Download Attachment SE2y, Maryland State Forensic Nurses Examiners

Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
TOPIC: Maryland State Forensic Nurse Examiner Training - Adult/Adolescent
EDUCATIONAL ACTIVITY OVERVIEW
OBJECTIVES
CONTENT (Topics)
TIME FRAME
PRESENTER
Learner-oriented with one,
measurable behavioral verb per
objective.
Outline of the content to be covered that
will enable the learners to meet their
objectives
State the time
frame for each
objective.
List the faculty or
content expert for
each objective.
Overview
1. Define FNE
2. Review research findings pre and post
FNE development.
3. Review the educational guidelines
established by the Maryland Board of
Nursing
30 minutes
Karen Jackson,
Memorial Hospital
Amanda CardoneLuyben, MCASA
Historical Perspective
of Forensic Nursing
1. Define Forensic Nursing
2. Identify types of forensic nursing
practice:
a. correctional,
b. death investigation,
c. sexual assault
d. interpersonal violence
assessment, etc.
• Child maltreatment
• Intimate Partner Violence
• Sexual Violence
• Youth Violence
• Elder/Vulnerable Adult Abuse
60 minutes
1. Participant will be able to
describe the roles and
responsibilities of the forensic
nurse examiner.
Debbie Holbrook,
Mercy
TEACHING
METHODS
EVALUATION
METHOD
Describe the teaching
methods, strategies,
materials, and resources
for each objective.
Lecture
PPT
Handouts
Describe how each
objective will be
evaluated
Text Books for the
program :
Medical Response to
Sexual Assault: A
Resource for
Clinicians and Related
Professionals (2011) by
Linda Ledray, Ann
Burgess, and Angelo
Giardino.
and
Atlas of Sexual
Violence (2013) Tara
Henry, Volume Editor
Lecture
PPT
Handouts
Participant evaluation
form
1
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
2. Participant will be able to
explain the process for obtaining
informed consent.
3. Participant will be able to
summarize the components for
performing the forensic history and
physical examination.
3. Discuss the development of forensic
nursing with the International
Association of Forensic Nurses
(I.A.F.N.)
4. Present the historical development of
SANE programs.
5. Discuss the history and development
of FNE programs in Maryland.
6. Current trends and national research
Overview of the Role and
Responsibility of the Forensic Nurse
1. Define the roles of the forensic nurse
examiner.
a. Review the IAFN Scope and
Standards of Practice.
b. Review the State Scope and
Standards of Practice
c. Process for obtaining informed
consent
2. Discuss each component of care of
the
a. physical and psychosocial
assessment.
b. the evidentiary examination
(medical/forensic interview,
evidentiary collection of specimens
and chain of custody)
c. Expert witness testimony to court
system
d. Fact witness testimony
e. Referrals to victims for follow up care
(private MD, HMO, or clinic for follow
up sexually transmitted diseases and
HIV testing)
f. Prevent and treat sexually
transmitted diseases and pregnancy
3. Discuss the components for
performing the forensic examination
step by step: components include
history, head to toe examination for
trauma identification, detailed genital
examination for trauma identification
and collection of evidence
4. Identify forensic nurse examiner role
with Maryland criminal code of sexual
assault.
5. Discuss Maryland criminal code
defining penetration.
120 minutes
Debbie Holbrook,
Mercy
Lecture
PPT
Handouts
Participant evaluation
form
Participant evaluation
form
2
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
4. Participant will be able to
identify the requirements for
clinical rotations.
5. Participant will be able to
describe how SANE/FNE
programs have reduced the
barriers individuals faced on
reporting a sexual assault.
45 minutes
Debbie Holbrook,
Mercy
Lecture
Handouts
Medical Forensic History
Demonstrate history taking skills
a. Evaluating mental status,
b. Behavioral observations and
interpretation of verbal and nonverbal communication of the patient
c. Reactions that the examiner may
encounter from individuals that
have been sexually assaulted
d. Documentation of others present
in the room
2. Demonstrate how to obtain and
document the patient’s history in a
non-leading manner.
3. Identify questions that need
exploration during the history taking
process; (decline vs. refuses,
subjective vs. objective and nurses
120 minutes
Debbie Holbrook,
Mercy & Joyce
Williams, DNP
Lecture
PPT
Handouts
Statistics, Myths and Barriers to
Reporting
1. Demonstrate knowledge of current
national and local statistics related to
sexual assault.
2. Discuss misconceptions associated
with sexual assault
3. Identify barriers for individuals
reporting sexual assault and discuss
how the barriers have been decreased
due to SANE/FNE programs.
