Evidence-based Practice in Forensic Nursing: A Collaborative Effort

Transcription

1 Evidence-based Practice in Forensic Nursing: A Collaborative Effort

2 Kelli Eldredge, RN, MSN, CCRN, SANE-A Clinical Nurse III, Clinical Educator Sexual Assault Forensic Examiner Emily Huggins, RN, BSN, MHA, CEN, SANE-A, SANE-P Sexual Assault Forensic Nurse Program Coordinator

3 Objectives Discuss the collaborative Evidencebased practice (EBP) project between baccalaureate nursing students and nursing clinicians in a community hospital setting. Determine the best practice to identify trace DNA using an alternate light source (ALS) versus the Wood s lamp in sexual assault forensic examinations.

4 Background Forensic clinicians should address both legal and medical needs of sexual assault victims to provide the best patient care Ability to correctly identify and collect DNA evidence improves patient outcomes and prosecution rates

5 Alternate Light Source

6 Alternative Light Source Light is energy Wave theory: light energy moves through space and each specific color of light has a wavelength (like the ocean distance between wave peaks)

7 Alternative Light Source Fluorescence: an optical phenomenon wherein a material emits light in response to external stimulus A specific color or group of color is released when material is bombarded with light form another part of the color spectrum

8 Frequencies

9 Practice issue Alternate light sources may be useful as a tool in conjunction with patient history to the collection of routine swabs for locating trace DNA evidence on sexually assaulted patient Current practice is inconsistent in the use of a Wood s lamp versus other alternate light sources to identify potential DNA evidence

10 Collaboration Identify nursing clinicians interested in EBP project by blast Present didactic class to nursing clinicians before the semester begins Present didactic classes on EBP to nursing students as a regular class session Group nursing students according to clinical interest

11 Collaboration Identify the problem and narrow the practice question using the PICO framework Discuss the reference list and prioritize the most relevant literature Develop practice recommendations based on the strength and quality of the evidence Present a poster of each project.

12 JHN Evidence-based Practice Conceptual Model Practice Internal Factors Cultural Environment Equipment/Supplies Staffing Effectiveness Standards Research Experimental Quasi-experimental Non-experimental Qualitative Non-Research Organizational experience - Quality improvement - Financial data Clinical expertise Patient preference External Factors Accreditation Core Measures Legislation Licensing Standards Regulations Magnet Education The Johns Hopkins Hospital/ The Johns Hopkins University Research

13 Evidence Based Practice (EBP) Process Practice Question, Evidence, Translation (PET) Practice Question Evidence Translation

14 EBP The Process Practice Question How do I construct an answerable question? Try PICO approach* P Patient, population or problem (age, sex, patient setting) I Intervention (treatment, medications, education, diagnosis) C Comparison with other treatments (may not always be applicable) O Outcome (anticipated) *Richardson et al. (1998)

15 Practice Question Practice Question P- Reported sexual assault patient I- Use of Wood s lamp/alternate light source C- Comparison between Wood s lamp and alternate light source O- Positive identification of trace biological evidence

16 Practice Question Practice Question Does the Wood s lamp/alternate light source positively identify trace biological evidence containing DNA on patients reporting sexual assault? What is the best alternate light source to identify trace biological evidence containing DNA?

17 Evidence Key Words Evidence-based practice Alternate light source Forensic nursing Collaboration Nursing education Data Sources PubMed CINAHL National Clearing House Guidelines Google Scholar National Criminal Justice Reference Service

18 Results Evidence Strength Level I- no articles Level II-seven articles Level III- no articles Level IV-one article Level V-no articles Quality N/A Good/High N/A Good N/A

19 Key Findings Evidence Wood s lamp ineffective at distinguishing semen from other stains Optimal fluorescence of semen at longer wavelengths: >450nm Best to rely on victim s account when collecting swabs: ALS should be used as an adjunct tool Education improves accuracy of identifying semen with ALS

20 Recommendations Translation 1. Eliminate use of the Wood s lamp 2. Purchase an ALS that provides appropriate wave length to detect DNA 3. Educate forensic nurse clinicians on use of ALS and its advantages and limitations 4. Conduct more research

