Preservación de los rastros forenses que realizan los enfermeros en los servicios de emergencias: revisión de alcance

1 Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Campus Pesqueira, Pesqueira, PE, Brasil.

Carlos Adriano Alves Ferreira

1 Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Campus Pesqueira, Pesqueira, PE, Brasil.

Guilherme Guarino de Moura Sá

2 Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Campus Belo Jardim, Belo Jardim, PE, Brasil.

Rafaella Queiroga Souto

3 Universidade Federal da Paraíba, João Pessoa, PB, Brasil.

Lívia Moreira Barros

4 Universidade da Integração Internacional da Lusofonia Afro-Brasileira, Departamento de Enfermagem, Redenção, CE, Brasil.

Nelson Miguel Galindo-Neto

1 Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Campus Pesqueira, Pesqueira, PE, Brasil.

1 Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Campus Pesqueira, Pesqueira, PE, Brasil.

2 Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Campus Belo Jardim, Belo Jardim, PE, Brasil.

4 Universidade da Integração Internacional da Lusofonia Afro-Brasileira, Departamento de Enfermagem, Redenção, CE, Brasil.

Contribuição dos autores: Concepção e desenho da pesquisa: Rute Xavier Silva, Carlos Adriano Alves Ferreira, Guilherme Guarino de Moura Sá, Rafaella Queiroga Souto, Lívia Moreira Barros, Nelson Miguel Galindo-Neto. Obtenção de dados: Rute Xavier Silva, Carlos Adriano Alves Ferreira, Guilherme Guarino de Moura Sá, Rafaella Queiroga Souto, Lívia Moreira Barros, Nelson Miguel Galindo-Neto. Análise e interpretação dos dados: Rute Xavier Silva, Carlos Adriano Alves Ferreira, Guilherme Guarino de Moura Sá, Rafaella Queiroga Souto, Lívia Moreira Barros, Nelson Miguel Galindo-Neto. Análise estatística: Rute Xavier Silva, Carlos Adriano Alves Ferreira, Rafaella Queiroga Souto, Lívia Moreira Barros, Nelson Miguel Galindo-Neto. Obtenção de financiamento: Rute Xavier Silva, Carlos Adriano Alves Ferreira, Nelson Miguel Galindo-Neto. Redação do manuscrito: Rute Xavier Silva, Carlos Adriano Alves Ferreira, Guilherme Guarino de Moura Sá, Rafaella Queiroga Souto, Lívia Moreira Barros, Nelson Miguel Galindo-Neto. Revisão crítica do manuscrito quanto ao conteúdo intelectual importante: Rute Xavier Silva, Carlos Adriano Alves Ferreira, Guilherme Guarino de Moura Sá, Rafaella Queiroga Souto, Lívia Moreira Barros, Nelson Miguel Galindo-Neto. Todos os autores aprovaram a versão final do texto.

Abstract

Objective:

to map the scientific production on the preservation of forensic traces by Nursing professionals working in emergency services.

Method:

a scoping review, with searches for studies carried out in six databases, in the gray literature available in Google Scholar and in the references of the studies selected. For analysis, the data reduction method was adopted.

Results:

26 studies were included, organized into five categories: 1) Nursing professionals’ knowledge on the preservation of forensic traces; 2) Procedures performed by Nursing to preserve traces in the victim’s body; 3) Procedures performed by Nursing to preserve traces in the victim’s belongings/objects; 4) Procedures performed by Nursing to document traces; and 5) Actions to maintain the chain of custody performed by Nursing.

Conclusion:

the studies showed situations in which the emergency nurse may act in the preservation of forensic traces present in the victim’s body and in objects, as well as in the registration of traces, verifying the role of Nursing to ensure integrity of the chain of custody, especially in situations of aggression, firearm injury, sexual violence, child abuse and assistance to trauma victims.

Resumo

Objetivo:

mapear a produção científica sobre a preservação de vestígios forenses pelos profissionais de enfermagem que atuam nos serviços de emergência.

Método:

revisão de escopo, com buscas dos estudos realizadas em seis bases de dados, na literatura cinzenta disponível no Google Scholar e nas referências dos estudos selecionados. Para análise, adotou-se o método de redução de dados.

Resultados:

foram incluídos 26 estudos que foram organizados em cinco categorias: 1) Conhecimento dos profissionais de enfermagem sobre a preservação de vestígios forenses; 2) Procedimentos realizados pela enfermagem para preservação de vestígios no corpo da vítima; 3) Procedimentos realizados pela enfermagem para preservação de vestígios em pertences/objetos da vítima; 4) Procedimentos realizados pela enfermagem para documentação dos vestígios; e 5) Ações de manutenção da cadeia de custódia realizada pela enfermagem.

