medisec

Interesting post and perspective of both countries. I have worked more on the medical documentation and policy side of things, and just moved to New Zealand to pursue an academic lecturer track. I am curious, now that you are in Australia and working as a nurse, do you know if Australia or New Zealand have the same strigent workplace policies regarding nurses with disabilities e.g. monitor programs, penalities/stigma for (non)disclosure? I am finding that NZ is more compassionate with their policies, although there are some documented reports from some Kiwis who felt discrimated against or stigmatized due to mental health diagnoses.

Ha Viva, no, not a real "hypothetical" nurse but a situation I wondered about cause my son takes the meds without having bipolar. Just wondered how it "might" work if that were the case in nursing. Again, I agree, definitely a violation of HIPPA if you "have" to disclose your diagnosis to the workplace to keep your job or not get penalized. BTW, I did present at a medical conference last May on this topic based on the feedback you all gave me from this forum. Great response and recommendations to maybe publish, which might raise some awareness. When I am done with my dissertation I really would like to continue with interviewing some willing participants from this forum. When I looked up some states BON's (un)ethical practices with disclosure and NMPs, I don't find many articles. I also don't like the language used in the documents you all are required to sign when disclosing and for the NMP. I "think" it was Wyoming's BON?? especially that had contradictory language, then there are those publicly posted I think it was the Texas BON hearings for infractions...that totally is mind boggling to me how such personal information is made so public. Talk about unethical violations esp of HIPPA if it is related to disclosure.

Thanks. I wasnt sure about the meds disclosure part since monitoring programs are also for those with addictions to controlled substances, or if that factored into disclosure for those not addicted but take meds that fall into that category. I think NMPs and BON from what I've read here have been unfair in treatment of those who are forced to participate just because they have bipolar and take such meds to help with that diagnosis. During my research, I came across one state's forms for it's NMP. One requires credit card info to charge participant. But the other forms that require medical information disclosure did ask for list of meds. To me it was a violation of patient rights (HIPPA). That is why I was asking. I do appreciate the feedback and the insight.

Hi everyone, been off for a bit cause i had to take my dissertation quals exams...4 days of writing 3 papers...passed. Anyway, i have a hypothetical question about bipolar meds and monitoring. This came about when my eldest son recently started showing signs of bipolar...waiting to see dr for definitive diagnosis. Anyway, it made me think....my other 21 yo son has Tourettes. He takes a bipolar med to minimize his tics. Lets say he was a nurse, did not have a diagnosis of bipolar, but takes a bipolar med strictly for TS, would he still be mandated by the BON to disclose the med and be forced into a monitoring program to keep his job?

Sorry I've been a bit MIA but dissertation work and teaching simultaneously, especially this semester, has been very time consuming. I just wanted to give a shout out and thank you to those of you who provide some responses and gave voice to some of the issues regarding the monitoring program. I am working on the editing stages of hopefully a publishable article based on ethical practices of health professionals in the workplace regarding disclosure/nondisclosure, monitoring and marginalization of nursing professionals with disabilities, AND a summarized version of the research I worked on this past fall based on some of your input has been accepted for an ethics panel/presentation at a conference on medicine and technologies in May. So your voices/concerns, in this respect, will be represented in another type of public forum. I am still hoping to continue the research by documenting oral histories or personal accounts from some of you have expressed interest in telling your story. I need to see if I need IRB approval first...usually with narrative oral histories, and because this is a publicly open forum, oral histories may be exempt from the process. Will keep you all posted but if anyone else is interested

Viva, can I ask what state you are in? I know you mentioned Texas, where I am, is very strict. I'd like to look into some other states and see if I can dig a little deeper for information....or if anyone could chime in who is from another state for a heads up about policy??

So far I think I might get the to ahead to do the study, although it will take a while to get IRB approval through my university...maybe by the semester's end?? I will keep everyone posted, but I do appreciate the interest and hope to get some great feedback when I do get the green light. In the meantime, I am focusing on the narrative analysis of some of the threads concerning this topic and how nurses diagnoses of "bipolar" are medicalized as "addicts" - which two of my professors thought was just mind boggling. One of them is a disability studies specialist in the field and he kept asking if that is legal, how that violates privacy, especially when a employer asks in your new hire paperwork disclosure of meds and mental health history. Is that when and where they determine you have to participate in a monitoring program? The available literature is very sketchy, mostly about actual "addicts." Anyway, I did want to find out, and Viva I might have email you separate since you have been sharing detailed knowledge of this topic... Is the monitoring at the discretion of individual hospitals, the state and/or a combination of that and the BON? I ask because it is very difficult to find specific information about this other than the BON website, which even there it says monitoring is voluntary?? and/or is it at the discretion of the hospitals' hiring policy as to how long a nurse with bipolar needs to go through such as program? and who pays for it? I hope to gain a little more insight, especially since most research in this field refer to older studies that include interviews and observations, nothing too recent.

