macawake

I'm not privy to the thoughts of California lawmakers but my guess is that they want to send a signal about what values they want to promote in their society and also strengthen the protections of a group of people who are often vulnerable and discriminated against. It's basically what all laws are. They are a signal regarding what society considers acceptable behavior, and what it does not. In my country we have one law that is a bit strange when you compare it to the equivalent law in other countries. It's the criminal code regarding prostitution. Here it's actually legal to sell your body, the rationale being that it's yours to sell. BUT.. it's illegal to use the services of a prostitute, because another person's body isn't yours to buy and use. So the customer/john commits a crime, the prostitute doesn't. It can be regarded as a rather convoluted solution but it is intended as a signal. It also has the advantage that a prositute who gets battered or sexually assaulted, can report the crime without fear of incriminating her or himself. Yes, some people lie. It's hardly a majority of people or patients who are in the habit of making false accusations regarding being the victims of crimes, but they do exist. However, I don't see how that fact can be used as a rationale to not make more laws if they are deemed necessary. People can lie about offenses that are already criminal, like rape, assault/battery or theft. Surely you don't think doing away with those laws is the proper response to the fact that some people lie? I suspect we've all used the wrong pronoun at some point in time. As you say, sometimes we're just tired or unfocused. It happens. I highly doubt that anyone will lose their license over it, and I don't think the respective BoNs will come gunning for nurses with English as a second language, when it's obvious that they mangle their pronouns regardless of the gender identity of the person they're talking about. It will likely be quite apparent to any semi-competent investigator when they're facing an example of maliciously motivated and intentional discrimination as opposed to poor language skills. I think you're warning about scenarios that are extremely unlikely to occur. Who are you having this argument with? Who in this thread has advocated banning this song? Aren't we all in agreement that we can turn it off or change stations? Do you care to clarify this comment? It's not super clear who you're addressing or what you're actually saying. The way I interpret it is that you think that you are a member of the kind and respectful camp, and that some other posters aren't. Is that correct?

I think that you're absolutely correct. If the complaints were legitimate, the people who make them shouldn't find it so darn difficult to come up with examples of things they'd like to be able to say, but feel that they are prohibited to say. I've asked for examples on multiple occasions in this thread, but no one appears to be able to verbalize them. That makes me suspect that what they wish they were able to say, in all likelihood isn't able to withstand the scrutiny of daylight. You guys are free to prove me wrong by providing examples of what you would like to be able to say, but that will have serious negative consequences on your employment status, personal safety or liberty if you do. If you're unable to do that, my previous conclusion will remain. Bottom line, I'm not giving anyone who's not willing to specify what they wish they'd be able to say but are prevented from saying, the benefit of doubt. The entire term PC in my opinion has a deliberate negative connotation. It's an attempt to minimize the validity of opinions that are different than your own. If you call someone's opinion PC, it implies that the person doesn't have the opinion due to personal beliefs and values, but rather that they are trying to adhere to some kind of external rules and norms. The implication is that if someone is PC their convictions aren't internal in origin, but externally dictated. Who're you calling stupid I agree with you regarding the golden rule and if everyone could just follow it, things would be so much better. ~~~~~~~~~ One of the few concrete examples I've seen in this thread of what a person would like to say, was a poster who thought it important to him to be able to talk about (and to I guess) a transgender person, using the "correct biological" pronoun. How is it to live by the golden rule to deliberately disrespect another person's wishes? Why does someone feel they should have the right to be able to say to a person, that they reject the other person's entire identity and that the other person's feelings are less important than their own? How is that not simply cruelty masquerading as freedom of speech? Why not respect the other person even if you yourself don't understand how it is to feel like they do and be like they are? Why is it so important to be able to shove your own convictions down the other person's throat? What kind of satisfaction does that offer? Think and believe what you will in private, but treat other people with respect. As you're "good griefing", how many people in this thread have actually supported banning this song? It's a non-issue. It's has got to be a teeny-tiny insignificant percentage of the population who would actually go as far as a ban. You have rap music with some blatantly misogynistic lyrics so I don't see a countrywide ban being imposed on this song. In my opinion you and others are inflating this way out of proportion. In my opinion there's a whole lot wrong with that annoying song, but as far as I'm concerned you are free to listen to that ode to repressed sexuality to your heart's content. Of course it's religious extremism at the root of this. I know several religious persons who are tolerant of others and who genuinely embrace the golden rule and they are just as appalled as I am, by people who think they have the right to impose their world view on others. Not so the extremists. They are watching in dismay when their once dominating worldview is now challenged and no longer allowed to reign supreme. They feel the control and dominance they once had, slipping through their fingers. They miss the 1950s and they don't feel at home in this new world. They feel threatened, so now they try to fabricate one ludicrous threat after another and use misinformation as a strategy to sway people's minds to their own authoritarian and liberty-hating way of thinking. I say liberty-hating because the only liberty they want, is their own. And it's always at the expense of other people's rights, autonomy and happiness. A couple of years ago they were trying to disguise their bigotted views by faking concern that women would be raped in public restrooms just because transgendered people would be allowed to use the women's restroom. Now they're trying to make it sound like LTC staff will serve hard prison time for a simple slip of the tongue. I don't even have to read the proposed law to know that it isn't about sending someone to jail for mistakenly addressing someone as she when they wish to be addressed as he, or vice versa. It's about protecting residents from discrimination based on for example sexual orientation, gender identity or hiv status. In order to be sentenced to actual jail time, I'm pretty sure that the discriminatory action by an employee would have to be systematic and involve more components than merely using the wrong pronoun, and there would likely have be an aspect of actual harm to the resident as a consequence of the discrimination present as well. That said, I think that insisting on being able to call a patient or resident something else than what they wish to be called, is selfishness of the first order. Any intelligent person ought to question their own motivation for making that particular "freedom" a priority.

