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Forensic Nursing 101

Forensic Nursing 101. Jennifer Johnson, RN, BSN, MSN, CRN, APRN. First worked for women health clinics, however, is primarily a crime lab nurse now. Through her own business, she does serve as an expert witness. The Forensic Nurse.

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Forensic Nursing 101

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  1. Forensic Nursing 101

  2. Jennifer Johnson, RN, BSN, MSN, CRN, APRN First worked for women health clinics, however, is primarily a crime lab nurse now. Through her own business, she does serve as an expert witness.

  3. The Forensic Nurse Provides direct services to individual clients, consultation services to nursing, medical and law related agencies, as well as providing expert court testimony in areas dealing with trauma and/or questioned death investigative processes, adequacy of services delivery and specialized diagnoses of specific conditions as related to nursing. Lynch, 1989

  4. Role Forensic examiners focus on establishing what is evidence, preserving the evidence and maintaining it in such a manner that when the time comes the evidence is impeachable. Our responsibility is to accurately recognize, identify and individualize an item of evidence, and provide clear and unambiguous report of what the evidence is, what it implies and how it relates to the matter at hand.

  5. Types of Forensic Nurses • Crime Lab • Morgue/Medical Examiners Office • Criminalists-Scene Investigation • Expert Witness • RN to Police Officer • RN to FBI Academy • RN to JD to Assistant Attorney/County Attorney • Death Investigators/Nurse Coroner • Legal Nurse Consultant • Forensic Psychiatric Nurses • Nurse Attorneys • SANE • Clinical Forensic Nurse • Correctional Nurses • Pediatric Forensic Nurses

  6. Forensic Patients • Elder Abuse • Child Abuse • Sexual Molestation • Physical Abuse • Physical Assault • Neglect • Sexual Assault-Adult and Adolescent, Pediatrics • Intimate Partner/Domestic Violence • Suspicious Injuries

  7. Types of injuries specific to abuse, assault or other criminal behavior: • Contusions • Abrasions • Fractures • Sprains • Stab wounds • Burns • Incision • Gun shot wounds • Multiple sites of injury • Injuries in various stages of healing • Repeated or chronic injuries • Injuries that are inconsistent with the history given

  8. The Forensic Science Perspective • It’s all about the evidence and finding the truth • You cannot go back to a crime scene/patient and collect the evidence at a later time • The evidence is what it is (un-biased) – this is why experts need to testify to explain the results and what it means to a jury • For DNA – is there a reasonable explanation as to how the DNA was deposited on the item or not? • Up to the 12 members of a jury to decide

  9. Locard’s Exchange Principle • Guiding principle to all evidence collection • You should expect physical evidence although it may be in quantities to small to detect • Contamination concerns

  10. Contamination:

  11. The Forensic Exam Where do I collect evidence from? What evidence do I collect? What did the victim tell me about the assault? What if the victim can’t remember?

  12. Known vs. Questioned Evidence • Known Evidence = of known origin • Standard reference samples (base line) – • Buccal Swabs • Known blood • Known hair • Questioned Evidence = of unknown origin • Samples collected from “crime scene” or body • Vaginal swabs • Pubic hair combings • Swabbing from suction injuries on neck • Human Bites

  13. KBI Sexual Assault Kit

  14. Photography What to photograph: • The goal is full-coverage photography • All evidence • All injuries • Everything relevant • Always take the three types of pictures • Overall • Medium range • Close-up

  15. What is missing?

  16. Woods lamp/Alternate light source

  17. Neat Semen 24 hours post-deposition on forearm of volunteer SBRofin FLARE PLUS ALS unit; JCCL Crime Scene Unit

  18. Neat Semen 24 hours post-deposition on forearm of volunteer RRRofin FLARE PLUS ALS unit, JCCL Crime Scene Unit

  19. Neat Semen and 1/10 dilutions on forearm of volunteerBurton Medial 31501; St. Luke’s Northland

  20. Semen Dilutions 1/20 and 1/40 on forearm of volunteer 4-6 hours post-depositionSpectroline BEA 160; Leavenworth SANE program

  21. 2012 2013 • 183 sexual assaults • 338 physical assaults • 122 intimate partner • 44 strangulation disclosures • 26 human bites • 66 weapons disclosures • 450 ETOH was involved • 273 KPRC Mandatory Reports • 65 Reports to Dept. of Aging • 685 patients total • 490 female • 148 sexual assaults • 281 physical assaults • 155 intimate partner • 54 strangulation disclosures • 18 human bites • 58 weapons disclosures • 398 ETOH was involved • 223 KPRC Mandatory Reports • 58 Reports to Dept. of Aging • 622 patients total • 435 female FACT STATS

  22. Drugs and Increasing Lethality

  23. Law Enforcement

  24. Jurisdictions Served

  25. 2012-450 in the US and 42 in Canada Kansas City Metro area SANE/Forensic Programs: Kansas Shawnee Mission Medical Center Kansas University Overland Park Regional Saint Luke’s South Children’s Mercy South Missouri COVERSA: Research, Ray County Liberty, Lees Summit Cass, Saint Joseph North Kansas City, Center Point, Belton Regional Saint Luke’s East, Midtown, North Truman Mercy Downtown

  26. Where do I even start?

  27. The Forensic Organizations • American Academy of Forensic Sciences • American Board of Criminalistics • American Board of Forensic Anthropology • American Board of Forensic Document Examiners • American Board of Medicolegal Death Investigators • American Board of Forensic Odontology • American Board of Forensic Toxicology • American Society of Crime Laboratory Directors (ASCLD) • American Society of Crime Laboratory Directors, Laboratory Accreditation Board (ASCLD/LAB) • American Society of Questioned Document Examiners • Association of Certified Fraud Examiners • Association of Firearms and Toolmarks Examiners (AFTE) • Association of Forensic Quality Assurance Managers • Association of Forensic Physicians • California Association of Criminalists (CAC) • Canadian Society of Forensic Science • High Technology Crime Investigation Association • International Association of Identification (IAI) • International Association of Bloodstain Pattern Analysis • International Association of Forensic Nurses • International Information Systems Forensics Association • International Society for Forensic Genetics • International Wound Ballistics Association • Midwestern Association of Forensic Scientists (MAFS) • National Forensic Science Technology Center • North East Association of Forensic Scientists (NEAFS) • Society of Forensic Toxicologists • Southern Association of Forensic Scientists • Southwestern Association of Forensic Scientists (SWAFS)

  28. Contact Information Jennifer Johnson, RN, BSN, MSN, CFN, APRN, SANE-A, SANE-P Shawnee Mission Medical Center Jennifer.johnson2@AHSS.org

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