I was asked about the BALD STEP guide in the IAFN core curriculum and why I developed it. My PhD work was to look at factors leading to mental and physical health consequences, including injuries. In doing the literature search I realized that injury terms were used incorrectly and inconsistently (e.g. a bruise and ecchymosis are NOT the same, nor is any open wound a laceration). The TEARS mnemonic also used incorrect terms. We cannot begin to understand patterns of injury and significance if we can't be sure we are talking about the same kind of findings- did that nurse actually mean a bruise (blunt trauma) or ecchymosis (gravitational spread thru fascial planes)...? I created a list of blunt and penetrating injuries that could be found with any trauma including sexual assault and used it for my training to increase consistency of terms (see attached article- Carter-Snell, 2011)
. This is now used in the Canada-wide RCMP kit and the international core curriculum for forensic nursing. BALD STEP can also be used to make charting more efficient. The guide can be handwritten onto documentation and abbreviations can be used on traumagram, making documentation more efficient. SImply start charting with "examined from head to toe for physical findings as per BALD STEP guide, refer to traumagram for findings". No negative charting required as you have indicated what you looked for and documented what you found. Happy to answer questions
Wonderful stuff
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