Knock yourself out. I'm convinced that you're plenty smart enough to figure out that if you talk about or address a person in a different manner than they want to be addressed, you know that you've made the deliberate decision to disrespect their wishes and depending on the person, quite possibly also hurt them. My conclusion is that being allowed to do that matters more to you, than the possible pain you inflict. Right or wrong? If wrong, feel free to explain why you think so. Personally I don't get it. If something's no skin off my nose and the person isn't being a **** towards me, my default setting is to simply respect the person and their wishes. Different strokes I guess. Sweetcheeks, your terms of endearment are really tugging at my heartstrings, but I suspect Farawyn ain't your dear... It's kind of funny. This thread is over a hundred posts long, and no one has managed to provide a meaningful list of things that they want to be able to say, but feel is frowned upon or even condemned by a sizeable portion of the population. What have we got so far? * Being able to say Merry Christmas. * Being able to call Easter eggs; Easter eggs. (I've searched the internet for credible incidences of people being assaulted or jailed for using the phrase Merry Christmas or saying Easter eggs, but rather unsurprisingly, I drew a blank). * If I interpreted it correctly, being able to call a person who's transgender the pronoun you prefer, instead of the one they prefer? Isn't this a rather pathetic list? Have I missed anything major? There are so many posters in this thread who seem to share the common belief that you guys are way, way too PC, and that's the best the collective you can come up with? Come on! Careful, y'all are starting to sound like special snowflakes Are you telling me that you have a genuine fear that it will become illegal and punishable by a jail sentence, to simply call a person the wrong he or she? Without even bothering to research where you've picked up that strange idea, I can safely predict that it doesn't have a snowball's chance in hell of becoming law. So stop fretting. I swear it's as if some of you guys are actively looking for things to get upset about. In my opinion there's a bit of a victim mentality lurking in there somewhere... I have to wonder why is it so hard for you to "keep up with the goalposts"? It ain't rocket science. I find that kindness and respect, and a sincere apology if if I've shoved my foot in my mouth (and that's certainly been known to happen), usually does the trick. TraumaRUs, I was planning on asking you about this in my first post in this thread, but I forgot. As I've already said, I appreciate your posts and I find that you are always respectful and kind (a lot more so than I often am). I must admit, to me it came a bit out of left field, that this PC stuff bothers you. The thing I was going to ask about, is why would anyone want to bring up Hiroshima and Nagasaki while in Japan? I mean, the bombs "you" dropped on them are horrific. With a nuclear bomb, if you're "lucky" you are instantly "vaporized". If you're less lucky, you suffer an agonizing, protracted death, with thermal burns, radiation burns, vomiting, severe bloody diarrheas, extensive internal bleeding, bone marrow and central nervous system death. Or if the amount of radiation you were exposed to was lower, you might just get milder nausea, vomiting, diarrhea, painful mucous membranes and develop leukemia two years or so down the road. Who could blame the Japanese for not wanting to be reminded of this, especially by citizens from the country that bombed them?

