As nurses, we care for people. We care for our patients and our peers. It is what we are trained to do. Forensic Nurses and all of our peers who care for patients of violent or extreme circumstances are at even higher risk of experiencing compassion fatigue and vicarious violence. COVID-19 has only added another layer to this challenge. Hopefully, with the support of each other, we can meet and uplift those most impacted.

After completing the following learning, you will have met the following learning objectives:

1. Examined the risk of vicarious trauma in your work.
2. Utilized reflective analysis to identify your current level of stress and work related trauma.
3. Examined mindfulness as a way to de-stress.
4. Created a plan to support your mental-health in the upcoming year.

"Helping forensic nurses recognize the situations that lead to moral distress is the first step in helping them to relieve their distress, reduce their burnout, and continue longer in practice" (Karakachian & Colbert, 2019, p.139).

Karakachian, A. & Colbert, A. (2019).  Nurses' Moral Distress, Burnout, and Intentions to Leave: An Integrative Review.  Journal of Forensic Nursing,15 (3), 133-142.  http://doi:10.1097/JFN.0000000000000249.

To read a copy click here:

https://drive.google.com/file/d/1SrISVV6Aw0NKJ0M5QpsWXVM-Vl8Vrj48/view?usp=sharing

Mindfulness can simply be defined as, "...the state of being attentive to and aware of what is taking place in the present” (Jacob & Holczer, 2016, p.33).

Jacob, C. J., & Holczer, R. (2016). The Role of Mindfulness in Reducing Trauma Counselors’ Vicarious Traumatization. Journal of the Pennsylvania Counseling Association, 15, 31–38.  http://pacounseling.org/aws/PACA/asset_manager/get_file/129164?ver=44#:….

You can download a copy at:

https://drive.google.com/file/d/1cj34FcZcAdz56upxwaCKfino_kHwXhnR/view?usp=sharing

"A Survey of Stress and Burnout in Forensic Mental Health Nursing"

https://drive.google.com/file/d/1eAe1qnHcCgOwJNT7uc4LcwG-q6yQYKWk/view?usp=sharing

"Intervening to Improve Compassion Fatigue Resiliency in Forensic Nurses"

https://drive.google.com/file/d/1QYW-3eIU7bAxJNHD2oKbfxNWVVDKQkec/view?usp=sharing

"Vicarious Trauma Among Sexual Assault Nurse Examiners"

https://drive.google.com/file/d/1U_A6tXBkkwKdxYNfLn1eGFBFMxjKcFh8/view?usp=sharing

• Sodium accounts for 90% of the extracellular cations 
• Important for electrolyte and water balance because accounts for half of the osmolarity of the ECF
• Normal serum concentration: 135-145 mEq/L
• important in generation and transmission of nerve impulses and the regulation of acid base balance
• regulated by kidneys, ADH, aldostorone

• Hypo = low (less than 135 mEq/L) 
• decreased osmolarity 
• cells are swollen: associated w ECF hypo-osmolarity from excess water. To restore balance, fluid shifts out of the ECF and into the cells, leading to cellular edema
• 

• Direct Loss of Na+
  • GI losses: diarrhea, vomiting, fistulas, NG suction
  • Renal losses: diuretics, adrenal insufficiency, Na+ wasting renal disease
  • Skin losses: burns, wound drainage
• Excess water in ECF which dilutes Na+ conc
  • SIADH: syndrome of inappropriate secretion of antidiuretic hormone (retain water)
  • Heart failure
  • Excessive hypotonic IV fluids
  • Excessive water intake (polydipsia

• irreversible neurological damage or death from brain herniation can occur
• rapid, weak thready pulse
• postural hypotension
• Brain Swelling : headache, lethargy, headache, confusion, apprehension
• nausea vomiting
• low BP

• water excess treatment: fluid restriction, for severe symptoms (seizures): small amts of IV hypertonic saline solution is admin to restore the serum sodium level while the body is returning to a normal water balance
• sodium-containing fluid loss treatment: fluid replacement w sodium-containing solutions
• oral rehydration fluids containing electrolytes may help prevent it (home setting)

Nursing 

• monitor serum sodium levels and pts response to therapy to avoid rapid correction or over correction
• record I&O

• CNS function slows down 
• Can affect different systems 
• regulates vital organs, digestion, circulation

Causes

• metabolic acidosis
• diabetic ketoacidosis
• CNS depressants: opioid overdose
• stroke, brain trauma

Symptoms

• lack of coordination
• reduced HR
• muscle weakness
• NV
• constipation
• low BP
• slow RR
• confusion

  assesses balance, coordination, the function of nerves, reflexes, mental status, motor and sensory skills 

LOC: alert? 

Eye opening, verbal response, motor response

Subjective: health hx 

• bones: trauma, ROM
• ADLs
• Self care 
• Joints: pain, stiffness
• Muscles: cramps, weakness 

Objective:

• inspect joints for size, colour, swelling, deformities
• palpate: temp, tenderness, mass
• ROM
• Muscle testing: against opposing force
• compare sides 
• Pupils: PERRLA, accommodation 
• Motor function: grip test
• Pain: sternum rub (can cause bruising)

CASE STUDY

You are working on an inpatient psychiatric unit and need to do an initial assessment of your patient Randy, who has just been admitted. He has a diagnosis of schizophrenia, paranoid type. He is 24 years old and has been attending the local college and living at home with his parents. Randy has always been a good student and participates regularly in social activities.

Last semester his grades began declining. He became very withdrawn and started to spend most of his time alone in his room. His personal self-care has deteriorated as he goes days without showering.

Prior to admission, Randy spent several weeks in seclusion. He refused to join social gatherings, isolated himself, and kept his window blinds closed.

Over the past 2 days he refused to eat, telling you, “They have contaminated the food.” As you approach Randy, you note that he appears to be talking to himself. When you talk to him, he looks around and answers in a whisper but gives you little information. He states, “They are watching me and told me not to cooperate with you.”

What happens? unregulated hyperplastic growth of the epithelial and fibromuscular tissues of the transition zone (TZ) and periurethral area. This blocks the flow of urine.  

Genetics/ Hereditary

• loss of Y chromosome
• single-nucleotide polymorphisms (SNPs)

Androgen 

• testosterone derived play role in prostate health 
• Androgen receptor expression may be upregulated 
• incidence increases with age, when testosterone also decreases 

Oestrogens 

• men with metabolic dysfunction 
  • larger adipose tissue can lead to increased conversion of androgens to oestrogens 
  • along with the decrease in testosterone, the altered balance may account for the hyperplasia

Insulin 

• increased incidence of BPH in diabetes pts
• the receptor for an insulin mediator is found in higher levels 

Growth Factors

• changes in sex hormone balance maintain hyperplastic processes 
• linked with inflammation? 

https://bjui-journals-onlinelibrary-wiley-com.libaccess.senecacollege.c…

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 https://libguides.royalroads.ca/apa7

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https://apastyle.apa.org/instructional-aids/handouts-guides#mastering