iafn testimony presentations 2016 - forensic health
TRANSCRIPT
8/26/16
1
ForensicNursingApplica1onofCriminalTrialTes1mony
JeniferMarkowitz
Acknowledgements
• SpecialthankstoSashaRu@zer,KimDay,JenniferPierce-WeeksandTaraHenrywhocontributedsomeofthiscontent.
Introduc1onandExpecta1ons
8/26/16
2
DiscussionPoints:
• Aspectsofdefensibleprac@ce• Founda@onsofnursingprac@ce• Readingandunderstandingresearch• Tes@mony• Defensetes@mony• Expertin@mida@on
Whatisadefensibleprac@ce?
• Onethatissupportedbyclinicalexperience,currentresearch,andacceptedprac@cestandards.
KeyAspectsofaDefensiblePrac1ce
8/26/16
3
Twokeyques@ons:
• Howdoyouknowwhatyouknow?• Whydoyoudowhatyoudo?
Knowthestandards
• Knowtheprac@cestandards,protocolsandguidelinesthatinformyourprac@ce.• Befamiliarwithyourstatenurseprac@ceactandhowyourownprac@cefallswithinitsbounds.
Ownthefullpa@entencounter
• Themedical-forensicexambeginsattriageandendswhenthepa@entisdischarged.• Pickingandchoosingtheaspectsofthepa@entencounteryouwanttobeinvolvedwithmayleaveyouvulnerable.
8/26/16
4
Don’tprac@ceinavacuum
• Aqualityassuranceprocessthatinvolvesanothertrainedindividualreviewingallofyourchartsandphotoswithiden@fiedbenchmarksiscri@cal.• Howelsedoyouknowyou’reperformingtherole
competently?
Embraceevalua@on
• ANA:professionalnursingprac@ceincludesevalua@on.• Forensicnursesshouldbeevaluatedannually,specificallyinthatrole.
Belongtoyourorganiza@on
• Considerwhichorganiza@onsetsthestandardsforprac@ceandguidelinesforeduca@oninyourfield.• Thisiswhereyouwillgetthebiggestreturnonyourinvestment.
8/26/16
5
Source:h]p://abc13.com/news/nurse-fired-over-man-vs-6-train-instagram-post/168345/
8/26/16
6
Whataresomegoodrulesforsocialmediauseasaforensicnurse?
Illustra@on:ChrisPiascik
ReadingandUnderstandingResearch
8/26/16
7
ReadingandUnderstandingResearch
• Howcomfortableareyouinterpre@ngaresearchar@cle?
• Howcomfortableareyoudeterminingapplicabilityofar@clecontenttoaspecificcase?
• Howcomfortableareyouinterpre@ngtheoverallresearchunderlyingthebasisofouropinions?
Cri@callyReadingResearch
• Whatisaresearchar@cle?– “Apaperwri]enbyauthorswhoeithercollected
andanalyzedtheirowndata(primarydataanalysis),oranalyzeddatathathadbeencollectedbysomeoneelse(secondarydataanalysis).”
20RachelDunifonPh.D.,(2005)HowtoReadaResearchAr@cle,CornellUniversityCoopera@veExtension
Howisresearchgenerallypresented?
– Abstract– Introduc@on– Methods– Results– Discussion– Implica@onsforpolicyandprac@ce– Conclusion– References
8/26/16
8
Source:
PeerReviewedJournalvs.
ResearchBriefvs.Web
22RachelDunifonPh.D.,(2005)HowtoReadaResearchAr@cle,CornellUniversityCoopera@veExtension
Source:h]p://www.compoundchem.com/2014/04/02/a-rough-guide-to-spogng-bad-science/
Knowledgeofliterature
• Youdonotneedtoknoweveryar@cleorbookwri]eninthisfield.• Youshouldknowandbefamiliarwiththewell-knownar@clesthatarefounda@onofyourtrainingandopinions.
