24

surrounding the privacy, security and integrity of forensic images. While the majority of survey participants reported they would not use a personal cell phone or device to take pictures during an examination if their workplace equipment was not available, 13% said they would. This finding supports anecdotal accounts of personal cell phone use in forensic nursing practice and is very concerning as it represents a clear breach of privacy and confidentiality, may harm patient perception, and raises serious criminal implications for the healthcare professional, such as images of children being considered child pornography if collected (“produced”), found stored (“possession”) and/or transmitted (“distributed”) via a personal device. A second area of serious concern revealed by these findings centered around tracking and monitoring of access to photodocumentation of forensic exams. Access to the photographic 72 documentation is typical in the healthcare settings. Images of wounds, intraoperative surgical findings, and other visual records are stored in the electronic chart allowing access to this important information by the interprofessional team. Are forensic medical examination images different? If so, how are they different. Some nurses may believe that by their very nature, these images are intimate, often shocking, intensely personal, and carry legal import in addition to their value for patient direct care. However, are other types of medical images also considered intimate, often shocking and intensely personal such as images related to gross congenital malformations or anomalies, gender affirmation surgeries, or reconstructive surgery following a mastectomy? Should images from the forensic medical examination be in a patients’ medical records? Almost one-quarter of survey respondents did not have a way to track or monitor who accessed the photographic documentation they took during the forensic medical examination. Respondents reported multiple methods for storage and encryption including with the electronic medical record (EMR), on a secure network but not part of the EMR, and on portable drives, suggesting that no method has evolved yet as best practice. Coupled with the findings regarding the low volume of cases for some forensic nurses and forensic practices, this raises grave concerns about privacy, confidentiality and integrity of photodocumentation of forensic examinations. In addition, forensic nurses may be naively putting themselves at risk of criminal charges by having images of ano-genital structures of minors on their personal cell phones or other digital devices because of the legal definitions around producing, possessing and distributing child pornography. All respondents on this survey who use photodocumentation in their forensic nursing practice reported using photodocumentation in the forensic medical exam for medical purposes.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24