Photo-Documentation in
Elder Mistreatment
Cases
Module 10
Nursing Responses to Elder Mistreatment
An IAFN Education Course
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Learning Objectives
By end of this module, participants will be able to:

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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
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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
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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
provider’s reference guide to partner and elder abuse, 2007
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What Happens to Photographs?
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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
o Staff nurse?
o Other staff?
o Forensic nurse examiner or medical
photographer?
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Digital Cameras

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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

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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
1.
2.
3.
4.
5.
6.
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

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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
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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

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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”
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Start with a front-facing, full-body
photograph of patient
Photographs of each injured area
should be taken from three different
distances
o
6 feet
o
4 feet
o
2 feet
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4. Labeling Images
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All photographic images must be properly
labeled with the following information
o
o
o
o
o
o
o
Patient name
Date of birth and ID number
Facility name
Date and time photograph is taken
Photographer’s name
Location of wound
Case number (if assigned)
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Labeling Images
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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
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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
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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
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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
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Every time nurses take photographic
images of a patient, they should also
document wounds on a pre-printed
body map/diagram, notingo
o
o
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
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What have you learned from this
module that you can apply to your
practice setting?
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