The document discusses forensic nursing and the responsibilities of forensic nurses. It defines forensic nursing as applying nursing care and processes to legal cases. Forensic nurses must collect evidence from crime scenes, which can include a living victim's body. They document injuries, preserve evidence, and provide psychological support to victims. Forensic nurses must be knowledgeable about applicable laws and procedures for evidence collection, storage, and chain of custody. Their goal is to properly collect and document evidence to aid legal investigations while also caring for victims.

1. GOVT.COLLEGE OF NURSING KIMS, HUBBALLI
COMPREHENSIVE CARE OF FORENSIC VICTIMS AND THEIR FAMILY
BY
BASAVARAJ KUMBAR
MSC NURSING
DEPARTMENT OF MEDICAL SURGICAL NURSING
GCON KIMS HUBBALLI
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2. FORENSIC NURSING
DEFINITION:
• Forensic nursing is defined as the application of the
nursing process to public or legal proceedings, and the
application of forensic health care in the scientific
investigation of trauma and / or death related to abuse,
violence, criminal activity, liability and accidents.
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3. OBJECTIVES
• Physical aspect
• Psychological aspect
• Cultural and spiritual aspect
• Legal aspect
• Assist forensic team care beyond scope of her practice
• Admission and discharge/ referral/death of victims of
violence
• Responsibility of a nurse as a witness.
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4. CATEGORIES OF CLINICAL FORENSIC CASES
• Sexual assault
• Substance abuse
• Child maltreatment
• Occupational related injuries
• Domestic/intimated partner violence
• Suicide attempts
• Violence crimes
• Workplace violence
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5. • Police/corrections custody abuse
• Physiological and psychological abuse
• Motor vehicle crash
• Food and drug tampering
• Human trafficking
• Suspicious trauma or death
• Medical/nursing malpractice
• Disasters/environmental hazards
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6. FORENSIC PROCEDURES
• Component of emergency nursing practice
• Accurate documentation
• Part of scientific investigation, evidence collection
and preservation, and treatment of medico-legal
related issues
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7. Legal standards
• Penal code
• Mandatory Reporting
• Patients legal rights
- Recognition
- Collection and preservation of evidence
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8. SANE
• A Sexual Assault Nurse Examiner is a nurse
registered who has been specially educated to
provide comprehensive care to sexual assault
patients, who demonstrates competency in
conducting a forensic exam and the ability to be an
expert witness.
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9. Responsibilities of SANE
• S/A medical and evidentiary exam
• STI risk evaluation
• Pregnancy risk evaluation and interception
• History of event and collection of forensic evidence
• Emotional support and crisis intervention
• Testifying in court
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10. PRIMARY SURVEY
• Taking care of the patients immediately medical
and psycho-social needs is always the highest
priority
• Primary survey: ABXDE’s are the priority of care,
preservation of evidence follows
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11. Airway
• Airway ( patency, foreign objects, obvious injuries)
- Consider C- spine with patients of possible trauma
or assault
- Preserve unusual foreign objects
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12. Breathing
• Breathing ( effectiveness, integrity of the chest wall, JVD
or tracheal deviation, especially with victims of assault
- Do not cut through bullet or knife tracks in
clothes
- Label and retain any unusual objects, scrapings,
etc.
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13. Circulation
• Circulation/perfusion (pulse rate and quality, skin color and
temperature and capillary refill.
• Alterations in assessment may indicate blood loss with
patients of assault)
- Asses for signs of uncontrolled bleeding
- Assess for occult bleeding such as abdominal
distension, bruising, signs of head injury
- Elevated heart rate could be due to emotional
response to the event, medications, street drugs OR
volume loss
- Do not clean the injury sites at this time
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14. Disability
• Disability (alteration in level of consciousness shock,
presence of medications or street drugs)
- Does the patient appear to be disassociating?
- Are there occult or obvious head wounds?
- Do you see identification bracelets that might indicate
a seizure disorder, diabetes, or other findings that might
be a cause for the decreased level of consciousness?
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15. Exposure
• Exposure ( carefully remove clothing and preserve as
evidence, documentation of injuries)
- Remove clothing intact if possible and
place in separate paper bags
- Carefully and thoroughly document
injuries
- Keep patient covered to prevent heat
loss.
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16. Full set of Vitals and Family Presence
• Obtain a Full set of Vital signs
• Facilitate family presence
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17. SECONDARY SURVEY
• Identify all the injuries
• Secure the scene
• Collect baseline laboratory specimens
• Obtain thorough history
-only ask for details necessary to perform
medical and evidence collection tasks
• Preserve clinical data
• Collect any potential evidence
• Wear gloves and change often.
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18. GET RESUSCITATION ADJUNCTS
• Laboratory analysis
blood typing, blood gases, lactate
• Cardiac monitor
• Consider naso-gastric tube/oro-gastric tube
• Using appropriate pain scale, assess pain
- Non-pharmacological comfort measures
- Analgesic pain medication
• Fast exam if uncontrolled internal hemorrhage
suspected
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19. COMMON INJURIES
• Physical assault.
• Grab or restraining
- Neck
- Arms
- Wrists
- Legs
• Ligature marks.
- Choke vs. strangulation
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20. • Sexual assault.
• Note injuries to
- Breasts
- Upper portion of the inner thigh
- Injuries or soreness
. Scalp
. Back
. Buttocks
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21. LOCAD’S EXCHANGE PRINCIPLE
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22. EVIDENCE COLLECTION
• Evidence is used to establish the facts of the crime:
- Was a crime been committed?
