their evidence collection and that they were not deterred and entangled in the circumstance of the case. In the book forensic nurse, Sharon Crowley, RN, MN, and California forensic examiner says that, What I do as a forensic nurse is going to be dissected in a court, or in a crime lab. Forensic nursing practice is mandated by science, and I dont have a problem with that because I see my advocacy come through science (Pyrek, K., P. 30, 2006). The reason behind the origin of forensic nursing was that forensic pathologists believed that pertinent legal questions were not being addressed, and inspite of resistance the specialty has grown significantly (Hammer, R.M., Pagliaro, E.M., 2006). As forensic nursing continues to grow, there will have to be increased interprofessional collaboration, communication, and sharing of information and knowledge to achieve justice. Currently, there are not many hospitals, clinics, if any, that have a forensic nurse in place, because not many institutions believe that it is necessary to have them, not to mention there is already a poor patient to nurse already. Some challenges that the specialty will face will probably include job opportunities, funding, education and training, professional development mandates, and continuing acknowledgment of importance and respect from other health care colleagues (Pyrek, K., 2006). Forensic nurses have to be self-directed, and be confident in their abili ties. I have been interested in forensic science for a long time, and took a full year course at University of Toronto as an elective about 3 years ago. We were introduced to different areas of forensics, but forensic nursing was not one of them. It was very interesting to research this topic and learn about the roles of forensic nurses. Having had done a placement in long term care, I have heard of many of elder abuse, and realize that the issue is probably not getting the attention it deserves. I like that forensic nurses extend the roles of registered nurses to include the forensic aspect in their care. I realize that it would be very challenging to pursue a career as a forensic nurse, and hope that it will continue to grow. Since its establishment, forensic nursing has gained a lot of attention, and continues to grow. A Forensic Nurse is important because they can provide an appropriate response in trauma cases, the appropriate response being, collecting, preserving and documenting the evidence. A Forensic nurses extends the role of a registered nurse by including the forensic aspect in their care plan. While as nurses we are trained to provide caring for our client is one of our primarily responsibility, in forensic nursing, the evidence and documentation take the priority because without them, it is hard to prove legitimacy in court cases. Lastly, they fufill their roles in a manner that is unbiased and scientifically objective. The whole purpose of forensic nurses is to aid their law enforcement and forensic science colleagues in analyzing the evidence, and to do that, it must be important that they take out their emotions about the victim, victimizer, and case, to collect what they see without bias and utmost objectivity to ensure justice. Forensic nursing is a speciality that face many challenges in its growth mainly in terms of job opportunities, especially in todays clients where institutions hardly are able to keep a good nurse to client ratio, it will probably be hard to establish the need for forensic nurses, however, until there is a high profile case that increases concentration on forensic nursing, they will just have to be more self-directed in their career (pyrek, K., 2006).

The Old Man and the Storm

This program starts with the family patriarch, 82-year old Herbert Gettridge, out in his yard cleaning up from the wake of hurricanes Katrina and Rita. He has made it his mission to recreate the home he’d originally crafted more than 50 years earlier, this was literally his creation. So there was nothing in his body that was going to allow him to walk away from that. Mr. Gettridge was trying to get the house together so that he could bring his wife (Lydia Gettridge) of 60+ years home.Nobody felt comfortable bringing her back to a city where there really was no hospital, no ambulance service or anything. She suffers form congestive heart failure and diabetes, New Orleans is the only place she has ever known so it was really important for her to come back. And so, therefore, really important to Mr. Gettridge, him being a good husband and all. To make sure that she is able to get back to her home. Officials said the area was uninhabitable but Mr. Gettridge didn’t care. I t hink his attitude was, well, the house withstood the water.I’ll be damned if I’m going to just walk away from it. I worked too hard to get this. He has worked since the time he was seven years old, he dropped out of school during the Depression. And had learned to work with his hands. He fought racism and diversity at work and over came it, becoming a master plasterer. He took pride in his work and it showed. He did a lot of one of a kind work, one of the houses he did work on is a historical landmark. The Gettridge family has a lot of perseverance, love and strength he and his wife raised nine children.Only seven are living now, they have thirty-six grandchildren and many great grand children. The house is only part of his tragedy. Three generations of his family, were scattered across the country in the wake of hurricanes Katrina and Rita. His family has been in New Orleans for over five generations. It’s very possible that the Gettridge house is on land that his ancestors had once worked as slaves. His family of 200 people or so, all lived within fifteen-minute drive from each other and would still get together for holidays and to celebrate things they were a close knit family.Mr. Gettridge with the help, support, and sacrifice of volunteers, and charities finishes his house against the huge odds he faced. Lydia is brought home by one of her daughters just before July fourth of 2007. A year and a half after the flood. She is disoriented when she arrives from a stroke she had suffered. She doesn't recognize the house she left and says she wants to leave. Mr. Gettridge tries to lighten the mood with his since of humor telling he she looks as beautiful as she did when she was sweet sixteen. However, she’s not buying it.Only when their children and grand children start visiting them for the up coming forth of July festivities does Mrs. Gettridge start to feel as if this is her home again. Mr. Gettridge was asked if he had to do it al l over again, would he? He answers, â€Å"I’m kinda skeptical about that now. Once upon a time I could answer that question in a split second for you. I can’t do that now†. He’s a man of incredible determination and incredibly stubborn. But, He’s been worn down. There’s just so much you can do at 84 to start over again. It takes hands to build a house, but only hearts can build a home. ~Author Unknown

