The Need For Uniform Forensic Policies And Procedures In Healthcare

The Need For Uniform The Need For Uniform Forensic Policies And Forensic Policies And

Procedures In HealthcareProcedures In Healthcare A Research ProjectA Research Project

by by

Paula Walsh, RNPaula Walsh, RN

Background & SignificanceBackground & Significance

The Commonwealth of The Commonwealth of Massachusetts offers Massachusetts offers only one uniform only one uniform forensic policy and forensic policy and procedure that governs procedure that governs how the healthcare how the healthcare industry collects industry collects forensic evidence.forensic evidence.

Sexual Assault Sexual Assault victimsvictims


The The Rape Rape KitKit


Forensic patients in the health care Forensic patients in the health care facility:facility:

Focus of health care professionals: Focus of health care professionals: Lifesaving interventionsLifesaving interventions Lack recognition of potential evidence Lack recognition of potential evidence Protocol & Procedure of organizationProtocol & Procedure of organization Training & EducationTraining & Education

Background & Significance cont.Background & Significance cont.

Interagency Interagency collaboration between collaboration between healthcare and law healthcare and law enforcement enforcement

Creating a medical-Creating a medical-legal bridgelegal bridge

Imperative for Imperative for establishing protocols establishing protocols and procedures for the and procedures for the collection of forensic collection of forensic evidenceevidence

Purpose of the StudyPurpose of the Study

To assess the need for the To assess the need for the development of uniform forensic development of uniform forensic policies and procedures between policies and procedures between healthcare and legal agencies.healthcare and legal agencies.

Research QuestionResearch Question

Does a lack of uniform forensic policies Does a lack of uniform forensic policies and procedures within Massachusetts and procedures within Massachusetts healthcare facilities have an impact healthcare facilities have an impact on criminal cases prosecuted in on criminal cases prosecuted in Massachusetts? Massachusetts?

Study DesignStudy Design

Retrospective-correlationalRetrospective-correlational

SurveySurvey Case typesCase types Evidence typeEvidence type Disposition of the evidenceDisposition of the evidence Case outcomesCase outcomes

Theoretical Model: Neuman’s Theoretical Model: Neuman’s Systems ModelSystems Model

Utilizing “a basic structure Utilizing “a basic structure of concentric rings” of concentric rings” (McEwen & Wills, p. 153, (McEwen & Wills, p. 153, 2007) Neuman places the 2007) Neuman places the person as the client/client person as the client/client system at the core system at the core

Protective rings Protective rings surrounding it providing surrounding it providing resistance and defense resistance and defense against environmental against environmental forces that would influence forces that would influence and impact the stability and impact the stability and wellness of the client. and wellness of the client.

AssumptionsAssumptions

Practice of health care professionalsPractice of health care professionals

Protocols & procedures of facilityProtocols & procedures of facility

Impact of protocols & proceduresImpact of protocols & procedures

Quality of evidenceQuality of evidence

Significance to NursingSignificance to Nursing

Development and Development and application of application of uniform forensic uniform forensic policy and policy and procedureprocedure

The masters-level The masters-level Forensic Nurse Forensic Nurse SpecialistSpecialist

History of the ProblemHistory of the Problem

Traditionally, evidence has been collected Traditionally, evidence has been collected by trained law enforcement personnel.by trained law enforcement personnel.

Increased social sensitivity to Increased social sensitivity to interpersonal violence over the last interpersonal violence over the last decades decades

Significantly shifted the responsibility for Significantly shifted the responsibility for evidence collection and its preservation to evidence collection and its preservation to healthcare providershealthcare providers

History of the ProblemHistory of the Problem

Methods used for the collection of Methods used for the collection of evidence and the maintenance of the evidence and the maintenance of the chain of custody are crucial to the chain of custody are crucial to the integrity of physical evidence that is integrity of physical evidence that is the basis of successful prosecution.the basis of successful prosecution.

Contamination and even disposal of Contamination and even disposal of key evidentiary matter can occur.key evidentiary matter can occur.