- What person committed the crime?
- What is the modus operandi of a crime ( how a
crime was committed)
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23. FORENSIC EVIDENCE COLLECTION
AND PRESERVATION -CONCEPTS
• The patient is a crime scene whether dead or alive
• The crime scene has been moved to the emergency
department
• Law enforcement is dependent on nursing to process
the human body when the patient is in the hospital
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24. FORENSIC EVIDENCE COLLECTION AND
PRESERVATION -CONCEPTS
• This includes physical and objective data obtained from
the patient
• The human body is the most intricate crime scene ever
documented
• Evidence collection is inclusive of documentation
(including body diagram), photography (if available) and
trace evidence gathered from the scene of a crime
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25. TYPES OF EVIDENCE
• Physical evidence
- Physical findings, including surface trauma
- Body fluids
- Clothing
- Missiles and other debris
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26. GENERAL RULES FOR COLLECTION
• There is only one chance for collection
• When in doubt, collect
• Never use plastic to store evidence: plastic causes mold
• Pack in clean unused paper bags
• Wet evidence should be air-dried, without heat, before
packing
• Separate all items to avoid cross contamination
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27. IMPORTANT
• Every item submitted to the forensic lab for analysis
must be labeled as to site (vaginal, oral, anal,
penile, surface areas), name of the patient, date,
and examiner’s initials
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28. EVIDENCE COLLECTION KIT AND FORM
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29. EVIDENCE COLLECTION PRINCIPLES
• Label all bags with.
- Patients name and hospital number
( case number)
- Date
- Time
- Your initials
Fold top of bags two times
- Seal with tape all the way across
- Time, date and initials
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30. FORENSIC EVIDENCE-PROCESS
• Evidence collection from the human body:
- If possible, have the patient remove clothing and
comb hair over a clean, white sheet. Carefully fold
sheet, place in paper bag and label.
- Use disposable tools and clean them between each
sample.
- Do not sneeze, cough or talk in a manner that might
contaminate the evidence.
- Do not use stables or lick envelopes to seal
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31. PSYCHOLOGICAL SUPPORT
• Post traumatic stress disorder
• The first cluster of symptoms are referred to re-
experiencing symptoms
• The second cluster of symptoms are referred to
avoidance symptoms
• The last cluster of symptoms are referred to hyper –
arousal symptoms
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32. THE FOLLOWING POINTS SHOULD BE
CONSIDER WHILE SUPPORTING THE VICTIM
• Establish positive rapport
• Promote physical comfort
• Allow the victim to discuss his/her account of the trauma
• Listen and document any changes in the tone of voice
• Observe and document non-verbal behaviors
• Emotional support
• Counseling or psycho-therapy
• Stress reduction training
• Anxiety management training
• Group therapy
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33. • Physical aspect.
• Cleaning of wound
• Applying dressing
• Giving medication for pain etc
• Preparing for surgery if needed
• Help the patients in ADL
• Education for self management
WORKSHOP ON "FORENSIC NURSING AND
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34. ROLE OF A NURSE IN ADMISSION AND
DISCHARGE OF FORENSIC VICTIM
• After receiving patient from OPD, immediately inform the doctor
on duty of that unit.
• All the records of the patients like OPD slips, admission files, must
be kept under lock and key to prevent legal issues.
• Not to show the patient records to anybody
• Not to show the patient records to police personnel.
• Not to throw any discharges of patients without permission of
physician.
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35. • Nurse should keep belongings of the patient in her
custody.
• Take consent of relative or patients for any kind of
procedures or treatment.
• Avoid answering enquiries to an insurance agent and
other unauthorized persons.
• The condition of the patient should be reported
verbally to relatives.
• Maintain all the records of the patients accurately.
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36. DISCHARGE
• On discharge, no records should be handed over to the
police.
• Enter clearly, if patient is transferred to another ward
or hospital
• Before allowing the patient to leave the hospital, nurse
should clearly enter or write the name of relatives of
the patient.
• Keep all the records concerning to patient under lock
and key after discharge of the patient.
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37. FORENSIC NURSE RESPONSIBILITY
REGARDING THE DEATH INVESTIGATION
• Crime scene investigation.
• Physical examination
• Identification of wounds
• Abrasion
• Scratches
• Graze
• Pressure abrasion
• Pattern abrasion
• Contusion
• Laceration
• Avulsion
• Stab wounds
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38. POST MORTEM CHANGES
• Algor mortis
• Livor mortis
• Rigor mortis
• Cadaveric spasm
• Putrefaction ( decomposition)
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39. FORENSIC NURSE RESPONSIBILITY IN
DIASTER VICTIM IDENTIFICATION
The victim can be identified based on the following
identifying factors;
• Tattoos and scars
• Evidence of prior surgical marks or bone fractures
• Unusual deformity
• Approximate age, built, sex and race
• Personnel belongings (jewelry, clothing,shoes etc)
• Superimposition techniques.
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40. • In cases of unidentified dead bodies, the identification
through fingerprints is a possible way.
• When there is rigidity in the fingers, the joint should be
bent many times until it becomes flexible. The tips of
the fingers are then inked using a roller and printing ink
and the prints can be taken on the card. The finger
should not be rolled on the card rather card may be
rolled around the fingertip for better results.
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41. THANK YOU
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