Monday, February 28, 2011

Creative Storytelling Intervention Helps Dementia Patients | National Nursing News

Participation in a creative storytelling intervention improves communications skills and demeanor in people with dementia, according to a study by University of Missouri researchers.

The program, TimeSlips, encourages participants to use their imaginations to create short stories as a group. Participation does not require factual recall, but rather responses to humorous images presented by facilitators. The facilitators record the responses and read narratives to further develop or conclude the stories.

“TimeSlips provides rich, engaging opportunities for persons with dementia to interact with others while exercising their individual strengths,” said Lorraine Phillips, RN, PhD, FNP-BC, assistant professor in the Sinclair School of Nursing.

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Food safety, drug safety, and pregnancy information are among eight new topics included in our survey. | Pew Internet & American Life Project

Health information remains one of the most important subjects that internet users research online. The Pew Internet Project and California HealthCare Foundation have added eight new topics to our national survey measuring internet users’ interest in health information:

  • 29% of internet users look online for information about food safety or recalls.
  • 24% of internet users look online for information about drug safety or recalls.
  • 19% of internet users look online for information about pregnancy and childbirth.
  • 17% of internet users look online for information about memory loss, dementia, or Alzheimer’s.
  • 16% of internet users look online for information about medical test results.
  • 14% of internet users look online for information about how to manage chronic pain.
  • 12% of internet users look online for information about long-term care for an elderly or disabled person.
  • 7% of internet users look online for information about end-of-life decisions.

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The internet gives patients and caregivers access not only to information, but also to each other. | Pew Internet & American Life Project

Many Americans turn to friends and family for support and advice when they have a health problem. This report shows how people’s networks are expanding to include online peers, particularly in the crucible of rare disease. Health professionals remain the central source of information for most Americans, but "peer-to-peer healthcare" is a significant supplement.

This report is based in part on a national telephone survey of 3,001 adults which captures an estimate of how widespread this activity is in the U.S. All numerical data included in the report is based on the telephone survey. The other part of the analysis is based on an online survey of 2,156 members of the National Organization for Rare Disorders (NORD) who wrote short essays about their use of the internet in caring for themselves or for their loved ones.

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Sponge Count Off, Patient Develops Sepsis, Surgeon Blames Nurse.

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Summary:  Sponge Counts are a basic and critical safety measure during a surgical operation.  In this case, the standard three counts were not performed.  A sponge was left in the patient that would later lead to infection.  When the issue went to court, the surgeon claimed "it was not his responsibility" to keep track of the sponges.

The patient was admitted for surgical repair of a hernia.  The operation was performed and the patient returned to the floors without obvious incident.

"A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels, may protrude through the defect causing a lump or bulge felt by the patient. Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions."1

Post-operatively, the patient's incision would not heal.  It would soon after start to display signs of active infection.

"Postoperative wound infections have an enormous impact on patients' quality of life and contribute substantially to the financial cost of patient care. The potential consequences for patients range from increased pain and care of an open wound to sepsis and even death. Approximately 1 million patients have such wound infections each year in the United States, extending the average hospital stay by one week and increasing the cost of hospitalization by 20 percent."5

In investigating the situation, it would be found that a sponge had been left in the patient in the Operating Room.  The patient sued both the surgeons and the nurses who had assisted in the procedure.

"Materials counts are necessary to provide a standard of quality of care for the surgical patient and to provide a method of accounting for items placed on the sterile field for use on a surgical procedure."2

The patient claimed that substantial negligence on the part of the surgeon and nurses contributed to the sponge being missed and the development of complications.  These complications, the plaintiff asserted, could have been avoided had proper procedure been adhered to.  Specifically, if accurate sponge counts had been maintained and the missing sponge accounted for.

Questions to be answered:

1. Who is primarily responsible during an operation to verify sponge counts and prevent one from inadvertently being left in a patient.

2. What are the explicit responsibilities of the Nurses and Physicians involved.

For the operation in question, less than a dozen sponges were required.  It was standard policy and procedure for three sponge counts to be performed during the operation.

Anytime there is a discrepancy, the surgeon is to be notified immediately.  Upon notification, it is his duty to the patient to resolve the discrepancy to the best of his ability.

"In cases where there is an incorrect sponge count, wound closure absolutely must not be completed (unless the patient is unstable) until the missing sponge is accounted for. The surgeon should not pressure the nursing staff to ignore an incorrect count. If after appropriate steps have been taken to find the missing sponge or instrument and it is unsuccessful, every detail of the search should be documented and the surgery completed."3

Neither the nurses or the surgeon involved stated that they clearly remember the operation in question.   The nurses' documentation of the event would show that only a single sponge count had been performed.  The hospital policy in effect at the time required three per procedure.