Thanks Viva. I'll keep everyone and you posted if I move forward with the study. I need to go over the logistics with my advisor about creating a small study. However, I'm working with her on expanding this analysis/study while taking a medical rhetoric course this semester. We just finished a book by Judy Segal where the author touches on medicalization and medicalizing illness, not specifically mental health though. I'd also still like to hear from some other participants to get their thoughts.

Great question, but also complicated. Medicalizing disability has it's positive and negative connotations in relationship to social constructs. It's basic definition is not really negative, it just means to 1. view or treat as a medical concern, problem, or disorder those who seek to dispose of social problems by medicalizing them; 2. to view or treat as a medical concern, problem, or disorder (Webster). However, I am still exploring how this applies to disability in particular nurses and nursing students with (who disclose) bipolar and mental health. I think an example woud be the monitoring program. From what I've read in this forum, nurses with bipolar for example are medicalized by the BON as "addicts" because they are required by the BON to be placed in a treatment program designed specifically for drug and alcohol addiction. ****Viva gives a better description below about how nurses with bipolar are marginalized by being subjected to monitoring***** So, if I apply this definition correctly... basically the BON is medicalizing disability in a negative way to avoid a potential risk. It is identifying (medicalizing) bipolar as a disease/disorder while assigning it a negative social contruct. I really could not find any justification academically or otherwise as to why nurses who disclose bipolar are placed in this program. Anyway, that is one way of looking at it. The following are more "formal" and historical and theorizing definitions...you can also Google the general term "medicalization." I think disclosure fits in here also, which also perpetuates perceptions of disease, marginalization, and stigma. Here are some more complicated definitions of "medicalization" if that helps. Note the ones in asterisks, I think they might apply here: >Medicalizing disability is defined as a disability in the medical model is defined as bodily malfunction, while the social model converts it from an individual physical problem to a social problem. >Medicalization is a process whereby medical and health precepts have been embodied in individuals who assume this responsibility for themselves... ....a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illnesses or disorders. ...a medical perspective played in the analysis of society and its ills ...biomedical outlook on the management of populations ...a medical perspective over individual rights ...the modern welfare state governs the bodies of people with sovereign rights. They also fail to appreciate there is an inverse relationship between the progress of the medicalization in the twentieth century and individual liberty--that a doctrine of the healthy citizen has displaced, in some degree, a regime of the citizen of rights. *****....although doctors are always on the lookout for personal and professional reasons to medicalize a condition the treatment of which will increase their power or income, in the modern state they often as not act as experts in conflict resolution between private individuals and insurors or between individuals and state entities...medical opinion may have a bearing on matters ranging from the ability to hold down a job, be a good parent, receive injury compensation, and a host of other typical conflicts in the modern welfare state. ****...state's interventions in particular areas of life are brought under critical scrutiny in terms of their legitimacy (do they encroach on the necessary freedoms of individuals?) and the competence and cost-effectiveness of its methods (can the objectives be achieved without state intervention: that is by members of society themselves?)" In the twentieth century where the juridical institutions or procedures have been liquidated or crippled, the doctrine of the healthy body has been transformed into a justification for hygienic elimination of the weak and unfit, the medical sequestering of political and civil deviants, and a thoroughgoing control of reproduction and women's bodies (Kater, 1989; Proctor, 1988; Weindling, 1989).

I have been compelled by the narratives and stories I read in this forum esp about the medicalization of nurses and nursing students with disabilities, and the marginalization of those nurses with bipolar and other mental health diagnoses who disclose their conditions. From the some of the posts I've read over the years, it appears there needs to be more awareness generated regarding the effects of medicalization of nurses with disability in the workplace and classroom. Q: What are your thoughts? Q: Would there be a benefit for my conducting a study that raises awareness of medicalization in this field as well as the voices (narratives) of those who unecessarily experience marginalization and discrimination (e.g. disclosure, monitoring, etc)? About me....I am a graduate student (PhD) in technical communication focusing on medical rhetoric and communication. I have ADHD and have worked over 25 years in the allied health field before returning to school, and I can attest to my own struggles with ADHD while working in the health industry. This past summer, I took a disability studies graduate course where I wrote a preliminary paper analyzing the effects of how discussion threads like this one provide both support and knowledge-based information for nurses and nursing students with disabilities. However, through my analysis I became increasingly interested in the stories I read and need for awareness about some of the barriers you all are facing in the nursing industry.I haven't fully decided if this would be a good direction to expand on my summer research, and would really like some feedback from some of the participants in this forum who experience the effects of medicalization. I would love to hear your thoughts, concerns, and suggestions....and if this is something you might be interested in contributing to/participating in either through interviews and/or surveys.

