EP 176: The Evolving Role of Forensic Nursing With Debra Holbrook

EP 176: The Evolving Role of Forensic Nursing With Debra Holbrook

The Evolving Role of Forensic Nursing With Debra Holbrook

The evolving role of forensic nursing has changed over the years. What is forensic nursing? Perhaps you’ve heard about it and are interested in working as one. But what is it? A forensic nurse is a Registered or Advanced Practice Nurse with specific training and education.

They specialize in caring for patients who experienced acute and long-term health issues related to victimization or violence and have unmet evidentiary needs relative to having been victimized or accused of victimization. 

In addition to these skills, forensic nurses also provide testimony and consultation for civil or criminal proceedings. It concerns nursing practice, the care given to the patient, and their opinion regarding these findings.

Forensic nursing care is not separate and distinct from other forms of medical care but rather integrated into the overall care needs of individual patients.

Our Guest

We would like to introduce you to Debra S. Holbrook in this episode. Debra is currently the Director of Forensic Nursing at Mercy Medical Center in Baltimore, coordinating care for interpersonal violence victims for all Baltimore City hospitals. She is the President-Elect of the Academy of Forensic Nursing.

She has testified before a Senate Judicial Subcommittee on Crime and Drugs on behalf of a new law known as the DNA Justice Act. Debra also published the first research linking ALS to latent injury in strangulation. 

Changes in forensic nursing over the years, what forensic nursing is, and how alternative light source technology has changed the forensic sphere. 


The questions below are some we’d like to tackle. We often go off-topic, so we don’t expect to hit them all. If you have any ideas, please let us know. Looking forward to our conversation!

  1. Debra, can you give a little background about how you got into forensic nursing?
  2. You’re one of the leaders in the forensic nursing space. Was there a specific event in your life that pushed you to be a pioneer and an advocate for change in the forensic sphere?
    • We don’t remember any forensic nursing-related material from nursing school. We don’t even think we were given any info in the first place. If you were to ask us how to gather DNA or even the basic process of what to do when a victim presents in the hospital, we’d have no idea. 
    • How/when did you realize there needs to be a change in how we help victims?
    • What bothered you in the healthcare system, where was it flawed?
  3. Where do you think we could still improve? Where are we still lacking in helping the victim or the flaws in this giant healthcare system?
    • We spoke to a SANE nurse before, and one of the major issues in forensic nursing is the lack of resources and funding.
    • Some people get scarred for life and have the trauma for the rest of their lives. Does the current system help them through these times, or is it a one-and-done approach, and then the victim has to seek further care?
  4. You testified on capitol hill before a senate judicial committee on crime and drugs on behalf of a bill signed in 2005 as the DNA Justice Act. Can you walk us through how you came up with the bill and how you got to the point of presenting it and getting it signed into law?
  5. You published the first research linking alternative light source technology to latent injury. How does alternate light source technology assist in identifying injury?
  6. What is a project you are currently working on or a problem you are looking to solve?


Before we end the show, we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why?  

If you are a victim of abuse or assault or need someone to talk to about what you are going through, download the bmoresafe app. This app helps address the needs of patients in the Baltimore area and provides resources for sexual or domestic assault victims. You can download this app for free through PlayStore.

Get to know the evolving role of forensic nursing by watching this full episode here 👇


00:00 Introduction
01:19 About the guest
08:45 What are the flaws of our healthcare system
13:31 What is an asylum case
15:00 Where is the funding coming from
16:43 Qualities of a forensic nurse
18:48 Forensic nursing myth
21:34 Reasons why victims are not reporting the crime
24:10 The first thing a forensic nurse should do when dealing with a victim
26:58 Very brutal and degrading crimes
29:41 Advanced technology that helps solve crimes
32:41 Alternate Light Source :
36:49 What’s next for Debb?
38:12 Reasons why heinous crimes exist
44:22 Keeping work and life balanced
47:27 Wrapping up the episode


EP 173: Determining Fluid Status in Patients

EP 173: Determining Fluid Status in Patients

Determining Fluid Status in Patients

Maintaining the correct fluid balance in the body is crucial to the health of our patients. Knowing how to check for fluid status in patients will help determine if they are overhydrated or dehydrated. That said, learning how to determine fluid status in your patients is essential, and you will learn all about it in this post. Assessing a patient’s fluid status is a critical skill you will regularly do as a nurse. It involves evaluating if a patient is hypovolaemic, euvolemic, or hypervolaemic.

