Living forensics: a natural evolution in emergency care

Preservation of forensic traces by Nursing in emergency services: a scoping review

OBJECTIVE

to map the scientific production on the preservation of forensic traces by Nursing professionals working in emergency services.

METHOD

a scoping review, with searches for studies carried out in six databases, in the gray literature available in Google Scholar and in the references of the studies selected. For analysis, the data reduction method was adopted.

RESULTS

26 studies were included, organized into five categories: 1) Nursing professionals' knowledge on the preservation of forensic traces; 2) Procedures performed by Nursing to preserve traces in the victim's body; 3) Procedures performed by Nursing to preserve traces in the victim's belongings/objects; 4) Procedures performed by Nursing to document traces; and 5) Actions to maintain the chain of custody performed by Nursing.

CONCLUSION

the studies showed situations in which the emergency nurse may act in the preservation of forensic traces present in the victim's body and in objects, as well as in the registration of traces, verifying the role of Nursing to ensure integrity of the chain of custody, especially in situations of aggression, firearm injury, sexual violence, child abuse and assistance to trauma victims.

Preservación de los rastros forenses que realizan los enfermeros en los servicios de emergencias: revisión de alcance

Resumen Objetivo: mapear la producción científica sobre la preservación de rastros forenses por profesionales de enfermería que trabajan en los servicios de emergencias. Método: revisión de alcance, con búsqueda de los estudios realizados en seis bases de datos, en la literatura gris disponible en Google Scholar y en las referencias de los estudios seleccionados. Para el análisis, se adoptó el método de reducción de datos. Resultados: se incluyeron 26 estudios organizados en cinco categorías: 1) Conocimiento de los profesionales de enfermería sobre la preservación de rastros forenses; 2) Procedimientos que realizan los enfermeros para preservar rastros en el cuerpo de la víctima; 3) Procedimientos que realizan los enfermeros para preservar rastros en las pertenencias/objetos de la víctima; 4) Procedimientos que realiza el personal de enfermería para documentar los rastros; y 5) Acciones que llevan a cabo los enfermeros para mantener la cadena de custodia. Conclusión: los estudios demostraron que hay situaciones en las cuales el enfermero de emergencias puede actuar para preservar los rastros forenses presentes en el cuerpo de la víctima y en los objetos, así como también registrar los rastros, lo que comprueba la actuación del enfermero para garantizar la integridad de la cadena de custodia, particularmente en situaciones de agresión, heridas con arma de fuego, violencia sexual, abuso infantil y asistencia a víctimas de trauma.

Preservation of forensic traces by Nursing in emergency services: a scoping review

Objective:

to map the scientific production on the preservation of forensic traces by Nursing professionals working in emergency services.

Method:

a scoping review, with searches for studies carried out in six databases, in the gray literature available in Google Scholar and in the references of the studies selected. For analysis, the data reduction method was adopted.

Results:

26 studies were included, organized into five categories: 1) Nursing professionals’ knowledge on the preservation of forensic traces; 2) Procedures performed by Nursing to preserve traces in the victim’s body; 3) Procedures performed by Nursing to preserve traces in the victim’s belongings/objects; 4) Procedures performed by Nursing to document traces; and 5) Actions to maintain the chain of custody performed by Nursing.

Conclusion:

the studies showed situations in which the emergency nurse may act in the preservation of forensic traces present in the victim’s body and in objects, as well as in the registration of traces, verifying the role of Nursing to ensure integrity of the chain of custody, especially in situations of aggression, firearm injury, sexual violence, child abuse and assistance to trauma victims.

New Zealand emergency nurses knowledge about forensic science and its application to practice

INTRODUCTION

Violence is a major public health problem worldwide. Emergency nurses are often in a unique position to identify, assess, evaluate, and treat these patients, but there is limited forensic knowledge and skills to enable emergency nurses to feel confident to guide their practice in New Zealand. The purpose of this study was to establish the level of forensic knowledge and skills currently known and used by nurses in clinical practice working in New Zealand District Health Boards (DHB)'s emergency departments. The study aimed to develop a tertiary education course based on the needs and the knowledge required, to enable nurses to practice confidently and safely with Forensic patients in the emergency department setting.

