Posts Tagged ‘Forensic Nurse Response Team’

Patient Health Care & Forensic Nursing Assessment

August 14, 2008

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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Trauma quality management process improvement

December 18, 2007

This discussion relates to trauma quality management process improvement through the incorporation of forensic nurses. For this discussion forensics will include living as well as deceased patients and events. The discussion will emphasize the value of evidence collection, documentation, mechanism of injury and complications after the primary event by all members of the health care team. Forensic trained nurses enhance the quality management process in trauma center. Forensic nurse specialist training combine’s clinical expertise, which blends nursing knowledge with the legal system. Physical, behavioral, and cognition aspects are all included during the patient assessment as they are each indicators of health. The benefits of the forensic nurse role can be seen in proper evidence collection, documentation through the chain of custody, proper terminology use, interfacing with law enforcement, and identification of unsuspected injury through application of the nursing assessment. In the trauma environment a problem-based assessment involving the history and examination is limited in scope to the specific problem that brought the patient to the emergent care setting initially. If a nurse performing this assessment identifies physical signs of past trauma or identifies subtle signs of abuse in the initial assessment she would be lead to a comprehensive assessment and involvement with other members in the trauma team. The comprehensive assessment will encompass current health problems, health promotion, disease prevention and assessment for problems associated with known risk factors. The knowledge base of a trained forensic nurse specialist allows correct terminology use during the documentation process, which allows for a smoother interface with the law enforcement. A forensically educated nurse will identify exigent evidence and work to preserve it through collection and photography so it can be utilized for future law enforcement needs. The documentation completed serves as a legal document of the evaluation and provides a baseline for subsequent evaluations. The accurate nonbiased health assessment can be used for future encounters and trend identification for recurrent injuries. Collaboration with a team promotes accurate management of trauma patients. Raising the index of suspicion and recognizing the patient’s problem is critical to opening the issues of abuse or other crimes against patients who present to trauma centers for care. The forensic nursing assessment of the patient and situation may lead to closing a circle of violence. Management of clinical forensics is important in the trauma care centers. The forensic nurse specialist has an important role in drafting policies and guidelines for the areas of: evidence identification, collection and documentation. The forensic nurse specialist provides an emergent role in developing ongoing Trauma Quality Management.

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Organ Donation

September 10, 2007

Yes, in Ohio we are asked that question of “do you want to donate your organs”. This does seem rather cold and heartless. There is no follow up to that question if it is answered yes. There is no counseling. You have people at the BMV/DMV asking you. Not medical/forensic personnel who know what they are talking about. I could have said yes at the age of twenty and now I’m forty and my family might not know anything about that decision I made a long time ago. I had a baby on my unit that was terminal and on life support and it took the family weeks to come to a decision. The “loop” team was involved and talking with the family. But they did seem a little “pushy” about getting those organs. We just instituted a new policy at my hospital stating that if one went to the OR to harvest organs then the ethics committee would have to be on standby and come in as a “double check” for the family. Just to make sure they understand what they are deciding upon. If one says yes to organ donation at the BMV/DMV there should be information given/sent by forensic nurses/team so the person saying yes has a more informed consent.

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Anthrax

September 5, 2007

I often wonder if Anthrax has not already been released. In small amounts does it cause less severe symptoms. If you know you have been exposed, what antibiotic treats it? What is actually in the vaccine, if the vaccine is not intended for humans? How much would have to be released and how is it released? What does it look like?

A full head to toe nursing assessment would have to be done. Anthrax seems to mimic so many different diseases. The focus would be on skin, GI, and Respiratory systems. It would be difficult to figure out if you did not know that there was a definite Anthrax exposure. The forensic nurse would have to have a calm and respectful approach to the victim and the family. But, in order to figure out the puzzle the forensic nurse would have to ask the questions. One would not want to induce panic either, from the family or the media.

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Forensic Nurse Response Team

February 22, 2007

The article entitled Forensic Nurse Response Team is about a forensic nursing unit and the quick comprehendible process of evaluation within a timely manner. This is a four step process that includes step 1 triage nurse determines patients visit, medical history and documents the findings. If a situation where police needs to be involved the nurse will also contact police at this time. Step 2 involves a physician, NP or PA providing screenings and medical exams before patients medical needs are taken care of. Step 3 includes basic information in order to register patient, as example DOB, Height, Weight ext. Step 4 entails a forensic nurse collecting evidence for the processing of law enforcement. At this time the client will also be receiving referral number or social services consults. This article was interesting in the fact that it gave a quick and easy way to understand the complete goal of forensic nursing; while explaining the importance of each individual task involved. The article also discussed who was billing for the procedures and how personal insurance would and would not cover procedures depending on the incident. Forensic nursing is a multidisciplinary nursing field and will only be successful if each discipline provides correct/useful information.

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