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5/4/17
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ForensicNursingApplica1onofCriminalTrialTes1mony
JeniferMarkowitz
Acknowledgements
• SpecialthankstoSashaRu@zer,KimDay,JenniferPierce-WeeksandTaraHenrywhocontributedsomeofthiscontent.
Handouts
www.forensichealth.com/conference-handouts
Introduc1onandExpecta1ons
DiscussionPoints:
• Aspectsofdefensibleprac@ce• Founda@onsofnursingprac@ce• Readingandunderstandingresearch• Tes@mony• Defensetes@mony• Expertin@mida@on
Whatisadefensibleprac@ce?
• Onethatissupportedbyclinicalexperience,currentresearch,andacceptedprac@cestandards.
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KeyAspectsofaDefensiblePrac1ce
Twokeyques@ons:
• Howdoyouknowwhatyouknow?• Whydoyoudowhatyoudo?
Knowthestandards
• Knowtheprac@cestandards,protocolsandguidelinesthatinformyourprac@ce.• Befamiliarwithyourstatenurseprac@ceactandhowyourownprac@cefallswithinitsbounds.
Ownthefullpa@entencounter
• Themedical-forensicexambeginsattriageandendswhenthepa@entisdischarged.
• Pickingandchoosingtheaspectsofthepa@entencounteryouwanttobeinvolvedwithmayleaveyouvulnerable.
Don’tprac@ceinavacuum
• Aqualityassuranceprocessthatinvolvesanothertrainedindividualreviewingallofyourchartsandphotoswithiden@fiedbenchmarksiscri@cal.• Howelsedoyouknowyou’reperformingtherole
competently?
Embraceevalua@on
• ANA:professionalnursingprac@ceincludesevalua@on.
• Forensicnursesshouldbeevaluatedannually,specificallyinthatrole.
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Belongtoyourorganiza@on
• Considerwhichorganiza@onsetsthestandardsforprac@ceandguidelinesforeduca@oninyourfield.• Thisiswhereyouwillgetthebiggestreturnonyourinvestment.
Source:h\p://abc13.com/news/nurse-fired-over-man-vs-6-train-instagram-post/168345/
Whataresomegoodrulesforsocialmediauseasaforensicnurse?
Illustra@on:ChrisPiascik
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ReadingandUnderstandingResearch
ReadingandUnderstandingResearch
• Howcomfortableareyouinterpre@ngaresearchar@cle?
• Howcomfortableareyoudeterminingapplicabilityofar@clecontenttoaspecificcase?
• Howcomfortableareyouinterpre@ngtheoverallresearchunderlyingthebasisofouropinions?
Cri@callyReadingResearch
• Whatisaresearchar@cle?– “Apaperwri\enbyauthorswhoeithercollected
andanalyzedtheirowndata(primarydataanalysis),oranalyzeddatathathadbeencollectedbysomeoneelse(secondarydataanalysis).”
21RachelDunifonPh.D.,(2005)HowtoReadaResearchAr@cle,CornellUniversityCoopera@veExtension
Howisresearchgenerallypresented?
– Abstract– Introduc@on– Methods– Results– Discussion– Implica@onsforpolicyandprac@ce– Conclusion– References
Source:
PeerReviewedJournalvs.
ResearchBriefvs.Web
23RachelDunifonPh.D.,(2005)HowtoReadaResearchAr@cle,CornellUniversityCoopera@veExtension
Source:h\p://www.compoundchem.com/2014/04/02/a-rough-guide-to-spogng-bad-science/
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Knowledgeofliterature
• Youdonotneedtoknoweveryar@cleorbookwri\eninthisfield.• Youshouldknowandbefamiliarwiththewell-knownar@clesthatarefounda@onofyourtrainingandopinions.
Tes@fyingtoResearch
• Whathappensifyouareconfrontedwithresearchonthestand?– Whenit’sfromanar@cleyouhaveread?– Whenit’sfromanunfamiliarsource?
TESTIMONY
Tes@mony
• Tes@monyiswheredefensibleprac@ceistested.• Whathaveyoudonetomakesureyouarepreparedtoprovidethemosteffec@veandethicaltes@mony?
PreparingToBeanEffec1veWitness
1.)MaintainCurrency
• Whatdoyoudotomakesureyourknowledgebaseisascurrentaspossible?• Peer-reviewedjournals(e.g.JFN)• Con@nuingeduca@on(www.forensichealth.com)• Networkingwithcolleagues• Peerreview/QA/QI• Rou@neclinicalprac@ce
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2.)Analyzescien@ficsources
• Whatarethescien@ficsourcesyouuseandarethey:
• Currentwiththestateofthescience?• Scien@ficallysound?• Generallyacceptedasreliableamongtheprofession(e.g.adequatesamplesize;reproducibleresults)?
3.)Knowyourlimits
• Knowyourlimitsandconsiderhowtheywillimpactyourtes@mony:• Thinkaboutwhatyoucancomfortablysayand
whatyoumaynotbecomfortablesaying(andconveythatonprepwiththesubpoenainga\orney).• Canyoubackupyouropinionswiththescienceand/or
yourclinicalexperience?
4.)Tes@fytruthfully/accurately
• Acknowledgeerrorsinyourrecordorgapsinyourknowledge.• Donotmakethingsup;“Idon’tknow”isanacceptablesentence.
• Refrainfromspecula@on.• Don’tallowanyonetopressureyouintoprovidingtes@monyyoudon’tagreewithorareuncomfortablewith.