Conclusão:

os estudos mostraram situações em que o enfermeiro de emergência pode atuar na preservação de vestígios forenses presentes no corpo da vítima e em objetos, bem como no registro dos vestígios, verificando-se a atuação da enfermagem para garantir a integridade da cadeia de custódia, principalmente em situações de agressão, de ferimento com arma de fogo, violência sexual, abuso infantil e na assistência a vítimas de trauma.

Descritores: Enfermagem, Enfermagem Forense, Prova Pericial, Enfermagem em Emergência, Emergências, Revisão

Resumen

Objetivo:

mapear la producción científica sobre la preservación de rastros forenses por profesionales de enfermería que trabajan en los servicios de emergencias.

Método:

revisión de alcance, con búsqueda de los estudios realizados en seis bases de datos, en la literatura gris disponible en Google Scholar y en las referencias de los estudios seleccionados. Para el análisis, se adoptó el método de reducción de datos.

Resultados:

se incluyeron 26 estudios organizados en cinco categorías: 1) Conocimiento de los profesionales de enfermería sobre la preservación de rastros forenses; 2) Procedimientos que realizan los enfermeros para preservar rastros en el cuerpo de la víctima; 3) Procedimientos que realizan los enfermeros para preservar rastros en las pertenencias/objetos de la víctima; 4) Procedimientos que realiza el personal de enfermería para documentar los rastros; y 5) Acciones que llevan a cabo los enfermeros para mantener la cadena de custodia.

Conclusión:

los estudios demostraron que hay situaciones en las cuales el enfermero de emergencias puede actuar para preservar los rastros forenses presentes en el cuerpo de la víctima y en los objetos, así como también registrar los rastros, lo que comprueba la actuación del enfermero para garantizar la integridad de la cadena de custodia, particularmente en situaciones de agresión, heridas con arma de fuego, violencia sexual, abuso infantil y asistencia a víctimas de trauma.

Descriptores: Enfermería, Enfermería Forense, Testimonio de Experto, Enfermería de Urgencia, Urgencias Médicas, Revisión

Highlights

(1) The Nursing workforce in emergency services contributes to preserve forensic traces.

(2) There is a gap in Brazilian evidence on the preservation of traces in emergency services.

(3) Traces on the victim’s body and objects can be preserved by Nursing.

(4) Forensic traces found by Nursing in the emergency services must be documented.

Introduction

Emergency health services often act in the care of victims of crime situations; thus, they have in these environments a privileged opportunity to identify, collect and preserve forensic traces 1 - 2 . These traces can include palm and plantar fingerprints; biological elements such as blood, semen, saliva, hair, bones, teeth, hair and vaginal secretions; and physicochemical traces such as chemicals, projectiles, melee weapons, firearms and sharp objects or instruments 3 - 6 .

Nursing professionals, who are on the front line in the care of patients in emergency services, in addition to having specific attributions to preserve life and reduce sequelae, must collaborate with the preservation of the traces present in the victim, in the possible aggressor, in the objects and at the crime scene 3 . Such traces, of high presence in Nursing care in emergency services, are essential elements for the success of the criminal investigation and for integrity of the chain of custody, as such chain consists of maintenance and documentation of traces, from their identification, collection, possession and handling until their disposal 1 .

Collaboration of the Nursing professionals in forensic investigation can prevent the unnecessary loss or destruction of evidence; however, lack of knowledge in these professionals who work in the emergency services about proper preservation of traces exerts an impact on the work of the expert team 7 .

Although the action towards victims of crimes occurs in the Nursing practice, most of the professionals do not have access to information on the theme 3 . Lack of training or moments of permanent education on the preservation of forensic traces, a content transversal to the Forensic Nursing specialty, results in the non-association of forensic care as inherent to the Nursing actions in emergency services 2 .

In this context, knowing the scientific production about the preservation of forensic traces by Nursing professionals who work in emergency services is relevant, as it may enable nurses to access scientific information about the preservation of traces, given the growing reality of situations involving crime in emergency services. Thus, it is pointed out that this study will allow for the compilation and construction of new knowledge, which can be used in the training and qualification of Nursing professionals who work in the emergency services, in order to empower them with regard to the correct performance in situations in which forensic remains need to be preserved. In addition, although the review focus is on the Nursing team, it is noteworthy that this study is of potential interest to the multidisciplinary health team and managers whose professional performance permeates the context of emergency services.

Thus, this study mapped the scientific production on preservation of forensic traces by Nursing professionals working in emergency services.

Method

Type of study

This is a scoping review that followed the stages recommended by the Joanna Briggs Institute (JBI) 8 and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist 9 . The review was developed in five stages: identification of the research question; survey of relevant studies; selection of the studies; data mapping; and presentation of the results 10 .

Study setting

This review was conducted in six databases: National Center for Biotechnology Information (NCBI/PubMed); Excerpta Medica Database (EMBASE); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Web of Science; Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) via Biblioteca Virtual em Saúde(BVS); and Índice Bibliográfico Español en Ciencias de la Salud (IBECS).

