Focused Health Assessment

Trauma one Pediatric Emergency Department! Trauma one Pediatric Emergency Department responding over! Rescue Unit 29 transporting a 12 year-old boy, named Mike, hit by a car while riding his bicycle. This is a hit and run accident, but other motorists called a rescue unit. The child was not wearing a helmet. Facial bleeding is under control, but he suffered facial and head trauma. There appeared to be no facture of the extremities. Presently he is awake and semi-alert. Vitals signs: BP 120/56, Pulse 120, Oxygen saturation on room air 90%, Respiratory rate, 24. He is mobilized with a cervical collar on a gurney. Rescue 29 over! Emergency department preparing for arrival over! As a nurse working in the Pediatric Emergency Department, the writer recognized that rapid assessment and evaluation is essential for a positive outcome in head trauma victims. According to the Neurological Disabilities Center, "every 11 minutes one child in the United States has a brain injury which results in permanent disabilities (30,000 children per year)." The article goes on to say "Only one percent of the children admitted to trauma units after a bicycle injury were wearing helmets" (National Disabilities center, 2001). This writer also notes that the mortality rate of head injury is high and can lead to physiological, cognitive, and physical impairment lasting a life time. With this in mind, initial observation, assessment, diagnosis and management is crucial to the outcome in a head trauma patient. For any patient entering the emergency department, a proper history taking is essential to their care and subsequent treatment. Observations at the scene (using forensic nursing assessment skills) may provide valuable information, which maybe gathered from the paramedics or bystanders. Pertinent information about the speed of the vehicle, how big was the vehicle, the height of the fall, any loss of consciousness at the site, and bleeding may be critical in determining the course of treatment. Focused health assessment for injuries also asks questions similar to forensic nursing. Rapid initial assessment would be airway, work of breathing, circulation for life-threatening hemorrhage, and level of consciousness. In an emergency situation, it is imperative that a focus assessment be the top priority. This will allow the nurse and the physician to focus on any immediate life threatening symptoms. Observation of the patient should always be done before touching. A quick observation should include the child's behavior and activity, skin color, breathing, and positioning. Gaining the cooperation and confidence of the pediatric patient is of utmost importance, even in the presence of the parent. In this case, the child needs to be reassured that his parents are on their way. Use simple terms and do not make promises that cannot be done. They should always be told what is happening and the outcome. The nurse should remain calm and talk in a quiet voice. Trauma patients are prone to hypothermia, especially in pediatrics due to their body surface. In assessing the child exposed only the body part needed, traumatic children are very susceptible to hypothermia. Once the child has been stabilized, initial vital signs should be noted and recorded. A priority in head trauma is neurological screening to evaluate the degree of injury to the head. The involvement of other body systems should also be the focus of this assessment. According to the Canadian medical association journal "children are more predisposed than adults to head injury because of their head. A child's body ratio is greater, their brains are less myelinated, and thus prone to injury, and their cranial bones are thinner." (Canadian Medical Association Journal.2002, p.948 (9). Careful examination of the head is necessary to identify any tenderness or deformity of the skull, skull fontanels, and facial bones for facture. While the child is awake and semi-alert, questions such as "where did you hit your head?" or what part of your head hurts?" should be asked. This will give the examiner an indication of the area of injury and which part of the brain that may be affected. The child's response will help the nurse to evaluate his neurological state such as level of alertness, orientation, speech and comprehension. Using the Glasgow coma scale (GCS) will provide in depth incite to his neurological state. The score is calculated from best eye opening response (1to 4), verbal response (1 to 5), and motor response (1 to 6). A score of 15 is good while 3-8 is considered serious. According to Gilligan "patients with GCS less than 9 usually required intubations via the oral route" (Gilligan, 2006. p.277). The Glasgow coma scale should be used when the patient is initially evaluated and after each intervention. Pupillary response is critical for the head trauma patient. The child should be asked if he/she has any difficulty seeing or blurry vision. Pupil size, shape, reaction