Hypovolaemia vs Hypervolaemia 

Hypovolaemia refers to a deficit of fluid in the body. Causes include:

  • Poor fluid intake.
  • Excessive fluid loss (e.g., vomiting, diarrhea, hemorrhage, excessive diuretic therapy).
  • Third, space loss of fluid.

Hypervolaemia refers to an excess of fluid in the body. It is also known as fluid overload. Hypervolaemia is expected in the elderly and those with renal or cardiac failure. It can be caused by excessive fluid intake or inappropriate fluid retention (e.g., heart failure, renal failure). It is also why checking patients’ fluid status is crucial. 

Assessment Findings Determining Fluid Status in Patients

  • Bleeding from any source
  • Vomiting: frequency, volume, presence of blood
  • Stools: frequency, volume, presence of blood
  • Fever and diaphoresis
  • Urine output: color and volume
  • Heart rate
  • Lung sounds
  • Pre-syncope/syncope
  • Mucous membrane – Wet or dry?
  • Skin tugor – skin tenting 
  • Capillary refills <3 seconds
  • Oral intake
  • Daily weight 
  • Fluid restrictions
  • Fluid overloaded symptoms:
    • shortness of breath
    • Orthopnoea
    • paroxysmal nocturnal dyspnea
    • leg swelling

Labs of Fluid Status in Patients

  • Full blood count – May reveal raised hematocrit in hypovolaemia  
  • Urea and Electrolytes – Urea/creatinine will be raised in hypovolaemic patients and those with acute or chronic renal disease. Electrolytes such as sodium may be low in hypervolaemic patients (e.g., dilutional hyponatremia).
  • Urine and Serum osmolality – consider if suspected SIADH or DI. 
  • BNP is a marker of cardiac stretch under the effect of fluid overload.

Passive leg raise

If a patient has a blood pressure cuff, and you want to see if the patient will be fluid responsive, a passive leg raise is easy to check. Passively raise the patient’s legs to at least 45 degrees and check a patient’s blood pressure before and after the leg raise.

You can also lift the foot of the bed and see if there are changes in the blood pressure. This motion acts as a mini fluid bolus because you are forcing the blood to go from the legs into the core. 


Orthostatic hypotension, also called postural hypotension, is a form of low blood pressure that happens when standing after sitting or lying down. To check orthostatic:

  1. Have the patient lie down for 5 minutes.
  2. Measure blood pressure and pulse rate.
  3. Have the patient stand.
  4. Repeat blood pressure and pulse rate measurements after standing for 1 and 3 minutes.

A drop of 20 mmHg in the systolic is supportive of hypotension.  

Jugular venous pressure (JVP)

JVP provides an indirect measure of central venous pressure. The Internal jugular vein runs between the medial end of the clavicle and the ear lobe. 

To check this position, see that the patient is in a 45-degree place, turn their head slightly to the left, and assess the vein. 

A raised JVP indicates the presence of venous hypertension/hypervolemia. It can also be indicative of Right-sided heart failure. 

Patients with a Central Venous Pressure (CVP) 

These patients have access to the central venous system and peripheral arterial line. When you have a Central Venous Pressure (CVP), you can measure the patient’s preload. That will directly correlate with the patient’s fluid status. 

A CVP is good for checking where your patient’s fluid level is moving. A normal CVP is between 8 to 12 mmHg. 

Systemic Vascular Resistance (SVR)

If you don’t have a Swan, you can still check and SVR by Non-Invasive Continuous Measurement. SVR is the afterload, the pressure the heart is working against to push blood across the body. A normal SVR is between 900 and 1440 dyn/s. If your SVR is below 900, you will be more dilated vascularly; if above 1500, you will be more clamped down. 

So if you have a patient that needs fluids, you will have someone with a high SVR because the body is clamping down to increase volume to help maintain blood pressure. Maybe your patient is low BP, but the SVR is down, well, that can be a sepsis issue, and we can fix the SVR with vasopressors. 

Swan-Ganz catheterization

Swan-Ganz catheterization is also known as right heart catheterization. The tiny catheter is placed into the right side of the heart and the arteries leading to the lungs. This catheter monitors the heart’s function, blood flow, and pressures in and around the heart. 