Period

The study was conducted between August and October 2021.

Population

The study population consisted of the 190 scientific articles found in the searches in the databases and in the gray literature available on Google Scholar.

Selection criteria

Articles with different types of research addressing the preservation of forensic traces by Nursing professionals in emergency services were included, without limitation regarding language or year of publication. For exclusion of the studies, we adopted the criteria of letters to the editor, abstracts of annals of events and not presenting information that contemplated the population, concept and context of interest of this study.

Study variables

The study variables were as follows: title of the article; year of publication; country; journal; language; objective; type of study; public studied; type of injury; location of the trace (crime scene, objects and belongings, victim’s body or others); and information on the preservation of forensic traces. After data extraction, the findings of both reviewers were compared, any and all discrepancies were resolved and the information was grouped into a single table.

Instruments used to collect the information

The diverse information extracted from the studies was recorded in a data collection instrument adapted from a form recommended by the JBI, organized in a Microsoft Excel 2001 spreadsheet 11 .

Data collection

In a previous search in the JBI database, no reviews were found to investigate the issue.

For elaboration of the research question, the PCC (Population, Concept and Context) 8 mnemonic was used, where: P - Nursing professionals, C - Preservation of forensic traces and C - Emergency service. Thus, the research question adopted was as follows: “What scientific evidence is available on the preservation of forensic traces by Nursing professionals working in emergency services?”

The searches took place in August 2021, through remote access to the databases, from registration in the journals portal of the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES), via the Federated Academic Community (Comunidade Acadêmica Federada, CAFe), at the login of the Federal Institute of Education, Science and Technology of Pernambuco (Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, IFPE).

From the research question, the descriptors of the Medical Subject Headings (MeSH), EMBASE Subject Headings (EMTREE), CINAHL Headings and Descriptors in Health Sciences (Descritores em Ciências da Saúde, DeCS) were selected. In addition to that, uncontrolled descriptors were used to broaden specificity of the search.

Figure 1 presents the descriptors used in each database, as well as the use of the Boolean operators in the search for high sensitivity.

Figure 1

* NCBI/PubMed = National Center for Biotechnology Information; † EMBASE = Excerpta Medica Database; ‡ CINAHL = Cumulative Index to Nursing and Allied Health Literature; § LILACS = Literatura Latino-Americana e do Caribe em Ciências da Saúde; || IBECS = Índice Bibliográfico Español en Ciencias de la Salud

The results obtained in the databases were exported to the Rayyan reference manager, developed by the Qatar Computing Research Institute (QCRI) 12 , for removal of duplicates, selection and screening of THE studies by two researchers, independently and masked, and the divergences were resolved with the participation of a third examiner. After the search developed according to the strategy outlined above, the studies were selected. In addition, there was a search in the gray literature available on Google Scholar and a survey of potentially eligible articles was made in the reference lists of the studies selected. Reading of titles and abstracts was performed. The studies that met the inclusion criteria were analyzed by reading the manuscripts in full. Finally, manual searches were performed in the references of the studies included.

Data treatment and analysis

For analysis, the data reduction method was adopted, which aims at conceptually classifying the results after critical reading 13 . For the review report, the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) were followed 9 .

Ethical aspects

As the studies used were of public domain access, there was no need to submit the study to the Research Ethics Committee.

Results

A total of 190 articles were identified, of which 111 were found in EMBASE, 73 in PubMed, three in Web of Science and three by consulting Google Scholar. In the CINAHL, LILACS, BVS and IBECS databases, no studies were identified in the search to constitute the sample. After exclusion of the duplicate studies, 126 articles were evaluated for eligibility by the researchers, remaining 26 articles as shown in the flowchart in Figure 2 .

The 26 articles analyzed were published in English. Regarding the countries where the studies were developed, there was predominance of the United States with 16 (61.5%), three from Canada (11.5%), two from Brazil (7.7%), two from Turkey (7.7%), one from Australia (3.8%) and one from Sweden (3.8%). Of the studies selected, 12 (46.2%) were cross-sectional; three (11.54%) were narrative reviews; two (7.6%) consisted of literature reviews; two (7.6%) were retrospective and longitudinal studies; one (3.8%) was an experience report; one (3.8%) was a case study; one (3.8%) was a prospective observational cut; one (3.8%) was a descriptive study (pilot); one (3.8%) was a retrospective study; one (3.8%) was a reflective study; and one (3.8%) was a brief communication. The characteristics of the studies are presented in Figure 3 .

Figure 3

Characteristics of the studies that comprised the scoping review sample, according to title of the article, journal/country, study design, participants and/samples. Pesqueira, PE, Brazil, 2021

Figure 4 details the objectives of the studies, as well as the main results on the preservation of traces addressed by health professionals in emergency services.

