Posts Tagged ‘Forensic Nursing Process’

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Successful Collaboration equals successful forensic nursing process, comment

December 23, 2008

I agree that there must be a successful collaboration between the judicial system, law enforcement agencies, social services, and healthcare providers. Each person who is in the specific system is certainly a vital link in the chain. This link in the chain can not be broken and each person should respectfully carry out there duties to serve the public when violence, abuse, neglect, or exploitation is considered. There are chains of commands that are also in place and must be followed so that each case is considered individual and guidelines are followed. Broken chain of command or custody is the reason that cases are sometimes dismissed in court cases. Everyone involved must act professional and in a timely manner so that each different case can be a good outcome for the individual involved. Naturopathic physicians and healthcare providers will also be involved in the collaboration and I think this is vital, as we will be educating communities and individuals that we come into contact with.

Original Post:
October 7, 2008
In order for successful forensic nursing interventions to occur in the healthcare setting, there must be a successful collaboration between law enforcement, judicial systems, social support systems, and healthcare providers. Each form vital links to the chain of justice that must be afforded to every individual impacted by trauma directly or indirectly related to violence, abuse, neglect, maltreatment, or exploitation.

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Suspicious injuries, comment

November 10, 2008

As far as the consent to take the pictures and maintain them in his medical record is concerned, on first entry into the ER the mother was given forms to fill out along with a consent for treatment which she would have had to sign in order for the ER to get to this point in the examination. But I understand that there is a separate consent form specifically for pictures and if this form is not signed by the parents then the pictures cannot be made part of the medical record. Now the issue of the father coming to the ER and the police being called is another problem that needs addressing. As mandated reporters the ER staff should have notified the social worker or social services not expect the police to take care of it the next day. Since one of the parents is suspected of having caused the injuries, the child should not have been released to them until cleared by Social Services.

Original Post:
November 5, 2008
Suspicious injuries
I want to discuss an interesting forensic case that came through the ER this weekend. An 11-year-old male came in with L wrist pain. He denied any injury and gave an elaborate account of a dream he had the night before where he injured his wrist and woke up with his wrist hurting. There was obvious bruising to the dorsal aspect of his hand and wrist with petechiae inside the bruising. It looked to me like someone had stepped on him or applied a lot of pressure. I asked him what he did before he went to bed. He said he was playing a game with his friend (gamecube). Again denied any injury occurring, couldn’t remember any type of pain before bed. The patient was in the ER with his mother only. On XR his radius and ulna were both broke. We called the sheriff department immediately. We looked up the mothers medical records which also showed multiple hand and arm injuries. The mother was in complete denial and refused to believe he got the injury from something else than a bad dream (she wasn’t an individual with a high IQ). She got upset and called the father who came to the hospital and was also upset. The father has a history of head trauma and is known to have rage outbursts. Anyways, the police came and interviewed all and said he would contact social services the next day. My question is-we took pictures of the child’s injury and bruising noted. We usually need a consent form signed to take and maintain pictures in a medical record. But since the injuries are suspicious and abuse may be suspected by one of the parents, do we still need consent or is it implied since it is a mandatory report to law enforcement?

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Suspicious injuries

November 5, 2008

I want to discuss an interesting forensic case that came through the ER this weekend. An 11-year-old male came in with L wrist pain. He denied any injury and gave an elaborate account of a dream he had the night before where he injured his wrist and woke up with his wrist hurting. There was obvious bruising to the dorsal aspect of his hand and wrist with petechiae inside the bruising. It looked to me like someone had stepped on him or applied a lot of pressure. I asked him what he did before he went to bed. He said he was playing a game with his friend (gamecube). Again denied any injury occurring, couldn’t remember any type of pain before bed. The patient was in the ER with his mother only. On XR his radius and ulna were both broke. We called the sheriff department immediately. We looked up the mothers medical records which also showed multiple hand and arm injuries. The mother was in complete denial and refused to believe he got the injury from something else than a bad dream (she wasn’t an individual with a high IQ). She got upset and called the father who came to the hospital and was also upset. The father has a history of head trauma and is known to have rage outbursts. Anyways, the police came and interviewed all and said he would contact social services the next day. My question is-we took pictures of the child’s injury and bruising noted. We usually need a consent form signed to take and maintain pictures in a medical record. But since the injuries are suspicious and abuse may be suspected by one of the parents, do we still need consent or is it implied since it is a mandatory report to law enforcement?

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Successful Collaboration Equals Successful Forensic Nursing Process

October 7, 2008

In order for successful forensic nursing interventions to occur in the healthcare setting, there must be a successful collaboration between law enforcement, judicial systems, social support systems, and healthcare providers. Each form vital links to the chain of justice that must be afforded to every individual impacted by trauma directly or indirectly related to violence, abuse, neglect, maltreatment, or exploitation.

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Pandemic influenza (H5N1)

September 25, 2008

I work in Alaska on the Aleutian island occasionally.
Recently a village had a ‘dry run’ to practice giving immunizations incase the pandemic flu strikes here. Alaska is a threat because of migration of birds. It is felt that Alaska will be one of the first hit with the avian flu.
This small village was able to immunize 68 people in 4 hours.
The staff was eight people but they probably could have done it with six because they used two people to evaluate and work on spousal and child abuse issues with the ‘dry run’
One person was an intake at the door of the community center to guide the people through and help fill out forms.
Two people took vital signs and screened to make sure the person receiving the immunization had never been allergic to other flu shots or allergic to eggs.
Two people gave the vaccines; one person helped the person go out of the clinic and answered any other questions.
The village thought this ‘dry run ‘ was a success.