I wonder for those of you who "scribed" as a transition while searching for an RN position, does or did "scribing" help you become more familiar and comfortable with navigating the EMRs when you finally did settle into an RN job? I know each system/hospital is customized or built different, but provided some familiarity??

I was reading your post and was thinking back to a week ago when I was talking to a physician liason for a hospital. She said some of the ER drs paid out their own pocket for "scribes" to chart and navigate the EHRs for them. Said it allowed them to interact more quickly with patients and see more patients in a day. She said they usually hire nursing or med students as scribes. The hospital does not hire and feels there is a liability with hiring someone not employeed with hospital because of passwords, scans in/out, etc. Have you heard much about the position of "scribe"? I've only heard of it once before with a physician's private practice that used one.

Thanks HouTx. Good info. I'll take a look at that link. Question, do all EHR system builds/vendor products provide those options you mentioned? It's the first I've heard of the sticky keys as an accommodation. For vision impaired, are the graphic interfaces with touch screen easy to navigate? Do the interfaces need a screen reader? I just completed my literature review and it seems as though schools and hospitals do provide accommodations for hearing and vision impaired nurses, many are working as healthcare clinicians especially accommodations for hearing impaired. I have read how PHRs are being worked on to be compliant with Web 2.0 accessibility and Section 508 standards for disability, but concerns lie with I think with visually impaired and HIPAA. I think what sparked my curiosity even more is when I asked a publisher of one of the educational SIM EHRs used in nursing schools, and they said they have not modified but are currently in discussions about how to modify for students. I read about all the past studies about nursing students and nurses with disabilities "capabilities" to equally perform in a clinical setting/point-of-care, and how many have successfully transitioned from school to the workplace, but then all the a barriers and attitudes of instructors, program admissions that disabled nurses encounter. I thought the same thing too, about the "severely disabled ability to work as health clinicians," but the studies showed that many have supposedly met the technical standards set based on the ADA and Rehab. Act. and graduated from medical schools and practice medicine. Although, patient safety was still a concern that came up by participants AND the researchers. There are some great "I" stories published by Donna Carol Maheady in her books "Nursing Students with Disabilities" and "Leave No Nurse Behind: Nurses Working with Disabilities" but no mention of more advanced assistive technologies beyond amplified stethoscopes, digital monitors, etc. Because EHRs are still being integrated into healthcare facilities and slowly into nursing schools, I wondered what kinds of accommodations or modifications are available or should be available.

I'm taking a grad class on web accessibility and disability this summer and am writing my final paper about nursing and EHRs, well I had hoped to....I can't find anything specific to this topic in nursing, mostly PHRs and patient access. Does anyone have any experience or observations about how EHRs help or even hinder accessibility for disabled nurses or clinicians in the workplace, or nursing students? If so, how do the medical facilities modify or accommodate for disability with employees accessing the EHR? (I had another post on the Nurses with Disabilities thread, but it seemed to get lost in the shuffle. Would really like some insight since the available literature is sporifice to none.)

With providers being mandated to use EHRs, I was wondering if anyone has experienced obstacles or challenges with using EHRs/EMRs in the workplace or as nursing students in the classroom? If so what kinds of disabilities/challenges do you face? I am a first year PhD grad student, with ADHD and 30 years experience in allied health. I am currently taking a course in web accessibility and disability studies this summer. The course has really made me think about the accessibility of technology and where EHRs fit in with ADA, WCAG 2.0 and Section 508 compliance in the workplace. Disability modifications for EHRs in the workplace have not been addressed in the literature I am reviewing thus the reason for this post. I know personally my ADHD has been a challenge and has affected my past work performance when documenting health information, and wondered with the newly mandated EMR/EHRs if accessibility is an issue(or not) and why? Note: I am not conducting a formal study or survey, my course content for the summer has just made me curious as to how nurses overcome technology especially since there is very limited research/articles available on this topic. My actual dissertation research is mostly directed toward simulated educational EHRs as resourceful tools for both the classroom and potentially CME training in the workplace. However, I would be interested to hear back from nurses with disabilities if the study of disability and EHR accessibility would a good research direction (or not). I would greatly appreciate any feedback or even direction toward some interesting articles you might have come across. Thanks.