to light and symmetry of both eyes should be checked to detect any cranial nerve involvement. Jarvis states, "in a brain-injured person, a sudden; unilateral; dilated; and non-reactive pupil is ominous. Cranial nerve II runs parallel to the brain stem. When an increase in intracranial pressure pushes the brain stem down (uncal herniation), it puts pressure on cranial nerve III and causes pupil dilatation" (Jarvis, 2002. p.702). Around the eye should be examined for ecchymosis and the ears and nose for bleeding or watery discharge, which may indicate spinal fluid. In the book clinical manual of emergency pediatrics the Cain and Gershel state, "spinal cord injury is sometimes overlooked during the initial evaluation of the severe brain injury patient" (Crain & Gershel, 2004. p.642). The head in humans is connected to the neck bone, therefore injury to the cervical spine should be ruled out. To evaluate this, ask the child if any numbness or tingling in any body part or does it feel like pins or needles. The toes or sole of the feet should be touched to detect sensation then ask, "can you feel your toes being touched." "Paresthesia is an abnormal sensation,” says Jarvis (2002. p.670). The goal is to detect any spinal cord injury. If there are any indications of a suspected traumatic brain injury a CAT scan of the brain should be done as long as no spinal injury is detected. The nurse should continually be alert to the signs and symptoms of increases in intracranial pressure, such as restlessness, nausea and vomiting, altered mental status, and changes in vital signs. Monitor closely for seizure activity. The child that was riding a bicycle and was struck by a vehicle is more prone to injuries to the head, spine and the abdomen. According to Cook, Schweer, Shebesta, Kaaren& Falcone "The flexible skeletal structure in young children may allow traumatic forces to extend to deeper structures, creating injury without fracture." (Society of trauma Nurses, 2006. p 58) The child's chest should be examined for any broken ribs, tenderness or instability of the chest wall while asking him/her "does your chest hurt when you breathe?" This is done to ensure there is no cardiac involvement or ribs facture. Observation of the thorax says Gilligan "may reveal the 'see-saw' respiratory pattern of a high spinal injury or upper airway obstruction, or a paradoxical segment ('flail chest'), usually due to the mechanical instability of extensive rib-cage injury" (Gilligan, 2006. p.279). The child's abdomen should be evaluated for internal bleeding. Asked questions like "is there any tenderness when your abdomen is touched?" Palpate abdomen while monitoring facial grimace for signs of pain. Once the life threatening assessment is completed and the patient is stabilized; and there is no physical evidence of fracture, the child should be log rolled to assess the spine and back for any injuries. Pertinent scans, x-rays, abdominal sonograms, and any labs can be completed. Risk factors related to the brain injured child's condition can be numerous, depending on the severity of the injury and the organs involved. Paralyses from spinal cord injury can be an unfavorable outcome in head trauma patients. Seizures are also very common in patients with head injury. Bleeding in the brain is also a major risk factor. Small children can revert to an earlier stage of development, while others suffered memory loss. The parents or care-giver should be involved in the care of the child. Education of the child and parents to the importance of helmet while riding a bicycle must be emphasized. The parents or caregiver should also be educated on the care of the child to ensure continuation of care after leaving the hospital. Managing patients with head injury can be complex and can result in post traumatic disability and death. Proper diagnosis, treatment, and management can aid in alleviating some of the long-term complications associated with head trauma in children. Many traumatic injuries could be from abuse at home, but blamed on a fall. A good nurse will use her health assessment skills to assess the patient but also questions about the circumstances of the injury. References (2002, January). Management of children with head trauma. Canadian Medical association journal, 142, 949. Retrieved December 14 2006, from htt://www.caps.ca?english/statements/EP/ep90-01.htm Cook, R.; Schweer, L. Kaaren, F.; & Richard, A. (2006, April-June). Mild traumatic brain injury in children just another bump on the head. Retrieved December 14, 2006 from Health reference center, from http://find.galegroup.com Crain, E.Gershel, J. (2004, November). Retrieved December 12, 2006 from http://www.edu.pitt.edu/neurotrauma/thebook/chap15.pdf Gilligan, J. (2006, October). From accident site to the Trauma Center, p.279. Retrieved December13, 2006, from http:/www.edc.pitt.edu/neurotrauma/the book/book.html Jarvis, C. (2002). Physical Examination & health assessment (4th ed). Elsevier Philad