One way to check fluid status on a Swan is by looking at the cardiac index. The index relies on cardiac output and turns cardiac output into a normalized value that accounts for the patient’s body size. A normal Cardiac Index is 2.5 – 4.0L/min/m2

Here’s how you can determine fluid status in your patients correctly. Click here for the full episode 👇


00:00 Introduction
01:21 Hypovolaemia vs Hypervolaemia
03:36 Assessment findings to determine fluid status
13:28 Passive leg raise
15:13 Orthostatic
17:02 Jugular Venous Pressure
18:06 Central Venous Pressure
24:55 Systemic Vascular Resistance
28:24 Swan-Ganz catheterization
33:07 Wrapping up the episode

EP. 171: NICU Nursing & Building Good Habits with Alexis Correa

EP. 171: NICU Nursing & Building Good Habits with Alexis Correa

NICU Nursing & Building Good Habits with Alexis Correa

Having a baby is exciting, but sometimes, some babies are born with difficulties adjusting to life outside their mother’s womb. NICUs and NICU nursing were created to provide a similar environment for these babies to thrive and survive.

Any preterm birth, a difficult birth, or congenital disabilities in babies can make this adjustment changes more challenging. But with proper care in an environment where they are safe, secured, and monitored, they can also overcome these challenges. 

What is NICU?

NICU stands for newborn intensive care unit. It is a special nursery in the hospital where sick or premature newborn babies are provided with around-the-clock care. 

The NICU is equipped with advanced technology and trained healthcare professionals like NICU nurses to provide the best care for the hospital’s tiniest patients. Some NICUs may also have areas for babies who are not necessarily sick but need specialized nursing care. 

In today’s episode, we would like to introduce you to Alexis Nicole, a registered nurse with experience working in the ER, OB & NICU. She is also the creator of the Nurse Nook. Nure Nook is a Youtube Channel and brand created to share Alexis’ personal journey as a nursing student and nurse. She shares both experience and inspiration along the way. 


The questions below are some we’d like to tackle. We go off-topic, so we don’t expect to hit them all. If you have any ideas, please let us know. Looking forward to our conversation!

  1. Can you give us a little background about yourself? 
  2. What is it like being a Neonatal ICU nurse? 
    • What is it like being a nightshift nurse? We have our struggles, doing it for about five years. 
  3. How do you manage your nursing and social media career?
    • What are the dos and don’ts for using social media as a nurse? 
    • How do you stay motivated and productive as an influencer?
  4. What piece(s) of advice has resonated with you the most along your journey as a nurse?
  5. Can you recall the time in your career when you opened your mind to mindfulness?
  6. What are the healthy habits you follow in your daily routine?
  7. What is your favorite self-help book? 
  8. What is your current obsession?
    • Talk to us about therapy 


Before we end the show, we have one last question we like to ask all our guests.

If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why? 

You can follow Alexis on her Instagram @aalexisnicole or subscribe to her YouTube Channel The Nurse Nook

What does it take to be a NICU nurse and how can you build good habits? Check out the full video here 👇


00:00 Intro
01:54 About the guest
04:11 The difference between working with pediatrics and with adults
07:01 What does a NICU shift look like?
11:45 Reasons why there are NICU patients
16:29 Neonatal Abuses
18:32 How to deal with stress and trauma?
22:50 Keeping work and life balanced
27:33 Advice for nurses
30:19 The dynamics of the NICU floor
33:19 How and why did you start making videos?
38:24 The Do’s and Don’ts of a Nurse Content Creator
42:02 How to keep of things you want to do.
45:15 How did you discover mindfulness
47:03 Benefits for nurses that you should know
51:07 Wrapping up the episode


How Nurses Cope with the Death of a Patient: 7 Ways to Do it

How Nurses Cope with the Death of a Patient: 7 Ways to Do it

How Nurses Cope with the Death of a Patient: 7 Ways to Do it

We all die in the end. It sounds morbid, but this is the reality and commonality for us all. For nurses, dealing with a patient’s death can be traumatic in some ways. How do nurses cope with the death of a patient anyway? 

How to Cope with the Death of a Patient

If you are a new nurse and have just experienced the death of a patient, it can be overwhelming. It is not always easy to deal with it. And just because you are a nurse, that does not mean you are immune to grieving. Truth is, it is part of the challenges nurses face. We do grieve for our patients, and we do these seven steps to help us cope with the loss. 

