Forensic nursing

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Forensic nursing is defined as the application of the nursing process to public or legal proceedings, and the application of forensic health care in the scientific investigation of trauma and/or death related to abuse, violence, criminal activity, liability, and accidents.

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Before there was a specialty recognized as forensic nursing, the term used was clinical forensic medicine. This term describes the use of clinical practices to support judicial proceedings to protect a victim, usually after death has occurred. It was not until the late 20th century that medical professionals wanted more collaboration between the medical and legal systems. In the United States this problem began to be addressed. A strong advocate for the forensic nursing specialty in United States was Virginia Lynch. She pushed to have the specialty recognized and helped to form programs in the U.S. for proper education. In the 1980s articles were being written about how the important evidence needed to build a legal case was not being preserved during the treatment of a victim. From there began an explanation of the nurse's role in not just forensic medicine but also the criminal justice system when dealing with a victim of violence.

Most nurses practice with the holistic framework of body, mind and spirit. With forensic nursing established, the role of a nurse was altered to also include the law. There has been an establishment of this specialty but it was not created to have nurses become investigators. Their goal is to work with a possible victim and make sure the proper medical but also forensic tasks are accomplished. The forensic evidence is then passed on to the criminal justice system for proper investigation. This specialty has started to be recognized worldwide and is helping to promote an international focus on violence. The nurses are becoming vital resources for the healthy relationship needed between the health and justice systems. [1]

History

Forensic nursing developed in response to concerns in the 1980s regarding the treatment of patients with crime-related injuries and the proper handling of evidence. Globally, the development of general clinical forensic medicine and the forensic nursing have progressed at different speeds, with one preceding the other on a country-by-country basis. Founded in 1992, the International Association of Forensic Nurses is the primary professional association for forensic nursing, which as of 2019 included 4,400 members in 25 countries. [1]

Although forensic nursing can be traced back to the 1980s for the development of the specialty, it can be noted that the foundation may have been laid as early as the 18th century. Certain medical professionals were involved in court cases that involved crimes like rape. These medical professionals began to move these issues from a simply criminal justice view to a more recognized health concern. [2]

Role and responsibilities

Forensic nursing combines nursing practice and forensics in the scientific investigation of death and injury resulting from criminal activity and accidents. In addition to providing care, forensic nurses act as multidisciplinary team members with and consultants to other nursing and medical professionals and law enforcement. They receive advanced training in collecting and preserving evidence, treatment protocols, and legal proceedings and testimony. [1]

The specialized training that forensic nurses receive related to both the medical and legal needs of these patients drives demand for the specialty. Crime victims face a higher risk of post-traumatic stress disorder, depression, suicide, and medical complications than other patients; forensic nurses improve both legal outcomes and quality of life for these patients relative to standard Emergency Department care. [3] Forensic nurses also assist in providing professional insight to potential causes of patient injuries in situations in which witnesses are unavailable. [4]

Prior to beginning an exam, forensic nurses must receive consent from the patient. In addition to documenting obvious injuries, forensic nurses specialize in looking for subtle signs of assault, such as petechiae, voice changes, and loss of bowel or bladder function. [3] Forensic nurses document patient injuries through tools including cameras, measuring tapes, fluid swabs, rape kits, and a high-powered light that can reveal hard-to-see bruises and fluids like semen, urine, or saliva. They document every injury for potential use as evidence in a later court case, where they may be called as an expert witness to testify to the injuries. [5]

Forensic nurses are also responsible for educating a patient on his or her rights. In the United States, for example, patients are not required to pursue legal action to receive a medical exam, and it is the forensic nurse's responsibility to discuss this with each patient. [3]

More specifically, forensic nurses go through training to be able to understand and treat different types of trauma that is experienced by many different types of people. [6]

Child abuse

Child abuse is a common type of trauma that forensic nurses work with.