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"Heparin imported from China kills 18 people," comment

Just another bad blotch on the Chinese pharmaceutical trade market. Chinese chemical companies are also largely responsible for providing steroids to U.S. underground labs. One Chinese company sold poison mislabeled as a drug ingredient and killed over 200 people in Haiti and Panama. Another sold cold medicine laced with diethylene glycol that in 2006 killed over 100. Diethylene glycol is usually used in antifreeze and brake fluid. Because of its' relatively sweet taste it often poisons dogs and other animals upon exposure to open containers. Exposure to it causes liver damage and rapid kidney failure by elevation of the Blood Urea Nitrogen levels and creatine levels. Exposure also can result in hematuria. It is substituted for glycerol illegally by these illegitimate Chinese companies. Glycerol, also called glycerine, is much tougher to work with and also much more expensive. Substituting diethylene glycol provides a much cheaper alternative to normally expensive cold medicines. The only problem is it kills people.



Original Post:
November 11, 2008
Heparin imported from China kills 18 people
Heparin imported from China kills 18 people. Baxter International is the maker of the tainted Heparin. Baxter received a letter from the F.D.A warning about the Chinese plant identified as the source of contamination stating the plant had unclean tanks to make heparin, accepted raw materials from undependable vendors and did not have adequate ways to remove impurities. F.D.A. has discovered cheap fake additives to heparin in 2006. Poor inspections of plants have been acknowledged by the Bush administration and plans have been made to improve the situation. One cause of this crisis appears to be budget cuts to the F.D.A. that has caused a backlog in inspectors. F.D.A. would need decades to complete inspection of every foreign plant. The 1938 law "The Food, Drug, and Cosmetic Act" enacted following the deaths of more than 100 people caused by ingestion of a solvent-laced antibiotic. The cut down on chances of another tragedy Congress passed the law requiring all new drugs undergo testing for toxicity. This law should have prevented the heparin tragedy but without enough F.D.A. staff to test drugs and inspect factories the heparin got on to the market and caused deaths.

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Biological Agents, comment

Most would agree that the United States has come a long way in preparation for a biological terrorist attack. Have we come far enough? Establishing a department of homeland security as president Bush has was a major step in the right direction, but I feel like the aftermath of a large scale attack would be such that many would question why we were not better prepared for it. On pages 345 and 346 of Kumar’s Robbins & Cotran Pathologic Basis of Disease, 7th Edition, it talks about the spread of biological agents. Smallpox spreads through the air and very small doses are needed for infection. Because vaccinations were last administered in 1972, the majority of our population would be susceptible. It seems to me that the production of the smallpox vaccination would be done and readily available in case of an attack. Waterborne and foodborne pathogens could also be used by terrorist and would have similarly disastrous consequences. Kumar et. al, go on to talk about a category of agents that would have a higher mortality than even smallpox or anthrax attacks. These pathogens that are held in category C include the Nipah virus and Hantavirus. There are no cures or effective treatments for Nipah virus. It causes encephalitis, drowsiness, convulsions, and myalgia and usually results in a coma and then death.



Original Post:
November 17, 2008
Biological Agents
One short discussion talks about only two agents that might be used in an biological attack. It points out that Anthrax is rarely seen in modern hospitals but it can be argued that most biological agents have not been seen in hospitals. If this is indeed true, what will be the number of infected health care workers. During a mass biological disaster there will be victims, there will also be secondary victims (those who are infected from the contact with the initial victims) surely there must be some projected estimates. If so where can this information be found?

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Benadryl, Comment

I agree that Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Many young parents have used Benadryl to give their children to calm them down when they travel. I was working the emergency room one night when a mother with 3 small children came running into the emergency room with her youngest who was 12 months old. She said they were traveling to Iowa and she stopped at a road side park to change the baby’s diaper. She started screaming her baby was cold and not breathing. She tried to do CPR and drive at the same time. She did not have a cell phone and no other cars were at the park. We assessed the baby and did a tox screen which also showed nothing. I asked the mother if she ever gave her kids any over the counter medicine for colds or coughs. She said sometimes. The 6 year old sister said, "mommy gave us some pink medicine". The mother then told us she gave them Benadryl liquid. We tried to revive the baby, but after 45 minutes of CPR she died. The death was ruled accidental and no charges were made. But I am sure the mother was emotionally blaming herself for what she did and will have to live with that the rest of her life. I think there needs to be an education program for parents that over-the-counter medications can be lethal at any age.

Original Post:
November 21, 2008
Benadryl, comment
How do we combat the abuse of drugs that are unable to be detected through any toxicology tests? The fact remains that people, especially young teenagers, will try almost anything to attempt to get high. It becomes almost impossible for law enforcement to prevent such actions and therefore lies solely on the parents. It is definitely time to be involved in the lives of your kids and know what they are doing.

