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I suggest consideration of the effects of low literacy in both Canada and the United States as an issue in this type of situation. As educated persons, we consider the information we are giving patients is effective in helping them to manage health conditions. I suggest the following research paper as useful: How Does Literacy Affect the Health of Canadians? by Burt Perrin http://www.phac-aspc.gc.ca/ph-sp/phdd/literacy/literacy.html The Partnership for Clear Health Communication (PCHC) also provides information about improving our approaches in giving health information. National Patient Safety Foundation, 132 MASS MoCA Way, North Adams, MA 01247 http://www.p4chc.org/ Regards from Canada Sharon

Many people who consider not having vaccinations as an appropriate behaviour have little or no appreciation of the risks from communicable diseases. As was observed, they lack basic information about public health issues. The presence of an unprotected pool of individuals puts everyone at risk. The efforts to erradicate polio are an example. The pool of "wild" polio virus maintains the risk. Sharon

As a Registered Psychiatric Nurse in Canada for 40 years, I suggest that the employer is obligated to protect the employee both at work and off-duty. Please note that the behaviour described is bad behaviour and not all bad behaviour is evidence of a treatable psychiatric disorder. His use of violence has met his needs in his family and in the rest of his community. Considering the genetic information for this young woman is she of an age in your community requiring reporting of sexual abuse by this man??? I want to state that being Canadian is NOT protection against increasing violent behaviour in health care work places. As nurses, we are at a higher risk for injury on duty than police officers. Unfortunately, we seem to blame OURSELF when someone else's behaviour harms us. So, risk management is involved. Good for now. If you are unionized, is your union involved???

As a Registered Psychiatric Nurse in Canada for 40 years, I suggest that the employer is obligated to protect the employee both at work and off-duty. Please note that the behaviour described is bad behaviour and not all bad behaviour is evidence of a treatable psychiatric disorder. His use of violence has met his needs in his family and in the rest of his community. Considering the genetic information for this young woman is she of an age in your community requiring reporting of sexual abuse by this man??? I want to state that being Canadian is NOT protection against increasing violent behaviour in health care work places. As nurses, we are at a higher risk for injury on duty than police officers. Unfortunately, we seem to blame OURSELF when someone else's behaviour harms us. So, risk management is involved. Good for now. If you are unionized, is your union involved???

Have you ever heard of Typhoid Mary??? Indeed you may not get sick BUT you could be carrying the bug to work to your vulnerable patients. So stick out that arm and protect yourself and others

I have 3 concerns: 1. the incomplete information about this patient given to this nurse i.e. his existing dementia; 2. the poor post meal hygiene care given to him if his moustache was full of old food; and 3. the seeming lack of involvement of a dietictian to ensure he was getting food of the correct texture. The challenge for us all is to consider the person as an individual when we are all stretched to the limit with the complex care needs of most persons in hospital in this day and age

I am one of those who was trained in a hospital setting, graduating in 1967. I had a broad base of clinical settings. In reality, nursing school prepares us for starting to be nurses. The resources of technology and knowledge in health care are constantly changing. The art aspect of nursing requires us to constantly relearn and grow in our practice. The "fact" of today will be tomorrow's outdated approach. ------------------