When these nurses encounter a possible situation involving child abuse they must make sure to protect the child from any more trauma. The forensic nurses look at things such as bruises, possible head injuries and sexual abuse. [7] The importance of a nurse here is key to determine the difference between an inflicted bruise or a usual activity bruise. A forensic nurse will know that a bruise located on the ears, neck and other soft tissues of the body should raise a red flag. [8] Once the physical marks are assessed for abuse or an accident a nurse can decide what to do next, whether that is more tests or a consultation with the physician. When working with children it is important that the nurse makes the child comfortable to ensure a trusting relationship. Forensic Nurses make sure to build this relationship to allow the child to share details they otherwise might keep to themselves. There may be abuse that is not visible to the eye and it is important to make sure the child shares those key details. If abuse is detected the nurse will take the next step of reporting the abuse. Although many policies are similar, each state in the U.S. has its own laws and systems in place for reporting possible child abuse. [9] This is where forensic nursing connects to the legal side of investigation. The nurse must make sure to report their findings, and report them accurately because the nurse is held liable. [7]

Sexual assault

Another type of trauma that forensic nurses provide care for is sexual assault which includes rape. Forensic nurses are trained to screen for sexual assault because many assaults go unreported. Patients may have some fear, embarrassment, or denial that could inhibit their willingness to report their assault. These nurses have the ability to know whom to screen, and how. Questions are essential to these nurses because not all potential victims are going to be honest about what they may have or may have not experienced. The questions asked need to be worded properly to avoid discomfort and inaccurate information. Recently, there has been an integration of written and verbal questionaries' that may help the patient and the nurse address a possible assault. [10] A possible question to begin would involve asking if the possible victim was forced to do something that he or she did not want to do. It is important that the nurse is able to help a possible victim understand the question without forcing or leading an inaccurate answer. If a patient admits to being sexually assaulted then the next step is to ensure patient safety. There are protocols in place that help a forensic nurse in taking the next step, when a patient admits to being sexually assaulted. For example, the nurse may explain to the victim their legal rights in regard to reporting the assault, as well as the details of the physical exam for evidence. A specialty in forensic nursing is a Sexual Assault Nurse Examiner (SANE). These nurses will collect and record the forensic evidence needed for a criminal case. Some of the evidence included should be a history of the incident, removal of clothing, head-to-toe assessment, urine collection, blood draw, oral swabs, genital exams, and a STD screening. [11] After there has been an evidence collection or not (if the patient does not want the assault reported if over 18) follow-up care is essential. The forensic nurse should be able to provide the victim with necessary resources. These resources may include crisis centers, therapy referrals, and support group information.

Professions

Forensic nursing includes roles such as: [1]

Certification

As of 2015, the International Association of Forensic Nurses offers two professional certifications under its certification body, the Commission for Forensic Nursing Certification (CFNC), for Sexual Assault Nurse Examiners: the Sexual Assault Nurse Examiner - Adult/Adolescent (SANE-A) and the Sexual Assault Nurse Examiner - Pediatric (SANE-P). [12]

Worldwide

United States

Virginia Lynch, an early advocate of forensic nursing, proposed creation of the forensic nursing specialty in 1986 and helped establish the first graduate studies program at the University of Texas at Arlington's School of Nursing. The American Academy of Forensic Sciences recognized the forensic nursing specialty in 1991 and the American Nurses Association followed in 1995.

Great Britain

In Great Britain, forensic nursing includes a forensic psychiatric nursing sub-specialty, which emphasizes practicing forensic nursing for mental health patients. [13]

Canada

As of June 2015, forensic nursing is not recognized as a nursing specialty in Canada and does not have a PhD program. [14]

See also

Related Research Articles

Hymen Membrane that surrounds or partially covers the external vaginal opening

The hymen is a thin piece of mucosal tissue that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia, and is similar in structure to the vagina.

Sexual assault is an act in which one intentionally sexually touches another person without that person's consent, or coerces or physically forces a person to engage in a sexual act against their will. It is a form of sexual violence, which includes child sexual abuse, groping, rape, or the torture of the person in a sexual manner.

A proportion of victims of rape or other sexual violence incidents are male. Historically, rape was thought to be, and defined as, a crime committed solely against females. This belief is still held in some parts of the world, but rape of males is now commonly criminalized and has been subject to more discussion than in the past.