Original Post: November 12, 2008 Benadryl, comment I have a response for the blog entry from November 10, 2008 entitled Benadryl. In the emergency department I work in we had an adolescent arrive in a psychotic state. He was hallucinating, was manic, combative and then would calm down and become very docile. He was slightly tachycardic and at times tachapneic and his blood pressure wavered between normo to slightly hypertensive. He didn't have a diagnosed mental disorder. Our toxicology screens all came back negative and so we were getting ready to transfer him to an inpatient mental hospital when one of his relatives came in with Benadryl wrappers and opened capsules of Benadryl found in his waste basket in his room (they think he may have smoked it on a cigarette or joint). The kid overdosed on Benadryl. Not because he wanted to die, because he wanted to get high. Benadryl doesn't show up in a tox screen and all his other labs were pretty normal. He ended up going to our ICU for a day and was discharged.

Original Post November 10, 2008 Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Teenagers have discovered Benadryl, an over-the-counter medication, which is easily obtainable and affordable. The effects of Benadryl produce a "High." Benadryl in this population is also taken with alcohol and high energy drinks. Parents also give their infants Benadryl to produce sleep and the outcome has been fatal intoxication. I have been made aware of Benadryl and its deadly side effects when a 10-year-old child was told by his mom to take a Benadryl tablet for his allergies. The child unfortunately took an overdose and was placed in the hospital for 2 days to withdraw from medication.

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Government, the Law, and Policy Activism

Two legal aspects of concern to nursing are professional negligence and scope of practice. All nurses, community public health, informatics, and forensic nurses must consider the legal implication of their own practice in each patient encounter. According to the text the issue of scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other healthcare providers. Professional negligence or malpractice is defined as an act or a failure to act that leads to injury of a client. Despite the legal theory of sovereign immunity and the Good Samaritan law all nurse should carry their own professional malpractice liability insurance. (Stanhope: Community and Public Nursing Chapter 8)

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Cultural Diversity and Community Oriented Nursing Practice

Culturally competent nursing care is guided by four principles (AAN Expert Panel, 1992). One of those four guided principles addresses sensitivity. Cultural competent nursing care entails providing care with sensitivity based on the cultural uniqueness of your patient. Sensitivity would be of utmost importance in the field of forensic nursing. One subspecialty of forensic nursing is the care of sexual assault patients. As a sexual assault nurse examiner cultural competence must be demonstrated as a caregiver as you observe, recognize and collect evidence in legal cases for traumatic sexual assault injury. Because we live in such a diverse society it is essential that the nurse demonstrate cultural competence in the care of all patients but especially sexual assault patients. (Stanhope: Community and Public Nursing Chapter 7)

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Ethics in Community-Oriented Nursing Practice

Ethics decision making has application to healthcare professional both in community-oriented nursing and forensic nursing. Webster’s New World Dictionary defines forensic as 1) characteristics of, or suitable for a law court, public debate, or formal argumentation. 2) specializing in or having to do with the application of scientific, esp. medical knowledge to legal matters, as in the investigation of crime. Forensic nursing makes application of the science of nursing to the administration of justice. The International Association of Forensic Nurses, code of ethics states in part that the association expects its members to adhere to the highest standards of ethics. Forensic nurses have professional obligations to colleagues, to science, and to the public, and especially to those members of the public who are demonstrably disadvantaged. Accordingly, the International Association of Forensic Nurses expects its members and associate members to abide by its Code of Ethics as a condition of initial and continued membership. So just as the ethical principles and approaches to community oriented nursing are enduring and dynamic so to with the ethical principles that apply to forensic nursing. (Stanhope: Community and Public Nursing Chapter 6)

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Inflammation

Inflammation could relate to forensic nursing in that forensic nurses sometimes take tissue samples from the bodies they are performing autopsies on or patients they are working on that may be criminals or victims for evidence of a crime that has been committed. If the mechanism of injury or death was from trauma, there may be lasting evidence of acute inflammation in the tissues. Some signs of acute inflammation are swelling, redness, pain, heat, and loss of function. Obviously if someone is dead, they would probably no longer have those signs I just mentioned. They may however have increased neutrophil or eosinophil levels and possibly an increased amount of macrophages out of the venules and into the interstitial tissues. If there is evidence of MBP (major basic protein) present, that could serve as evidence that the person’s body was trying to fight off a parasite.