METHODS

A descriptive approach using online questionnaires including both quantitative and qualitative components was sent to all emergency departments in New Zealand DHB's as well as the New Zealand Nurses Organisation (NZNO) emergency nurses' section. Open-ended questions were analysed by thematic analysis. Closed questions were analysed by SPSS version 15 data analysis software (SPSS Inc, Chicago, IL). Themes identified focused on the knowledge and skills emergency nurses currently possess and the level of specialist education required to ensure patients receive the best medicolegal care.

RESULTS

Results of the questionnaire revealed limited knowledge in being able to correctly identify all forensic patients, insufficient knowledge around evidence preservation and collection and limited knowledge around legislation or legal processes governing clinical care were discovered. However, 84% of all participants felt that having forensic knowledge was important for their practice, indicating a need for increased forensic education. Practice implications indicate that forensic education is warranted, needed and desired among ED nurses within the clinical setting.

DISCUSSION

As forensic patients generally require emergency medical attention, it is important that nurses as part of the front-line first responders have forensic knowledge around preservation and collection of evidence during the provision of medical care. It was found that, emergency nurses do not have enough knowledge around forensic issues indicating that forensic education is warranted, needed and desired among ED nurses within the clinical setting. The study also provides support for the implementation of tertiary forensic science nursing postgraduate study in New Zealand.

Challenges of caring for victims of violence and their family members in the emergency department

INTRODUCTION

Interpersonal violence causes illness and suffering for victims and their family members. Emergency nurses are often given responsibility for forensic patients and their family members, but there is limited knowledge of their experiences regarding this task. This study aimed to describe nurses' experiences when caring for victims of violence and their family members in the emergency department.

METHODS

Individual interviews were conducted with twelve nurses from seven emergency departments. Data were analyzed using qualitative content analysis.

RESULTS

The analysis resulted in the theme: a challenge to create a caring encounter. Hindering factors comprising this challenge are described under four categories: struggling to intervene and talk about violence; contradictions when caring for family members; being helped by forensic guidelines but needing more knowledge; and dealing with one's own strong emotions towards violence.

DISCUSSION

Creating a caring encounter is perceived as a prerequisite to providing forensic care. Nurses often felt hindered to act and forensic issues were left unaddressed. Family members are offered little or no support in the aftermath of violence. The hindering factors must be overcome to ensure forensic care for victims of all types of violence.

Sexual assault victims in the emergency department: analysis by demographic and event characteristics

The objective of this study was to analyze demographic and event characteristics of patients presenting to the Emergency Department (ED) for evaluation after sexual assault, using a Sexual Assault Nurse Examiner standardized database. Data were prospectively collected as part of the Sexual Assault Nurse Examiner program at an urban teaching hospital. This study reviewed all ED patient records with a complaint of sexual assault between January 1, 2000 and December 31, 2004. Data were collected on 1172 patients; 92.6% were women, with a mean age of 27 years. The sample was 59.1% black, 38.6% white, and 2.3% "Other." Black victims of sexual assault were significantly more likely to be young (25 years or less) than Whites. Over half (54%) reported involvement of drugs or alcohol during the event. Fifty-three percent knew their assailant(s), and black and young patients were significantly more likely to know the perpetrator(s). Threats of force were common (72.4% of sample), and multiple assailants were uncommon (18.1% of sample). Physical evidence of trauma was present in more than half (51.7%), with increased rates among Whites and older persons. Multivariate analysis showed that race, age, threats, and substance use during the event were independent risk factors for evident trauma on physical examination. Survivors of sexual assault who present to the ED are overwhelmingly female, relatively young, often know the perpetrator of the event, and are likely to be threatened and show signs of physical trauma. Differences between patients according to demographic and event characteristics may have important implications for ED management and treatment plans.