CO2emission

It depends on the level of security for each pod. They tend to hover about and the officers call them as we tell the officers. The methadone/suboxone parade is a bit different. They get in a line for that and when they have had their suboxone, they have to stand against the wall in line and be observed for diversions (usually under camera). They then have to come back to the window after a short while and show that they still have the sublingual pill. After a bit longer they then have to come back and and have their mouths inspected to make sure it has been absorbed. The big problem I have is the bulk bagging of the pills before we see them. Last week a nurse gave a whole bag of antihypertensives and cardiac drugs to the wrong patient. He was hypotensive but luckily didn't have to get sent out to hospital.

Thanks for that. We sort of do that too in the pods but they are bagged up by the nurses first in zip lock bags with the patients names/ min numbers and cell numbers before they see the patients. I think this practice can lead to the patients getting the wrong pills. We do this all over the jail, even in segro. I would rather get them out of a trolley and hand them to the patients directly according to their prescription but everyone thinks this would take too long. I work in a 990 bed reception/remand centre. I would like to see what others do to see if we can make it safer and not spend too much more time giving the meds.

Hi Correctional nurses. I work in Australia and am just wondering how you give out your pills. Some of our patients are on a lot of pills, especially those who have Mental Health issues. All the nurses bag up the pills in the dispensary in zip lock bags and write the patients name and number on the bag. Also their cell location. They then go out with the officers and knock on the cell doors and the patients come out and get their pills one by one. I think this is unsafe because we are then unsure of what the pills are by the time we get to the patients. I would prefer to get the pills out of a trolley with the medication order chart while the patient is there and give them that way. At least the orders and pills can be verified. What does everyone else do and how does this work with the pateints and the Corrections Officers. Are there any safety issues? Many thanks in anticipation

Hi, The 20 hours is professional development not necessarily education and training...easy peasy. It could be an article that you read. It could be a discussion with someone else when you learned something. It could be tertiary studies. It just has to be relevant to your practice. Engaging in this forum counts. You just need to keep a log of dates and how long. It's no big deal. We got the low down today from the NSW Nurses Association. There is no CPD points required; it is just hours. They include your mandatories etc. Portfolios are not mandatory. It starts from the date the registration kicks in and is not retrospective. Hope that clears things up. Cheers

Thank you for the ACT link. I have checked it out.This is fantastic. Many many thanks

I'm not sure active/passive is about different learning styles...it's more about teaching styles. Learning should be student-centred not teacher-centred. And does it have to be one or/vs the other? Can you not have both? As for simulated learning... a word of caution, it often has no context which removes it from left field thinking. If you are using "Sim" equipment there is a medical appliance company making a lot of money out of it. It's not a one size fits all. And I think you'll find the evidence/research to support it has been backed by one of those companies although it wouldn't be evident in the reference list. The spatial awareness of learners is changing and I don't think it is useful to talk about how we learned nor try to imitate it. We are talking about the Y generation and thei generation. Neural pathways are forming in different ways. Here is a powerful piece about today's learners. Draw your own conclusion and think about cognitivism and social constructs. I think you will be able to come up with some flexible options. Use the full screen and have the sound on. Enjoy

I know there is no turning back but I've been around long enough to remember the Nightingale wards. The desk was in the middle and you could see all your patients. When patients were put into private rooms or bays, they could no longer be seen or heard from a central point. This opened up many cans of worms. Patients were deteriorating and no one noticed. Patients who needed help could no longer get it in a timely way and...now we have to do houly rounding to observe and document our patients conditions. Some aspects of the old days had their merits!

Hi, My advice is you will get confused if you use this forum to build your knowledge because everyone has their own understanding and although people mean well, there needs to be some authenticity, references and peer consensus so you don't head off in the wrong direction. If you have some knowledge about basic chemistry the rest will come easy. I think this is something that you either do yourself or, you find a mentor/tutor. Take heart though many people have difficulty with this area of physiology. You can try this site for some fast track tutorials with concept maps but its not free. http://www.rapidlearningcenter.com/biology/anatomy-physiology/22-Fluid-Electrolyte-and-Acid-Base-Balance.html Good luck.

Where was the support/counselling etc from the workplace and the union while this was going on for this poor man? Who provided him with legal assistance? Is the workplace now providing him with help or is it just you guys?