Improving Wound and Pressure Area Care in a Nursing Home Essay

In Sprakes and Tyrer’s (2010) research article entitled â€Å"Improving Wound and Pressure Area Care in a Nursing Home†, the effectiveness of wound and pressure ulcer management was examined. The rate of wounds and pressure ulcers in a nursing home is often an indicator of the quality of care received as these injuries can lead to illness and a decreased quality of life (Sprakes & Tyrer, 2010). Sprakes and Tyrer have identified gaps in overall management of wound and pressure ulcers. They have also identified a large volume of referrals regarding advice and support for wounds and pressure ulcers. For these reasons the authors’ research was aimed toward whether utilization of a new wound and pressure ulcer management system in the nursing home would decrease rate and severity of these injuries (Sprakes & Tyrer, 2010). The reason this article was selected for critique was due to personal encounters with pressure ulcers in the nursing home setting and first-hand observations of the debilitating effects they can have on an individual. Summary Research took place in a nursing home that was selected due to observations of poorly managed wounds and pressure ulcers. The authors’ overall aim of the research was to â€Å"improve outcomes for patients requiring wound and pressure ulcer management† (Sprakes & Tyrer, 2010, p. 47). The authors planned on meeting this goal through improving staff knowledge, improving documentation, and finally encouraging owners to uphold the proper standards of care. Before implementing their management framework, the authors obtained data to establish a control. The authors collected data over a six month period regarding frequency of wounds and pressure ulcers and regarding the number of times additional support nurses were contacted to aid with wounds/pressure ulcers. Next, staff knowledge was assessed regarding wound and pressure ulcer assessment and management (Sprakes & Tyrer, 2010). The authors then created a unique competency-based framework. This competency-based framework served as the standard of care to be used throughout the project. It also served as an evaluating tool when measuring staff performance. From there the authors then went on to discuss the project with the staff. Concerns, barriers, and benefits were all discussed as the authors felt â€Å"if staff understand why change is occurring, they are more likely to implement the required change† (Sprakes & Tyrer, 2010, p. 47). When implementing their competency-based framework the authors selected four nurses to be supported through the program. Only four were chosen due to the amount of time required to support each individual member. The four nurses then received two theoretical training sessions with a day on wound assessment and a day on pressure ulcer prevention and management (Sprakes & Tyrer, 2010). Once complete, the nurses worked alongside one of the authors in implementing the framework in the clinical setting. Completion of the process took an average of six weeks per nurse (Sprakes & Tyrer, 2010). After completion of the program the four nurses had their knowledge reassessed and another set of data was collected over a six month period to allow time for the nursing staff to incorporate the framework into practice (Sprakes & Tyrer, 2010). After analyzing the data, the authors found a 77% decrease in the number of wounds and a 57% decrease in the number of pressure ulcers. The data also revealed a significant increase in wound and pressure ulcer documentation and a decrease in the number of contacts to supportive nurses. When reassessed the staff demonstrated an increase in knowledge and skill. Overall the authors came to the conclusion that both the nursing staff and patients considerably benefited from the project. Based off the results, they encourage the implementation of similar projects in other nursing homes (Sprakes & Tyrer, 2010). Analysis of the authors’ references affirms their appropriateness to the study; however, 66% of the references used are not current as indicated by a publication date greater than 5 years. Critique Based on the article, the authors’ purpose of the study was apparent and the results were conclusive. The authors’ decision to implement an evidenced-based wound assessment tool was a great choice as it significantly benefited documentation rates as one was not being used in the nursing home prior. Through this choice it was evident that the authors were able to help the nursing staff to â€Å"ensure the credibility of their profession and provide accountability for nursing care† (North Carolina Concept-Based Learning Editorial Board, 2011, p. 2324). When analyzing the study it clearly demonstrates the impact that proper guidelines and education can have on wound and pressure ulcer management. Through education the authors were able to aid the nursing home in preventing the occurrence of more wound and pressure ulcers as â€Å"prevention is the goal for the clients at risk for pressure ulcers† (NCC-BLEB, 2011, p. 1918). Although this article is a good resource for information and statistics on wound and pressure ulcers, it is not recommended for individuals looking for particular nursing interventions used for wound and pressure ulcers. While the authors did broadly explain their competency-based framework, they lacked depth in explaining specific information and interventions taught and used throughout the project. In conclusion, this work greatly contributes to the nursing profession because it created a unique quality management plan that has the potential to better numerous nursing homes and improve the lives of many patients. References North Carolina Concept-Based Learning Editorial Board. (2011). Nursing: A concept-based approach to learning (Vols. 1-2, pp. 1915-1926, 2324, 2425). Upper Saddle River, NJ: Pearson Education, Inc. Sprakes, K. , & Tyrer, J. (2010). Improving wound and pressure area care in a nursing home. Nursing Standard, 25(10), 43-49. Retrieved from http://search. ebscohost. com/login. aspx? direct=true&db=rzh&AN=2010893921&site=

