After hours medical ward duties in a teaching hospital

In many Australian hospitals a medical officer is available for urgent review of in-patients outside normal working hours. Current practice in nurse-initiated requests for medical officer involvement out of hours may adversely affect patient outcome as well as medical and nursing resource use at these times. Of 10 523 nurse-initiated requests for out-of-hours review recorded by medical officers at our hospital in 2002-2003, the most frequent reasons for the requests were medication review, IV fluid orders, IV resite, venesection and pathology review, none of which are related to acute changes in clinical condition. Requests for routine review of medication and fluid orders were found to be rarely essential and often inappropriate. Medical officer activity was highest before midnight and least after midnight, suggesting most requests are fulfilled in the evening. Several strategies to reduce inappropriate out-of-hours requests were identified. Routine tasks could be completed by primary treating unit staff before going off-duty. IV cannulation and venesection may be performed by appropriately trained phlebotomists or skilled advanced practice nursing staff. Meticulous ordering of 'as required' analgesia and night sedation would reduce unnecessary requests. Clinical protocols for nurse-initiated adjustment of drugs with variable dosing may also decrease inefficiencies. This would leave the ward cover medical officers more available for their primary function of urgent patient review.

Delivering demons punishing wives: False imprisonment, exoricism and other matrimonial duties in a late 20th-century manslaughter case

This article provides an analysis of R v Vollmer and Others, Australia’s most famous ‘exorcism-manslaughter’ case, in which a woman, Joan Vollmer, underwent an ‘exorcism’ performed by four people, resulting in her death. We examine how taken-for-granted distinctions were collapsed during the resulting trial - distinctions between crime and punishment, exorcism and punishment, church and state, the past and the present, law and religion, reason and unreason and between a demon and a woman. We show how the defence argument for the reality of demonic possession normalized the bizarre, while simultaneously exoticizing the mundane or ‘traditional’ criminal case involving a husband defendant and a dead wife. The apparent assumption on the part of the police and the media that this case was bizarre serves to veil the fact of its relative ordinariness. A wife is killed, and the lethal punishing violence inflicted on her body downplayed, to be reinterpreted in the legal context as somehow a consequence of something she herself precipitated. Our analysis of the Vollmer case provides a novel perspective on that always intriguing conundrum of crime and punishment.