Forensic Nursing Chronicles

For forensic alcohol blood testing to be done, it is imperative to know that process of specimen collection.

A warrant or a signed consent must be obtained for the blood draw procedure. The skin must first be prepped with a non-alcoholic based solution (preferably Betadyne or iodine-prep). The blood must be obtained from the site and transferred into two-blood tubes. Typically, these tubes contain a preservative, EDTA. The tubes must be filled to capacity and gently rotated at least a half a dozen times. The tubes must be labeled and placed into the blood collection kit. The kit should be sealed and given to the police officer in charge of the case.

This procedure must be done consistently with each collection. The more often a forensic nurse performs this procedure, the more comfortable he/she will be. If called to court, the forensic nurse must be able to testify as to the means of collection. It is utterly important that the forensic nurse follow the same procedure each and every time for credibility. In addition, the nurse must be sure that the blood collection is documented appropriately and completely.

When a crime scene investigator arrives at a crime scene, it is important for them to survey the scene. Also, the scene should be secured as soon as possible. The scene should be processed as systematically as possible. Physical evidence identification, collection and evaluation are important concepts for the forensic nurse to be aware of.

Note-taking is one of the most important pieces to a crime scene investigation. It is important to note key times related to the investigation. Notes should be taken in the order that things happen. They should be detailed and as specific as possible. They should report step-by-step details of the investigation. The following items should be included in note-taking:
• Date and time first reported
• Type of crime
• Location of crime and description of the area
• Name of person who requested CSI
• Name of all officers, witnesses, investigators, specialized personnel
• Name of person who conducted the crime scene search
• Weather and lighting conditions
• Description of the primary crime scene
• Location of any evidence found, names of those who collected it, results of search for fingerprints, trace evidence
• Description of location, surrounding houses , streets, community
• Description of the interior and exterior of the crime scene
• Date and time crime scene investigation has concluded
Additional documentation of the crime scene includes photographs, videotaping, and sketches of the scene.

As documentation is being done, evidence may start being collected. Because fingerprints are the most fragile, they need to be processed first. Blood stained evidence and trace evidence should then be collected.

Wet, damp or soiled items need to be air-dried. These items should be packaged separately as not to cross-contaminate or destroy evidence. Package the items in separate containers. The containers should be sealed and labeled with their contents. A chain of custody should be maintained for all evidence. A list of all evidence that is submitted to the laboratory should accompany the evidence.

Interested in this topic and considering online forensic nursing certification? Canyon College is now acepting admission applications.

Fingerprints are classified by their ridge flow patterns: loop, arch and whorl. The ridge flow patterns are class characteristics. An individual cannot be identified by a fingerprint patterns, the individual can be lumped into a category.

If a latent print has one of the three general pattern types (arches, loops and whorls), any inked print not having that pattern is quickly removed from future comparisons against that print. While not all latent prints will have pattern types, most will have some general ridge flow that also can be used as a class characteristic. This ridge flow is also useful in determining from what skin area the print originated. Each area of ridges on the fingers have customary ridge flows that are characteristic of their location. A good example of this would be the delta region of a print. After determining the proper skin area, the pattern, or ridge flow, can be further utilized to orient the evidence in alignment with the inked print you are comparing it to.

After the class characteristics have been used to narrow the search to the correct print area, and the evidence print has been oriented, the examiner will select a reference point, with which to begin the comparison.

This starting point will frequently be at the core. A comparison of the individual characteristics, is then initiated. First, the examiner selects an individual characteristic within the evidence print, and then locates the same characteristic on the inked print.

When reexamining the evidence print, the examiner will then follow that ridge until a deviation of path or another unique feature is located. These features may be a bifurcation of the ridge, an ending ridge, a dot, a short ridge, a notable feature along the edge of the ridge, or distinctive pores atop the ridge. The comparison phase will continue until the entire evidence print has been compared, or until sufficient area has been examined to support a definitive conclusion.

Fingerprint identification is a complex topic, but is important for the forensic nurse to be abreast to what an investigator is looking for in a fingerprint.

There are three general rules regarding blood stain evidence that the forensic nurse must take into account.