Figure 4

* SANE = Sexual Assault Nurse Examiner

The scope of the scientific production on the preservation of forensic traces by Nursing professionals working in emergency services is presented in five categories: 1) Nursing professionals’ knowledge about the preservation of forensic traces 14 , 16 - 17 , 20 - 22 , 25 - 27 , 29 - 30 , 34 - 35 , 37 ; 2) Procedures performed by Nursing to preserve traces in the victim’s body 6 - 7 , 15 , 18 , 20 - 21 , 24 - 26 , 28 - 36 ; 3) Procedures performed by Nursing to preserve the victim’s belongings/objects 14 - 15 , 18 , 23 , 25 - 26 , 29 , 32 - 33 , 35 - 36 ; 4) Procedures performed by Nursing to document traces 19 , 21 , 24 - 29 , 31 - 37 ; and 5) Actions performed by Nursing to maintain the chain of custody 7 , 16 - 17 , 25 . The synthesis of the scientific production is presented in Figure 5 .

Figure 5

Main recommendations cited for the preservation of forensic traces by health professionals. Pesqueira, PE, Brazil, 2021

Discussion

Preservation of forensic traces is fundamental to solve a case, and Nursing professionals are relevant actors in this process since, in the emergency health services, they are the first to receive victims involved in crime situations. In addition to providing health care, Nursing also has the function of identifying, collecting, storing, documenting and continuing the chain of custody, which contributes both to the effectiveness of the care provided to the victims and to justice 7 . Thus, knowledge and technical capacity in forensic Nursing need to be expanded, and dissemination of the mapping of scientific production in this area contributes to this.

It is noteworthy, however, that, although general strategies such as insertion of forensic content since the training and qualification of the professionals already trained are relevant, translation of the knowledge must be adapted to regional particularities, given the heterogeneity of the Brazilian context. To this end, there is a need for research studies that investigate the teaching-learning process on the theme in the various Brazilian realities, so that there is support for evidence-based practice in the training of professionals about the forensic aspects.

Most of the studies in this review correspond to the international reality of nurses’ performance in the face of forensic situations, as Forensic Nursing is not a reality in all countries. In Brazil, although Nursing class entities recognize Forensic Nursing, its actual practice in the health services still needs extensive expansion. The national reality found in the sample explains the low implementation of most of the actions related to the preservation of traces, related to the incipient inclusion of this theme, from the training of these professionals to permanent education 7 . In this sense, the procedures adopted in other countries need to be implemented in countries where the forensic scenario is not routine in the Nursing practice, as is the case in Brazil. Thus, the urgent need to include forensic content in the curricula of technical courses, undergraduate courses and specializations in Brazilian Nursing is confirmed. In addition to that, there is a need to expand and strengthen the class struggle so that there is a legal obligation regarding the inclusion of forensic nurses in emergency services, so that they can act in crime cases and in the permanent education of the professionals, as well as collaborate with managerial improvements that favor preservation of traces.

The lack of training, knowledge and technical competence for forensic tasks by the majority of nurses working in the emergency room was highlighted in the studies. Those who possessed some level of forensic knowledge did not master all stages of the preservation processes, which caused insecurity 18 , 34 - 37 . In Turkey, this scenario was also identified: 80% of the nurses who attended to forensic cases were able to differentiate types of evidence; however, they did not know how to collect, store and refer to the competent authorities 6 . In this context, there is an urgent need for permanent and continuing education aimed at training Emergency Nursing not only to act on topics that are generally addressed, such as the care of trauma victims and clinical emergencies, but that is also consistent with training for the Nursing care to be provided in cases involving crime, with proper preservation of forensic traces. To this end, forensic content should be inserted as mandatory in professional training and updates; it should be covered in selection processes, in residency tests and academic job competitions in the area, so that there is also demand and interest in the professionals for the content, thus becoming agents of the pedagogical process.

Regarding preservation of traces, the most prominent contexts in the studies were about the professionals’ safety, preservation of traces in crimes involving firearms, identification of signs of child abuse, and recognition of traces in cases of trauma and sexual assault 7 , 18 , 20 - 22 , 25 , 27 , 29 , 34 - 35 , 37 . It is inferred that Nursing has sufficient training to prioritize physiological, pharmacological and procedural aspects of such themes, which may even involve subjective issues such as humanization. However, they may be unaware of the judicial consequences of their assistance actions, so that they discard relevant evidence for criminal investigation. This fact was observed in a research study conducted in New Zealand, which investigated nurses in the emergency department and whose results showed limited knowledge about criminal legislation, as well as that 84% reported considering the theme important for their professional practice 38 . These findings point to the need for greater intersectoral and interdisciplinary approximation of Nursing with the transversal legal aspects of emergency health care. Such approximation is presented as the duty and responsibility of Nursing professors and professionals who, in the Brazilian context, recommend/determine the profile of the training for the profession in the National Curricular Guidelines.

