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Violence has been identified as one of the leading public health hazards of our time. The majority of the victims of violence are being seen in emergency departments and critical care areas. This compels today's nurse to be educated in the proper recognition, interpretation, collection, documentation, and photo-documentation of the ramifications of violence and the associated forensic evidence. The categorization of these patients should be determined by the critical care nurse. Categorical determinations will ensure that the nurse develops a systematic, algorithmic management plan for any client with potential forensic implications associated with their care. It will also assist the nurse in recognizing the mandated reporting that must be completed in certain instances. The additional benefit is to determine what educational needs are required by the critical care nurse staff to posit the forensic population; and, to consider what future research must be accomplished in order to better serve this unique clientele.

Munchausen by Proxy Syndrome (MBPS) is a rare form of abuse in which a caregiver fabricates or produces symptoms of an illness in a child, elder, or disabled person. The deception is usually repeated on numerous occasions, resulting in many hospitalizations, considerable morbidity, and sometimes death. MBPS is a factitious disorder in which caregivers injure their victims in order to gain sympathy or attention for themselves. It was named after Baron Karl von Munchausen, the 18th century cavalry officer who returned home from war and told embellished tales of his adventures. MBPS is a very horrifying circumstance of abuse. Unwillingness or the inability to recognize this abuse deprives the victim of the opportunity to be shielded from future harm. There is a need for strategic protocols and a multidisciplinary approach to this baffling problem. Discussing the clinical profile of the perpetrator, the victim, and the family may help nurses distinguish medical fact from fiction.

1. Although the nurse's first duty is to provide life-saving treatment for the trauma victim, the patient and society are best served when the nurse also can recognize and preserve evidence that may later be used in a forensic investigation. 2. Photography should become part of trauma protocol, along with performing the ABCs of cardiopulmonary resuscitation. It should be an automatic function. 3. Photographing injuries also protects the hospital and staff from allegations that patients never received the proper care.