Pain is a biological characteristic that enables us to keep away from danger. Without it, we may hurt ourselves so seriously without knowing it that we risk death. This tells us that pain is in fact an objective experience. There are many different types of pain receptors and pathways. Try putting your hand on a red hot object. How much say do you have in how long you keep it there? I reiterate, that the interpretation of pain by observers of pain behaviours is subjective. Pain as a stand alone biological phenomenon is objective. I note the cat who purred throughout the delivery of the kittens. Animal ethicists and veterinarians have researched animal pain behaviours and often they are quite different to how humans demonstrate pain. For example, rabbits yawn and demonstrate stretching behaviours as a response to painful stimuli. Most of us would not recognise that the rabbit was in pain unless it was doing what we do when we are in pain. I think if we only see pain as subjective, this limits our capacity to understand it and treat it effectively.

It doesn't come with the t-shirt. If you can see it for what its worth you aren't puting up with it. If it makes you angry then are you any better? Your frustration lies in the fact that you can't give it back to them. I don't want to give it back to them. My attitude is... go for it, if it wasn't me it would be someone else. Take a chill pill.

The question is..is pain subjective? No it's not but pain behaviours are and many are standing in judgement by measuring pain by pain behaviours. I guess most are talking about the narcotics/drugs of addiction and placing big value statements on the use of these. These drugs are excellent for managing pain but pain is not a pure sensation. These drugs also treat "pain" by being dissociative...they take people away from unpleasantness. So if you are going to measure pain on a scale of no pain to excruciating agony then you are being subjective. What about the profilaxis that allows patients to move, exercise, accept adjunct therapies and tolerate hospitalisation? When you arrive and say, "score your pain", that is a snapshot in time..... you need to have a look at what else is going on.

Ahh...the battle of the wills! I've seen it all and I've felt your fire and passion. At the end of the day, it's not an us and them situation. There is nothing to be achieved by being defensive. There are no winners and no losers. After a while I realised that anything I said or any defense I mounted wasn't going to change a damn thing... What works for me? I internalise the WHATEVER attitude..like rant and rave...tell it to someone who cares! Go glassy eyed and let it wash over you.

"pain addeth zest unto pleasure and teacheth the luxury of health" pain is what the patient says it is, nothing more and nothing less.

Hey..... its better than those that nod off and snore with everyone worrying that they are obstructing their airway. We had a student a couple of weeks ago who was yawning so much she dislocated her jaw. And then there are the ones that nod off and their heads bounce around. Some even get that dribble slowly finding its own little way down the chin. At least the "its all about me" ones keep you awake ZZZZZZZZZZZZZZZZZZ!

I'm not too sure that most of us see them as scary. The general theme seems to be that many of us see them as downright rude and I'm sorry but I don't accept gratuitous rudeness. I think we are well versed in being efficient when contacting a doc. Nurses are not their whipping boys. Bullying is an offence and it needs to be reported.

Ya gotta luv it that nurses are expected to communicate information in a way that accommodates doctor's limited adaptability to interpret the English language. So as we are being trained to do Doctor Speak are doctors being trained in the art of Nurse Speak. If they don't understand 'I need you to review a patient, I am very worried' then perhaps they shouldn't be practicing medicine.

Do you guys have a government organisation that investigates and handles health care complaints? In some of the posts it seems there are cases for failure of duty of care. Do your managers advocate and mediate for you when you have a grievance against a doctor? You as nurses can change this so last century culture. As you will probably have heard in the news, Dr Patel, former head of surgery at a large public hospital in Oz has been extradited back to Australia from the US (thanks) to stand trial on numerous charges of manslaughter and others related to a failure of duty of care. This all came from a nurse manager who stood up for her patients, her colleagues and stared in the face of a hostile medical fraternity and complacent government.

I totally agree. Like nurses are squeaky clean with no lateral violence or devouring their young! I've had more problems with nurses than doctors. It works both ways. One word...respect... doctors and nurses are incidental.