8/26/16
9
Tes@fyingtoResearch
• Whathappensifyouareconfrontedwithresearchonthestand?– Whenit’sfromanar@cleyouhaveread?– Whenit’sfromanunfamiliarsource?
TESTIMONY
Tes@mony
• Tes@monyiswheredefensibleprac@ceistested.• Whathaveyoudonetomakesureyouarepreparedtoprovidethemosteffec@veandethicaltes@mony?
8/26/16
10
PreparingToBeanEffec1veWitness
1.)MaintainCurrency
• Whatdoyoudotomakesureyourknowledgebaseisascurrentaspossible?• Peer-reviewedjournals(e.g.JFN)• Con@nuingeduca@on(www.forensichealth.com)• Networkingwithcolleagues• Peerreview/QA/QI• Rou@neclinicalprac@ce
2.)Analyzescien@ficsources
• Whatarethescien@ficsourcesyouuseandarethey:
• Currentwiththestateofthescience?• Scien@ficallysound?• Generallyacceptedasreliableamongtheprofession(e.g.adequatesamplesize;reproducibleresults)?
8/26/16
11
EXERCISE
• AlternateLightSourcear@cle• Pleasereadthear@cleandmakenoteofwhatyouthinkitsstrengthsandweaknessesare.
• Wewilldiscussthear@cleasagroupwheneveryoneisdone.
3.)Knowyourlimits
• Knowyourlimitsandconsiderhowtheywillimpactyourtes@mony:• Thinkaboutwhatyoucancomfortablysayand
whatyoumaynotbecomfortablesaying(andconveythatonprepwiththesubpoenainga]orney).• Canyoubackupyouropinionswiththescienceand/or
yourclinicalexperience?
8/26/16
12
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.
8/26/16
13
7.)KnowYourTerms
• MedicalTerms(includinginjurydescriptors)• Scien@fic/prac@ceterms(e.g.evidence-basedprac@ce)
8.)Remember:Tes@monyisforever
• Priortes@monycanbeusedtoimpeachyouonthestand.
• Donottaketheexperiencelightly—prac@ceandprepare
• Dothearer-ac@onreviewsoyoulearnfromtheexperience
Yourjob
Teachingthejudgeorjurymembers.
8/26/16
14
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.
8/26/16
15
InDefenseoftheDefense
Tes@fyingforthedefense
• TheroleoftheSANEisnotthatofprosecu@onwitness.– Whilethatisorenwhatweareaskedtodowhenwegotocourt,thereisnoreasontoshundefensework.
Tes@fyingforthedefense
• “Itmaybehelpfulfora]orneyscallingthem(bothprosecutorsanddefensea]orneys)tofirstdeveloprela@onshipswithcoordinatorsofexaminerprograms,iftheyexist,orstaffthatoverseeexaminersattheexamsite.”
• “Althoughitismostlikelythatexaminerswillbecalledbytheprosecu@on,theymayalsobecalledbythedefense.”
(Na@onalProtocolforSexualAssaultMedicalForensicExams)
8/26/16
16
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.
OpposingExpertIn@mida@on
8/26/16
17
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
8/26/16
18
INSUMMARY
Thebesttes@monyis…
• Plainlyworded• Simple• Concise• Peerreviewed
Defensibleprac@ce
• Isanar@cula@onoftheen@retyofwhoyouareasanurse.– Whatallowsyoutodothiswork.– Whatguidesyourprac@ce.– Howyouknowyouareprovidingthestandardofcare.
– Whatformsthebasisofyouropinions.
8/26/16
19
Tes@mony
• Tes@monyistheplacewhereyoudiscoverjusthowdefensibleyourprac@ceis.• It’salsowhereyoulearnthattheconceptofdefensibleprac@ceisnotasta@cone.– Asthesciencechanges,sodoweasclinicians.– Aspoliciesandprotocolschange,sodoweasclinicians.
Q&A