forensic nurse - Purchasing 101

Photographic documentation occurs at the crime scene, during medical examination of the patient, and in the lab. Whether employing the traditional film single lens reflex (SLR) camera or digital documentation, the key is learning simple techniques and making the most of photography as a valuable tool in the investigative and documentation process.

"For some reason when people put a camera up to their eye, they switch their brain off because it's an unfamiliar skill," says Patrick Besant-Matthews, MD, a forensic photography consultant. "The skilled professional scans the image with their eye before they push the shutter release and asks themselves, is the photo going to show what I want it to show?" It comes down to proper lighting, composition and viewpoint. "The single most important thing is to think before you push the shutter release," he says. "Think about what the tool is meant to do for you. You have got to show every detail. Drawing injuries on diagrams and making a photographic record may be the only proof remaining weeks later when the district attorney wants to push action against the responsible party. One of the huge hurdles in the medico-legal business is learning to document."

"Photography is only a part of forensic work. Documentation should be simple," says Ron Taniwaki of Nikon Forensic Services. Nikon's D100 single lens reflex is interchangeable with lenses and other accessories, which can be a lifesaver should the user encounter technical challenges."

The Polaroid Macro 5 SLR is a complete camera system for generating instant close-up photographs. Five built-in lenses provide all-in-one, single-unit portability with magnifications at 20, 40, 100, 200 and 300 percent. Convergent light beams show the user where to focus without looking through the viewfinder, allowing nurses to maintain eye contact with patients. Photos are automatically stamped with the date and time. The unit also features lighten/darken control, manual flash override, and accessory lens and filter attachments for increased flexibility. "What's great about an instant photo is the user can immediately see the result and determine if it is appropriate for future use, " says Kim Reingold of Polaroid. "In cases where criminal violence is suspected, vital forensic evidence may be lost unless photos are obtained. Those photos can corroborate -- or refute -- patient statements."

Although many think digital technology is new, it has been around for more than a decade. Some of the very first digital cameras were built on Nikon bodies in a joint venture with Kodak in the early s. Today, digital represents the next wave in photographic technology. An advantage of going digital is being able to view the image after the photo is taken to see if the composition, lighting and detail are acceptable. The quality of a digital image depends in part on the number of pixels used to create the image. More pixels add detail and sharpen edges. The size of a photograph is specified by its dimensions in pixels or by the total number of pixels it contains. "A lot of people get caught up in the pixel count, that more pixels is better, or make a better image," says Taniwaki. "That's only part of the story. It's the way you handle the information or the data. You can have a camera with many mega-pixels and if the data is processed poorly, then all you have is a lot of bad pixels." As a general rule, 3 million pixels will give you an excellent 5-by-7-inch print, and depending on your printing software can produce a good 8-by-10-inch print.

The Nikon Coolpix line is user-friendly, offers a wide range of accessories, and is compatible with Nikon SLR lenses. "You pick it up, turn it on, press the button," says Taniwaki. "The automatic exposure and automatic flash really do a great job, and the close-up capability is very easy to use. You don't have to buy a separate macro lens, because it's built into the camera." The Coolpix line also has a swivel feature, enabling the user to see the monitor from almost any angle."

A variety of institutions offer advanced education in forensic science and nursing. The Forensic Nurse Clinical Specialist track at Quinnipiac University in Connecticut prepares nurses to practice in a variety of healthcare settings. The curriculum meets the standards set by the American Nurses Association and the American Association of Colleges of Nursing and provides a sufficient number of hours of precepted practice.

"We believe this knowledge is essential if nurses are to meet the demands posed by the situations we are confronted with," says Barbara Moynihan, PhD, APRN, associate professor of nursing and director of the master's level forensic nursing program. "Forensic nurses will be called upon to be the experts in situations that involve mass disasters, terrorist attacks and the assessment and intervention in cases of sexual assault and intimate partner violence."

Mount Royal College offers a Forensic Studies Certificate of Achievement program as a general introduction to forensic science enabling professionals more able to collaborate in effective prevention, direction and treatment of victims and perpetrators of trauma, abuse, violence and neglect. The program offers credit-based training for professionals in healthcare, law enforcement, corrections and social work who seek to upgrade their credentials. It is designed for maximum flexibility to meet the needs of professionals who must study while they work.

Kaplan College has launched two new online programs for registered nurses: a Forensic Nursing Certificate and a Legal Nurse Consulting Certificate. Both programs are not for credit and are part of Health Care Pathways, a series of programs within Kaplan College's School of Continuing Education developed for healthcare professionals. The Forensic Nursing Certificate curriculum teaches skills in the legal, scientific and psychosocial aspects of forensic nursing. Students explore the scientific investigation and treatment of victims and perpetrators of abuse, violence, criminal activity, sexual assault and traumatic events. The attorney-instructed Legal Nurse Consultant Certificate curriculum trains RNs in legal principles and practices, civil litigation, torts and medical liability, medical records summary and review and healthcare risk management.

St. Louis University Division of Forensic and Environmental Pathology offers a four-day advanced-level conference designed to provide the veteran, trained medico-legal death investigator with the latest advancements in the forensic sciences. The Masters Conference is conducted every two years to provide a colloquium for those who wish to keep current in death investigation.