5.)Professionalism!
• Thelessprofessionalyouappear,thelessweightjurorswillgiveyourtes@mony.• Considerappearance,bodylanguage,and
choiceofwords.• Showupprepared.
• Professionalismextendsbeyondthecourtroom.
6.)KnowYourFounda@ons
• [email protected]:– Educa@on,regula@onandpolicythatsupportsyourprac@ce.
– Anyna@onal,stateandlocalprotocolsthatimpactprac@ce
– Agencypolicyandprocedure.
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7.)KnowYourTerms
• MedicalTerms(includinginjurydescriptors)• Scien@fic/prac@ceterms(e.g.evidence-basedprac@ce)
8.)Remember:Tes@monyisforever
• Priortes@monycanbeusedtoimpeachyouonthestand.
• Donottaketheexperiencelightly—prac@ceandprepare
• Dotheaoer-ac@onreviewsoyoulearnfromtheexperience
Yourjob
Teachingthejudgeorjurymembers.
Whatcons@tutesgoodtes@monytechnique?
Tes@monyissues
• Problemareas:– Inabilitytodefinebasicterms.– Inabilitytoar@culateclinicaldecision-making.– Strayingfromscienceorexperience.• Ifyou’regivinganopinion,itmustbesupportedbycurrentandcredibleresearchORbysufficientclinicalexperience.
Pretrialchecklist• Iden@fyelementsofyourprofessionaleduca@onand
experiencethatshouldbehighlightedforthejuryandconveythisinforma@ontothea\orneyduringpretrialprep.
• Reviewthecasefileandknowitwellenoughtohavethegeneraldetailsofthecasememorized.
• Iden@fytheresearchthatsupportsanyopinionsyouan@cipategivingonthestand;ifthereisopposingresearchonyouropinions,knowthat,too.
• Iden@fyanylapsesinprotocol,policyandprocedureandbepreparedtoexplainwhyifthereare.
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ANoteAboutBilling
• Peopleooenaskiftheycanbilltheprosecutors’officeiftheyareprovidingexperttes@mony– YES:Ifyouaretes@fyinginacaseinwhichyouwerenotatrea@ngclinicianorassociatedwiththepa@entinanyway.
– NO:ifyouwerethetrea@ngclinicianorassociatedwiththepa@entinanyway.
• Court@meshouldbecoveredbytheprogram.
InDefenseoftheDefense
Tes@fyingforthedefense
• TheroleoftheSANEisnotthatofprosecu@onwitness.– Whilethatisooenwhatweareaskedtodowhenwegotocourt,thereisnoreasontoshundefensework.
Tes@fyingforthedefense
• “Itmaybehelpfulfora\orneyscallingthem(bothprosecutorsanddefensea\orneys)tofirstdeveloprela@onshipswithcoordinatorsofexaminerprograms,iftheyexist,orstaffthatoverseeexaminersattheexamsite.”
• “Althoughitismostlikelythatexaminerswillbecalledbytheprosecu@on,theymayalsobecalledbythedefense.”
(Na@onalProtocolforSexualAssaultMedicalForensicExams)
Tes@fyingforthedefense
• Ablanketruleofrefusingtoprovidedefensetes@mony,orostracizingnurseswhoprovidedefensetes@monyul@matelyweakenstheen@reresponse.– Nurses’objec@vitycanbecalledintoques@on.– SANEtes@monygoeslargelyunchecked.
• Understandingtheapproachofeachsidecanenhanceanurse’stes@monyskillset.
Tes@fyingfortheDefense
• Thefirstques@onyoumustconsiderwhendecidingtododefensework:canIethically/scien@fically/experien@allygivethemwhattheywantmetoprovide?– Some@mestheanswerwillbeno.
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OpposingExpertIn@mida@on
TheOpposingExpert
• Easytosuccumbtoopposingexpertin@mida@on.– Usuallyself-created
• Par@cularlywhenyouarethetrea@ngclinician,defensemayobtainanexpertwhohasdonethislongerandhasgreaterprofessionalvisibility(becauseofeduca@on,professionalstandingorboth).
TheOpposingExpert
• Cri@calnottoviewyourtes@monyinthecontextofanyoneelse’san@cipatedtes@mony(remember:defenseexpertsdon’talwaystes@fy).
• Regardlessof*who*theexpertmaybe,nooneinthattrialknowsmoreabouttakingcareofthepa@entinthecasethanyou.
TheOpposingExpert
• Weneedtohelpa\orneysunderstandnursingisnotalesserincludedaspectofmedicine:
Source:AALNCPosi@onStatement,ProvidingExpertNursingTes@mony
INSUMMARY
Thebesttes@monyis…
• Plainlyworded• Simple• Concise• Peerreviewed
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Defensibleprac@ce
• Isanar@cula@onoftheen@retyofwhoyouareasanurse.– Whatallowsyoutodothiswork.– Whatguidesyourprac@ce.– Howyouknowyouareprovidingthestandardofcare.
– Whatformsthebasisofyouropinions.
Tes@mony
• Tes@monyistheplacewhereyoudiscoverjusthowdefensibleyourprac@ceis.• It’salsowhereyoulearnthattheconceptofdefensibleprac@ceisnotasta@cone.– Asthesciencechanges,sodoweasclinicians.– Aspoliciesandprotocolschange,sodoweasclinicians.
Q&A