In addition to allowing understanding the processes in forensic cases, education for emergency nurses on how to preserve traces enables improvements in patient care. However, training on this theme for Nursing is scarce, including the gap of intersectoral articulation with public safety 7 , 18 , 34 - 36 . In the United States, it is common to offer online training courses, which have already shown a 25% increase in the participants’ knowledge 39 . Therefore, new studies addressing the elaboration, validation, application and comparison of teaching strategies on the theme are relevant to guide the decision-making processes of the professionals involved in Nursing professionals’ education and training.

As for the procedures to preserve traces in the victim’s body, the studies included in this review presented diverse information on this procedure in the most varied crime scenarios, such as firearm violence, trauma, sexual assault and run over cases. The findings corroborate with a literature review that points out the importance of the diverse information contained in the traces of the victim’s and the aggressor’s bodies, which must be collected during the physical examination and need to be carefully stored and documented, for clarification in the criminal investigation 1 . The implementation of these practices implies effective preservation, rich in materials and with lower risk of contamination, and is relevant because the body consists of an area exposed to constant alteration, both by the physiological and metabolic dynamics, and by the actions inherent to the self-care routine, such as bathing and personal hygiene.

For comprehensive care to victims of sexual assault, a detailed physical examination is essential. The Sexual Assault Nurse Examiners (SANE) program, present in some emergency health services in the United States, has nurses specialized in the care of sexual assault victims, and establishes the use of protocol and forensic evidence kits, necessary for the collection of traces 15 , 19 , 21 , 24 , 28 . The program also works with preventive measures for the victims, which include pregnancy tests, emergency gestational contraception and administration of prophylactic drugs for Sexually Transmitted Infections (STIs), as well as emergency contraceptives, clinical and psychological professional monitoring for 72 hours, in addition to storage of the evidence kit for up to six months, until the victim decides to use its content 40 - 41 . It is noted that it is appropriate for Brazilian Nursing and the Federal Nursing Council to implement a similar initiative, in conjunction with the Criminal Investigation Police Department, in order to optimize care and corroborate the holistic view of Nursing care and the equity and resoluteness recommended by the Unified Health System (Sistema Único de Saúde, SUS).

In the context of preserving the victim’s belongings/objects, the importance of the clothes as one of the main sources of traces is highlighted, as they may contain physical and biological aspects and components that help elucidate the crime. However, clothing is usually discarded or mischaracterized in emergency care. A study carried out in the United States highlighted the importance of clothing in victims of perforations by firearms and the wealth of information it can present about the crime suspect, the victim, the weapon used and the dynamics adopted at the scene since, for example, gunpowder can be deposited in the tissue and the pattern of blood spatter and holes can determine the projectile’s entry and exit pattern, which may even allow inferring the position of those involved at the time of firing 42 . Thus, the Nursing professional needs to recognize the types of traces in the patient, as well as to know how to proceed with the belongings and clothes that arrive at the emergency room, as they contain relevant information about what happened and need to be preserved.

The studies of the sample pointed to the preservation of traces performed by emergency nurses, which occurred in shoes, bed sheets and other objects of the victim 17 - 18 , 23 , 25 , 29 , 33 , 35 - 36 . These findings differ from those found in a study conducted in Brazil, whose results showed that, although the Nursing professionals recognized the need to preserve traces, it did not occur in such items, due to lack of routine and absence of documentation/registration about the victim’s objects and belongings 7 , 23 . Thus, it is perceived that to strengthen the practice in the Brazilian territory, it is necessary to devise and implement institutional protocols, in order to better guide the forensic practice by nurses working in emergency services.

After the collection stage, documentation of the traces must be done in a thorough and attentive manner by Nursing because it is through this procedure that it will be possible to structure diverse information and prepare arguments to be analyzed in order to solve the crime. In this review, contents were identified that include actions ranging from the record about the patient’s condition to the detailing of the record about the objects found 19 , 21 , 24 - 25 , 27 , 29 , 32 - 35 . Such actions are in line with a study carried out in Portugal, which highlights the relevance of detailing the documentation and record, which must be descriptive and accompanied by a photographic record 43 . Despite being often associated with the bureaucratic and tiring routine, documentation/recording stage, with a wealth of details not only contributes to justice occurring through the resolution of a crime, but also culminates in legal support for the professional Nursing practice and can be triangulated with the professional’s report/testimony, if summoned to give testimony to the Police and/or judicial authorities.