"The nurses count the unused, sterile sponges and note on a form that sponges were counted.   When the surgeon completes the operation, the nurses do a second count by combining the number of  unused sponges with the number of used sponges that have been removed from the patient.  The total of the unused and used sponges must correspond to the number of sponges originally laid out prior to surgery.

If the sponge count does not correspond, the surgeon is to be notified by the nurses.  The nurses complete a third count shortly before the surgeon closes the incision.   If nurses fail to account for a sponge, they are to report this directly to the surgeon.  The nurses must note the results of the second and third counts on the same form on which they  noted the initial count."

The surgeon in his notes would document that a third count had been performed.  He also documented that only after receiving this confirmation from the nurse, did he "close" up the patient.

Is it plausible that the surgeon simply documented as if by habit, that the third count had been completed?  A nurse documenting her assessment may sometimes by habit write "lungs clear" and "bowel sounds active x 4q."  A moment later it is realized that in fact that was not the case and a correction made.  Could the surgeon have fallen into the same trap?

Upon discovery of the missed sponge and resulting infection, the surgeon insisted that "counting sponges" was not his responsibility.  He went on to explain how in the body cavities they can become soiled with blood and take on the color of internal viscera.

It was the surgeon's argument that it was the nurses' responsibility, not his that a proper sponge count be maintained.  The surgeon, not the nurse is the person manipulating the sponges inside the patient's body.  Can the surgeon release himself from responsibility for a sponge left in a patient because he relied on an inadequate sponge count given by a nurse?

"Counting is the legal responsibility of the surgical team. Each institution must develop a policy and procedure for such counts and should include the delineation of materials counted, interval of counts, mechanism for performing the count , and documentation of the count status on the intraoperative record. The responsibility for accurate sponge counts rests with the circulating and scrub nurses. The operating room nurses are charged with the responsibility to ensure that no foreign objects remain in the body at the conclusion of surgery."

The standards of care clearly state that if a sponge is missing, the nurse must notify the surgeon.  There's little mystery to the fact that objects "left" inside patient's bodies can have catastrophic effects.

The question remains, will the surgeon blaming the nurses get "off the hook" because a count was incorrectly reported?

"While the surgeon may rely on the nurses' sponge counts the surgeon is ultimately responsible and liable for any foreign object left in a patient after surgery. Only x-ray detectable sponges should be utilized. A retained sponge occurs almost always in the presence of a normal sponge count."

The trial court held, and appeals court confirmed that the surgeon shared in the negligence.  The standard of care governing both the nurses and the physicians respectively had been breached.

It is quite interesting to observe how quickly the physician sought to "dump" the blame on the nurses.

The nursing staff by poorly documenting the sponge counts (omitting the 2nd and third) left themselves open to scrutiny.  Had a proper count at least been documented, the surgeon would have had less ground to stand on when blaming the nurses for his mistake. Related Link Sections:

Sponge Counts, Operating Room Links:

Sources:

1. Pleatman, MD, Mark A. No date given.  "Questions and Answers about Hernias."   Retrieved May 23, 1999 from the World Wide Web:  http://www.laparoscopy.com/pleatman/hernia.htm

2. San Antonio Chapter of AORN.  No date given.  "Counts, Sponge, Needle, Instrument."  Retrieved May 23, 1999 from the World Wide Web: http://www.connecti.com/~remmert/p0008.txt

3. The Standard of Care. August 1998. "Retained Surgical Foreign Body."  Retrieved May 23, 1999 from the World Wide Web: http://www.standardofcare.com/publications/980801.htm

4. 38 RRNL 2 (July 1997

5. Woods, Ronald K.  and Dellinger, E. Patchen. June 1998.  "Current Guidelines for Antibiotic Prophylaxis of Surgical Wounds." Retrieved May 23, 1999 from the World Wide Web: http://www.aafp.org/afp/980600ap/woods.html
 

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Created on Saturday, May 22, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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DAISY Foundation - Welcome

DAISY is an acronym for Diseases Attacking the Immune System. The Foundation was formed in January, 2000, by the family of J. Patrick Barnes who died at age 33 of complications of Idiopathic Thrombocytopenic Purpura (ITP).