The song doesn't make me think of date rape but rather that I'm glad that I wasn't young in that era. Since I've never been shy about stating what I want, I probably wouldn't have been very content to live in such a repressed state where game playing and fake coyness was the norm and the expectation. I guess I welcome the "decadence " with open arms

I agree. I'm quite convinced that I could fly to Sea-Tac International and run around all the terminals yelling Easter egg at the top of my lungs and not have to worry about being scolded and flogged by a huge angry PC mob :) Airport police/security might be a different matter... They might disapprove of my behavior, but hardly based on my being PC-illiterate One can always find a small amount of people who object to basically any silly thing, but as long as they aren't a significant/majority portion of the population or those who wield absolute power over you, their little idiosyncracies don't really have any meaningful bearing on your or my life. I doubt that this spring sphere has spread sufficiently to actually impact/restrict anyone else's life. Personally I think it's pretty silly to focus on weird outliers and try to magnify the phenomenon into something of relevance. Let that person call it a spring sphere if it floats their boat :) I think it's a perfect example of a non-issue that doesn't affect me whatsoever. Is anyone here seriously genuinely afraid to utter the words Easter egg out loud to the point that they'll refrain from it out of concern for the negative consequences? Somehow I doubt it.

I've never heard that song before now and I must admit that listening to it annoyed the **** out of me. Mostly because it was painfully repetitious. Should it be banned though? No. I can change stations. It's interesting how differently we perceive things. I don't really see it as more "innocent" than today. I just find whatever games those two couples are playing, irksome and repressed. For ***** sake, if you're attracted to someone, just come out and say it. That's the easiest way to find out if the attraction is mutual. First couple I see a man who's dense as a log. The second couple I see a woman who's equally dense. If someone keeps trying to put on their jacket and leave, chances are they aren't that into you. People who beat around the bush annoy me. A lot. And as far as I'm concerned, people who keep pulling your arm in order to stop you from leaving when you've made your intent clear, have earned themselves a no, a swat and a smack (in that order, as needed). While I'm semi jesting here, it should be noted that physically preventing a person from going where they're trying to go, is in most cases a criminal offense. (Well, unless you keep on singing at/to them in a jolly manner, in which case I guess it's okay ) I still don't think the song should be banned, but I guess it's safe to say that I won't be downloading that tune any time soon Before I can even begin to answer that, we'd have to agree on what "PC" even is. I have a feeling that if you asked ten posters to try to actually define what PC means, we'd get ten different versions. I also think that in some instances, some people stick the label PC on others, as a lazy copout when they don't want to or aren't able to support their own viewpoint in a rational and cogent manner. It's easy to just dismiss someone's position as being "PC", instead of accepting that the other person feels differently than oneself, based on their own opinions and personal values/convictions, rather then being "politically correct". Was there a clear definition of the term PC provided in this survey, or were respondents answering with their own personal/individual definition in mind? *** Could someone here who thinks we are too PC, give me ten clear examples (even five will do :)) of things they would like to be able to say, but feel they aren't able to, without being struck down be the "PC brigade"? I genuinely don't understand what PC means. Because I never feel curtailed or hemmed in. I feel that I can speak my mind and if someone objects it's usually because they have a different opinon than I, which is fine. It's not normally for the way I way it. I can't identify with this feeling of being restricted by what's PC, so I'd really appreciate if someone could give concrete examples. Personally, when I do manage to offend, it's normally because I intended to offend (or at a minimum, didn't care if I did). It doesn't just, oops, just happen... I can't blame that on anyone else, or hide beind that I don't like this "PC nonsense". I always try to own the insults I deliver. I'm responsible for them. @traumaRUs. I've never seen you be anything but well-mannered and civilized on this board. I assume that you're not habitually offensive to others in real life as well? I guess that just as with the term PC, we have to find a common definition for what's offending to others, cause I simply don't see being offensive as being something you do. Personally and generally speaking, I find it's always a good idea to think before I/one speak/s :)