Synthesis of Synthesis of Literature/ResearchLiterature/Research

Many experts and studies have Many experts and studies have identified the lack of educational identified the lack of educational resources and/or uniform forensic resources and/or uniform forensic protocol and procedures in protocol and procedures in healthcare institutions as a healthcare institutions as a significant problem.significant problem.

Joint Commission recommendationsJoint Commission recommendations

Synthesis of Synthesis of Literature/ResearchLiterature/Research

Standard I. Assessment within the Standard I. Assessment within the standards of practice as established standards of practice as established by the American Nurses Association by the American Nurses Association (ANA)(ANA)

Emergency department nurses are Emergency department nurses are required to have specialized training required to have specialized training and education.and education.

York Hospital 2008 Pilot York Hospital 2008 Pilot StudyStudy

Level II trauma center in York, Level II trauma center in York, PennsylvaniaPennsylvania

Survey of 38 trauma and ICU nurses Survey of 38 trauma and ICU nurses on their knowledge of forensic on their knowledge of forensic practicepractice

York Hospital 2010 York Hospital 2010

Multidisciplinary team was Multidisciplinary team was assembled to develop a set of assembled to develop a set of evidence based guidelines for evidence based guidelines for forensic evidence collectionforensic evidence collection

Team was comprised of:Team was comprised of: an emergency physicianan emergency physician seven emergency nursesseven emergency nurses a master’s prepared forensic nursea master’s prepared forensic nurse a local forensic techniciana local forensic technician

Sexual Assault Nurse Examiner Sexual Assault Nurse Examiner (SANE) Program(SANE) Program

Demonstrates the successful impact Demonstrates the successful impact a uniform protocol and procedure a uniform protocol and procedure can provide between healthcare can provide between healthcare providers and prosecutorsproviders and prosecutors

Specialized trainingSpecialized training Quality and reliabilityQuality and reliability Impact on prosecutionImpact on prosecution

Research Design & MethodResearch Design & Method

Retrospective – historical look at both the proposed Retrospective – historical look at both the proposed cause and the proposed effect cause and the proposed effect

Correlational - examines the relationships among Correlational - examines the relationships among the variables included within a research study the variables included within a research study

Cases outcomes will be examined in relation to the Cases outcomes will be examined in relation to the protocols and procedures of evidence collection protocols and procedures of evidence collection employed by the healthcare professionals. employed by the healthcare professionals.

Therefore, the retrospective-correlational approach Therefore, the retrospective-correlational approach to this research study is appropriate.to this research study is appropriate.


Participant selectionParticipant selection InstrumentInstrument Protection of Human SubjectsProtection of Human Subjects SettingSetting Definition of Terms/VariablesDefinition of Terms/Variables


Data Collection:Data Collection: Online surveys completed via Online surveys completed via

Tigersurvey.comTigersurvey.com Results collected through weblink and Results collected through weblink and

protected by a secure method of protected by a secure method of encrytptionencrytption

Data Analysis:Data Analysis: Supervised by an experienced researcherSupervised by an experienced researcher SPSS softwareSPSS software

ResultsResults

Pending execution of the research Pending execution of the research studystudy

Limitations of StudyLimitations of Study

Lack of evidentiary researchLack of evidentiary research

Level of participationLevel of participation

Lack of knowledge and expertise in Lack of knowledge and expertise in the area of trauma situations in the area of trauma situations in health carehealth care

DiscussionDiscussion

Justice / RetributionJustice / Retribution

Treatment of Victim and/or Treatment of Victim and/or PerpetratorPerpetrator Same facilitySame facility Management of the forensic patientManagement of the forensic patient

Training/education/experience of the health Training/education/experience of the health care teamcare team

Direction of Future ResearchDirection of Future Research

Possible opportunities:

Need for more specialized forensic policy and procedure

Types of professional relationships

Questions ??Questions ??

ReferencesReferences

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Health & Medicine

The Need For Uniform Forensic Policies And Procedures In Healthcare