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April Stanley-Banks, Modbury Hospital Acute Assessment Unit: Clinical Forensic Nursing
 

April Stanley-Banks, Modbury Hospital Acute Assessment Unit: Clinical Forensic Nursing

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April Stanley-Banks, Clinical Nurse, Modbury Hospital Acute Assessment Unit delivered this presentation at the 2013 National Forensic Nursing conference. The annual event promotes research and ...

April Stanley-Banks, Clinical Nurse, Modbury Hospital Acute Assessment Unit delivered this presentation at the 2013 National Forensic Nursing conference. The annual event promotes research and leadership for Australia’s forensic nursing community. For more information about the conference and to register, please visit the website: http://www.healthcareconferences.com.au/forensicnursing

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    April Stanley-Banks, Modbury Hospital Acute Assessment Unit: Clinical Forensic Nursing April Stanley-Banks, Modbury Hospital Acute Assessment Unit: Clinical Forensic Nursing Presentation Transcript

    • April Stanley-Banks Clinical Nurse / Clinical Practice Consultant Emergency / Acute Assessment Unit Education Link Nurse
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    • • • • • • • • • • 4 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. 9
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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 11
    • • 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 12
    • 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 13
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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. 16
    • 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 19
    • 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 20
    • • 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 21
    • 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 23
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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. 25
    • 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. 26
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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. 31
    • • Minimise handling of evidence • Prevent crosscontamination • Maintain evidentiary integrity • Maintain evidentiary probative value 32
    • 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. 33
    • • 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. 34
    • • 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. 35
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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. 37
    • • u-shaped arches not touching at the base • central contusion or erythema • sucking marks • some shallow puncture marks 38
    • • v-shaped and deep puncture marks • associated parallel linear lacerations and abrasions 39
    • • age, race, skin thickness/elasticity • location/underlying support of body structure • strength/movement of biter • temperature/humidity • contamination 40
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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 42 ages
    • Preservation of Evidence
    • • all evidence collected • all treatment and procedures implemented • all wounds and their location, severity, size, colour and characteristics • any statements, utterances and behaviours expressed 44
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    • • Who handled the evidence • What was handled • Why it was handled • Where it was located at all times 47
    • • 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? 48
    • A = Airway B = Breathing C = Circulation + E = Evidence F = Forensics 49
    • • Ballistics • Legal standards • Deposition and courtroom testimony • Crime scene processing 50
    • As well as contemporary and social justice issues such as: • Human rights/reconciliation and justice • International Humanitarian Law • Terrorism and torture 51
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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. 53
    • • 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. 54
    •  Facilitating the legal and ethical obligations of forensic clients  Preventing miscarriages of justice in the community 55
    • • • • • • • • • • • • 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 56