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Contrast of forensic nursing and public and community health nursing

Forensic nursing, literally meaning nursing as it pertains to the law, combines the health care industry with the judicial system. It is a fairly new specialty of nursing that involves providing care to victims of crime and patients within the prison system. Forensic nurses not only provide direct care to victims, but also collect evidence for law enforcement agencies. The term “forensic nursing” was coined in 1992 and the American Nurses Association officially recognized the field beginning in 1995. The professional organization for forensic nursing is the International Association of Forensic Nurses (IAFN). IAFN has more than 2,400 in the United States and abroad. Community and public health nursing in contrast has a long rich history. The National Organization for Public Nursing founded in 1912 provided essential leadership and coordination of community and public nursing. The field of nursing continues ever evolving and diverse. (Stanhope: Community and Public Nursing Chapter 2)

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Community health nursing and forensic nursing

Community health nursing coincides with forensic nursing in the area of assessment. Assessment is one of the core functions of the public health system. Forensic nursing requires effective assessment competence. Community and public health assessment refers to systematic data collection on the population, monitoring of the population's health status, and making available information on the health of the community. The role of a forensic nurse would also require the assessment along with clinical investigation skills. (Stanhope: Community and Public Nursing Chapter 1)

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Benadryl, comment

How do we combat the abuse of drugs that are unable to be detected through any toxicology tests? The fact remains that people, especially young teenagers, will try almost anything to attempt to get high. It becomes almost impossible for law enforcement to prevent such actions and therefore lies solely on the parents. It is definitely time to be involved in the lives of your kids and know what they are doing.



Original Post:
November 12, 2008
Benadryl, comment
I have a response for the blog entry from November 10, 2008 entitled Benadryl. In the emergency department I work in we had an adolescent arrive in a psychotic state. He was hallucinating, was manic, combative and then would calm down and become very docile. He was slightly tachycardic and at times tachapneic and his blood pressure wavered between normo to slightly hypertensive. He didn't have a diagnosed mental disorder. Our toxicology screens all came back negative and so we were getting ready to transfer him to an inpatient mental hospital when one of his relatives came in with Benadryl wrappers and opened capsules of Benadryl found in his waste basket in his room (they think he may have smoked it on a cigarette or joint). The kid overdosed on Benadryl. Not because he wanted to die, because he wanted to get high. Benadryl doesn't show up in a tox screen and all his other labs were pretty normal. He ended up going to our ICU for a day and was discharged.



Original Post
November 10, 2008
Benadryl, an antihistamine often used for its sedation effect in adults, can cause paradoxical central nervous stimulation in children with effects ranging from excitation to seizures and death. Teenagers have discovered Benadryl, an over-the-counter medication, which is easily obtainable and affordable. The effects of Benadryl produce a "High." Benadryl in this population is also taken with alcohol and high energy drinks. Parents also give their infants Benadryl to produce sleep and the outcome has been fatal intoxication. I have been made aware of Benadryl and its deadly side effects when a 10-year-old child was told by his mom to take a Benadryl tablet for his allergies. The child unfortunately took an overdose and was placed in the hospital for 2 days to withdraw from medication.

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Stages of Exhumation

Exhumation of a forensic scene must be done meticulously to preserve evidence. Briefly, the steps are outlined here:

A. Exhumation strategies and recovery methods - All logistical details should be worked out before starting groundbreaking - Exaction grid is placed around the site and proceeded through in an orderly manner - Never mark directly on the evidence; always on the container - Record specific information on each photographic exposure including date, time, and personnel involved.

B. Postmortem identification of remains - Bodies and remains are transported to the lab where they are first radiographed before forensic autopsy - Goals of autopsy are identification, documentation of injury, determination of cause and manner of death.

C. Reconstructing crime scene and criminal events leading to death - It must be determined whether assault took place at the grave or if the bodies had been moved to the grave site after death occurred - 3 stages of change after death: early, late and tissue changes.

D. Identifying and prosecuting the criminal - Obtaining physical evidence.

References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Excited Delirium Syndrome

Excited Delirium Syndrome is a cause of sudden death on an individual who is confused, irrational, delusional and violent. They may present high risk in this manner: a. A prior episode of excited delirium b. Violent and aggressive behavior c. Use of medication that increases the release or blocks reuptake of norepinephrine d. Cardiac disease e. Asthma or any pulmonary disease involving restriction of airway f. Epilepsy g. Use of stimulants such as cocaine and methamphetamine Age is not a factor. Behavior characteristics are: a. Verbal threats of violence b. Screaming, swearing, shouting at others c. Breaking or throwing objects d. Motor agitation, rigid/taut body expressions with poor concentration e. Projecting angry emotions onto another (e.g. blaming) f. Nonverbal behavior of rejecting others g. Pacing, restlessness, inability to sleep or eat, hyperactivity, history of violent behavior with need for physical restraint h. Delusions and confusion of mental state i. Defiance j. Bullying others k. Using stimulants (e.g. cocaine, methamphetamine) l. Paranoid behavior with auditory hallucinations. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Taphonomy