4. Discuss differences in how males and
females are socialized to accept
sexual assault
5. Discuss research recommendations
related to forensic nursing.
6. Discuss quality assurance measure of
a sexual assault program.
60 minutes
Amanda CardoneLuyben, MCASA
Lecture
PPT
Handouts
Movie/Film
Psychological Reactions
1. Define rape trauma syndrome.
2. Describe acute and chronic symptoms
experienced by survivors.
3. Identify characteristics of survivors and
the process of healing and what
60 minutes
Amanda CardoneLuyben, MCASA
Lecture
PPT
Handouts
Movie/Film
Clinical Requirements
Review of required clinical rotations
Participant evaluation
form
Participant evaluation
form
3
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
4. Explain the natural reactions of sexual
assault patients and the appropriatetherapeutic response to clients.
5. Role of the Advocate
6. Participant will be able to
identify the variations of adult
genital anatomy and common
injuries seen in sexual assault
cases.
Head to Toe Assessment and
Documentation
1.Primary assessment- airway,
breathing, circulation/triage
2. Secondary assessment- detailed head
to toe assessment of any injury
a. Past/recent medical history
b. Head to toe examination for trauma
identification, includes oral
examination for injury assessment to
the lip, frenulum, inner aspects of
the lip, tongue and palate and
collection of forensic evidence
c. Review the physical anatomy of
both male and female:
1. Tanner Stages
2. Mons Pubis
3. Labia Majora
4. Labia Minora
5. Clitoris
6. Hymen
7. Penis
8. Scrotum
9. Anus
d. Detailed genital examination for
trauma identification and collection of
forensic evidence
3. Overview of injury documentation
4. Physician consultation as indicated
5. Define types of injuries most
commonly seen in victims of sexual
assault
a. Physical injuries
b. Genital injuries
120 minutes
Joyce Williams,
DNP
Lecture
PPT
Handouts
Review of Genital Anatomy
1. Discuss the genital anatomy and
development stages through the
lifespan.
2. Identify advanced genital examination
techniques:
a. Inspection
b. Separation
180 minutes
Joyce Williams,
DNP
Lecture
PPT
Handouts
Interactive Exercises
Participant evaluation
form
4
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
c. Traction
d. Knee chest
e. Foley catheter balloon technique
f. Toluidine Blue dye
h. Colposcope/Medscope
3. Identify techniques for the anal
examination of the sexual assault
client
a. Positioning patient for examination,
side lying position, knee-chest
position, lithotomy position
b. Visualization of the anal area
c. Anal dilatation techniques- gluteal
separation
4. Discuss types of common anal injuries
seen
5. Review controversy of the Human
Sexual Response
6. Demonstrate expert witness testimony
skills level. (Vaginal vs. vulva vs.
genital and anus vs. rectum)
Police Roles and Responsibilities
1. Define the role of the uniform officer
vs. the detective when responding to
the sexual assault patient
2. Review the police roles in response to
sexual assault cases
45 minutes
Sgt. Erika Heavner,
HCPD
Lecture
PPT
Handouts
Adult Genital Variations
1. Discuss normal variations found in
adult male and female patients
a. Surgical
b. Age-related changes
c. Dermatological variations
2. Discuss abnormal genital variations
found in adult male and female patient
a. Diseases
b. Non-sexually related trauma
3. Congenital
4. Female mutilation
5. Circumcised male vs. uncircumcised
male
60 minutes
Joyce Williams,
DNP
Lecture
PPT
Handouts
Characteristics of Sex Offenders
1. Review the human sex drive
2. Discuss types of sexual assaults
a. Stranger
90 minutes
Amanda CardoneLuyben, MCASA
Lecture
PPT
Handouts
Movie/Film
5
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
b. Acquaintance
c. Date rape
d. Intimate Partner
e. Internet/computer crimes
3. Define the four phases of a sexual
crime:
a. Antecedent/Fantasy
b. Victim selection
c. Commission of the crime
d. Post offense behavior of the
perpetrators
4. Discuss approaches commonly used
by perpetrators (con, blitz, surprise)
5. Review rapist typologies of sex
offenders:
a. Power reassurance
b. Power assertive
c. Anger retaliatory
d. Anger sadistic
e. Gang
6. Review actual case studies of victims
and their offenders.
7. Participant will be able to outline
the various identities and roles of
the members of the multiple
disciplinary team (SART).
Multidisciplinary
Team Concept
1. Define the multiple discipline team
(SART) concept.
2. Identify members of the
multidisciplinary team (sexual assault
nurse examiners, law enforcement,
rape crisis staff, judicial staff and adult
and child protective services)
3. Discuss the roles of the members of
the team.
