Forensic Aspects of Emergency Nursing

CHAPTER 43 Forensic Aspects of Emergency Nursing



JAMIE J. FERRELL, BSN, RN, DABFN, CA/CP-SANE, SANE-A, CMI-III, CFN



MAJOR TOPICS



General Overview


Clinical Forensic Issues

Emergency Nursing Responsibilities

Assessment


Primary and Secondary Assessments/Resuscitation

Focused Assessment

Forensic Evidence


Collection and Preservation

Documentation

Chain of Custody


Documentation

When random acts of violence are experienced by members of the community, the victims often seek treatment in an emergency department. Emergency personnel are frequently the first responders and possess the greatest opportunity to identify, evaluate, and treat patients whose care overlaps with clinical forensic issues. All forensic issues carry the stigma of serious social and public health impact; therefore, it is preferable to have a forensic nurse examiner available to assist with assessment, documentation, and preservation of forensic evidence. However, because the forensic nursing specialty is not always available, it is essential that all emergency nurses have the basic skills to gather and preserve evidence effectively and correctly. The emergency nurse accepting responsibility as the care provider and custodian of evidence must also be prepared to testify in court.



I. GENERAL OVERVIEW



A. Clinical Forensic Issues




1. Span a multitude of presentations surrounding trauma and violence


2. Include but are not limited to bioterrorist acts, mass disasters, motor vehicle crashes, missile injuries, burns, workplace violence, elder abuse, child maltreatment, sexual assault, and intimate or domestic partner violence


3. Resultant patient outcomes range from emotional devastation to morbidity and mortality


4. All trauma patients should also be categorized as forensic patients



B. Emergency Nursing Responsibilities




1. Priority is directed toward lifesaving interventions


a. Lifesaving interventions should not be delayed or compromised in order to collect or preserve forensic evidence

b. A safe environment must be provided for patient and personnel

2. Working knowledge of legalities, reporting mandates, and patient information dissemination for jurisdiction of practice (see Chapter 44)


3. Collection and preservation of forensic evidence according to state and federal requirements is a component of emergency nursing practice


a. Identification of need for forensic evidence collection and preservation

b. Initiation and maintenance of legal records


II. ASSESSMENT



A. Primary and Secondary Assessments/Resuscitation (see Chapters 1 and 31)




B. Focused Assessment




1. Subjective data collection


a. History of present injury/chief complaint

1) Mechanism of injury (see Chapter 30)

2) Time of injury

3) Injuries sustained

4) Patient’s statements admissible in court
a) Record statements exactly as stated using quotation marks

b) Statements are not interpreted or sanitized

b. Past medical history

1) Current or preexisting diseases/illness

2) Substance and/or alcohol use/abuse

3) Last normal menstrual period: female patients of childbearing age

4) Current medications
a) Prescription

b) Over-the-counter/herbal

5) Allergies

6) Immunization status

2. Objective data collection


a. General appearance

1) Level of consciousness, behavior, affect

2) Vital signs

3) Odors

4) Gait

5) Hygiene

6) Level of distress/discomfort

b. Inspection

1) Obvious injury/deformity

2) Skin color

c. Auscultation

1) Breath sounds

2) Heart sounds

3) Bowel sounds

d. Palpation/percussion

1) Skin temperature

2) Areas of tenderness


III. FORENSIC EVIDENCE



A. Collection and Preservation


A combination of the importance and value of physical evidence in criminal and civil investigations and the continuing advance of the applications of science and technology has caused the role of physical evidence to grow to unprecedented levels within the legal arena. Collecting and maintaining uncontaminated forensic evidence are of paramount importance. Although most crime laboratories follow the Federal Bureau of Investigation (FBI) crime laboratory standards for evidence collection, labeling, and/or packaging, there may be some local or state differences.




1. Reasons for evidence collection


a. Determine who the “wrong” was committed against (victim)

Related posts:

  1. Genitourinary Emergencies
  2. Shock Emergencies
  3. Disaster Preparedness and Response
  4. Cardiovascular Emergencies

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Nov 8, 2016 | Posted by in NURSING | Comments Off on Forensic Aspects of Emergency Nursing

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