1. Understand that Death is Inevitable.

When you understand that life is a cycle, it is easier to cope with all the stress. We all are bound to die at some point, and while death can’t be avoided, you should accept that this is part of life. Of course, accepting it does not mean you are someone who doesn’t feel anything. You do, but you understand better, and as a nurse, it is part of your understanding that all life comes to an end. 

2. It is part of your job. 

As a nurse, dealing with loss is a daily part of your life. Showing empathy toward your patients is what makes you an excellent nurse, but it can also be painful when you lose a patient. You also mourn the loss whenever you lose a patient, and sometimes, longer than you thought you could. Death becomes personal for nurses with empathy, but they must also remember that it is part of their chosen profession. And as a nurse yourself, you must realize that your profession deals with caring for people, and grieving for your patients means you have done your job. 

3. Talking about it helps.

Being in the healthcare field means you are often surrounded by the sick and dying. Fortunately, you have coworkers and colleagues who have dealt with the same situation before. Whatever you are feeling, they have experienced it too. Processing your emotions out loud to another empathetic nurse can help you with that. Colleagues who have dealt with patient death can often relate to how you feel and may even advise you on what to do.

4. It’s OK to feel how you feel.

Sometimes, as healthcare providers, we often rationalize how we feel about the death of a patient. While this can sometimes help, this is not realistic. Of course, you have to remain as professional as you can be after losing a patient, but you can also feel sad about it. Understand that death is a tricky thing, but you are also entitled to feel how you feel. You can grieve for your patients in your way as long as it doesn’t affect your work. 

5. Take care of yourself.

As nurses, we often form a close bond with our patients. And when we lose that patient, we often find ourselves grieving for them like family. How nurses cope with the death of a patient can sometimes be more personal than anything. However, in the aftermath of this, you need to take care of yourself. Remember, your job as a nurse means taking care of patients. That said, you must also take care of yourself by getting enough sleep, eating well, and exercising regularly. 

6. Remember, you are making a big difference.

Part of a nurse’s job is to not only care for patients but their families as well. The loss of a patient can affect family members the most, and as a nurse, you have the opportunity to be there for them too. How you treat family members who suffer and talk to them can make a huge difference in their lives. It can also help them cope with the loss. So, in your little way, you helped them. 

7. Find an outlet to destress. 

Dealing with patient loss is no doubt stressful. How nurses cope with the death of a patient can sometimes be done creatively. If you are a creative nurse, finding an outlet to express your emotions can help you in a big way. You can try crafting, arts or painting, joining an art club, or anything creative. Nurses need a break, too, significantly when they are affected deeply by the death of a patient. Pent-up emotions can be deadly, so finding an outlet to destress helps. 

Your Takeaway

We all deal with death and dying differently. Choosing the path of being a professional nurse means you will be exposed to death more often than you think, so be ready for such cases. Remember that death does not mean you failed as a nurse, nor does it signify the end of patient care. 

Your life and job as a nurse are bittersweet – there will always be ups and downs. Always remember that the way you cared for and loved your patients will be remembered by those around them, so keep doing your best! 


EP 170: Understanding Diabetes with Kimberly Ellis

EP 170: Understanding Diabetes with Kimberly Ellis

Understanding Diabetes with Kimberly Ellis

Understanding diabetes is a long-lasting health condition that affects how the body turns food into energy. The food you eat is broken down into sugar and turns into glucose. It is then released into the bloodstream.s the key to letting the blood sugar into the body’s cells. It is then used as energy.

Having diabetes means your body does not make enough insulin. It cannot use insulin well either. Too much blood sugar stays in your bloodstream when insulin isn’t enough or if the cells stop responding to it. It could lead to serious health problems like loss of vision, h

What is Diabetes?

When the blood sugar goes up, the pancreas is signaled to release insulin. It then leads to heart disease and even kidney problems.

Understanding Diabetes is Important

In this episode, we welcome our guest, Kimberly Ellis. She is a Family Nurse Practitioner specializing in diabetes education and management, chronic disease prevention & management. She is also an expert in patient and provider engagement and culturally responsive care in marginalized communities.

Kim has a decade of experience and knowledge in Primary Care, Long Term Care, Medically Assisted Weight Loss Clinics, and Community Health.

Her consulting firm, Ellis Diabetes Education & Consulting, LLC., assists health organizations in developing Clinical Initiatives, Strategies, and Implementation aligned with the Quadruple Aim of Healthcare to improve health outcomes in their unique demographic.


The questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas please let us know. Looking forward to our conversation!

  • Can you give us a little background about yourself? 
      1. What got you into nursing? 
      2. Is there a reason why you pursued the nurse practitioner route? 
      3. What made you specialize in Diabetes education?
  • With diabetes and even nondiabetics, we pay attention to the Hgb A1c.
      1. What is it?
      2. How do we use it to predict diabetes? 
  • How is diabetes developed over time?
      1. What is prediabetes? 
    • “According to the CDC, more than one-third of American adults are categorized as “pre-diabetic.”  That’s 88 million people!  The sad part about it is that a large number of people do not even know that they have prediabetes.” [1] 
  • We love talking about prevention. 
    • Illnesses affect everyone individually and the only way to prevent them is for the individual to do something about it. No one can help you better than you can help yourself, good health is our own responsibility. 
  • Key risk factors
  • Age 45 or older
  • Overweight/Obese
    1. How does being overweight lead to diabetes? Can we touch base on the physiological process of how obesity leads to diabetes?
    2. How does insulin resistance fit into this picture?
      • Obesity causes stress in a system of cellular membranes called the endoplasmic reticulum (ER), which in turn causes the endoplasmic reticulum to suppress the signals of insulin receptors, which then leads to insulin resistance.
      • The endoplasmic reticulum is a network of membranes found inside cells. It is responsible for processing proteins and fats.
      • As you enter a state of overnutrition, as we often do living in our supersized society, all of those nutrients that come in need to be processed, stored and utilized and the ER factory is overworked and starts sending out SOS signals.
      • These SOS signals, he said, tell cells to dampen their insulin receptors. Insulin is the hormone that converts blood sugar to energy for the body’s cells.
      • When there’s too much going on, the cell knows that insulin is out there, but doesn’t want insulin receptors signaling for more insulin because there’s already enough on board. This has a downside because insulin soon loses its ability to help clear sugar from the body [2].
  • A sedentary lifestyle (physical activity <3x/wk)

Questions About Diabetes

  1. How does a sedentary lifestyle contribute to diabetes/prediabetes? 
    • Is it because it leads to obesity or is there a different underlying reason?
    • A low amount of activity leads to more circulating glucose and metabolism change. Activity leads to an increasing amount of work on our muscles and body leading to a higher demand for nutrition, our body uses up and needs the circulating glucose [3].
  • First-degree relative with Diabetes Type 2
  • A personal history of gestational diabetes

When someone develops gestational diabetes does that just show that the person is more likely to develop diabetes based on a genetic predisposition? 

  • A personal history of Polycystic Ovary Syndrome (PCOS)
      1. How does PCOS play a role in a higher likelihood of diabetes? 
      2. Is it directly related to PCOS causing insulin resistance?
  • Racial Group: African American, Hispanic/Latino, American Indian, Pacific Islanders
  • Is diabetes reversible? 
  • What are the keys to proper diabetes management and something everyone should know?


Before we end the show we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why? 

Catch more on Kimberly through her socials, and connect with her on Instagram at @thediabetesNP. Visit her Facebook page at Kim E., the Diabetes NP, or check her YouTube channel, Kim E., the Diabetes NP here.

For more information on diabetes management, you can visit her website at https://www.ellisdiabetes.com/. Or check out her LinkedIn profile at https://www.linkedin.com/in/thediabetesnp/.

Want to learn more about diabetes? Click on our full episode here 👇


00:00 Intro
02:03 About Kimberley
04:00 Common Problems In Communities
08:18 What Made Kimberly Specialize In Diabetes Education?
10:17 The Difficulty In Educating People About Diabetes
12:44 The Physiology Of Diabetes
16:14 Does Glucometer Really Help Detect Diabetes?
18:33 Why Is It Crucial To Prevent Diabetes?
20:28 When Is The Ideal Time To Check Your Blood Sugar?
23:01 What Should A Person With Prediabetes Do?
26:23 Is Diabetes Reversible?
30:10 Frequent Misdiagnosis of Diabetes
32:51 Ethnic Groups And Cultures Susceptible To Diabetes
34:47 About Gestational Diabetes?
38:09 Diets To Help You Avoid Diabetes
42:34 Improving Eating Pattern
44:23 Kimberly’s Role As A Healthcare Provider
47:11 How Can We Raise Awareness About Diabetes?
48:55 What healthcare professionals are lacking?
54:06 Wrapping up the episode