Trauma Identification
1. Review types of trauma seen in
patients of sexual assault
a. Blunt
b. Sharp
c. Penetrating
2. Discuss mechanisms of injuries,
documenting trauma of patients of
sexual violence.
3. Describe techniques utilized by the
nurse examiner for assessing,
identifying and documenting trauma in
patients of sexual violence.
a. Gross visualization
60 minutes
Amanda CardoneLuyben, MCASA
120 minutes
Debbie Holbrook,
Mercy
Lecture
PPT
Handouts
Movie/Film
Interactive Exercises
Participant evaluation
form
Lecture
PPT
Handouts
6
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
8. Participant will be able to define
the role of the police in response
to sexual assault and the two
elements of crime necessary for
the charge of rape.
b. Toluidine Blue dye application
c. Colposcope/medscope
magnification
d. Use of alternate light sources
(infrared, wood's lamp)
e. Photographic documentation
4. Discuss patterns of injuries
a. Injuries in various stages of
healing
5. Patterned injuries
a. Ligature marks
b. Foot prints
Continuum of Care Referrals
And Discharge Instructions
1. Continuum of Care
a. Review the initial sexual assault
process
b. Ongoing medical care
c. Referrals
d. Local Health Department
e. Follow up with physicians
f. Resource/Advocacy/ Counseling
centers
g. Discharge Instructions
2. Review samples of current
documentation
3. Discuss civil legal services for victims
Sexual Assault and Intimate
Partner Violence
1. Define intimate partner violence (IPV)
2. Describe the dynamics of abusive
relationships.
3. Identify physiological and behavioral
signs and symptoms of intimate
partner violence.
4. Identify barriers that prevent victims
from leaving abusive relationships
Judicial System and Laws
1. Give 2 elements of crime necessary
for a charge of rape
2. Discuss what constitutes sexual
abuse
3. State the order of proof in a criminal
trial
4. Discuss the rules of testifying as an
expert witness
60 minutes
Debbie Holbrook,
Mercy
Lecture
PPT
Handouts
120 minutes
Jennifer Morton,
MNADV and
Audrey Bergin,
Northwest Hospital
Lecture
PPT
Handouts
90 minutes
Jabeen Reza, Esq.,
Sexual Assault
Legal Institute
Lecture
PPT
Handouts
Participant evaluation
form
7
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
9. Participant will be able to
explain the techniques for specific
types of evidence collection,
preparation, and preservation of
specimens in sexual assault
cases.
Special (Underserved) Populations
1. Identify special populations of sexual
assault and their special needs
a. Physically or mentally challenged
b. Ethnicity
c. Non English speaking
d. Elderly
e. Male
f. Same sex/transgender
g. Cultural barriers
(taught in a special course)
Introduction to the Sexual Assault Kit
1. Review various kits
a. victim
b. suspect
2. Discuss contents and paperwork in
the kit that the examiner will be
utilizing in evidentiary examinations.
Evidence Collection and
Preservation
1. Demonstrate the technique step by
step for evidence collection of the
sexual assault client (video)
2. Review types of specimens collected
based on gender and orifice
penetrated. (Perioral, oral, perivaginal,
vaginal, endocervical, perianal and
anal orifices will be reviewed in the
video)
3. Discuss use of the ultraviolet light
source in use of evidence collection
4. Establish need to properly package
and prepare specimens collected.
a. Physical findings
b. Clothing evidence
c. Hair evidence
d. Bite mark evidence
e. Fingernail scrapings
f. Fluoresced exudates
g. Foreign material
h. Blood splatters
5. Review preservation and integrity of
the evidence:
a. Physical findings
b. Clothing evidence
c. Hair evidence
d. Bite mark evidence
e. Fingernail scrapings
60 minutes
Amanda CardoneLuyben, MCASA
Lecture
PPT
Handouts
60 minutes
Kathy LeComte,
FMH
Lecture
PPT
Handouts
Interactive Exercises
150 minutes
Kathy LeComte,
FMH
Lecture
PPT
Handouts
Video
Interactive Exercises
Participant evaluation
form
8
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
f. Fluoresced exudates
g. Swabs (perioral, oral, perivaginal
vaginal, endocervical, penile,
perianal anal and other dried body
fluids)
h. Whole blood specimen in lavender
top tube with EDTA preservative –
Transfer the FTA blood care,
check expiration date on blood
tube
i. Saliva specimens
j. Toxicology blood/urine screen
k. Electronic data & image
management
6. Explain purpose of laboratory tests
performed and the impact they have
on sexual assault cases.