Forensic psychology Using psychological science to help answer legal questions

Forensic psychology involves the application of psychological knowledge and methods to help answer legal questions arising in civil or criminal proceedings. Historically, forensic psychology was defined narrowly as the application of clinical psychological knowledge to criminal cases or questions in criminal justice settings. Contemporary definitions of forensic psychology recognize that several subfields of psychology apply "the scientific, technical, or specialized knowledge of psychology to the law." While the American Psychological Association (APA) officially recognized forensic psychology as a specialty under the narrower definition in 2001, the Specialty Guidelines for Forensic Psychologists were revised in 2013 and now reference several psychology subdisciplines, such as social, clinical, experimental, counseling, and neuropsychology).

A rape kit is a package of items used by medical personnel for gathering and preserving physical evidence following an allegation of sexual assault. The evidence collected from the victim can aid the criminal rape investigation and the prosecution of a suspected assailant. DNA evidence can have tremendous utility for sexual assault investigations and prosecution by identifying offenders, revealing serial offenders through DNA matches across cases, and exonerating those who have been wrongly accused.

Rape crisis centers (RCCs) are community-based organizations affiliated with the anti-rape movement that work to help victims of rape, sexual abuse, and sexual violence. Central to a community's rape response, RCCs provide a number of services, such as victim advocacy, crisis hotlines, community outreach, and education programs. As social movement organizations, they seek to change social beliefs and institutions, particularly in terms of how rape is understood by medical and legal entities and society at large. There is a great deal of diversity in terms of how RCCs are organized, which has implications for their ideological foundations, roles in their communities, and the services they offer.

Rape Type of sexual assault usually involving sexual intercourse without consent

Rape is a type of sexual assault usually involving sexual intercourse or other forms of sexual penetration carried out against a person without that person's consent. The act may be carried out by physical force, coercion, abuse of authority, or against a person who is incapable of giving valid consent, such as one who is unconscious, incapacitated, has an intellectual disability, or is below the legal age of consent. The term rape is sometimes used interchangeably with the term sexual assault.

Emergency nursing

Emergency nursing is a specialty within the field of professional nursing focusing on the care of patients who require prompt medical attention to avoid long-term disability or death. In addition to addressing "true emergencies," emergency nurses increasingly care for people who are unwilling or unable to get primary medical care elsewhere and come to emergency departments for help. In fact, only a small percentage of emergency department (ED) patients have emergency conditions such as a stroke, heart attack or major trauma. Emergency nurses also tend to patients with acute alcohol and/or drug intoxication, psychiatric and behavioral problems and those who have been raped.

Initiatives to prevent sexual violence

As sexual violence affects all parts of society, the responses that arise to combat it are comprehensive, taking place on the individual, administrative, legal, and social levels. These responses can be categorized as:

Victimisation is the process of being victimised or becoming a victim. The field that studies the process, rates, incidence, effects, and prevalence of victimisation is called victimology.

A psychiatric assessment, or psychological screening, is the process of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes. The assessment includes social and biographical information, direct observations, and data from specific psychological tests. It is typically carried out by a psychiatrist, but it can be a multi-disciplinary process involving nurses, psychologists, occupational therapist, social workers, and licensed professional counselors.

Rape in the United States is defined by the Department of Justice as "Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim." While definitions and terminology of rape vary by jurisdiction in the United States, the FBI revised its definition to eliminate a requirement that the crime involve an element of force.

Rape investigation is the procedure to gather facts about a suspected rape, including forensic identification of a perpetrator, type of rape and other details.

Drug-facilitated sexual assault (DFSA) is a sexual assault carried out on a person after the person has become incapacitated due to being under the influence of any mind-altering substances, such as having consumed alcohol or been intentionally administered another date rape drug. The rape form of DFSA is also known as predator rape. 75% of all acquaintance rapes involve alcohol and/or drugs. Drugs, when used with alcohol, can result in a loss of consciousness and a loss of the ability to consent to sex.