Spanish Idioms Using Haber

Like many other common verbs, haber is used to form a variety of idioms. As phrases whose meanings dont depend on the literal meanings of the individual words, idioms can be somewhat challenging to learn. But they are a necessary part of language, and some of them using haber express everyday concepts and are used often. Following are the most common idioms using haber. For other usages of haber, see lessons on its use as an auxiliary verb and as a translation for there is or there are. Also note that the conjugation of haber is highly irregular. haber (in the third-person singular) que infinitive — to be necessary to, to be essential to — Hay que comer. It is necessary to eat. Habrà ¡ que salir a las tres. It will be necessary to leave at 3. haber de infinitive — to be to, to be supposed to — Hemos de salir a las tres. We are to leave at 3. He de viajar a Nueva York. I am supposed to go to New York. haber de infinitive — must (in the sense of showing high probability) — Ha de ser inteligente. He must be intelligent. Habà ­a de ser las nueve de la noche. It must have been 9 p.m. habà ­a una vez (or, less frequently, hubo una vez) — Once upon a time ... — Habà ­a una vez un granjero que tenà ­a una granja muy grande. Once upon a time there was a farmer with a very large farm. no haber tal — to be no such thing — No hay tal cosa como un almuerzo gratis. Theres no such thing as a free lunch.  ¡Quà © hubo!,  ¡Quihà ºbole! (regional variation) â⠂¬â€ Hi! Whats happening? No hay de quà ©. — Dont mention it. Its not important. No big deal. habà ©rselas con — to have it out with, to quarrel with — Me las habà ­a con mi madre. I had it out with my mother.  ¿Cuà ¡nto hay de ... ? — How far is it from ... ? —  ¿Cuà ¡nto hay de aquà ­ al parque nacional? How far is it from here to the national park?  ¿Quà © hay?  ¿Quà © hay de nuevo? — Whats happening? Whats new? he aquà ­ — here is, here are. — He aquà ­ una lista de nombres. Here is a list of names. Heme aquà ­. — Here I am. He lo aquà ­. He lo allà ­. He los aquà ­. He los allà ­. — Here it is. There it is. Here they are. There they are.  ¡He dicho! — And thats that! Keep in mind also that many expressions use hay. Although the meaning of many of them can be deduced from the words, they arent necessarily translated literally. For example, hay sol (literally, there is sun) is often used for it is sunny, and  ¡eres de lo que no hay! (literally, you are of that which there are none) can be used for youre unbelievable! or something like that.