Your two coworkers sound quite dramatic and frankly thin-skinned. I don't understand how a single challenging patient hospitalized for what must have been for a relatively brief period of time for a hip surgery, could make one nurse quit her job altogether and another switch from full time to part time. That seems like a massive overreaction. It seems both you and your coworkers give this patient way too much power. You've been a member here since 2006. Have you been a nurse for all that time? I don't think you should let one demanding patient question your entire career. Frankly, I'm very surprised if this is first time you've encountered a difficult patient. We deal with all of humanity and are bound to see all sorts of behavior. Back when I did floor nursing, if a specific patient acted out in ways that made me worry that they were capable of lying about the care they received, I'd bring a coworker along as a witness. That only happened on a couple of occasions. For the vast majority of patients, I'd just carry on and do my job, and not worry about it. Personally, I never worry about losing my license as long as I do my job conscientiously and according to best practice.

I don't think that anyone here has been arguing that double gloving for surgical procedures isn't recommended by various organizations. I think we all agree that it is. I just found the OP a bit vague on exactly when it's recommended to double glove. I would also like to see references for the stats presented by OP. Here's a Cochrane Systematic Review from 2006. Double gloving to reduce surgical cross-infection - Tanner - 26 - The Cochrane Library - Wiley Online Library Authors' conclusions: Hi OP. This is a prime example of something you'd need to support with evidence if you want to make a claim like this to a bunch of nurses. We're not trained to just accept any claim, quite the opposite really. We would appreciate seeing the supporting evidence. That way we can evaluate the study design and any weaknesses it might have. It is absolutely possible that your figures are accurate, but I still need to see the research that you base your claim on. Also, the logical next question is the one that hhern brought up. I want to know what benefit a 71% reduction of inner glove perforations has for me and/or my patients. So I need to know, how often do inner gloves perforate? That way I can assess if the 71% reduction is meaningful. If the inner glove perforates once in a blue moon, then the benefit is obviously less, as opposed to if inner glove perforation happens once in every five surgeries. I also want to know what the risk is to me and/or my patients on the occasions that the inner glove does perforate. Does an inner glove perforation mean that pathogens are indeed transferred between healthcare professionals and patients and if it is, how often does it happen. Is it 1:4 or 1:852 or 1:30,000? Do we know? Only when we know how often inner gloves perforate and how often that perforation actually leads to transmission of blood/bodily fluids, is it possible to fully evaluate the risks to patients and healthcare professionals and the benefit of the 71% reduction. Yes, I am somewhat giving you a hard time here. The fact is that my feathers do get a bit ruffled when I'm expected to just accept a statement at face value. I'm not in the U.S., but during my eleven years of nursing we've always used dark green or dark blue gloves as an inner glove and a semi-transparent outer glove. I'm sure that some people might find your product helpful as it removes the need to don the second glove, but personally I think having the ability to choose sizes on the inner and outer gloves respectively, is a good thing. I work in anesthesia so I don't normally double glove, but I have noticed that the surgeons and OR nurses I work with combine their inner and outer gloves differently sizewise.