Taphonomy is the fascinating science of the study of human remains after death. It has been used both as an anthropological sense such as “the Ice Man” from 5300 years ago and King Tut’s remains from 1343 BC. It is also useful as a forensic tool. Anthropologists, archaeologists, botanists, naturalists and climatologists are all team players involved in the process. The key questions that anthropologists must answer are: a. Are the bones from an animal or a human? b. If human, what are the approximate age, race, gender, and stature of the individual? c. Have scavenging animals disarticulated the body or damaged bones? d. If there are defects in the body assemblage, were they caused by premortem or postmortem events? e. What effects have plants, animals, weather, and climate had on the body over time? References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Sexual Assault Homicides

It is interesting to note that 44% of sex-related homicides are committed by family members and about one third of these are spouses. This is shocking. Domestic violence laws have come a long way over the past twenty years in this country, but still, the unwillingness of the victim to leave such a situation is heart-breaking. These crimes are said to be repetitive, serious and shocking with the offenders carefully covering their tracks. Of course, the victims have been intimidated and threatened into submission and fear for their lives; this is why they do not flee. They believe they cannot exist without the spouse or significant other in their life. Indeed, these malicious individuals are sexual predators that must be brought to justice. Emergency department nurses need to take a more active stand when victims come in with injuries before the violent outbursts escalate to stop this senseless cruelty. This Forensic Nursing course has opened my eyes to a lot of information. I am much more careful about my documentation and openly direct and blunt with my patients. If I can save one individual, I feel I have done my job. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Autoerotic Fatalities

This course has truly revealed my naiveté even though I have considered myself a seasoned emergency department nurse. I was astounded to learn that people indulge in sexual preferences that are of such risk-taking that might lead to their death by asphyxiation, chains, infibulations, or other masochistic behavior. Unfortunately, they can very easily be misconstrued as a suicide attempt. In reading this chapter, I can very well understand how a lonely individual with misguided thinking could indulge in fantasies that could lead to dangerous paths leading to sexual arousal. Unfortunately, when their risk-taking fails due to the lack or inaccessibility of a self-rescue mechanism, all bets are off. One could also wonder if disapproving significant others contribute to the demise - in this case leading to a homicide. I have personally witnessed many “huffers,” cutters, and those who have used bondage and plastic bags for induced suffocation to obtain a high. Fortunately, for the most part, they have been “found” in time, although we did have one girl who I believe was truly suicidal who came in with a note pinned to her nightie that read “this time I did it right.” Autoeroticism is one area I hope I do not bear witness to very often, however. This must be a devastating way to die. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Murder Intent

I found a section of the reading very interesting that pertained to the intent of murder. Profiling and murder and investigation are very much a science. I was stunned to learn the precise causative factors of the “why” and “wherefores” of how one individual could take another’s life. According to the text, when one person is murdered, the criminal intent is probably for an insurance collection or contract killing. The emotional or specific causes are: - Self-defense - Compassion, such as mercy killings - Family violence - Paranoid reaction - Emotional disorder - Assassination - Religious - Cult activity - Fanatical reaction. It the crime was sexually motivated the following play into the murder: - Rape and other sexual activity - Mutilation - Dismemberment – Evisceration. A murder that involves two or more victims is usually gang related, competition or politically motivated. The emotional or specific causes and the sexually motivated actions remain the same as above. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Cultural Competency in Death

The family is the central caretaker of the dead throughout the world, including the US. The US is also a virtual melting pot of cultures and we must be cognizant of all the different belief systems at work. According to the text, cultural competency from the death related standpoint looks at subjective, objective and the cross-cultural encounter. The first encompasses the victim, family, cultural and social characteristics including worldview and communication. Subjective perspectives deal with self-awareness, values and beliefs. Communication is key. Death notification should never be communicated by telephone; rather empathetically face-to-face. Factors that are of upmost importance are compassion, consideration of the family’s language skills, tone of voice, nonverbal communication, privacy, personal space, eye contact, touch, time orientation, socioeconomic status, social class, sexual orientation, disability and death rituals. Support of the grieving family is a major factor in this process. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Definition of death

Death is declared using the Triad of Bichat that states that death is “the failure of the body as an integrated system associated with the irreversible loss of circulation, respiration and innervations.” This is somatic or clinical death with irreversible brain function. A person who is declared brain dead is legally dead. Certification of death is based on the physician’s ability to determine the cause of death based on reasonable medical certainty. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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