21 Translation Apply for grant for new alternate light source Develop new policy Educate forensic nurses Compare data from crime lab to determine if use of ALS improved confirmation of trace DNA

22 Conclusion Innovative strategy to benefit both nursing students and nursing clinicians Reduction of anxiety for clinicians and students in completion of EBP project Practical use of an academic exercise: exercise can actually be translated into clinical practice

23 Evidence Based Practice This was a win-win opportunity, the SAFE team could find the answer to our question with the help of the students and the students were exposed to forensic nursing and practice issues Emily Huggins, RN, BSN, MHA, SANE-A, SANE-P Sexual Assault Forensic Examiner Program Coordinator

24 Evidence Based Practice At the beginning of the project I was a little apprehensive to the project and how much our research would actually help to change protocol and your procedure at York Hospital. But after we met and we had done some research, I truly enjoyed doing the project and learning about the subject as a whole.. I actually think this project gave me a new interest in SAFE nursing and that I will look into it when I step out into the real world. Mary Kathleen Berease York College of Pennsylvania Nursing Major

25 I think it s a very useful exercise to bring students and nurses together in the conduct of EBP. Projects with focused, narrow questions are easier to complete. I see it as a win-win. Nurses are able to identify meaningful practice issues and students learn the value of basing their practice on strong evidence. Linda Pugh, PhD, RNC, CNE, FAAN, Professor NUR 314 Research and Professional Nursing Practice York College of Pennsylvania

26 What a great experience for our students to partner with working nurses on real clinical projects! The students benefit and patient care benefits and the nurse s commitment to lifelong learning and professional growth is renewed. Deborah Barton, MS, RN Nursing Laboratory Coordinator York College of Pennsylvania

27 Questions??

28 References Alternate Light Source Analysis. World of Forensic Science. Ed. K.Lee Lerner and Brenda Wilmoth Lerner. Gale Cengage, Retrieved April 1, 2010 from Breeding, K. (2008). The basic theory behind alternate light sources. Evidence Technology Magazine, 6(1), Campbell, R. (2004, November). The Effectiveness of Sexual Assault Nurse Examiner Programs. Harrisburg, PA: VAWnet, a project of the National Resource Center on Domestic Violence/Pennsylvania Coalition Against Domestic Violence. Retrieved month/day/year, from: Carter-Nell, C. & Soltys, K. (2005). Forensic ultraviolet lights in clinical practice: Evidence for the evidence. The Canadian Journal of Police & Security Services, 3(2),

29 References Gabby, T., Winkleby, M., Boyce, W., Fisher, D., Lancaster, A., & Sensabaugh, G. (1992). Sexual abuse of children: The detection of semen on skin. American Journal of Diseases of Children, 146, Identification of semen (n.d.). Retrieved September 9, 2008 from Lincoln, C., McBride, P., Turbett, G., Garbin, C., & McDonald, E. (2006). The use of an alternative light source to detect semen in clinical forensic medical practice. Journal of Clinical Forensic Practice, 13, Lynch, V. Forensic Nursing. Elsevier Mosby, St. Louis, MO Marshall, S., Bennett, A., & Fraval, H. (2001). Locating semen on live skin using visible fluorescence. Rofin Australia Property Limited. Retrieved September 24, 2008 from

30 References McGraw, D. (2005). New LED s enable innovations in forensic alternative light sources. Forensic Magazine. Retrieved September 24, 2008 from Morris, A. (n.d.).what is fluorescence and how do the lights work. Not published Nelson, D. & Santucci, K. (2002). An alternate light source to detect semen. Academy of Emergency Medicine, 9(10), Santucci, K., Nelson, D., McQuillen, K., Duffy, S. & Linakis, J. (1999). Wood s lamp utility in the identification of semen. Pediatrics, 104(6), Vandenberg, N. & VanOorschot, R. (2006). The use of polilight in the detection of seminal fluid, saliva, and bloodstains and comprison with conventional chemical-based screening tests, Journal of Clinical Forensic Medicine, 51(2), Wawryk, J. & Odell, M. (2005). Fluorescent identification of biological and other stains on skin by the use of alternative light sources. Journal of Clinical Forensic Medicine, 12,