OP, I eat healthy and exercise regularly for me. I don't think it's part of my job description as a nurse to "portray health". My job is to provide high standard evidence-based care to my patients. I don't view myself as a health role model. If one of the job responsibilities for nurses was portraying health then surely the employer should share in that responsibility. I like my nursing career but my previous career was much more health-friendly. 25% of my fulltime work was dedicated to physical exercise (weight lifting, running and self-defense and some tactical training) and it was easy to stay in excellent shape. It can still be done in nursing but it's in my opinion much harder. Shift work, long shifts with sometimes inadequate downtime between shifts/too little sleep, high stress levels and irregular meal break schedules can make maintaining a healthy lifestyle a bit more difficult. Well, I look like the dude in the middle, but thankfully with a slightly more feminine cleavage (and perhaps slightly smaller ears ) Oh, and I'm 6'1'' so I'm not sure what to do with the wrist size numbers.. I'm 8 inches taller than 5'5'', so do the numbers still apply?

(my bold) Oh, for crying out loud... Your original post certainly conveyed a lot of drama with a liberal use of exclamation points and words and phrases designed to paint a picture of a situation fraught with peril and emotions running high. Now you're saying that the mad, knife-wielding Ms. Carpenter wasn't at all unstable (I beg to differ, fetching a "wicked-looking" knife to threaten another human being with is neither stable nor remotely normal), and that you knew all along that all you needed to do was to confront her and she would back down. This raises several questions. Why were you in such a hurry to complete the task and why did you flinch, hoping this was just a bad dream if you were so in control of the situation? Why did you ask me in a previous post to explain which way I would have turned for safety, towards the knife or the weight? I certainly interpreted your question as meaning that you felt you didn't have an obvious solution to this problem. Wasn't that what you were attempting to convey? Why ask me if you knew all along that you could have just told the "bully" to back down? This latest addition to your story really begs the question; if you could easily have put a stop to this earlier, why on earth did you allow the procedure to continue? You chose to let an individual who had previously had an intimate relationship with your patient and who you knew your patient was afraid of witness a very personal procedure and stand a few feet from her exposed genitals, brandishing a knife. Why on earth would you make that choice? I honestly don't think you protected your patient the way we are expected to. I'm curious, if the ex-lover had been male instead of female, would that have affected the way you chose to handle this situation? In my opinion it shouldn't, the gender of an abusive partner/ex-partner doesn't make a difference to the victim. They are both scary and capable of doing psychological and physical harm.

It's difficult to give a detailed description of how I personally would have acted. This is in part due to the fact that I have incomplete information about the specifics of the situation. You've just now added information that wasn't included in your original post (your back being against the wall). Even if I was in possession of all the pertinent information, my course of action might not have been the recommended course of action for you. As I've previously mentioned, it depends on your experience and abilities/physical capability. I am in all likelihood much more physically able to safely disarm a knife-wielding individual, than you are. I have literally spent thousands of hours in self-defense training and tactical policing as well as of course apprehending numerous violent/armed offenders. Spotangel, according to this and some of your previous posts you have decades of nursing experience in various fields, including ER, ambulance and home health. You must be aware of the importance of situational awareness and scene safety! Despite that, your story suggests a surprising level of situational unawareness. You ask which way I would have turned for safety in the situation you described. The number one safety measure I would have taken, and that you should have taken, was to never end up boxed in/cornered in the first place. This part is important, and to anyone reading, please always have this simple self-defense strategy in mind. I've escaped harm on more than one occasion by always being aware of the layout of the locale I'm in, and the exit routes available to me. The moment that Sherry grabbed a weight and uttered the threat towards Ms. Carpenter, was your cue (if you hadn't sensed it earlier), that the situation was about to get out of control. When Ms. Carpenter left was when you should have acted. I would have quickly stood up, covered my patient's exposed genitalia with a sheet or whatever was at hand, and rapidly moved to a position were I had more space around me and more options available to me. You had no idea why Ms. Carpenter left or what she might return with, but you did know that you had a volatile and possibly escalating situation brewing. Sitting down and three out of four possible escape routes more or less unavailable (the wall route of course being completely unavailable ), leaves you in a very disadvantageous position. As I've explained, I wouldn't have allowed myself to get boxed in like you did. But if I for some reason ended up in a similar situation, I would never decide to perform a nursing task that would require that I take my eyes off the multiple threats close to me. The scenario you've described is strange to me. I don't understand why Ms. Carpenter who seemed primarily angry at Sherry chose to press herself against the wall after she returned from the kitchen with the knife, positioning herself so that you sat like a buffer between her and the person she was attempting to intimidate? You saw Ms. Carpenter with her knife from the corner of your eye as you sat with your back against the wall, ready to catherize your patient. That means that the knife-wielding ex-partner that your patient was already afraid of, was in the patient's direct line of sight as she lay there spread-eagled. What about the safety and dignity of your patient? This whole situation was in my opinion utterly undignified and unsafe. I can only imagine how exposed and vulnerable the patient must have felt. The scene that you've described is so absurd. You have two agitated, emotionally unstable and armed individuals, one a predatory ex-lover that you know the patient was afraid of, witnessing how you catherize your patient. Does anyone really question why this story bothers me? (This isn't really important, but the inquisitive legal mind in me, wonders how you knew that Ms.Carpenter got a knife from a kitchen drawer? How do you know that it wasn't from the sink, countertop, dishwasher or some other place? Could you see the kitchen from your position?? If you could you knew that she was arming herself with a lethal weapon).

