Patient Health Care & Forensic Nursing Assessment

There are two forces that have had a separate but parallel interest that has now merged and these two forces are increased rate of interpersonal violence in the United States and televisions exposure of criminal forensics. Patient health care extends beyond the traditional type of emergent treatment as a result of these forces. Trauma personnel routinely contact physical evidence. Some common types of evidence are: clothing, casings, projectiles, blood stains, hairs, fibers and fragments such as glass, metal, paint and wood. The handling of these items has gained the attention of medical administrators and law enforcement officials.

As clients come into the trauma unit the staff does not know if injuries are self-inflicted, accidental or criminal incident. The primary responsibility is to render medical attention to the individual, whether or not they are considered to be a victim or a suspect by law enforcement officials. While the patient is in the trauma unit his body needs to be considered a part of the crime scene. The staff now has the additional burden of responsibility to aid in evidence collection process while concurrently administering medical care. The problem of collecting evidence is often hampered by a lack of training and facility guidelines for these tasks. Traditional role of trauma unit staff has not been evidence collection and not all unit staff embraces additional work tasks. The increased role of forensic expertise in health care is greatly dependent upon continued education and training. The end application of forensic knowledge, technology and procedures is impacting the number of cases won or lost based on the handling of evidence in the hospital.

In the ideal world the forensic nurse will be part of the triage team and do a visual observation of the patient upon arrival. While the appropriate medical attention is given to the patient the forensic nurse could gather gunshot residue samples from wounds or hands. She would be the one to cut clothing off that would not cut through areas important to the investigation. The clothing would be handled so as not to contaminate it. This is done by placing the clothing in a paper bag that is labeled. Labeling would typical include patient name, medical number, hospital, staff bagging, date, time. The information would need to be duplicated in the patient chart. Then it needs to be sealed in a manner that show if tampering had occurred. The next hurdle for the trauma staff is then putting the bagged and sealed evidence in an area that is secure. This area would need stringent policies on access and turning evidence over to law enforcement. If these polices are not in place the integrity of the evidence could be questioned with the end result of criminal not be prosecuted successful for a crime.

The responsibilities for assessment of patient-trauma-related injuries deserve the attention of staff trained in forensic science. Forensic science needs to be part of continued education to medical personnel, the application of forensic knowledge, technology and procedures is impacting the number of cases won or lost based on the proper handling of evidence in the trauma unit. The forensic nurse is in an ideal position to formulate hospital policies and provide education to hospital staff. The nurse serves as liaison between the hospital, law enforcement and the judicial system. The end goal is competent handling of forensic evidence that may be the deciding factor in whether a violent offender is found guilty or released. It is the responsibility as patient advocates that the ensuring patients’ rights are upheld.

References:

Lynch, VA, “Clinical forensic nursing: A new perspective in the management of crime victims from trauma to trail,” Critical Care Nursing Clinics of North America 7(September 1995) 489-506.

Evans, Mary M, “Maintaining the chain of custody: evidence handling in forensic-cases.” AORN Journal (October 2003)

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