Archive for January, 2007

Lip Prints

January 31, 2007

Diamond grooves, long vertical grooves, short vertical grooves, rectangular grooves and branching grooves, they all sound like something you might find in the carving of wood, but in one instance they are how forensic scientist were able to convict a peeping tom.

Lip printing has not been firmly established in the courts, but is an evolving field in the study of forensic science. Otherwise called cheiloscopy, lip printing focuses on uniqueness of an individuals lip patterns to determine identity.

In one instance in Virginia police were able to lift the lip prints of a peeping tom from his neighbors window, match those to his own lips and convict him on five counts of being a peeping tom.

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History of Forensic Nursing

January 30, 2007

I was surfing the web and came upon an article entitled “ Forensic Nursing Investigating the Career potential in this emerging Graduate Specialty “. An interest fact that I had not know was that Forensic Nurses came about in the 18th century with their role being to testify in court regarding issues such as pregnancy, rape and virginity.

Today the role of Forensic Nursing has grown to include such specialties as Toxicology, Forensic chemistry, cause of death investigation, and in the role of Sexual Assault Nurse Examination.

It is believed that a Forensic Nurse’s greatest skills are those of observation, documentation, and evidence preservation.

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Responding to the September 8, 2006 article “Forensic Nursing Definition”

January 25, 2007

Besides signs of physical abuse and malnutrition one would do well to be aware of any signs of emotional abuse in children. This is of particular importance since emotional abuse can often be a precursor of physical abuse and its detection can help prevent further abuse before it starts. Of course emotional abuse is much more difficult to detect especially in children.

Part of the reason that emotional abuse goes undetected in children is that children laugh and play a certain percent of time each day even when they are suffering from depression. Due to their ability to put difficulties aside for periods of time much better than adults, children also manifest depression differently than adults. A child may not show the flat affect typical of adult victims of abuse until the abuse has reached an extreme. Yet another complicating issue is that given the child’s view of the world, abuse from one adult tends to make them suspicious and less trusting of all adults.

Therefore the first step in assessing a child should be to establish rapport. This is done primarily by showing respect for the child, her position and her opinion. Sitting or stooping so that one’s face is at the level of the child’s face, greeting the child politely just as one would an adult, addressing questions directly to the child and listening attentively while smiling and making appropriate eye contact is a good beginning. Asking the child’s permission before touching her and taking her answers and opinions seriously improves rapport. Avoid correcting the child’s grammar or word usage – instead listen for meaning and content. Correcting the child establishes a “one up” relationship, which can destroy rapport and trust. The same applies to correcting, or questioning a child’s statements even if they may seem fantastic or are obviously untrue. Young children do not readily separate fantasy and reality and may even use a story of an imaginary playmate or imaginary event to test the adult for trust ability before revealing more important closely guarded information.

Depression in a child manifests differently than in an adult. A child may glance fearfully or nervously at the parent or guardian before responding to questions. He may change his response based on a look from the parent. He may experience stomach aches, headaches, or exhaustion more frequently than normal. She may sleep more than normal, have an increase or decrease in appetite. A naturally slender child who begins to show signs of being overweight may be suffering from emotional abuse. Check the medical history for height and weight. A depressed or abused child may have trouble in school or be teased by peers and may thus dislike school in general without sighting specifics as to why. Asking questions about school or friends can help reveal some of these patterns.

While these signs may yet be considered too subtle to warrant legal action the nurse or attending physician could recommend a qualified children’s counselor or other intervention and support. Making a note of findings and concerns in the patient’s medical charts may well aid early detection should the abuse escalate. Offering parenting support services may also help circumvent further escalation. Such action can well save children from physical and sexual abuse before it starts.

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Tissue Donation Without Permission

January 24, 2007

Once I worked in a small lab. The pathologist was also the county coroner. I know he took the pituitary gland out of the deceased person and put it in a small cup in the refrigerator. He stated it was to get growth hormone to give to people who were dwarfs. Did I get that right? I though it was illegal to do something like this if the person or the family did not consent to a donation of tissue. I have asked family members if they wanted to donate tissue or organs for transplant. It is really hard to do because the family is grieving about the death and you are asking for a favor. I know that the death of their loved one is helping maybe several people but it is still hard for the health care worker. It is amazing what a donated cornea can do to help two people who were blind. The problem is the total eye needs to be enucleated but the harvester is careful to replace the eye with a small ball and I could not tell the difference before and after.

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ICU Autopsy

January 23, 2007

When we have a death in the ICU if there is an autopsy we need to leave all of the tubes and IV’s inplace. It is difficult to ask the family of the patients if they will agree to an autopsy. If the death is suspicious the coroner will step in and do an autopsy for legal concerns. I guess I have not paid attention to this question. What if the family refuses an autopsy? I think the coroner has power to do it anyway.

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Clinical nursing diagnoses and forensic nursing diagnoses

January 18, 2007

Clinical nursing diagnosis and forensic nursing diagnosis will differ as forensic nursing represents nursing practice in direct response to the squeal of criminal and interpersonal violence.
Daily, nurses encounter the results of human behavior extremes like abused children, victims of neglect, self-inflicted injury, firearm injuries and assaults.
In a case of assault the forensic nurse will do both diagnosis. He/she will determine the injury with the use of nursing assessment and come up with both the nursing diagnosis and the forensic nursing diagnosis. While she would be interested in the extent of injury she will also be interested in providing solution to medico-legal related problems.