It made me cringe too, but probably for a different reason. I saw OP's post earlier but it was back on page two so I decided to not reply as I didn't want to bump it. However now that it's back on page one, I will add my two cents. To me, it's too colorful. Spotangel, this is a serious question. Are you an aspiring mystery novel author? Your tales are usually full of dramatic flair; like the "wicked" looking knife in this story. A mentally unstable person wielding a knife (even if that knife had been "kinder" looking), an arms length away from you, could have slit your throat several dozen times in the two minutes you in my opinion unwisely, decided to devote to that catherization. It would be one thing if you were writing your stories solely for entertainment purposes. But when you present them as actually having happened as you describe them, I think they amount to poor advice on how to handle a situation that could have gotten real ugly, real fast. Threats and volatile situations is something that most nurses might encounter during their careers. My advice to anyone reading this is that if they find themselves in a similar situation as the one OP described, is to prioritize your own and your patient's safety. The nursing task at hand will have to wait until the situation has stabilized. Yóu DO NOT attempt to catherize your patient when you have a mentally unstable and physically threatening individual with a knife less than two feet from your jugular & carotid! The knife was bad enough, but adding a second emotionally upset person with the weight makes for a situation with too many moving parts. A wholly unpredictable situation. Exactly how you handle it depends on your experience and abilities, but one of the two following things need to happen. You either remove the threat or you remove yourself from the threat. You do not remain within striking range of a lethal weapon in the hands of an aggressive person. That's basic safety thinking. Also law enforcement should in my opinion have been contacted before the task was done, not afterwards. You and your patient are lucky that the situation didn't escalate further. Please everyone; act smart, remain vigilant and stay safe at work.