Everyone who met Pat even once was touched by his positive spirit and his sense of humor. Twice a survivor of Hodgkin's Disease, Pat was driven by a desire to befriend others and help them in any way he could. His legacy is clear: whenever he came across anyone in need, he never turned his back. He reached out to comfort, to make them feel okay. Pat was a natural mentor, sharing his phenomenally positive outlook on life with a wide network of friends and family around the country with whom he stayed in constant contact. The DAISY Foundation was established to keep his very special spirit alive.

As we brainstormed what to do in Pat's memory, the one really positive thing we could hold onto from the experience of his eight-week illness was the skillful and amazingly compassionate care he received from his nurses - even when he was totally sedated. So we created The DAISY Award For Extraordinary Nurses to recognize the super-human work nurses do every day all over the country. This program achieves one of the four goals we established for The Foundation, the others being

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Coffee, sex, smog can all trigger heart attack, study finds, USAToday

A major analysis of data on potential triggers for heart attacks finds that many of the substances and activities Americans indulge in every day — coffee, alcohol, sex, even breathing — can all help spur an attack.

Because so many people are exposed to dirty air, air pollution while stuck in traffic topped the list of potential heart attack triggers, with the researchers pegging 7.4% of heart attacks to roadway smog.

But coffee was also linked to 5% of attacks, booze to another 5%, and pot smoking to just under 1%, the European researchers found.

Among everyday activities, exerting yourself physically was linked to 6.2% of heart attacks, indulging in a heavy meal was estimated to trigger 2.7%, and sex was linked to 2.2%.

The researchers stressed that the risk for heart attack from any one of these factors to a particular person at any given time is extremely small. But spread out over the population, they can add up

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Fast response crucial in outbreaks of food-borne illness, study finds - USATODAY.com

Nearly three years after a nationwide salmonella outbreak that sickened about 1,500 people and claimed two lives, U.S. epidemiologists have learned that speed is of the essence in identifying sources of food contamination and preventing further infection.

    But speed requires resources that cost money and, as an editorial accompanying the paper in the Feb. 23 online issue of the
New England Journal of Medicine points out, funds may not be forthcoming.

Although the recently signed Food Safety Modernization Act could help the U.S. Food and Drug Administration respond better to outbreaks of food-borne illness, the reality is that Congress still needs to authorize the money, the editorial stated.

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Prevention.com - 28 Days to a Healthier Heart - Prevention

    Did you know that more than 41 million women in America have heart disease? And that more women than men will die from it? In fact, it’s the leading health problem that kills women (not cancer—a common myth).

    But the good news is that just five lifestyle guidelines—moderate alcohol, a healthy diet, daily exercise, normal body weight, and not smoking—can cut your heart attack risk by a whopping 92%, according to a Swedish study of more than 24,000 women. Incorporating just the first two into your routine cuts your risk by more than half.

    The 28 tips that follow are designed to help you get started. Try one a day for a month, and then stick with as many as you can for the long haul.

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Melissa Solomon, RN, Tennessee Nurses, Medical Surgical Nursing

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The following form contents were entered on 23rd Oct, 2001

Last, First Name: Solomon, Melissa

License degrees: RN

E-Mail: melissasrn@nursefriendly.com

City: Morristown

State: Tennessee

What kind of nursing do you do? Medical/Surgical

How did you hear about the Nurse Friendly? from Andrew

What is your favorite search engine? no preference

What nursing-related topics have you looked for lately on the web? none

Website: n/a

Marital Status: married

Nationality: American

How many years have you been practicing as a nurse: 4

Professional organizations you belong to: none

Would you recommend the field?

Employment changes in career? none

If you lost your job tomorrow, how easily do you feel you find new employment? fairly easy

In how many years, would you like to retire? now! LOL

Have you started any type of retirement fund? no

What Certified Nurse or Patient Educational Materials Would You Like to See on the Internet? not sure

Where do you work? hospital

Do you feel having your own a malpractice insurance policy is necessary, why or why not? most definitely because no one else will cover your a** if anything happens:-)

Your most pressing concerns with the profession and healthcare: Poor patient care because of short staffing

Have you ever considered leaving the profession? If yes, what options have you explored? no

What attracted you to the field of Nursing? wanted to be a L&D nurse after my older children were born

Favorite TV show and musical artists: ER, many contemporary country artists

Favorite food: pasta

Personal or favorite Quote: What part of NO don't you understand?