    • • Australian Nursing Federation-Victorian Branch 2002, Zero Tolerance (occupational violence and aggression) Policy, ANF, Melbourne. • 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. • Baillie, L 2005, ‘An exploration of nurse-patient relationships in accident and emergency’, Accident and Emergency Nursing, vol. 13, issue 1, pp. 9-4. • Cashmore, J, Gilmore, L, Goodnow, J, Hyes, A, Homel, R, Lawrence, J, Leech, M, Najman, J, O’Connor, I, Vinson, T & Western, J 2002, ‘Pathways to prevention: development and early intervention approaches to crime Australia’, National Anti-crime Strategy: National crime Prevention Towards a Safer Australia, Australian Government, Canberra. • Catlette, M 2005, ‘A descriptive study of the perceptions of workplace violence and safety strategies of nurses working in level 1 trauma centres’, Journal of Emergency Nursing, vol. 31, issue 6, pp. 519 -525. 57
    • • Department of Health South Australian Government 2002, Mental Health- the Case for Change, submission 506, chapter 2, pp. 16, accessed 11th May 2009, http://www.aph.gov.au/senate.committee/mentalhealth_ctte/report/co2.pdf • Di Martino, V 2002, Relationship between work stress and workplace violence in the health sector, accessed 2 October 2010, http:// www.worktrauma.org/health/wv_stresspaper.pdf • Gacki-Smith, J, Juarez, AM, Boyett, l, Homeyer, C, Robinson,l & MacLean S 2009, ‘Violence Against Nurses Working in US Emergency Departments’, The Journal of Nursing Administration’, vol. 39, issue7/8, pp. 340-349. • Gerberich S, Church, T, McGovern, P, Hansen, H, Nachreiner, N, Geisser, M, Ryan, A & Monigan, S 2004, ‘Epidemiological study of the magnitude ad consequences of work related violence: the Nurses’ study’, Occupational Environmental Medicine, vol. 61, pp. 495- 503. 58
    • • International Labour Office, International Council of Nurses, World Health Organization, Public Services International 2002, Framework guidelines for addressing workplace violence in the health sector, International Labour Office Geneva Switzerland. • Jackson, D, Clare, J & Mannix, J 2002, ‘Who would want to be a nurse? Violence in the workplace – a factor in recruitment and retention’, Journal of Nursing Management, vol. 10, issue 1, pp. 13-20. • eather, P 2002, ‘Workplace violence in the health sector. State of the Art, in Cooper, Clare & Swanson, N University of Manchester Institute of Science and Technology and National institute of occupational safety and health, United State, working paper of the joint ILO/ICN/WHO/PSI programme on Workplace violence in the health sector, Geneva. • Leather, P 2002, ‘Workplace violence: Scope, definition and global context’, in Cooper, C & Swanson, N (Eds), Violence in the Health Sector: State of the Art, International Labour Office, Geneva, pp. 3-18, accessed March 2011, http://www.icn.ch.state.pdf • Lipscomb, J, Silverstein, B, Slavin, T, Cocy, E & Jenkins, L 2003, ‘Perspectives on legal strategies to prevent workplace violence’, Journal of Law and Medical Ethics, vol. 30, issue 3, pp. 166-172. 59
    • • Luck, L, Jackson, D & Usher, K 2006, ‘ Innocent or culpable? Meanings that emergency department nurses ascribe to individual acts of violence’, Journal of Clinical Nursing, vol. 17, pp. 1071-1078. • Luck, L, Jackson, D & Usher, K 2007, ‘STAMP: components of observable behaviour that indicate potential for patient violence in emergency departments’, Journal of Advanced Nursing, vol. 59, issue1, pp. 11-19. • Lyneham, J 2000, ‘Violence in New South Wales Emergency Departments’, Australian Journal of Advanced Nursing, vol. 18, issue 2, pp. 8-17. • Patterson, B, Leadbetter, D & Miller, G 2005, ‘Beyond zero tolerance: a varied approach to workplace violence’, British Journal of Nursing, vol. 14, pp. 810-815. • Percival, J 2001, ‘Don’t be too nice’, Nursing Standard, vol. 15, issue 19, pp. 22. • Perrone, S 1999, ‘Violence in the Workplace’, Australian Institute of and Criminology Researched Public policy Series, vol. 22, pp. 1-125. • Perrone, S 1999, Violence in the Workplace, Australian Institute of Criminology Research and Public Policy Series. No 22: Canberra. 60
    • • Sercombe, H 2002, ‘Preventing youth violence’, Paper presented to the ASEAN seminar on urban youth work II, Singapore, accessed 4th May 2010, http://www.lgaq.asnau/lgaq/resources/community/youth/space/preventingyouthviolence .pdf • South Australian Dept. of Health 2009, SA Health Prevention and Management of Workplace Violence and Aggression Guidelines, Government of South Australia. • Tulloch, J, Lupton, D, Blood, W, Tolloch, M, Jennet, C & Enders, M 1998, ‘Fear of crime’, National Campaign Against Violence and Crime, vol. 2 accessed 18th May 2010, http://www.crimeprevention.gov.au/agd/www/rwpattach.nsf/viewas • Vieira, EM, Perdona, GCS, Almeida AM, Nakano, AMS, Santos, MA, Daltoso, D & Ferrante, FG 2009, ‘Knowledge and attitudes of healthcare workers towards gender based violence’, Sci Elo Public Health, accessed 3 September 2010, http://www.scielosp.org/scielo.php?pid=S1415-790X2009000400007&script=sci_artt • Wand, TC & Coulson, K 2006, ‘Zero tolerance: A policy in conflict with current opinion on aggression and violence management in health’, Australasian Emergency Nursing Journal, vol. 9, issue 4, pp. 163-170. 61