Data was collected by means of questionnaires that were distributed in the critical care units of a private hospital group over five weeks. The questionnaires were completed and returned to the researcher. Of the two hundred questionnaires distributed, 171 were received back. This represents a response of 85%, which in view of the discussion can be rated as very good. 1.8. Layout of the study

The paper is divided into five chapters. Chapter one in generally on the general orientation of the paper while chapter is on the literature review. Chapter three on the other hand is on the methodology while chapter give the data analysis and the last chapter gives the general conclusion, recommendations and limitations of the study.

1.9. Conclusion

The main objective of the study was to certain the critical care nurses' knowledge on the legal liability issues in their critical nursing care environment. This would help come up with an education programme on the same. Both descriptive and quantitative research designs were used in their right contextual situations. A convenient sampling technique was also used among the critical care nurses in some of the selected private hospitals in NYC. The respond rate was high at 85% while the reliability and validity of this particular research was also guaranteed. On average, the total percentage achieved was 37.9% for 172 respondents. This below the set competency indicator of 60%, while only 8 respondents achieving the 60% competency target. There is the recommendation of an education programme to address these deficiencies on legal liability issues.

CHAPTER 2: LITERATURE REVIEW

2.1. Introduction to the history of forensic nursing

In 1992 at Minneapolis, Minnesota (United States of America-USA), the first national convention was convened. During this meeting, the main agenda that was brought forward was a deliberation on sexual assault. A delegation team comprising of 70 nurses gathered at Minneapolis with a mission statement declaring their readiness to commit themselves, their resources and abilities in ensuring the development of a forensic role geared towards improving and advancing the forensic science and health care profession in totality. During this delegates gathering, the International Association of Forensic Nurses (IAFN) was formed. Its main objective was to bring together all international forensic nurses together in ensuring that their roles in the health profession and particularly in forensic nursing was significant.

The membership of the association formed at Minneapolis expanded tremendously such that by the year 1998, its several chapters had registered many people. For instance, the New Jersey chapter had grown to 1500 members. The members of the association all over the world are those who specialize and operate in different fields of forensic nursing (Courson, 2003:1). Some of these fields include critical care, emergency, trauma, domestic violence, child, and elder abuse.

In 2002, forty nursing students were trained in forensic science at the University of Free State, United State of America following the establishment of a sexual Assault nurse Examiner short course. The events preceding these developments were the convention of a congress on the United State of American National Crime Prevention strategy that was held at Kimberly. Dr. Els, one of the best and resourceful pathologists from Bloemfontein established a contact with Virginia Lynch, the best consultant firm in forensic nursing at Minnesota. The main aim was to work on the introduction of the nurse examiner short course in United State of America. The commitment and technical assistance of Dr. Else was vital in this development.

2.2. Interaction with patients with legal liability issues

Critical care nursing encompasses an area of specialty that covers human interventions and responses emergencies and crises that threaten human life. Trauma is universally perceived and known as serious health complication that must be responded to efficiently. Working in critical care environment exposes a nurse to interact with those patients with legal liability issues. In the provision of intensive health care and emergency services, nurses working in critical care units are presented with special chances to exercise their contributions to forensic science. This may include among other factors, undertaking of investigations to unearth the crimes committed and those responsible. This followed by taking part in the legal process2es that pertains to such issues[footnoteRef:9]. [9: ACEP Policy Statements. Procedural Sedation in the Emergency Department (2004) and Delivery of Agents for Procedural Sedation and Analgesia by Emergency Nurses (2005).]

Violence oriented complications are some of the issues that critical care unit deal with. This requires some level of expertise in handling both the health complications and the legal issues that may be found. Unfortunately, nurses working on critical care environments do not possess as much expertise to be part...

This entails the requirements deep knowledge in forensic science, intensive care nursing, and traumatology. The integration of knowledge in forensic science, nursing essentials and legal credentials are important, useful, and imperative in finding out the facts behind a patient's death if in any case there is suspicion of unnatural death.
Optimal care to patients and their families is very important in as far as a holistic approach to critical care is concerned. This is therefore nurses' responsibility to handle patients with life threatening complications, offered in terms of consistent check and monitoring, complex assessment, technological intervention with some given levels of sophistication and vigilant intensive nursing care.

Critical care nurses can only be in the best position to professionally and efficiently handle critically ill, traumatized patients and their families if only they have specialized knowledge in critical care nursing, professional expertise complimented by experience within the area of specialization. They should also have the ability to deal with the advanced technology in rendering health services. Professional autonomy, problem solving skills, and critical thinking are very essential to critical care nurses. These will help them in addition to their knowledge skills and experience to undertake tasks like developing history of patients, risk appraisals, interpretation of diagnostic tests, patients' assessment, organizing nursing diagnosis, developing nursing planning, and implementing nursing care and to evaluate interventional outcomes.

Throughout the process of taking care of patients within the critical care units, nursing have the obligation of exercising high degrees of professionalism in acting as patients' advocate. This entails appreciating and respecting the basic human rights and values and the patients' beliefs. In doing so, the unstable and vulnerable patients feel good and this speed their healing process and to make their family members feel secure and positive about their hospitalization. This can also be made efficacious through nurses 'liaison with other stakeholders of the multidisciplinary team and the family of patients acting on their behalf[footnoteRef:10]. [10: ACEP Policy Statements. Procedural Sedation in the Emergency Department (2004) and Delivery of Agents for Procedural Sedation and Analgesia by Emergency Nurses (2005).]

2.3. The critical care unit as forensic domain

Critical care unit deal with patients who are vulnerable and unstable, some of whom have legal liability issues. This calls in the basics of forensic science to help in unraveling the unclear circumstances that surround the hospitalization of a patient in critical condition. The medical records that contain the patients' reasons for hospitalization and the suspects behind any suspicion of a life-threatening act may be used in a court of law; either to bring the suspects to book or to demand compensation. For the records to be permissible at any court of law, they have to be comprehensive and detailed enough to give evidence the suspects' crime liability. Forensic science is expendable in such circumstances. It only requires appropriate levels of expertise and investigation materials. During this process, the nurses keep their finding in the patients' medical records. Besides, the nurses are obliged to report any suspected case of abuse.

Victims of critical hospital incidents and those of crime are subject to forensic science within the critical care units. Clinical or health practitioners are, according to law held responsible for the death of a patient during the admission of anesthesia after being released from operating theatre. This requires that the evidence records be kept that will be useful tools linking the medical practitioners, police and the victim.

2.4. Recognizing patients with legal liability issues

Patie9nts with legal liability issues are those of abuse, sexual, emotional or physical, victims of domestic violence and neglect. This is considered regardless of age, sex or citizenship; whether a minor or senior citizen. Domestic violence involves humiliation or subjecting one to traumatizing pain, fear, intimidation through physical, social, financial, and sexual injuries in a coercive manner among persons in intimate relationship either at present or in the past. These can be seen through serious bleeding with wound that must be sutured, when internal organs bleed or malfunction due to internal injuries, evidence of fractured bones, skull, and vertebrae. Broken arms, legs, and jaws are also a manifestation of domestic violence. Burns wound on the body are too signs of domestic violence. Anxiety, depression, and excessive indulgence in substance abuse are signs of emotional problems. on-accidental injuries inflicted upon a child by either parent or guardian are a legal liability issue.

2.5. Wound characteristic

Medical environment's use of the words…