The five-day Medicolegal Death Investigator Training Course has been developed so that medical examiner/coroner's offices will have a basic training program available several times each year to their investigative staff. The course prepares investigators to conduct scientific and systematic scene and telephone investigations into deaths under the jurisdiction of a medico-legal office and then disseminate the investigative information to departmental forensic scientists to achieve a complete death inquiry.

Exami-Gowns, Inc. offers a specialty line of examination gowns designed to allow ease of examination while maintaining patient comfort and dignity. The OB/GYN gown is designed for modest examination of female patients by providing its own drape sheet built right into the front pleat. Because the gown has both front and back openings, examination is possible without disrobing the patient.

S.B.R. Medical manufactures an exclusive line of fluid-resistant scrubs, lab jackets and other garments made of breathable fabric with an antimicrobial finish that resists growth of gram negative, positive and fungi. "Bacteria gravitates to the lint that falls on the ground. That's where cross contamination can occur," says Rich Hensler of S.B.R. Medical. "All healthcare workers should be looking for protection," he adds.

The "ideal glove" is considered to be durable in use, a barrier to viruses and other pathogens, powder-free, low in latex proteins, low in residual chemicals and allows for optimum comfort and sensitivity. Latex hypersensitivity has become a concern among healthcare workers; those who have significant contact with latex gloves and other latex products are at risk of developing symptoms ranging from rashes, blisters and cracks in the skin to severe asthma, anaphylactic shock and even death. Nitrile gloves are a good synthetic alternative for latex-sensitive individuals, although they cost a bit more. Vinyl gloves are more suited for short-term, low-risk situations.

Best Manufacturing offers a wide variety of examination glove styles, all non-latex and powder free, featuring a beaded and rolled cuff. Best's N-Dex latex-free, nitrile disposable glove provides a latex alternative for puncture-resistant hand protection. N-Dex, made with Best's patented low-modulus formulation, helps reduce hand fatigue. Lola Johnston of Best recommends nurses check the quality level when purchasing medical-grade gloves. The FDA specifies an Acceptable Quality Level (AQL) of 4.0, meaning that four gloves out of every 100 could potentially have a pinhole and still pass standards for quality. The lower the AQL number, the higher the quality of glove. "We inspect our gloves to 1.5 AQL," says Johnston.

Regent Medical offers Biogel, a powder-free, polymer-coated surgical glove that is part of an entire line of powder-free, latex and non-latex medical gloves. Instead of powder, Regent uses a unique patented, polymer coating called Biogel to coat the glove and facilitate glove donning with either dry or damp hands.

To offer a powder-free quality alternative for every category of professional use, Ansell has developed a full range of powder-free examination gloves. "You certainly would not want a powdered glove for any kind of forensic work," says Jimmie McRay, RN, clinical consultant for Ansell. "Powder from the gloves can cause a false positive or a false negative in some of the analyses." Nelson Schlatter, technical applications chemist for Ansell, recommends their powder-free nitrile disposable gloves for forensic work. "They're very thin, which means if you're handling things like paint flakes, individual hairs or something like that at the crime scene, you'll have enough dexterity to get the job done." The gloves are thoroughly screened for use under critical clean conditions, so Schlatter says analytical forensic chemists will have an easier time because anything that they detect came from the crime scene isn't from the gloves.

"You want to make sure you aren't contaminating the samples you are picking up at the crime scene, or in an examination," says Wava Truscott, PhD, director of scientific affairs and clinical education for Kimberly-Clark. "Your gloves must be powder-free. Powder can lead to misdiagnosis and interfere with laboratory results, and can give you a false diagnosis for HIV." She recommends Kimberly-Clark's Safeskin line of powder-free, latex and nitrile gloves, and the PF Latex Surgical glove for sterile situations.

Hand hygiene is the single most important measure to prevent or reduce infections. Regent Medical manufactures Hibistat, a germicidal hand rinse containing a combination of alcohol and chlorhexidine gluconate (CHG), providing both immediate and persistent antimicrobial activity. "The addition of CHG in the formula allows Hibistat to continue to be effective, even after evaporation, unlike the majority of alcohol-based gels and rinses that lack persistent activity," says Rollie Kitchens of Regent Medical. Hibistat is latex compatible and was developed for repeated daily use.

In as little as 15 seconds, alcohol-based instant hand sanitizers like Gojo Industries' Purell Instant Hand Sanitizer kill 99.99 percent of most common germs that may cause illness. Purell is specially formulated to include moisturizers and is gentler on the hands than soap and water, making hand hygiene compliance significantly more practical. In addition to tabletop, cart and wall mounted dispensers, Purell is also wearable. Lanyards worn around the neck and retractable belt-clip dispensers make safe hand hygiene easily accessible. "The idea is to make it available where people need it," says Joe Drenik of Gojo. "If the clinician is wearing it, it's right there when they need it."

Dial Instant Hand Sanitizers are both fragrance and color-free. "In a healthcare environment, fragrance has two potentially negative impacts," says John Russell of Dial. "Perfume is often the ingredient in a hand hygiene product that causes skin irritation. Secondly, patients can often be nauseated by fragrance. Dyes in any hand hygiene product are also potentially skin-irritating."

Kimberly-Clark Professional has patented a new disposable dispenser called All-N-1. "The dispenser comes pre-loaded, you snap the unit on a wall bracket and when it's empty, you recycle it just like you would a milk carton," says Mark Fuglsang of Kimberly-Clark.

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