Health care and the law often become mixed up during critical moments, when patient’s care supersedes the concern for social justice.
Forensic nursing re-introduces the caring principle into the delivery of nursing care while still maintaining the legal rights of the victim.

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Latent Prints on Human Skin

January 17, 2007

The struggle with the removal of latent prints from human skin has been going on for over 25 years. One of the reasons for that is that fingerprint are made up of the same sweat and oils found on the victims skin.,

But one technique Alpha-naphthoflavone is the use of iodine fumes to visual the print on the body so you don’t have to remove the print from the body. There have been several techniques that have been studied and researched regarding finger prints on the human skin which makes this topic very interesting and always exciting.

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Medical Malpractice Related to Nosocomial MRSA Infections

January 16, 2007

The media and government have educated the public in the “super bugs” some patients become infected with in the hospital environment. The most widely known “super bug” is methicillin resistant staphylococcus aureus (MRSA). In June 2006 there was a case brought to court regarding the death of patient who had been in the hospital for a knee joint replacement. Since the patient had not been screened for MRSA prior to hospitalization it could not be proved if he picked up the MRSA during the hospital stay. With the documented community acquired MRSA he could have had the bacteria dormant in his body when he was admitted for the planned surgery. The doctor and hospital were not found negligent in this case.

Many hospitals are fearful of similar lawsuits based on nosocomial infections. Some hospitals are now culturing high-risk patients prior to hospital admission to determine if they are colonized. There is now a nasal swab test that has a turn around time of two hours to identify MRSA. Certainly this can be helpful so that colonized patients coming in for elective procedures can have this treated and also be isolated from non-colonized patients. Patients that test positive for MRSA can be cohorted with like patients or put in private rooms. There are multiple hospitals in Europe starting to follow this intervention with positive outcomes in their nosocomial rates.

It would seem to me the hospital administrators would prefer paying for the MRSA culture versus facing the potential of law suits from patients who develop nosocomial MRSA infections while inpatient. If I had a family member going to the hospital I would much prefer they be tested for MRSA prior to a surgery as “knowledge is power” Having the knowledge of colonized MRSA prior to surgical intervention can allow for adjustments that lead to positive outcomes for the hospital, surgeon and patient. I can visualize hospitals even being forced to do it to allow them better leverage in the court system by being able to say, “this person was colonized with MRSA” prior to hospital admission. From the epidemiology stand point it would also allow the opportunity to keep the more virulent strain of community MRSA from entering the hospital environment.

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Drug Monitoring in the Psychiatric Patient

January 13, 2007

As part of the medical clearance criteria for psychiatric patients arriving to the Emergency Department, it has been a long standing order to obtain urine drug screens and blood alcohol levels. Where these tests are indicative of the presence of mood altering substances, they represent am infinitesimally small amount of substances that can affect a person’s mood, affect and higher functioning.
As many of these patients can be described as disingenuous at best, and that poly-substance and alcohol abuse are not criteria for refusal of admittance, the use of these tests in the Emergency Department could be considered a needless use of resources. Since the data from these tests are relevant to the treatment regimen instituted by the psychiatric team, it may be more appropriate to complete these tests at the psychiatric facility.
This would decrease the time the patient stays in the Emergency Department and expedite earlier intervention of psychiatric treatment modalities.

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Forensic Nursing Theories

January 10, 2007

I am taking the Forensic Nursing course taught by Dr. J. Johnson. In reading chapter three of Forensic Nursing by Lynch, it discusses many of the theories that pertain to nursing but more to forensic nursing. The section of the chapter that really got my interest is the section regarding the role of the forensic nurse. I know that the theories are important but I prefer to read about what is really involved in doing the job. Forensic nursing, as we have previously read, not only deals with the deceased but also the living including the victim, and the victim’s family, deceased or alive, the suspect and the perpetrator. The aspect that plays the biggest part in this is the human behavior of each person involved. The beliefs of each individual, whether it is personal, religious, or cultural also plays a part.
Forensic nursing is a science of constant change and redefining their role and themselves as a nurse. For example the forensic nurse of twenty years ago are different from the forensic nurse of today. The forensic of twenty years ago did not have the technology, the information for solving a case that the nurse of today has. The forensic nurse today needs to understand and use the technology they have available to them. The forensic nurse today has many other sources available to them today than did previous nurses. The nurses of the past were the pioneers for the nurses today as are the nurses of today the pioneers for the nurses of tomorrow.
The human behavior aspect of forensic nursing is possibly the part that most nurses are trained to deal with in any aspect of nursing. Every individual, we as nurses come in contact with are going to be different. We are trained to deal with all different people from different walks of life, different beliefs, and different values. This is the aspect that makes nursing so interesting. When reading about the “integrated practice model for forensic nursing science”, this is a model that can apply to all different types of nursing with minor adjustments.
Pertaining to theories in nursing I feel that they are important. I think that the theories are what have advanced nursing to the level it is at presently. Theories have been developed by people who thought that there was a better way of doing things and the theory worked. The theories that we are taught in nursing programs have become a very important part of how we practice nursing. I mentioned before that I am more of an on hands person. But I also believe very strongly in theories and the people from the past and present who develop the theories.

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