In the chain of custody, follow-up of the stages causes concern to nurses, as it does not consist only in storing the evidence in sealed and labeled containers, but also in the delivery of weapons and projectiles to the authors of the law and in the recording, by stamp and signature, of all the information therein contained 7 , 17 , 25 . A case report for the implementation of the SANE course in Brazil pointed out that the nurses’ actions can contribute to the suitability of the chain of custody in the health services 44 . In the case of Saudi Arabia, nurses’ concern with legal responsibilities, in the face of forensic cases, proved to be a barrier to maintaining the chain of custody 45 . Thus, it is noteworthy that clarification about the stages that make up the chain of custody, as well as the importance of the nurses’ role for the success of such a chain is relevant for the professionals’ awareness and sensitization about the need and importance of their correct performance.

The findings of this study may contribute to the multiplication of information on a topic little explored in the Brazilian reality, provide the argument about the need for intersectoral and interdisciplinary articulation between health and safety, and favor the conduction of new research studies in the area, with a view to promoting the development of forensic protocols in health institutions and implementing training of Nursing professionals in emergency services

The limitations of this scoping review are the methodological heterogeneity of the studies found, which restricted the possibility of comparing the results, and the incipience of studies on the preservation of forensic traces carried out by Nursing, which acts specifically in the pre-hospital emergency context.

Conclusion

This scoping review made it possible to map diverse evidence on the preservation of forensic traces by Nursing professionals in emergency services. The Brazilian evidence on the topic is limited. Mainly in the international scenario, the studies surveyed pointed out limited knowledge of the Nursing professionals about the theme, whether in the procedures performed by Nursing to preserve traces in the victim’s body, belongings and objects, in the documentation of traces and/or in the actions carried out by Nursing to maintain the chain of custody, especially in situations of aggression, injuries involving firearms, sexual violence, child abuse, and in the assistance provided to trauma victims.

Referências

1. Rocha HN, Rodrigues BA, Paula GVN, Araújo JPA, Gomes TA, Souza ARN, et al. The nurse and the multidisciplinary team in the preservation of forensic traces in the emergency and emergency service. Brazilian J Health Review. 2020; 3 (2):2208–2217. doi: 10.34119/bjhrv3n2-073. [CrossRef] [Google Scholar]

2. Souza JSR, Resck ZMR, Andrade CUB, Calheiros CAP, Terra FS, Costa ACV, et al. Construction and validation of an instrument for Forensic Nursing and similar graduation disciplines. Rev Rene. 2020; 21 :e44196. doi: 10.15253/2175-6783.20202144196. [CrossRef] [Google Scholar]

3. Felipe HR, Cunha M, Ribeiro VS, Zamarioli CM, Santos CB, Duarte JC, et al. Knowledge Questionnaire over Forensics Nursing Practices: adaptation to Brazil and psychometric properties. Rev Enf Ref. 2019; 23 (4):99–110. doi: 10.12707/RIV19045. [CrossRef] [Google Scholar]

4. Afshari A, Borzou SR, Shamsaei F, Mohammadi E, Tapak L. Perceived occupational stressors among emergency medical service providers: a qualitative study. BMC Emerg Med. 2021; 21 (35):1–8. doi: 10.1186/s12873-021-00430-6. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

5. Mossburg S, Agore A, Nkimberg M, Commodore-Mensah Y. Occupational hazards among healthcare workers in Africa: a systematic review. Ann Glob Health. 2019; 85 (1):1–13. doi: 10.5334/aogh.2434. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

6. Asci O, Hazar G, Sercan I. The approach of prehospital health care personnel working at emergency stations towards forensic cases. Turkish J Emerg Med. 2015; 15 (3):131–135. doi: 10.1016/j.tjem.2015.11.007. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

7. Musse JO, Santos VS, Santos DS, Santos FP, Melo CM. Preservation of forensic traces by health professionals in a hospital in Northeast Brazil. Forensic Scienc Internat. 2020; 306 :110057–110057. doi: 10.1016/j.forsciint.2019.110057. [PubMed] [CrossRef] [Google Scholar]

8. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Aromataris E, Munn Z. JBI Manual for Evidence Synthesis. Adelaide: JBI; 2020. Scoping Reviews (2020 version) pp. s–s. [Google Scholar]

9. Tricco AC, Lillie E, Zarin W, et al. O'Brien KK, Colquhoun H, Levac D. PRISMA Extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169 (7):467–473. doi: 10.7326/M18-0850. [PubMed] [CrossRef] [Google Scholar]

10. O'Malley L, Arksey H. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005; 8 (1):19–32. doi: 10.1080/1364557032000119616. [CrossRef] [Google Scholar]

11. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. The Joanna Briggs Institute Reviewers Manual. Adelaide: The Joanna Briggs Institute; 2015. [2021 Jul 7]. Methodology for JBI scoping reviews; pp. 3–24. Available from: https://espace.library.uq.edu.au/view/UQ:371443 . [Google Scholar]

12. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan - a web and mobile app for systematic reviews. Syst Rev. 2016; 5 (1):1–10. doi: 10.1186/s13643-016-0384-4. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

13. Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005; 52 (5):546–553. doi: 10.1111/j.1365-2648.2005.03621.x. [PubMed] [CrossRef] [Google Scholar]

14. Lynch VA. Forensic nursing in the emergency department: A new role for the 1990s. [2021 Jul 7]; Crit Care Nurs Quart. 1991 14 (3):69–86. Internet. Available from: https://journals.lww.com/ccnq/citation/1991/11000/forensic_nursing_in_the_emergency_department__a.10.aspx . [PubMed] [Google Scholar]

15. Aiken M, Speck PM. Forensic considerations for the emergency department. [2021 Jul 7]; Tenn Nurse. 1996 59 (3):19–21. Internet. Available from: https://pubmed.ncbi.nlm.nih.gov/8920475 . [PubMed] [Google Scholar]

16. Smith K, Holmseth J, MacGregor M, Letourneau M, Minnesota M. Sexual assault response team: Overcoming obstacles to program development. J Emerg Nurs. 1998; 24 (4):365–367. doi: 10.1016/S0099-1767(98)90132-5. [PubMed] [CrossRef] [Google Scholar]

17. MacCracken LM. Living forensics: a natural evolution in emergency care. Accident Emerg Nurs. 1999; 7 (4):211–216. doi: 10.1016/S0965-2302(99)80053-8. [PubMed] [CrossRef] [Google Scholar]

18. McGillivray B. The role of Victorian emergency nurses in the collection and preservation of forensic evidence: a review of the literature. Accident Emerg Nurs. 2004; 13 (2):95–100. doi: 10.1016/j.aaen.2004.09.001. [PubMed] [CrossRef] [Google Scholar]

19. Stermac L, Dunlap H, Bainbridge D. Sexual assault services delivered by SANEs. J Forensic Nursing. 2005; 1 (3):124–128. doi: 10.1111/j.1939-3938.2005.tb00029.x. [PubMed] [CrossRef] [Google Scholar]

20. Campbell R, Patterson D, Lichty LF. The effectiveness of sexual assault nurse examiner (SANE) programs: A review of psychological, medical, legal, and community outcomes. Trauma Violence Abuse. 2005; 6 (4):313–329. doi: 10.1177/2F1524838005280328. [PubMed] [CrossRef] [Google Scholar]

21. Pennington EC, Zwemer JRFL, Krebs DA. Unique sexual assault examiner program utilizing mid-level providers. J Emerg Med. 2010; 38 (1):95–98. doi: 10.1016/j.jemermed.2007.11.109. [PubMed] [CrossRef] [Google Scholar]

22. Eldredge K. Assessment of trauma nurse knowledge related to forensic practice. J Forensic Nurs. 2008; 4 (4):157–165. doi: 10.1111/j.1939-3938.2008.00027.x. [PubMed] [CrossRef] [Google Scholar]

23. Abdool NN, Brysiewicz P. A description of the forensic nursing role in emergency departments in Durban, South Africa. J Emerg Nurs. 2009; 35 (1):16–21. doi: 10.1016/j.jen.2008.02.003. [PubMed] [CrossRef] [Google Scholar]

24. Sampsel K, Szobota L, Joyce D, Graham K, Pickett W. The impact of a sexual assault/domestic violence program on ED care. J Emerg Nursing. 2009; 35 (4):282–289. doi: 10.1016/j.jen.2008.07.014. [PubMed] [CrossRef] [Google Scholar]

25. Eisert PJ, Eldredge K, Hartlaub T, Huggins E, Keirn G, et al. O'Brien P. CSI new@ York: development of forensic evidence collection guidelines for the emergency department. Crit Care Nurs Quart. 2010; 33 (2):190–199. doi: 10.1097/CNQ.0b013e3181d913b4. [PubMed] [CrossRef] [Google Scholar]

26. Snow AF, Bozeman JM. Role implications for nurses caring for gunshot wound victims. Crit Care Nurs Quart. 2010; 33 (3):259–264. doi: 10.1097/CNQ.0b013e3181e65fec. [PubMed] [CrossRef] [Google Scholar]

27. Henderson E, Harada N, Amar A. Caring for the forensic population: Recognizing the educational needs of emergency department nurses and physicians. J Forensic Nurs. 2012; 8 (4):170–177. doi: 10.1111/j.1939-3938.2012.01144.x. [PubMed] [CrossRef] [Google Scholar]

28. Hornor G, Thackeray O, Scribano P, Curran S, Benzinger E. Pediatric sexual assault nurse examiner care: Trace forensic evidence, ano-genital injury, and judicial outcomes. J Forensic Nurs. 2012; 8 (3):105–111. doi: 10.1111/j.1939-3938.2011.01131.x. [PubMed] [CrossRef] [Google Scholar]

