Forensic Nursing Chronicles

JACHO has developed a checklist to prevent sentinel events from occurring in the hospital setting. I have not encountered these before and found them particularly noteworthy: a. Screening tools are available for personnel in clinics, the ED, inpatient, geriatric, or critical care units to identify patients who have been abused or neglected. b. All personnel are trained in the use of specified criteria for detecting abuse or neglect using objective assessments, not allegations alone, to identify cases for further management by appropriate authorities. c. Orientation and annual training programs include information and procedures useful in detecting forensic cases and referring them to appropriate individuals or services for treatments, reacted space for examining forensic patients which is equipped with locked units for storage of forensic evidence. d. Forensic reference resources are available to providers who may need guidance in identifying signs and symptoms of human abuse and neglect. e. The communication and reporting system within the facility is designed to maintain a high degree of patient privacy and discretion when forensic cases are being managed (short chain of reporting, dedicated phone lines, record security, release of information, etc.) e. Personnel are skilled in the appropriate techniques required for identification, collection, preservation and safeguarding of evidentiary items outlined in the facility’s policy and procedure manual. f. Patient standards of care include the recognition of forensic patients. g. Policy and procedures outline management of sudden, unexpected deaths, sexual assault and human abuse and neglect. h. Personal training folders incorporate required training and skills validation associated with the management of human abuse and neglect i. The facility has a clear plan for managing victims of sexual assault of all ages and both genders. j. Mechanisms are in place to accomplish various types of photo documentation and to manage these photos with high level of security and flawless chain of custody. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Standards of Care in nursing need to be performed at their highest in all areas of medicine. The critical care areas are not the only areas that have patients who have critical issues. The critical care units are the areas that are more prepared for critical care emergencies and the nurses in these areas often have added credentials such as ACLS, PALS, and many others. My concern is med/surg, pediatrics, and the nursery deserve to have staff nurses with the same credentials. Pediatric patients go bad fast and they need staff who are knowledgeable and able to care for their needs, they need the highest standard of care possible just like those in the ER and ICU do. How do we establish this standard of care when med/surg and pediatric nurses don’t see the amount of trauma and pulseless non-breathers as the critical care units, making them less experienced with these situations? Nurses who have excellent health assessment skills can help improve this problem, because they are more able to see an abnormality and act on it before it becomes a critical care need.

Original Post:
December 4, 2008
Standard of Care
All nurses are duty bound to provide an exacting degree of care that a reasonable and prudent nurse under the same or similar circumstances would provide. However, depending on the setting, this standard’s bar may be raised, especially in critical care areas. Also, any nurse who has gone beyond the basic credentialing and achieved additional training has taken upon herself the duty to hold her or himself to a higher standard. Neglect or fluffing off care by cutting corners is absolutely inexcusable in these conditions. Critical care areas include the OR, ED, CCU, ICU, PACU and NICU. That is not to say that med/surg, rehab and OB, nursery, pediatrics, geriatrics and psych do not deserve the best of care either. Folks on these floors can all go south very quickly, but they are often thought to be more stable in these areas. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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All nurses are duty bound to provide an exacting degree of care that a reasonable and prudent nurse under the same or similar circumstances would provide. However, depending on the setting, this standard’s bar may be raised, especially in critical care areas. Also, any nurse who has gone beyond the basic credentialing and achieved additional training has taken upon herself the duty to hold her or himself to a higher standard. Neglect or fluffing off care by cutting corners is absolutely inexcusable in these conditions. Critical care areas include the OR, ED, CCU, ICU, PACU and NICU. That is not to say that med/surg, rehab and OB, nursery, pediatrics, geriatrics and psych do not deserve the best of care either. Folks on these floors can all go south very quickly, but they are often thought to be more stable in these areas. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Testifying in court can be a trying and intimidating experience. Often the forensic nurse is called to testify for the prosecution. The defense, therefore, will try very hard to discredit the nurse and raise questions about credentialing and creditability; even enlarging handwritten documents glaringly pointing out misspelled words and poor penmanship. This should never be taken personally. The nurse has a job to and needs to focus on the case at hand. After all, as nurses, we are used to being maligned by disgruntled surgeons and cardiologist. These are merely attorneys: a different venue, but they can cause us no harm! References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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During the course of events in any facility, there are some unavoidable untoward events that occur. Although anything that centers on the patient should be documented, things like incident reports are never part of the chart. Sometimes, supervisors will ask staff to write paragraphs of a particular event and submit it to them. This is a dangerous practice since this can become “discoverable evidence” at some time later should the case got to litigation. Any such documentation should be turned over to the hospital risk management to allow them to deal with it, and not hidden by individual staff members. Any information used during litigation should be readily accessible by the individuals involved prior to trial and memorized before testifying in a court of law. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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Both jury and non-jury trials may call in an expert witness to testify. This individual is one that has extensive experience and hopefully creditability in proving the case for the attorney who deposed the witness. This is an intimidating position to be in because the questions are repetitious and often the cross-examinations are looking for minute flaws in previous testimony to disprove the creditability of the witness. A person in this position must remember to be well versed in the case, remain calm, speak clearly and audibly and ask to have any question repeated that is unclear. This is truly grace under fire. All aspects of the witness are under fire and fair game from the testimony to the CV. I know, I have been in this position once, a long time ago, but feel better prepared to head there again. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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