a. Serum pregnancy
b. Serum alcohol
c. Urine toxicology/serum toxicology
d. STIs
e. Hepatitis B
f. HIV
g. Drug Facilitated Sexual (DFSA)
Assault
Documentation and Impact on
Testimony
1. Maintaining congruency between
evidence collection, documentation,
and medical forensic history
a. Forensic history
b. Body maps/diagrams
c. Injury documentation
d. Photography
e. Exam findings
2. Rape Shield doctrine according to
Maryland Law
3. Detailed documentation process
including:
a. Objective vs. Subjective
b. Negative documentation vs.
positive documentation
c. Detailed narrative vs. checklist
Defining the Expertise of the FNE
1. Discuss the laws specific to the
protection of children reporting sexual
child abuse and how they relate to the
expertise of the FNE examiner
120 minutes
Kathy LeComte,
FMH
Lecture
PPT
Handouts
45 minutes
Kathy LeComte,
FMH
Lecture
PPT
Handouts
9
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
2. Learn how to list educational
accomplishments
3. Describe the didactic and clinical
components for FNE recognition
4. Describe the difference between a fact
witness and an expert witness
Suspect Examination
1. Identify the purpose:
a. Caring for the suspect as a
patient.
b. Examination and evidence
collection
2. Consent Versus Search Warrant
a. financial considerations
b. medical examination
c. evidence collection
3. Security/Law Enforcement
a. Law enforcement presence
b. Documenting all persons
present in room
c. Documenting personnel
performing exam
d. avoiding contact between
victims/suspect
4. Locard’s Principle
5. Trauma Identification, Evidence
Collection & Preservation to include
but not limited to:
a. Photographs
b. Body mapping
Crime Lab Trace Analysis
1. Identify types of trace analysis
evidence specific to sexual assault
cases
a. DNA
b. CODIS (Combined DNA Index
System)
2. Describe techniques and procedures
for trace analysis evidence.
3. Discuss challenges related to the
evidence gathering process, including
the evidence integrity and chain of
custody.
a. Evidence gathering process
b. Evidence labeling process
c. Documentation
d. Cross contamination
45 minutes
Kathy LeComte,
FMH
Lecture
PPT
Handouts
90 minutes
Julie Kempton,
Maryland State
Police
Lecture
PPT
Handouts
Movie/Film
10
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
10. Participant will be able to
identify current
recommendations for
treatment of STIs and the side
effects associated with morning
after therapy for the risk of
pregnancy.
Sexually Transmitted
Infections and
Pregnancy
1. Discuss STIs and pregnancy exposure
for sexual assault patients
2. Describe current recommendation for
treatment for STIs:
a. CDC recommendations
b. Chlamydia
c. Gonococcal infections
d. Syphilis
e. Bacterial Vaginosis
f. Hepatitis
g. HIV/AIDS
1. Pro
2. Cons
3. Reportable diseases to Health
Department and DHMH regional
regulations
4. Discuss pregnancy risk and morning
after therapy and side effects of
commonly prescribed medications
5. Practicalities of STI Testing
a. who gets tested
b. sampling and test selection
6. Overview of side effects of commonly
prescribed STI medication
90 minutes
Pam Holtzinger,
Meritus
Lecture
PPT
Handouts
Drug Facilitated
Sexual Assault
1. Discuss the incidence of substance
abuse and relationship to sexual
assault
2. Identify types of substances abused.
3. Discuss date rape drugs
4. Review current drug testing utilized.
60 minutes
Pam Holtzinger,
Meritus and
Amanda CardoneLuyben, MCASA
Lecture
PPT
Handouts
Mock Courtroom
Testimony
1. Review a simulation of actual court
proceedings that include all parties
involved
2. Witness and exert being cross
examined
150 minutes
Renee BattleBrooks, Esq.,
Prince George's
County State's
Attorney's Office
Interactive Exercises
Participant evaluation
form
11
Attachment SE2y, Maryland State Forensic Nurse Examiner Training Adult Adolescent Educational Activity Overview
11. Participant will be able to
predict what to expect when
giving witness testimony in the
courtroom.
Courtroom Testimony and
Application of the Medical
Forensic and Personal Protection
1. Discuss what to expect when you go
into a Courtroom
2. Discuss preparation for court
3. Review of medical/forensic history
taking process
4. Apply the process to the expert
witness testimony in courtroom.
5. Apply the process to the fact witness
testimony in courtroom
6. Apply courtroom testimony with
exception to hearsay ruling for RN,
FNE
90 minutes
Pam Holtzinger,
Meritus
Lecture
PPT
Handouts
Participant evaluation
form
12