daubney

Angela, 2004-2011....is this my life? Contact me for an update...if this hadn't happened to me I would not have believed it.

Angela, I will call as soon as I have a phone # let me know on my private e-mail the best time and best day. I have a frightening but thought provoking scenario.

Do you have any suggestions for me? I have been out of work since Nov 2004. I am in university - took my BN last year at university of Manitoba while waiting for an arbitration that supported the facility. This is a poor show and I would not have believed it could happen but it did and it can happen again. I should begin my masters next year and plan to pursue this situation to protect others and myself.

Angela, I somehow stumbled on your reply today. I am embroiled in a professional battle that involves my electronic charts. It seems to me that their should be "footprints" to indicate if one's charts have been altered after the writer has closed the chart. I am very concerned about the ability to alter charts and strongly suspect my charts have been tampered with. No harm has come to clients yet the result of my questioning revised protocols that do not seem to be evidence based resulted in allegations of unsafe practice in regard to my practice. It is difficult to prove that one's charts have indeed been altered when the facility has control over the records. Any idea on how to approach either concern. This situation concerns me and it flags a potential problem for other nurses. The idea of contacting the vendor is a good one yet there is a conflict of interest as the vendor and the facility have financial ties. If I were the vendor I would not appreciate my product protocols being altered by an RN, and endorsed by an MD. How could this situation have been prevented? I am now skeptical of the practice of electronic charting.

Man's Inhumanity to Man How do we attempt to explain to ourselves and to each other the reasons for what we identify as atrocities? It seems that we recognize and are conditioned to accept the fact that atrocities involving one or two people happen on a regular basis. It is when we hear of atrocities of magnitude, those that affect many, that our dialogue begins. In order to capture our undivided attention the event has either to be marked by magnitude or affected us in a personal or peripheral way. Cause for concern is that one act of atrocity may, in short order, beget another. The fact that we make any prediction indicates that we must realize on some level the reason for our prediction. Man's inhumanity to man or the perception of intolerable treatment seem to be the catalyst for the initial event. It is often difficult to predict initial events as we, as a society, are groomed to suppress exaggerated emotional responses. Emotions that result from the perception of being wronged, threatened, humiliated, betrayed, or rejected, create strong anger, or fear responses capable of generating irrepressible rage. The evoked emotional response can be discharged through emotional implosion; internalization, or explosion; externalization. Violence can manifest in suicide or homicide. It is the secondary atrocities or what is referred to as the copycat syndrome that is predictable enough to attract our attention and action. Many of us have experienced inequities and most of us are able to cope with our unpleasant emotional responses without serious incident. Some may choose to hold their noses and swallow; some may stand their ground and fight. The memory of any significant event remains with us. Each time we are reminded of the offending incident we tend to ruminate. One wonders what catalyst would cause these feelings to erupt. It is with the internalizers, the imploders that my concern exists. It seems it is possible to experience vicarious rage. Unbridled youth driven by raw emotion rather than reason may consider they have little to loose if even they pause to consider. Conversely those who receive the unexpected and unwanted golden handshake may be unable to absorb the shock. It does not require a quantum leap to imagine that those at both ends of the spectrum as well as the undefined inbetweens have been subjected to enough emotional damage to develop psychological scar tissue. Those who dare to function outside of what their community defines as "the box" are at risk of alienation. We can all recall the few classmates who, because they did not fit in, were singled out and taunted unmercifully. One wonders what has become of them. One such student has recently been identified. The recipe for disaster has created an autrocity. Those who would attempt to find reason by the assignment of blame are doing so. Blame is assigned to the perpetrator, described as a deranged, mean spirited, coward. Blame is assigned to the state for inadequate regulation of the provision of firearms. Blame is assigned to those who are responsible to provide security and protection. Blame is assigned to all those who had previous knowledge of the student's unusual conduct. Blame has even been directed toward the student's mother. The media has collected and unleashed a number of loose cannons that have assigned blame in every imaginable external arena yet most have failed to assign any weight to introspective blame. Where have we collectively failed this student? This student is not unique nor is he alone. There have been students before him, like him, and there will be others to follow if we are unable or unwilling to address the reasons that he felt compelled to act as he did. It is not reasonable to assign blame to those who are designated to protect us from harm or to expect those who had selective information to piece the bits of the puzzle together any more than we can hold the state responsible for issuing the inanimate object that fired the fatal bullets. We need not to condone but to find meaning. We need not to exact vengeance but to validate enormous loss. We must now rely on ourselves to attempt to create a pervasive climate of peaceful co-existence. Fortunately for all, most people are able to resolve their issues and redirect their lives in spite their perception of difficult beginnings middles or endings. The few who have harbored their emotional baggage may need only a small reminder to recall a flood of negative emotion. A trigger event can result in a suicidal implosion or a homicidal explosion. One needs to consider causation in the context of mental health and illness. Is there even one of us who is unaware of another who has exhibited the emotional extremes that, given a set of circumstances, could culminate in a recipe for disaster. We are indeed our brother's keeper. When we, by word or deed, deliver untenable messages to others we create the possibility of a climate of violence. Others who sit idly by acting neither in support nor in defense are not absolved from responsibility. We are all responsible on some level if we commit the sin of commission or omission. Edmond Burke once said, "The only thing necessary for evil to prevail is for good men to stand by and do nothing". What to do? Adopt a gentle tread. Practice decent treatment of one another. Celebrate the uniquety of individuality. Develop and promote the skills necessary to learn the ability to ventilate in safe environments. Develop and provide environments that are conducive to the discharge of emotional baggage. Years ago a profound statement appeared in a comic strip, Pogo announced "We have met the enemy, and he is us". We are indeed our brother's keeper. Peace at any level will begin when we individually and collectively commit to promote acceptance of each other; only then can we begin to create peace as a self fulfilling prophesy constructed step by step.

I have had employer allegations of unsafe practice in regard to telephone triage. The chart time was used ie. the time the file was open from beginning of call to the end of the discussion with a supervisor - long after the call had been dispatched. The phone time record or the time on the chart of advising the client to be seen was not considered. Used the system for 4 months.

Using the McKesson system where the nurse /opens the file(time dated) Records the name and data of the client as well as that of the parent if parent is caller/then links the two together in the data base/then types the presenting problem/Then completes a history screen/ Then asks triage questions using a yes-no or ana button. Once a yes button is pressed the screen progresses to a predetermined outcome page that indicates what the client should do ie 911/ER/family Doc/Home care and may also have advice. If anyone is familiar with this process PLEASE RESPOND I have critical questions.

Just learning how to use this ? chat program. I am trying to evaluate telephone triage and identify concerns or potholes in general. If you were asked " why did you handle a call in this way " where is your evidence based practice information to support your practice. Other area of concern... how can nurses ensure their documentation is protected from overwriting or deletion and identify the time advice was given as opposed to when the file was closed. These`areas of concern could be critical in a legal setting.

Can not find evidence based practice info to support practice - can anyone reply ?

I think you are right re duty to care from a legal asspect. I share your concern re omitting a history and rushing calls. Tell me more.

Interested to know what the concences was. Have worked in telephone triage for years and am concerned with recent developments too.

Need an opinion in regard to practice issues related to protocal driven software Need advice re professional issues with protocal driven software