Qualities you admire in your friends/loved ones: honesty, respect, loyalty, sense of humor

Pet Peeves: slow drivers in left lane

Major turn-offs: pushy telemarketers and salespeople

Hobbies and activities you enjoy outside of work: computer, walking, reading, family, shopping

Pets, favorite vacation spots: 1 cat, annual trip to Daytona Beach, Florida

Other areas of interest and expertise: trivia, business degree, women's health issues

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Last updated by Andrew Lopez, RN on Friday, October 17, 2010

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Editors Note: The urls to these cases are Permanent and Will Not Change. Feel free to link to any case you feel is helpful. We've been contacted by several schools who are using them as assignments for their nursing students, feel free to do the same. To host any of our cases on your website or reproduce them in your publications, please contact Andrew Lopez, RN.

Each case will be reviewed and supplemented with clinical and legal resources from the web. Legal Nurse Consultants and Nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material. If you have related materials and would like us to link to or use them as resources, kindly contact us.

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Current Case:

Physician Dismisses Nursing Assessments, Question of Nursing Advocacy.
Rowe v. Sisters of Pallottine Missionary Society, 2001 WL 1585453 S.E.2e – WV
Summary: The patient was involved in a motorcycle accident in which his bike fell onto and injured his left leg. When the nurses assessing the patient could not detect a pulse in that leg, an ominous sign of circulatory failure. The physician when notified chose to dismiss this fact and discharge the patient. The patient would return soon after with worsening symptoms that would require emergency surgery. Should the nurses have initially pressed for further action, treatment?
http://www.nursefriendly.com/041013

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Legal Eagle Eye Newsletter for the Nursing Profession:"Legal Eagle Eye Newsletter for the Nursing Profession was started in 1992 and has been published monthly ever since. Originally it was called Legal Eagle Eye Newsletter for Nursing Management, then changed to Legal Eagle Eye Newsletter for the Nursing Profession. The readers of Legal Eagle Eye Newsletter for the Nursing Profession are busy professionals in clinical nursing, nursing management, healthcare quality assurance and healthcare risk management. The newsletter focuses on nurses' professional negligence, employment, discrimination and licensing issues."

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Legal Eagle Eye Newsletter for the Nursing Profession:"Legal Eagle Eye Newsletter for the Nursing Profession was started in 1992 and has been published monthly ever since. Originally it was called Legal Eagle Eye Newsletter for Nursing Management, then changed to Legal Eagle Eye Newsletter for the Nursing Profession. The readers of Legal Eagle Eye Newsletter for the Nursing Profession are busy professionals in clinical nursing, nursing management, healthcare quality assurance and healthcare risk management. The newsletter focuses on nurses' professional negligence, employment, discrimination and licensing issues."

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Using Case Study Methodology in Nursing Research by Donna M. Zucker:"The purpose of this paper is to illustrate a research method that may contribute a unique and valuable method of eliciting phenomena of interest to nursing. Case study method can be used as a creative alternative to traditional approaches to description, emphasizing the patient's perspective as central to the process. This manuscript will define case study method, and discuss various case study designs. Approaches and tactics from a variety of disciplines, and theoretical or philosophical perspectives are discussed with an emphasis on method and analysis. The bulk of the manuscript outlines the stages used in a case study of men with chronic coronary heart disease (CHD), as well as presenting a case study protocol. Implications for its usefulness in nursing research, practice, and theory generation are discussed."
http://www.nova.edu/ssss/QR/QR6-2/zucker.html

A Nursing Primer On The Law: Being Named In A Lawsuit, by Joe A. Flores, JD, FNP, MSN, CCRN, Malenursemagazine:"Being named in a lawsuit can be an extremely stressful event for any nurse. The litigation process can cause devastating damage to a nurse's self-concept and to the nurse's practice. In the past suing the hospital and the doctor were generally the usual manner to obtain relief for someone bringing a lawsuit. However, now more than ever, the new order in the health care arena has made the nurse an integral part of delivering care to patients. The nurse has been delegated more responsibility and is also more accountability for the actions of licensed and unlicensed staff. This role has provided for increased autonomy as well as increased accountability. To make matters more complicated, the nursing shortage and limited resources have been a factor in nurses being increasingly involved in medical malpractice lawsuits."
Jerry R Lucas, RN
MaleNurseMagazine.com
10510 South State Hwy 3
Deputy, IN 47230
Phone: 812-352-1293 cell: 812-701-9014
Jerry.RN@verizon.net
http://www.malenursemagazine.com/lawsuit.html