Goodness, that is so bad! The health care system (public) that most of us work for was very quick to recognise that when things go wrong it is because there is something wrong with the system. On an individual basis, we have a "no blame" ethos. If an individual does something wrong then questions are asked about how the system allowed that individual to do that wrong. Additionally, our employers accept vicarious liability for our actions that are covered by their own insurance. If our employers want to sack us, they have to go through a disciplinary process that takes about six months. Our union supports us to the hilt all the way. If a nurse breaks the law or the code of conduct, they are reported to the Registration Board and a formal enquiry takes place. The Board can then revoke a registration until a later date which is then reviewed for reinstatement. Until this happens a Registered Nurse cannot practice. I don't know of anyone personally that this has happened to. You poor guys...it sounds like employment conditions from the 1900's. How can you care for others when no one cares for you?

Hi, This mightn't be much help but in Aus, reflective journaling carries a bit of weight. When you come to document in the patient's notes, you be honest, and write "unable to document progress due to workload and the provision of nursing care". Keep a little diary in your pocket; note the time and what you are doing; keep journaling throughout your shift in the form of a list with everything you do and if you don't have time at work, rather than staying back to do "paperwork" say "Sorry, Ive been too busy delivering patient care and unless I am paid for overtime see ya later". Than you go home and spend 15 minutes expanding on your diary by reflective journaling. You then go and put in an incident form or patient safety form or SBAR or whatever you use in the US and report it. Your journal will back you up when you get the please explain. If everyone does that for a week someone will eventually take notice and come up with a solution. If that doesn't work, you set up your patients to complain on your behalf. Management always listens to patients!

I think we are unknowingly conditioned to be dysfunctional communicators. The media promotes dysfunctional communication by stupid sitcoms where wit is perceived as slagging off one another,sentence by sentence. Reality TV doesn't cut it unless there is conflict. We have become voyers of aggression; Jerry Springer, Judge Judy and even your Dr Phil with our fascination for dysfunctionality. Political speeches are made by yelling at us;evangelical people scream at us semi-hysterically.We love watching arguments and one-upmanship. After a while this becomes the norm for communication. Just watch a group of children or a child who wants something. Where did they learn that? Somewhere in amongst all of this is the loss of respect. Turning away from aggression is not slinking out the back door, it's just not buying into it. Keep doing it luv; at the end of the day you will have the calm and the inner sanctum.

Unreal!!!!! Where's your manager? Where are your leaders? Who represents you? This is sanctioning unreasonable and selfish behaviour in a place for the sick. A hospital is not a hotel and nurses are not servants.They make judgement calls and prioritise all the time. Who is running these hospitals? Obviously people who don't live by principles or ethical behaviour

Unfortunately many doctors don't learn social skills because they spend most of their formative years with their heads in books. Their training makes them prescriptive and people become objectified, particularly their patients and those that they see beneath them. I'd love to see this one in a social situation outside the hospital. I bet he'd have a really hard time talking to people. I was once managing a patient with severe chest pain in a cardiac unit. The consultant arrived with his registrar and could see I was busy but chose to go into another patient's room and press the emergency bell. I rushed in to find them sitting there and laughing at me in front of the patient. He said "See that got her here". He stopped laughing as said in a stern voice, "I expect to be accompanied when I see a patient" showing off. I said, "I am attending to a really sick patient, I'm sorry but today you are going to have to find someone else to hold your hand. Please don't misuse hospital emergency equipment again and excuse me but I have to get back to my unstable patient or the next emergency bells you hear might be real". The patient gave me a knowing look as the consultant tried to make out like he was having a joke. I said "Sorry but I don't have time for this and you are lucky I also don't have time to make a report of your behaviour". Later the patient congratulated me. After that the consultant treated me with professional respect.

What you say in a very calm voice is (with lots of witnesses)"We have some really sick patients here and unless you keep your voice down, I am going to have to ask you to leave because you are distressing them". ...Family member continues to yell... you say " I'm sorry but I have the other patients to think of, I have asked you to keep your voice down which you have refused to do. I am going to give you one more chance otherwise I am sorry but I am going to have to call security", family member continues to yell... you say in a more urgent and louder voice... "Can someone call security and ask them to take this man (or woman) down for a psychiatric assessment" When the threat of report is made, you calmly show your ID and ask if they want you to write your name and number down for the report. The humiliation should shut them up. If you don't have the confidence to do this, just walk away. Nurses are not public slaves and are not paid to put up with abuse!