April Stanley-Banks, Modbury Hospital Acute Assessment Unit: Clinical Forensic Nursing
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Transcript of April Stanley-Banks, Modbury Hospital Acute Assessment Unit: Clinical Forensic Nursing
April Stanley-Banks
Clinical Nurse / Clinical Practice
Consultant
Emergency / Acute Assessment Unit
Education Link Nurse
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• Substance abuse
• Domestic violence
• Poverty and unemployment
• Access to weapons
• Gang formation
• Drug and alcohol abuse
• Interpersonal violence
• Criminal activity
• Medical conditions which affect
cognitive abilities.
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Forensic Nursing: Application of
Nursing to the Law
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An intersection where Nursing and the Law meet creating a cross-road where a new perspective to nursing exists.
The application of Forensic Science, combined with clinical Nursing practice as they are applied to the Criminal Justice System, civil litigation and public or legal proceedings in the law enforcement arena.
The application of Forensic aspects of health care combined with bio-psychosocial education of the Registered Nurse in the scientific investigation and treatment of trauma, violent or criminal activity, and traumatic accidents within the clinical or community institution.
A developing role involving the identification, collection and preservation of evidence in a chain-of-custody process from living Forensic patients.
An opportunity for Nurses to communicate with Law enforcement personnel, protective agencies, defence attorneys and prosecutors.
An opportunity for Nurses to uphold the principles of objectivity in public inquiry and human rights.
The facilitation of deterrence of criminal activity and violent assault.
(Lynch 2006)
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• Nurse Coroners
• Nurse Attorneys/Legal Nurse Consultants
• Forensic Psychiatric & Mental Health Nurse
• Domestic Violence Nurse
• Sexual Assault Nurse Examiner (SANE)
• Pediatric Forensic Nurse
• Correctional Nurse
• Clinical Forensic Nurse
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• Identification
•Care for the Survivor
•Care for the Perpetrator
• Identification & Collection of evidence :
Circumstances surrounding injury
Type of weapon(s)
Length of time between injury and treatment
Nature and their pattern of injury
Witnesses
Care of clothing
Chain-of-custody for evidence
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Emergency nurses are often exposed to extreme human behaviour such as:
• 1. Abuse of the disabled
• 2. Assault and battery
• 3. Burns > 5% body surface area
• 4. Child abuse and neglect
• 5. Clients in police custody
• 6. Domestic Violence
• 7. Elder abuse and neglect
• 8. Firearm injuries
• 9. Food and drug tampering
• 10. Forensic psychiatric clients
• 11. Gang violence
• 12. Human and animal bites
• 13. Malpractice and/or negligence
• 14. Motor vehicle trauma
• 15. Occupation-related injuries
• 16. Organ and tissue donation
• 17. Personal injury
• 18. Product liability
• 19. Questioned death cases
• 20. Sexual assault
• 21. Sharp force injuries
• 22. Substance abuse
• 23. Transcultural medical practices
• 24. Toxic exposure
• 25. Victims of mass destruction/terrorism
• 26. End of life decisions: Do Not Resuscitate (NFR)
• 27. Control of communicable diseases
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.
• Removal of hair from a person’s
body.
• Removal of material from
beneath a finger or toe nail.
• Removal of biological or other
material from the external part
of the body.
• The taking of a DNA sample by
buccal swab.
• The taking of a finger print.
• The taking of an impression or
cast of a wound.
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and preservation
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Things to note:
Circumstances surrounding injury
Type of weapon(s)
Length of time between injury and treatment
Nature and pattern of injury
Witnesses
Care of clothing
Chain of custody
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Besides emergency care, attention should also be focused on the responsibilities to preserve and protect as much evidence as possible.
Maintain an index of suspicion
Identify sustained patterns and patterned injury
Distinguish between intentional or accidental injury
Distinguish between blunt and sharp force injury
Documentation must be objective
Facts, not assumptions, opinions nor allegations are recorded
Care must be taken in any interpretation of any alleged explanation of injuries by patients
Patient behaviour and statements or utterances must be documented
• Domestic Violence, abuse or neglect
• Trauma (non accidental or suspicious)
• Vehicular/automobile vs. pedestrian accidents
• Substance abuse
• Attempted suicide/homicide
• Occupational injuries
• Environmental hazard incidents
• Terrorism/violent crime victims
• Illegal abortion practices
• Supervised care injuries
• Public health hazards
• Involvement of firearms/weapons
• Prominent individuals/celebrities
• Unidentified individuals
• Damaged/improperly used equipment
• Poisonings, illegal drugs, overdose
• Anyone in police custody
• Sudden, unexplained, suspicious deaths
• Sexual assault or abuse
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Physical evidence can:
Identify whether a crime has been committed
Identify the offender or exonerate a suspect
Link a person with another person or a scene
Link an object to another object or a scene
Verify or contradict specified statements by person(s)
Physical evidence is classified as any matter such as:
clothing,
hair,
fibres,
bullets,
body fluids,
DNA, debris,
contusions,
Lacerations
Marks on the skin such as bruises or bite marks,
Foreign bodies.
Physical evidence can be defined as any matter
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The forensic nurse looks for
deposits
of:
gun powder residue,
soot,
fire accelerant,
particle patterns,
imprints,
defining cuts from
penetrating
weapons,
bullets.
Extreme care must be taken
to preserve these findings
when removing clothing
from victims or offenders.
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A white sheet or
paper is placed under
the victim or offender
while
undressing to catch
such
evidence.
These sheets and
papers are then
folded and placed in
paper bags and
sealed.
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Care must be taken so as not to make folds through specific
evidentiary areas in clothing.