30. Rahmqvist JL, Benzein E, Årestest K. Nurses' views of forensic care in emergency departments and their attitudes, and involvement of family members. J Clin Nurs. 2015; 24 (1-2):266–274. doi: 10.1111/jocn.12638. [PubMed] [CrossRef] [Google Scholar]

31. Pasqualone G, Michel C. Forensic patients hiding in full view. Crit Care Nurs Quart. 2015; 38 (1):3–16. doi: 10.1097/CNQ.0000000000000043. [PubMed] [CrossRef] [Google Scholar]

32. Pasqualone GA. The relationship between the forensic nurse in the emergency department and law enforcement officials. Crit Care Nurs Quart. 2015; 38 (1):36–48. doi: 10.1097/CNQ.0000000000000047. [PubMed] [CrossRef] [Google Scholar]

33. Palestis K. Active Shooters: What Emergency Nurses Need to Know. J Forensic Nurs. 2016; 12 (2):74–79. doi: 10.1097/JFN.0000000000000113. [PubMed] [CrossRef] [Google Scholar]

34. Bush K. Forensic evidence collection in the emergency care setting. J Emerg Nurs. 2018; 44 (3):286–286. doi: 10.1016/j.jen.2018.03.010. [PubMed] [CrossRef] [Google Scholar]

35. Topçu ET, Kazan EE, Buken E. Healthcare Personnel's Knowledge and Management of Frequently Encountered Forensic Cases in Emergency Departments in Turkey. J Forensic Nurs. 2020; 16 (1):29–35. doi: 10.1097/JFN.0000000000000275. [PubMed] [CrossRef] [Google Scholar]

36. Sakalli D, Aslan M. Levels of Knowledge of Emergency Nurses Regarding Forensic Cases and Approaches to Evidence. Signa Vitae. 2020; 16 (1):65–72. doi: 10.22514/sv.2020.16.0009. [CrossRef] [Google Scholar]

37. Silva JO, Santos LF, Santos SM, Silva DP, Santos VS, Melo CM. Preservation of Forensic Evidence by Nurses in a Prehospital Emergency Care Service in Brazil. J Trauma Nurs. 2020; 27 (1):58–62. doi: 10.1097/JTN.0000000000000483. [PubMed] [CrossRef] [Google Scholar]

38. Donaldson AE. New Zealand emergency nurses knowledge about forensic science and its application to practice. Int Emerg Nursing. 2020:53–53. doi: 10.1016/j.ienj.2020.100854. [PubMed] [CrossRef] [Google Scholar]

39. Patterson D, Resko SM. Is online learning a viable training option for teaching sexual assault forensic examiners? J Forensic Nurs. 2015; 11 (4):181–189. doi: 10.1097/JFN.0000000000000084. [PubMed] [CrossRef] [Google Scholar]

40. Davis RC, Auchter B, Howley S, Camp T, Knecht I, Wells W. Increasing the accessibility of sexual assault forensic examinations: evaluation of Texas law SB 1191. J Forensic Nurs. 2017; 13 (4):168–177. doi: 10.1097/JFN.0000000000000169. [PubMed] [CrossRef] [Google Scholar]

41. Cochran CB. An evidence-based approach to suicide risk assessment after sexual assault. J Forensic Nurs. 2019; 15 (2):84–92. doi: 10.1097/JFN.0000000000000241. [PubMed] [CrossRef] [Google Scholar]

42. Peel M. Opportunities to preserve forensic evidence in emergency departments. Emerg Nurse. 2016; 24 (7) doi: 10.7748/en.2016.e1618. [PubMed] [CrossRef] [Google Scholar]

43. Machado BP, Araújo IMB, Figueiredo MCB. Forensic nursing: whats is taught in the bachelor's degree in nursing in Portugal. Rev Enferm Ref. 2019; 4 (22):43–50. doi: 10.12707/RIV19028. [CrossRef] [Google Scholar]

44. Silva JDOM, Allen EM, Polonko I, Silva KB, Silva RDC, Esteves RB. Planning and implementation of the Sexual Assault Nurse Examiner course to assist victims of sexual violence: an experience report. Rev Esc Enferm USP. 2021; 55 doi: 10.1590/S1980-220X2020029803739. [PubMed] [CrossRef] [Google Scholar]

45. Alsaif DM, Alfaraidy M, Alsowayigh K, Alhusain A, Almadani OM. Forensic experience of Saudi nurses; an emerging need for forensic qualifications. J Forensic Legal Med. 2014; 27 :13–16. doi: 10.1016/j.jflm.2014.07.004. [PubMed] [CrossRef] [Google Scholar]

Articles from Revista Latino-Americana de Enfermagem are provided here courtesy of Escola de Enfermagem de Ribeirao Preto, Universidade de Sao Paulo