Module 10 Nursing Responses to Elder Mistreatment An IAFN Education Course

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Module 10Nursing Responses to Elder
MistreatmentAn IAFN Education Course

• Photo-Documentation in Elder Mistreatment Cases

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Learning Objectives

• By end of this module, participants will be able
  to
• Discuss cases in which photo-documentation of
  findings is appropriate
• Describe nursing roles in photo-documentation
• Describe how to photograph findings using basic
  forensic techniques and document photographic
  images on body maps

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Case Study Questions

• Do you think photographic images are necessary in
  this case? Why? If so, what specific images would
  you document?
• What are your practice setting procedures for
  taking forensic photographic images? How would
  your procedures play out in this case?
• Is consent needed to take photographic images in
  this case? How might it be obtained?
• Does photo-documentation become part of the
  health record? If not, where are photographs
  stored?

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Photo-Documentation Purposes

• Photo-documentation in elder mistreatment (EM)
  cases can supplement written documentation
• Photographic images can often give life to
  patient history and findings from an EM
  assessment
• Blue Cross Blue Shield of Michigan et. Al, Reach
  out, intervening in domestic violence and abuse
  The health care providers reference guide to
  partner and elder abuse, 2007

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What Happens to Photographs?

• Photographic images become part of the patient
  medical record. They may also become part of
  evidentiary reports
• Medical photos can be subpoenaed and presented in
  court as evidence

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Who Should Take Photographs? How?

• Every health facility needs policies and
  procedures to determine how photographs are to be
  taken and by whom, as well as how to store
  photographs and copy digital images
• Staff nurse?
• Other staff?
• Forensic nurse examiner or medical photographer?

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Digital Cameras

• Digital cameras are rapidly replacing 35 mm
  cameras. There are many digital cameras on the
  market
• Facilities should have a fully functioning camera
  available at all times with charged batteries and
  ample memory on memory card or CD-ROM

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Consent to Photograph

• Explain to the patient or his/her guardian why
  you would like to take photographs, procedures to
  take and store photographs, and potential uses of
  photographs
• A signed consent by the patient or his/her
  guardian is required to take photographs
• P. Gray-Vickrey, Recognizing Elder Abuse, 1999

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Basic Techniques

• True/accurate representation of a wound
• Use of measurement scales
• Rule of thirds
• Labeling photographic images
• Storing images in medical record
• Timing of photographing wounds/evidence

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1. Accurate Image

• Obtain a true and accurate image of what was seen
  upon examination and treated on the day of the
  exam
• Be familiar with camera functions that control
  lighting

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2. Use of Scales

• A measurement scale should be included in each
  photograph to indicate approximate size of injury
• Commonly used scales standardized rulers, coins
  and pencils
• Ensure that the injury is clearly visible along
  with the scale

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Common Forensic Photography Scales
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ABFO Standardized Rulers

• The American Board of Forensic Odontologists
  (ABFO) has developed a standardized right angle
  ruler recommended for known or suspected bite
  injuries
• The right angle scale can be used in any image

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3. Rule of Thirds

• Photographs should be taken using a forensic
  photography technique called rule of thirds
• Start with a front-facing, full-body photograph
  of patient
• Photographs of each injured area should be taken
  from three different distances
• 6 feet
• 4 feet
• 2 feet

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4. Labeling Images

• All photographic images must be properly labeled
  with the following information
• Patient name
• Date of birth and ID number
• Facility name
• Date and time photograph is taken
• Photographers name
• Location of wound
• Case number (if assigned)

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Labeling Images

• Most software for digital cameras permits words
  to be superimposed directly onto an image
• To limit words on an image, include patient
  information in the first and last photo taken to
  ensure accurate case identification. Then other
  photos can just include location of the wound

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Labeling Photographic Images
Multiple pressure ulcers to left lateral calf,
left heel, left foot and right foot
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Labeling Images

• If and when photos of wounds are printed, never
  write directly on the back or front of prints
• If information is not imposed on an image using
  computer software, printed photographs can be
  labeled using 2 x 4 shipping labels

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5. Documentation

• Digital images can be labeled, burned onto a
  non-rewriteable CD-ROM, stored in the medical
  record and then printed as needed. Alternately,
  images can be printed multiples to a page and
  placed in the record along with the CD-ROM.
• Medical photos can be combined with medical
  records by printing digital images on a blank
  facility progress form or taping photographs on
  facility progress forms

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6.Timing

• When possible, take pictures of wounds prior to
  and after treatment
• When there is physical evidence, photograph
  evidence where it was found on body and/or
  clothing
• Take follow-up photographs as needed if there is
  ongoing contact

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Body Maps

• Every time nurses take photographic images of a
  patient, they should also document wounds on a
  pre-printed body map/diagram, noting-
• Area of body
• Type of injury
• Size of injury

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Example Body Diagram

• 1 Right lateral hip 2X2 cm bruise
• 2 Left medial thigh 2X4 cm bruise
• 3 Right lateral lower leg 2X4 cm abrasion

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Closing Assessment

• What have you learned from this module that you
  can apply to your practice setting?