Since you didn't quote the post you're responding to, I have no idea if your post is aimed at me or at someone else. It doesn't really make a difference, my reply to you still applies. Labelling people whom you disagree with "haters", while at the same time failing to address the actual opinions you disagree with, is no doubt convenient and comforting. It saves you the effort of having to ponder whether the opinions you object to, might actually have merit. Perhaps I/we aren't getting the point, but you know what? It's also possible that we are. I have in fact been an ER nurse. I have also worked slightly over a decade in law enforcement. Trust me, I don't need to be informed about this. This is (ER) nursing 101. In fact it's such a basic follow-up question to ask that I am shocked that it took eleven visits before someone finally connected the dots. I can give ER nurse 1 and ER nurse 2 a pass, but by the patient's third visit a clear pattern of the same complaint was established. A pattern that should have set off alarms. Frankly, I question the third, fourth, fifth, sixth, seventh, eighth, ninth and tenth ER nurses' competence (I'm assuming that nurse one through ten, weren't all the same individual, but that the patient was seen by different nurses on the various ER visits). I apologize in advance for this piece of cynical sarcasm, but since this poor patient had on more than half a dozen occasions met nurses who were either uncaring or surprisingly blind to the obvious possible scenario, I guess it's fortunate that she met the only one who managed to see it, mere hours before she was planning to commit murder. I've noted that some posters in this thread find OP's post inspirational. To me it isn't. For someone who's a novice nurse, completely unaware of domestic violence and sexual abuse the post could be viewed as informative and educational. For me personally, the woman and the child in OP's story had already suffered too much for me to feel any inspiration. I never felt particularly happy when I managed to send a abuser/rapist/molester to jail. I'd feel a certain grim satisfaction that they wouldn't be in a position to inflict any further harm on their victims (at least for the time being), but I was always acutely aware of the pain they had already inflicted. Sometimes those wounds would never properly heal in their victims. I'm not going to share whatever conclusions I've arrived at, because I don't see anything helpful coming from that. But rest assured that whatever conclusions have been drawn, were not based on one single thread, but based on the sum total of accounts in several different threads. Unreal? The reason I replied to your post is the same reason I will challenge nurses who for example express an anti-vaccine viewpoint. They reject science and I worry that their poor understanding of scientific research may do harm. I've seen some things in some of your posts that I think pose a risk. You can agree with me, or not. But the reason I post, is that I care. I bear no ill will towards you. You might not realize it or feel it, but I actually tried to be as gentle as I could when I identified which aspects of your post bothered me. I was trying to reach you and reason with you, not tear you down. You're doing it again, adding lots of information that would have been helpful to have from the beginning. I won't rehash this in detail, but you know from our previous discussion that changing/evolving narratives, give me pause. How come you added the gruesome and unnecessary information that the boyfriend threatened to kill your patient's four year old child piece by piece (threatening to murder a child is horrific enough, the graphic details aren't needed) , but failed to clearly express that you didn't leave a patient who'd voiced homicidal and suicidal ideation, alone? For any new nurse, unfamiliar with the ER and the patient population your post concerns, that information would in my opinion have been valuable. They could benefit from learning how to address a situation like the one you've described. It's quite possible that the baggage I carry from having met/seen so many victims of ugly crimes affects my perception, but to me including lurid details like the threat of dismemberment of a young child, lends a sensationalist slant to your post.

I agree that nurses are often in a situation where we can help people and due to the nature of our work, we are in a good position to notice/identify if a person is being abused, especially when it involves vulnerable groups like children, the elderly and individuals with disabilities or impaired cognitive functions. That's why we are mandated reporters. After reading your story I'm feeling sad but also a bit incredulous. I have worked with victims of domestic violence, pediatric sexual abuse victims and encountered many of the perpetrators of these crimes. In part during my nursing career but primarily in my previous career. Neither the perpetrator in your story nor the two victims are typical. In my experience it's unusual for a perpetrator to sexually abuse/assault both adult women and preschoolers. It's not impossible, but it's very rare. The adult victim's reaction to the abuse is also somewhat outside of the norm (but again, not impossible). You said that the mother/Ms. Williams' partner had recently started to sexually abuse the child, but the mother (your patient) had planned on murdering her child for a year? She'd come to the ER eleven (!) times in the past three months with GI/Gyn complaints. Had she been leaving her four-year-old at home with the man that molested her the previous ten times, just as she did the on the eleventh visit when she finally confided in someone (you)? She'd left her child with the molester but never asked for help when she had the chance during the ER visits, but just because you asked, she finally did? On the eve of the planned murder/suicide? Frankly, I wish God would have stepped in a bit more promptly, he was cutting it a bit close. Who knows what the child had to endure during her mother's eleventh ER visit. As I started off by saying, I have experience with sexual offenders and their victims. I'm well aware of the complicated dynamics that exist between a victim of domestic abuse and the perpetrator of the crime. For an outsider it might be difficult to understand why the victim doesn't simply leave her (or his) tormentor, but it's not that easy. It's not easy psychologically, and the time when the victim decides to leave (and attempts to) is usually also a very dangerous time for her (or him). That said, your patient left a child that she was supposed to protect with the child's molester and she had also been planning on killing the child for an extended period of time according to your account. The mother was actually also a threat to this child. You wrote that you flushed the pills the mother had planned to use in her child's murder and her own suicide, down the toilet. That's not something I would have done. What did you do to make sure that if the mother ever got involved in a new abusive relationship (sadly, not an uncommon pattern), that she'd be equipped with better coping skills and would be in a better position to fulfill her parental obligation to keep her child safe? Did you share the murder/suicide plan that the mother had spent a year plotting with anyone so that it could be addressed? I hope you did, but since you decided to flush away the evidence I worry that you didn't? From reading many of your previous posts, it seems you derive happiness from helping people and there's absolutely nothing wrong with that. If helping people is done for altruistic reasons, it's an admirable act in my opinion. I have however previously and am doing so again in this thread, questioned whether your judgment is always optimal. I don't really think I got through to you the last time I voiced my concerns, but I'm hoping I will this time.

