1. Forensic Evidence in Elder Mistreatment Cases
Module 9
Nursing Responses to Elder Mistreatment An IAFN Education Course
The course curriculum was developed by the International Association of Forensic Nurses (IAFN) under grant #2003-DD-BX-K006 from the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice.

2. Forensic Evidence
Part of an assessment of elder mistreatment (EM) may include collecting and preserving evidence of mistreatment on the patient’s body, clothing and/or bedding
Forensic evidence encompasses objects that can establish that a crime has been committed or can provide a link between a crime and its victim or a crime and its perpetrator
R. Saferestein, Criminalistics: An introduction to forensic science, 1998

3. Learning Objectives
By the end of this module, participants will be able to:
Discuss when evidence should be collected from patients in elder mistreatment cases and nursing roles in collection and preservation
Describe general strategies for evidence collection and preservation

4. Case: Mrs. Walker
Identify specific types of mistreatment occurring in case study and related needs of the patient
Do you think this case requires forensic evidence collection? If yes, why?
Who should be notified?
What effect do you think evidence collection might have on this case?

5. When to Collect Evidence
Case may have criminal elements
In course of an assessment, nurse sees or is told about possible physical signs of mistreatment on patient’s body, clothing and/or bedding
Vulnerable older adults present for health care and there are unexplained injuries
Consider time limits for obtaining evidence in light of specific case circumstances

6. Value of Forensic Evidence
Growing role for health care providers in last years in collecting, preserving and documenting forensic evidence
L. Stokowski, Forensic issues for nurses : Part 1. evidence collection for nurses, 2008

7. Nursing Roles
Nursing roles in evidence collection can vary depending on factors such as
Practice setting policies
Jurisdictional requirements
Type of mistreatment and circumstances of case
Experience/education of the nurse

8. Nursing Roles
If a forensic examiner is available, what do you think the general role of the attending nurse is?

9. Practice Setting Policies
Health facilities should have clear policies in place that direct nurses and other staff as to their responsibilities related to gathering, preserving and documenting forensic evidence and procedures for carrying out those responsibilities

10. Supplies and Materials
Health care staff should have access to supplies and materials they need to collect and preserve forensic evidence
Use of standardized pre-packaged evidence collection kits is common for some types of mistreatment (e.g., sexual assault/abuse)

11. Evidence Collection Kit

12. Law Enforcement Involvement
If there are signs of EM that suggest the need for forensic evidence collection, nurses should be aware of mandatory reporting requirements and procedures
In most jurisdictions, health facilities are required to notify law enforcement of suspected acts of EM that may be criminal in nature (gunshot wounds, domestic violence, etc.)

13. Questions
What do you currently do in terms of evidence collection, preservation and/or documentation when there are physical signs of EM?
Policies?
What is your role? Who else is involved?
Procedures and techniques?

14. Informed Consent
Explain to patient need for forensic evidence collection and what will be done
Ask patient for permission to collect evidence
Don’t do exam against will of patient
Law enforcement does not need to be in exam room when evidence is collected
Victim advocates or other support persons can accompany patients, if patients permit

15. Chain of Custody
Documentation of succession of persons responsible for evidence
Its purpose is to ensure there is neither alteration nor loss of evidence
Begins as soon as nurse locates physical evidence
L. Stokowski, Forensic nursing: Evidence collection for nurses: Chain of custody, 2008

16. Chain of Custody
Seal evidence bags/envelopes with tape; do not use staples
Label each item of sealed evidence
Patient's name
Description of item
Source of material
Name of person who collected item
Name of person who sealed evidence
Date and time it was collected and sealed
Names of those who release and receive evidence
Time it is transferred

17. Sealing and Labeling Evidence
Fold the bag over. Secure with tape. Label with a patient ID sticker, contents, source, your name, date and time. Then add transfer information.
Photos © Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

18. Sealing and Labeling Evidence
All envelopes used for evidence collection need to be sealed and labeled in a similar fashion
Photos © Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

19. Sealing and Labeling Evidence
Photos © Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

20. Storage of Evidence
Put sealed evidence containers into locked evidence storage locker and store until transfer to appropriate agency
Access to locked evidence restricted to trained/authorized supervisory staff who understand importance of chain of custody

21. Handling and Packaging of Evidence
Gloves should always be worn to prevent contamination of evidence
Practice setting/local procedures and type of evidence collected determines type of packaging used
Be familiar with practice setting/local procedures for wet evidence

22. Clothing Evidence
Clothing should be dried, placed on paper sheets to prevent cross contamination, and packaged in paper (not plastic) bags
Paper bags are air permeable. If there is any moisture (blood, body fluids and water), it will evaporate through paper, avoiding evidence destruction with mold and bacterial growth
Photos © Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

23. Clothing Evidence
Trace evidence on clothing and/or on patients may fall off while patient undresses
Whenever possible, have patient stand on two sheets/papers while patient is undressing

24. Clothing Evidence
To minimize cross-contamination, separate clothing on the drop sheet
Lay large items flat
Then individually place each item of clothing into a paper bag
Photos © Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

25. Trace Evidence on Body
If patient has debris (trace evidence), some of material should be collected and placed into clean and dry container before it is washed away
Place debris into clean container (e.g., envelope or sterile plastic cup)
Document when debris was collected, from where and by whom
Photos © Used with permission of Daniel J. Sheridan, PhD, RN. Do not reproduce photographs without permission.

26. DNA Evidence
DNA can be retrieved from blood, saliva and semen, as well as hair, hair follicles, bone, skin tissue, mucous membrane cells, and sweat
Since DNA from an individual is unique to that person, it can be used to positively identify person from whom the DNA was collected
States differ in terms of requirements for DNA evidence collection

27. Other Uses: Biological Samples
Biological samples may used to prove other issues besides contact between patient and suspect (e.g., to document presence of alcohol/drugs or STIs)
What procedures are used in your facility/community to collect these samples and maintain chain of custody?

28. Case Study Questions
Precautions evening shift nurse should take to prevent loss or contamination of evidence?
Where would forensic nurse look for potential sources of DNA evidence?
Other possible types of evidence to preserve?
What routine care for Ms. Smith should be avoided until evidence can be collected?
In light of your learning in this module, how should the evening shift nurse respond?

29. Closing Assessment
What have you learned from this module that you can apply to your practice setting?