Original Post:
November 29, 2007
If/when a pandemic takes place, clinical nurses will need to use advanced assessment skills to recognize those who have been infected as well as those at risk. The symptoms of H5N1 have been shown to mimic the pandemic flu of 1918. Early symptoms of H5N1 mimic that of regular seasonal flu. However, the disease process of the H5N1 appears to be more inflammatory in nature leading to a mortality rate >50% affecting those with healthy immune systems. There is no rapid method to test for H5N1 and no vaccine. A person with seasonal flu or a regular cold has upper respiratory symptoms and an increased WBC count. A person with H5N1 has upper respiratory symptoms and a low WBC count. Could these clinical markers be used as an effective screening tool to triage and disperse available treatments (anti-virals, ventilators, etc.) in the throws of a full blown pandemic? If/When H5N1 mutates to develop human-to-human transmission initiating the pandemic, could the virulence decrease?

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Rape is serious

September 23, 2008

Our American society takes rape seriously. Third world countries do not. The female anatomy and examination can be crucial to trial proceedings and the definition of innocence or guilt in a rape trial. The nursing assessment and collection of evidence is often performed by an emergency department nurse. Omission of an important feature can win or lose a case. In my organization, only specially trained Emergency Department RNs are allowed to utilize what we call the “Rape Kit.” This assures proper collection and assessment is performed to protect the client.

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Disaster management and forensic nursing

September 17, 2008

The chapter on disaster management was particularly informative in applying the principles of forensic nursing. In order to apply the preventive measures after disaster to prevent further destruction it is important for the community orientated Nurse to apply the science of forensic nursing. She or he must be alert to environmental clues or other factors that may be causing ongoing disease, disability, or death. Forensic nursing is definitely an area of I will pursue in the future.

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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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Documentation of Bedsores

July 16, 2008

Joint Commission and CMS (Medicare) have set a Patient Safety Goal of not allowing bedsores to occur during hospitalizations. My institution uses technology to document existing wounds at the time of admission assessment. We are a totally computerized charting hospital. When we identify an existing wound, we bring up a screen of the body and insert a photo of the wound into the patient’s medical record. This feature allows us to prevent lawsuits and receive the correct reimbursement of that patient’s hospitalization. Health assessment no longer has to rely on a verbal or hand written dictation to describe history and physical assessments!

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The Correlation Between the Health Assessment and Forensics Nursing, comment

March 21, 2008

I am writing in respond to the article titled “The Correlation between the Health Assessment and Forensics Nursing.” My job is performing assessments on patients for surgery, which in some way is similar to an assessment used in forensics nursing. I am not involved in forensics, but have read materials related to the assessment. I totally agree that as soon as I meet my patient, I start my assessment based on appearance, speech, skin color and facial expressions. Anesthesia assessment involves collecting all types of data that identifies the patient’s physiologic status, risk factors, knowledge and past health and anesthesia history. The most difficult challenge is keeping the patient focused and answering questions completely without omitting details, I can associate this also with a forensic assessment.
Once the subjective data is obtained, we do gather objective data to be complete. An example would be labs, EKG and x-rays which is also used in an investigation.

Subjective and objective data are the two primary components in performing a health assessment, whether it is any type. They both work together, if patient is unresponsive or unable to communicate, it does present a challenge. I than rely on family history or previous medical records. I agree with the last item in the article, “giving our clients a voice”, practicing as a nurse you must always assume the role as a patient advocate. Communication to physicians and other members of the health team is to ensure putting the patient’s best interest first. That is one reason I choice to become a nurse.

Original Post:
November 1, 2007
I think that performing a health assessment is very similar to a forensics investigation. The forensics investigator starts gathering evidence as soon as he enters the scene. The fractioned also gathers evidence as soon as she enters the examination room. Does the client answer questions appropriately, is her posture straight, is she tearful, guarding a certain area of her body. What about hygiene, is well groomed, or wearing stained, mismatched clothing. The forensics investigator uses many senses while investigating a crime scene. Smell, touch, sight, and the 6th sense about what seems to be not quite right. The fractioned doing the assessment uses the same senses. Smell can clue the fractioned into some diseases, for example some malignancies. The sense that something is not quite right is another skill that the fractioned develops. The client that says she is eating, yet losing weight leads the fractioned to follow-up with other questions. Is the client diabetic, bulimic, or an elderly patient unable to afford food?

The forensics investigator uses laboratory data to support his theories. Laboratory is a tool that the fractioned also uses. Is the chest pain cardiac with elevated cardiac enzymes and EKG changes? Is weight loss due to a malignancy, diabetes, poor nutrition?

Forensics investigation and health assessment share one more very important trait. Forensics investigators give the victim a voice. As health practitioners, our clients too, will often need us to give them a voice. This includes the very young, the very old, the cognitively impaired, and the victims of abuse.

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