They die because they are palliative patients. They don't die because symptoms like pain, anxiety and excessive secretions are properly treated. If you want to start being more "frugal" regarding how much you ease their symptoms, they will simply die experiencing more agony. But they will still die. What school of thought would that be? Is it supported by research? It's not about being blasé. I do wonder if there wasn't a little accusatory barb hidden somewhere in that statement? I don't know what kind of surgical scenario you're referring to, but it's certainly not the surgery itself. I assume you mean pain management for a patient recovering from surgery? Why is it that you find it hard to accept that rules can change somewhat depending on the circumstances? If you have a patient who is expected to live after they recovered from whatever is causing them pain, it makes sense to not take any risks at all that could negatively affect them. The risk versus benefit might in that scenario make it good practice to withhold opioids or other central nervous system depressants for the moment when they have a respiratory rate of ten. Not that you'd likely kill them just by giving them one more postoperative pain pill (whatever is prescribed), but because even the small risk involved might be considered to outweigh the benefit. Personally I think the risk-benefit assessment changes when the potential benefit is much smaller and the potential for harm is much greater (human suffering while knowing all along that there is no chance for recovery or health at the end of the suffering). Having a strict rule, RR I don't think you can know. The research I've seen doesn't at all suggest that adequately treating symptoms in the dying patient hastens death, but how can anyone know it (as in 100% certainty) for a fact in every individual case? Reading your post, I feel that you are making this all about you and your conscience. I've said this a hundred times before. Nursing is about the patient, it's not about the nurse. I assume that you're new to palliative nursing? I don't work with palliative patients but I do work with treatment of pain in a sense. I wonder since treating your patients adequately causes you this seemingly high level of distress, that perhaps this field isn't the best fit for you? I'm hoping that nurses who specialize in end of life care can offer you some helpful advice. Pretty much. Although it's absolutely possible to give boluses with the syringe driver/infusion pump (and change the infusion rate). I don't know if they habitually give boluses in palliative care where I assume that they administer the meds subcutaneously and I'm guessing (?) that they might mix several compatible meds in one syringe. Several meds in one syringe would make boluses tricky as you might not want to give extra of all. In the OR I have the drivers connected to an intravenous line. I have my syringe driver pumps "stacked", mounted on an IV pole and most often they all just contain one med each so I can have full control of the individual rates and boluses. The difference between a syringe driver and a "regular" infusion pump is basically that you draw up the medication in a syringe which you "place"/connect to the pump. With the other pumps you use medication in a bag or bottle. We also use them in all ICUs, (NICU, PICU, adult) for basically all meds apart from hydration and nutrition.