A Sexual Assault Nurse Examiner (SANE) is a qualification for forensic nurses who have received special training to conduct sexual assault evidentiary exams for rape victims. SANE nurses are specially trained in the medical, psychological, and forensic examination of a sexual assault victim. There are two different credentials available under the SANE designation: SANE-A for adult and adolescent examiners, and SANE-P, which is specifically for pediatric victims. Not all, but many SANE programs are coordinated by rape crisis centers in place of a hospital. Some programs are employed by law enforcement and conduct their exams at stand alone sites, not in an emergency department (ED). SANEs are on call 24-hours a day and may arrive at the hospital ED within an hour of a sexual assault victim's arrival. Some programs will wait until the patient has had a medical screening exam (MSE) and subsequently have law enforcement bring a stable patient to the sexual assault response team (SART) site for their exam. If the patient is in critical condition and admitted to the hospital, the SANE can perform a 'mobile exam' and bring their exam supplies and camera to the hospital. In addition to the collection of forensic evidence, they also provide access to crisis intervention counseling, STI testing, drug testing if drug-facilitated rape is suspected, and emergency contraception. A SANE will also supply medical referrals for additional medical care or possible follow ups to document how they are healing.

University College Hospital, Ibadan Hospital in Oyo State, Nigeria

University College Hospital, Ibadan is a federal teaching hospital in Ibadan, Nigeria attached to the University of Ibadan.

Genital trauma is trauma to the genitalia.

Ann C. Wolbert Burgess is a researcher whose work has focused on developing ways to assess and treat trauma in rape victims. She is a professor at the William F. Connell School of Nursing at Boston College.

Vaginal trauma is injury to the vagina. It can happen during childbirth, sexual assault, and accidental occurrences.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

References

  1. 1 2 3 4 Hammer, Rita; Moynihan, Barbara; Pagliano, Elaine (2011-06-05). Forensic Nursing: a Handbook for Practice. Jones & Bartlett Publishers. ISBN   9780763792008 . Retrieved 2015-08-15.
  2. ↑ Burgess, A. W., Berger, A. D., & Boersma, R. R.. (2004). Forensic Nursing. The American Journal of Nursing, 104(3), 58–64. Retrieved from https://www.jstor.org/stable/29745577
  3. 1 2 3 Esposito, Lisa (2014-08-07). "How Forensic Nurses Help Assault Survivors". U.S. News & World Report. Retrieved 2015-08-15.
  4. ↑ Blanchard, Bobby (2015-03-10). "A&M Hopes to Add Department of Forensic Nursing". The Texas Tribune. Retrieved 2015-08-15.
  5. ↑ Carson, Ilona (2015-05-12). "Demand for forensic nurses on the rise in Houston". ABC 13 Eyewitness News. Retrieved 2015-08-15.
  6. ↑ "What is Forensic Nursing? - International Association of Forensic Nurses". www.forensicnurses.org. Retrieved 2016-04-22.
  7. 1 2 Stephen Lazoritz, Katherine Rossiter, & Dina Whiteaker, What every nurse needs to know about the clinical aspects of child abuse , 2010
  8. ↑ Services, Department of Health & Human. "Child abuse - reporting procedures". www.betterhealth.vic.gov.au. Retrieved 2016-03-29.
  9. ↑ "Reporting Child Abuse and Neglect - Child Welfare Information Gateway". www.childwelfare.gov. Retrieved 2016-04-22.
  10. ↑ Moore, G., DNP, WHNP-BC. (2015). Sexual Assault Screening in the Outpatient Setting. American Nurses Today,10(8). Retrieved March 25, 2016
  11. ↑ "What Is a Rape Kit? | RAINN | Rape, Abuse and Incest National Network". rainn.org. Retrieved 2016-03-29.
  12. ↑ "Certification Opportunities". International Association of Forensic Nurses. Archived from the original on March 20, 2018. Retrieved February 27, 2015.
  13. ↑ Mason, T.; Lovell, A.; Coyle, D. (2008). "Forensic psychiatric nursing: skills and competencies: I role dimensions". Journal of Psychiatric and Mental Health Nursing. 15 (2): 118–130. doi:10.1111/j.1365-2850.2007.01191.x. PMID   18211559 . Retrieved 2015-08-15.
  14. ↑ Zytaruk, Tom (2015-06-04). "FORENSIC NURSES: 'We can't change their lives but we can help.'". Surrey Now. Archived from the original on 2015-08-25. Retrieved 2015-08-15.
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