Forensic Evidence in Elder Mistreatment Cases Module 9 Nursing Responses to Elder Mistreatment An...
-
Upload
bernadette-welch -
Category
Documents
-
view
215 -
download
0
Transcript of Forensic Evidence in Elder Mistreatment Cases Module 9 Nursing Responses to Elder Mistreatment An...
Forensic Evidence
in Elder Mistreatment
Cases
Module 9
Nursing Responses to Elder MistreatmentAn IAFN Education Course
1
Forensic Evidence
Part of an assessment of elder mistreatment (EM) may include collecting and preserving evidence of mistreatment on the patient’s body, clothing and/or bedding
Forensic evidence encompasses objects that can establish that a crime has been committed or can provide a link between a crime and its victim or a crime and its perpetrator
R. Saferestein, Criminalistics: An introduction to forensic science, 1998
2
By the end of this module, participants will be able to:
Discuss when evidence should be collected from patients in elder mistreatment cases and nursing roles in collection and preservation
Describe general strategies for evidence collection and preservation
Learning Objectives
3
Case: Mrs. Walker
Identify specific types of mistreatment occurring in case study and related needs of the patient
Do you think this case requires forensic evidence collection? If yes, why?
Who should be notified? What effect do you think evidence
collection might have on this case?
4
When to Collect Evidence
Case may have criminal elements In course of an assessment, nurse sees or
is told about possible physical signs of mistreatment on patient’s body, clothing and/or bedding
Vulnerable older adults present for health care and there are unexplained injuries
Consider time limits for obtaining evidence in light of specific case circumstances
5
Value of Forensic Evidence
Growing role for health care providers in last 15-20 years in collecting, preserving and documenting forensic evidence
L. Stokowski, Forensic issues for nurses : Part 1. evidence collection for nurses, 2008
6
Nursing Roles
Nursing roles in evidence collection can vary depending on factors such aso Practice setting policies
o Jurisdictional requirements
o Type of mistreatment and circumstances of case
o Experience/education of the nurse
7
Nursing Roles
If a forensic examiner is available, what do you think the general role of the attending nurse is?
8
Practice Setting Policies
Health facilities should have clear policies in place that direct nurses and other staff as to their responsibilities related to gathering, preserving and documenting forensic evidence and procedures for carrying out those responsibilities
9
Supplies and Materials
Health care staff should have access to supplies and materials they need to collect and preserve forensic evidence
Use of standardized pre-packaged evidence collection kits is common for some types of mistreatment (e.g., sexual assault/abuse)
10
Evidence Collection Kit
11
Law Enforcement Involvement
If there are signs of EM that suggest the need for forensic evidence collection, nurses should be aware of mandatory reporting requirements and procedures o In most jurisdictions, health facilities are
required to notify law enforcement of suspected acts of EM that may be criminal in nature (gunshot wounds, domestic violence, etc.)
12
Questions
What do you currently do in terms of evidence collection, preservation and/or documentation when there are physical signs of EM?o Policies?o What is your role? Who else is
involved?o Procedures and techniques?
13
Informed Consent
Explain to patient need for forensic evidence collection and what will be done
Ask patient for permission to collect evidence
Don’t do exam against will of patient Law enforcement does not need to be in
exam room when evidence is collected Victim advocates or other support persons
can accompany patients, if patients permit
14
Chain of Custody
Documentation of succession of persons responsible for evidence
Its purpose is to ensure there is neither alteration nor loss of evidence
Begins as soon as nurse locates physical evidence
L. Stokowski, Forensic nursing: Evidence collection for nurses: Chain of custody, 2008
15
Chain of Custody
Seal evidence bags/envelopes with tape; do not use staples
Label each item of sealed evidenceo Patient's nameo Description of item o Source of materialo Name of person who collected itemo Name of person who sealed evidenceo Date and time it was collected and sealedo Names of those who release and receive evidenceo Time it is transferred
16
Fold the bag over. Secure with tape. Label with a patient ID sticker, contents, source, your name, date and time. Then add transfer information.
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
Sealing and Labeling Evidence
17
All envelopes used for evidence collection need to be sealed and labeled in a similar fashion
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
Sealing and Labeling Evidence
18
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
Sealing and Labeling Evidence
19
Storage of Evidence
Put sealed evidence containers into locked evidence storage locker and store until transfer to appropriate agency
Access to locked evidence restricted to trained/authorized supervisory staff who understand importance of chain of custody
20
Handling and Packaging of Evidence
Gloves should always be worn to prevent contamination of evidence
Practice setting/local procedures and type of evidence collected determines type of packaging used
Be familiar with practice setting/local procedures for wet evidence
21
Clothing Evidence
Clothing should be dried, placed on paper sheets to prevent cross contamination, and packaged in paper (not plastic) bags
Paper bags are air permeable. If there is any moisture (blood, body fluids and water), it will evaporate through paper, avoiding evidence destruction with mold and bacterial growth
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
22
Clothing Evidence
Trace evidence on clothing and/or on patients may fall off while patient undresses
Whenever possible, have patient stand on two sheets/papers while patient is undressing
23
Clothing Evidence
To minimize cross-contamination, separate clothing on the drop sheet
Lay large items flat Then individually
place each item of clothing into a paper bag
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.
24
Trace Evidence on Body
If patient has debris (trace evidence), some of material should be collected and placed into clean and dry container before it is washed away
Place debris into clean container (e.g., envelope or sterile plastic cup)
Document when debris was collected, from where and by whom
Photos © 2006. Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission. 25
DNA Evidence
DNA can be retrieved from blood, saliva and semen, as well as hair, hair follicles, bone, skin tissue, mucous membrane cells, and sweat
Since DNA from an individual is unique to that person, it can be used to positively identify person from whom the DNA was collected
States differ in terms of requirements for DNA evidence collection
26
Other Uses: Biological Samples
Biological samples may used to prove other issues besides contact between patient and suspect (e.g., to document presence of alcohol/drugs or STIs)
What procedures are used in your facility/community to collect these samples and maintain chain of custody?
27
Case Study Questions
Precautions evening shift nurse should take to prevent loss or contamination of evidence?
Where would forensic nurse look for potential sources of DNA evidence?
Other possible types of evidence to preserve? What routine care for Ms. Smith should be
avoided until evidence can be collected? In light of your learning in this module, how
should the evening shift nurse respond?
28
Closing Assessment
What have you learned from this module that you can apply to your practice setting?
29