Nursing Malpractice: Protect Yourself. What to do when you’re the subject of a board of nursing complaint. American Journal of Nursing:"Q. I’ve just learned that a complaint against me has been filed with my state board of nursing. What should I expect? A. Complaints to a state board of nursing (BON) can be initiated by other health care providers, patients and their family members, and health care institutions. Once a complaint is lodged, an investigator—who may or may not be a nurse—is sent to the site to gather information about the incident. BON investigators can obtain and review medical records, drug logs, personnel records, and incident reports, as well as take depositions or call in potential witnesses for questioning. If the case concerns drug abuse or another matter pertaining to one’s physical fitness to practice, most states also have the right to ask you to have a physical examination conducted by your health care provider."
Lippincott, Williams and Wilkins toll-free at 1-800-627-0484
http://www.nursingworld.org/AJN/2001/dec/Wrights.htm

Nursing Malpractice: Implications for Clinical Practice and Nursing Education Janet Pitts Beckmann, Ph.D., R.N., Galen Press:"Protect yourself by reading this book! The increasing number of nursing malpractice cases is affecting clinical practice and nursing education. After describing a typical malpractice suit, the author details sixty actual cases, each categorized by the underlying cause of the malpractice, such as medication administration and equipment use. Also provides recommendations for reducing the occurrence of malpractice and improving nursing education."
Galen Press, Ltd.
P.O. Box 64400-WB Tucson, AZ 85728-4400 USA
Call toll-free: 1-800-442-5369 (1-800-4-GALEN-9) Fax: (520) 529-6459 Tel: (520) 577-8363 sales@galenpress.com
http://www.galenpress.com/00320.html

Nursing Malpractice by Patricia W. Iyer (Editor), Amazon.com:"A reference for attorneys and claims adjustors investigating a nursing malpractice claim. Covers the spectrum of the nursing process, from patient admittance to lawsuit, reveals typical ways in which nurses try to cover up their mistakes, and shows how nurses are caught in difficult positions between insurance company lawyers and hospital procedures. Details the defendant nurse's daily routine, whether as a surgical nurse or nurse-supervisor in a nursing home setting. Material is in sections on nursing practice and documentation; common areas of nursing liability, such as pediatric, emergency, critical care, and psychiatric nursing; and litigation of nursing malpractice claims. Specific topics include trial consulting, the role of the forensic economist in nursing malpractice actions, and today's health care environment. Includes a drug and chemical name index. Iyer is a legal nurse consultant and a medical surgical nurse expert witness.Book News, Inc.®, Portland, OR --This text refers to the Hardcover edition."
http://www.amazon.com/

Nursing Malpractice: What You Should Know, By Jennifer Larson, Nursezone.com:"If you think that the worst thing that could happen in a hospital is the accidental death or injury of a patient, you’re right. But sometimes sentinel events are followed by another dreaded event: a lawsuit. Do you know what you need to know to protect yourself from being sued for malpractice? Are you prepared in the event that you receive a letter from a patient’s attorney? Joe Flores, a nurse practitioner and practicing attorney, recommends that new nurses educate themselves as soon as they start their first nursing job. “I would strongly recommend that a nurse determine what the policies and procedures are at her individual facility and determine what type of preceptor program is in place,” said Flores, who works for a law firm in Corpus Christi, Texas."
NurseZone.com
12400 High Bluff Drive San Diego, CA 92130
Phone: (877) 585-5010 Fax: (866) 732-4535
E-mail: contact@NurseZone.com
http://www.nursezone.com/stories/SpotlightOnNurses.asp?articleID=9901

Nursing Malpractice Liability and Risk Management, By Charles C. Sharpe:"Students and professional nurses at any level of clinical practice will find this book to be a vital resource on the basic legal concepts and principles of malpractice, liability, and risk management, and their implications for the profession. The book also provides detailed strategies for dealing with these issues. The content is also highly relevant to practitioners in all other health care and legal disciplines that collaborate in the delivery of health care. Issues discussed include the expanding and evolving roles for professional nurses and the concomitant legal accountability and risk for liability, the increasing incidence of nurses named as defendants in malpractice lawsuits, anticipated changes in our health care delivery system, and breakthroughs in science and technology that will present new legal questions. The book also includes material on other important facets of today's nursing practice, including the growing phenomenon of tele-nursing, the essentials of malpractice insurance, and the legal significance of documentation and patients' medical records. It helps the reader identify the nurse at risk for a malpractice suit and the characteristics of the patient likely to sue. The appendices provide information on state laws concerned with access to medical records, a list of useful websites, a list of state boards of nursing, and a glossary of important terms."
http://www.goodreads.com/book/show/5673547-nursing-malpractice

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