First, spots of blood may be examined to determine the direction and pattern that the falling drop has produced. The shape of the spots may allow the investigator to estimate the velocity, angles and the distance from the source. The sharper end of the blood spots points to the direction where the blood has come from. If the diameter of the blood spot is unrecognizable, the distance that the drop has fallen is greater than 5-6 feet. Blood spatter may also give information about how many times the victim was struck and by what.

Secondly, the degree of spatter of a single drop of blood depends greatly on the smoothness of the surface where it lands than on how far the blood has traveled. If the surface where the drop lands is coarse or rough, the drop is likely to be ruptured or further spattered.

Lastly, the character of a bloodstain, made by drops or smaller droplets or by larger quantities of blood up to several ounces, may reveal movement at the moment of initial staining or later if a body or other stained surface is moved from its original position.

(Fisher, B., (2004), Techniques of crime scene technician, 7th edition, pg. 201.)

The treatment of Mental Disorders can be a very lonely place to be if you are the focus. Treatment in a controlled environment can actually cause more issues for the patient than the original reason for the confinement that they are being forced to face.

A person with a mental disorder is under the eye watch of many professionals, who are strangers to the confused and sometimes hostile individual. The patient is confined to a secured unit in which they have little to no contact with family and friends.

There are understandable reasons that a violent or hostile person needs to be confined for their safety and the safety of others, however, a great majority of the time, the patients home life are contributing factors in their behavior and illness.

Keeping a person confined and away from family will not help promote healthy, appropriate interaction between the patient and real life situations that they are having trouble dealing with.

This leads to feelings of isolation and loneliness, which in fact can add to the unruly behaviors exhibited by the patient. More family therapy, including taped private interactions involving immediate members of the patients life could give the medical staff insight into better treatment interventions.

Almost anyone can improve behavior and moral outlook for a period of time when confined to a controlled environment. Patients with mental disorders need real life situations being experienced with appropriate responses taught to them in order to have a positive outcome when returning to life outside confinement.

Patients need their family members to be part of the solution, not only part of the problem.

The nursing field today offers many opportunities. One of the most rapidly developing areas of the nursing field is that of forensic nursing. Forensic nursing combines the medical aspects of nursing with the legal system. This could be in conjuntion with a crime or it could be in a civil matter such as worker’s compensation.

Some of the job descriptions within the forensic nursing field include Sexual Assault Nurse Examiner, Legal Nurse Consultant, Forensic Clinical Nurse Specialist, Correctional Nurse, Forensic Psychiatric Nurse, Nurse Coroner and Nurse Death Investigator.

Just as nurses in general can work in many places of employment (acute care, doctor’s office, public health, home health, etc.) so can the forensic nurse.

For example, the Sexual Assault Nurse Examiner could work in a hospital emergency room or in a free standing sexual assault clinic. The Legal Nurse Consultant could work in a traditional nursing job and do consulting on the side, or she could work full time for an attorney’s office.

Educational opportunities abound with respect to forensic nursing. A recent search on google revealed over 3 million “hits” for information related to forensic nursing education. The educational opportunities range from traditional classroom programs related to each type of forensic nursing specialties to online programs which give an excellent overview of many
aspects of forensic nursing from the comfort of your home.

Canyon College is now accepting applications for it’s Online Forensic Nursing Certification Program.

Simply opening a textbook or two cannot teach a prospective forensic nurse how to proceed in a death investigation. Practical experience is necessary and requires years of learning to become proficient.

Forensic nurses can enroll in internship programs to work side by side with death investigators. They are able to go out on calls and view autopsies and see what is required of an investigator first hand.

A unique program is available at the University of Tennessee. It is known as the “body farm” but its official name is the University of Tennessee Forensic Anthropology Facility. This is a place where donated or unclaimed bodies are placed in order to study decomposition. Under controlled
circumstances the workers there can study how long it takes bodies to decompose. Also, the farm is used to simulate crime scenes to further facilitate learning.

The forensic nurse death investigator must also be knowledgeable in jurisdictional as well as state and local laws. They must be excellent communicators. They have to communicate with authorities as well as with families of the victims. They will be called on as expert witnesses in
court and also as fact witnesses. They must be knowledgeable in anatomy and physiology and also be skilled at writing reports.

The job of a death investigator can be exciting and rewarding but requires study and dedication. The role has the potential to touch many lives in a positive way during a difficult time.