Clothing cut away is preserved
and reconstructed to reflect
circumstances of trauma.
Holes, rips and tears often
reveal mechanism of
injury.
Consider if bodies have been
washed down before
arrival.
• Minimise handling of
evidence
• Prevent cross-
contamination
• Maintain evidentiary
integrity
• Maintain evidentiary
probative value
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Apart from physical evidence, early
collection of biological specimens are
invaluable for prosecutorial outcome.
Positive blood toxicology can be used to
corroborate the involvement of a drug in
sexual assault.
This is crucial as recent legislative efforts
are issuing higher penalties for those who
use controlled substances with the intent to
commit sexual assault or other violent
crime.
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• Hair indicates drug use over months
• Saliva indicates the present parent
drug
• Sweat indicates drug use over
weeks
• Nails demonstrates drug use over
months
• Blood determines drug use over
hours or days
• Urine carries a high potential for
donor if contamination of collection
is unsupervised.
• Buccal, vaginal and genital swabs
yield information for DNA
profiling. These swabs are dried
before storing.
• Mitochondrial DNA is harvested
from hair plucking’s including hair
roots.
• In cases of sexual assault, pubic
hair combings and fingernail
scrapings are collected.
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• Research reveals that
knowledge of type,
location and severity of
injuries and wounds in
both male and female
victims and offenders is
extremely useful for the
identification of
mechanism of injury.
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Research demonstrates:
most head lesions occur on the left side of the victim’s head/face
males generally sustain wounds to their nose and mouth
females sustain abrasions to their neck through strangulation
most offender upper limb injuries occur at the dorsal right hand
involving fourth and fifth metacarpal bone fracture.
• u-shaped arches not
touching at the base
• central contusion or
erythema
• sucking marks
• some shallow
puncture marks
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• v-shaped and deep
puncture marks
• associated parallel
linear lacerations and
abrasions
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• age, race, skin
thickness/elasticity
• location/underlying
support of body
structure
• strength/movement of
biter
• temperature/humidity
• contamination
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• Multiple bruises of different ages
• Any wound showing the shape of the object causing it
• Flow of hot liquid not consistent with burned areas of skin and body position at time of burning
• Scalds to buttocks, perineum, genitalia
• Splash or immersion burns
• Dislocations/sprains not fitting with age or mobility of a child
• Facial, head/neck bruising, choke
marks
• Unexplained abdominal injury,
bleeding/rupture
• Unexplained unconsciousness
• Evidence of skull fracture
• Bleeding in back of eye
• Any fracture in infant too young to
walk
• Fractured ribs (especially
posterior)
• Multiple fractures of different
ages 42
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• all evidence collected
• all treatment and procedures
implemented
• all wounds and their location, severity,
size, colour and characteristics
• any statements, utterances and
behaviours expressed
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• Who handled the evidence
• What was handled
• Why it was handled
• Where it was located at all times
• Recognize: Does the patient fit into a Forensic category?
• Assessment: Does the patient have specific Forensic needs?
• Collection & Preservation: Does your patient require you to
collect evidence?
• Documentation: Patient history in quotes, measure injuries,
maintain Chain-of-Custody, lock up all evidence collected,
discharge referrals, (does the patient require specific referral
agency upon discharge?
• Report: Do you need to call the Police and/or inter-agencies?
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Chain of Custody Form Patient Label
List of Evidence/Items:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
___________________________________________________________________
Total Number of Items/Evidence Bags Collected __________________________
Agency receiving
evidence:____________________________________________________________
Person given
evidence:____________________________________________________________
Signature of person receiving
evidence:____________________________________________________________
Date Evidence was
Released:____________________________________________________________
Time Evidence was
Released:____________________________________________________________
Hospital Staff
Collector:____________________________________________________________
Hospital Staff
Signature:___________________________________
A = Airway
B = Breathing
C = Circulation
+
E = Evidence
F = Forensics
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• Ballistics
• Legal standards
• Deposition and courtroom testimony
• Crime scene processing
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As well as contemporary and social justice issues
such as:
• Human rights/reconciliation and justice
• International Humanitarian Law
• Terrorism and torture
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The objectives of Forensic Nursing intervention remain largely
unaddressed even though…
‘Every individual who works in a health care facility should receive
basic Forensic education. This is essential to meet the standards and
limit liability in the event of a failure to recognise indications of
injuries associated with;
• sexual assault
• child or elder abuse
• domestic violence
• other Forensic trauma”
Lynch 2006 p10.
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• A patient’s evaluation must be adequately documented,
narratively, diagrammatically and photographically in the
patient’s chart for possible use in future legal actions.
• The failure to do so may have far ranging consequences for
the hospital, the patient and potentially for the treating
physician.
Facilitating the legal and ethical obligations of forensic clients
Preventing miscarriages of justice in the community
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• Training in interviewing forensic clients
• Supply of camera to capture photographic evidence
• Supply of appropriate kits for evidence collection
• Provision of side room privacy for victims of abuse and sexual assault
• Raising awareness of inter-agency membership for protection of human
rights
• Training in documenting evidence according to judicial requirement
• Raising awareness for various classifications of forensic populations
• Training in identification of physical, trace and biological evidence
• Raising knowledge of levels of court proceedings
• Preparation of testimony Supply of appropriate documentation and
anatomical charts
• Training in communication with law enforcement personnel
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• Bailey, S 1998, ‘An exploration of critical care nurses and doctors attitudes towards psychiatric patients’, Australian Journal of Advanced Nursing, vol. 15, no. 3, pp. 8-14.
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• Department of Health South Australian Government 2002, Mental Health- the Case
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