Forensic Nursing in the Past

Forensic Nursing

In the past few years, the practice of forensic nursing has emerged as a dramatic new profession as the result of numerous crime television shows, and media attention on the medical aspect of criminal investigations. The media has portrayed forensic nursing as a new phenomenon used to solve crimes to public society. Realistically, however, nurses have historically been practicing forensic nursing for many years. The nursing profession defines forensic nursing as "the application of the forensic aspects of healthcare combined with the bio/psycho/social/spiritual education of the registered nurse in the scientific investigation and treatment of trauma and/or death victims and perpetrators of violence, criminal activity and traumatic accidents (Morris, 2006). The forensic nurse plays several different roles, not all of which are related to solving homicide crimes. This paper will discuss the history, need, educational requirements and the practice of the forensic nurse. It will also analyze the current and future implications of the forensic nurse in relation to healthcare trends, and will conclude with a projection of this role in the future as technological advancements in the industry progress.

The History of and the Need for Forensic Nursing

Although the role of the forensic nurse has existed for several decades, this profession did not receive acknowledgement as a distinct profession until the 1990s. During 1992, the International Association of Forensic Nurses (IAFN) was formed in Minneapolis, Minnesota, serving as a cohesive organization for all arenas of forensic practitioners to network and share information. In 1995 the American Nurses Association recognized forensic nursing as a specialty and collaborated with IAFN to develop the Scope and Standards of Forensic Nursing Practice (Morris, 2006). The role of the forensic nurse became largely recognized in 2000 as the result of a Virginia circuit court sexual assault case, Commonwealth v. Johnson. Suzanne Brown was a nurse that was considered to be an expert by the presiding judge, was allowed to testify about injuries she observed in a rape victim. Her testimony stated that the injuries visible without magnification indicated that the sexual activity occurred without consent, however, the defense declared her opinion to be scientifically unreliable. The court consulted various studies and ruled that none of them supported Brown's opinion, and held that since the medical literature did not support Brown's opinion about the human sexual response relating to genital injury, there was no foundation to admit evidence, and excluded her testimony.

Although portions of her testimony were not admitted by the court, it was considered a small victory for forensic nursing because the court recognized Brown as an expert witness. In 2002, another court held that nurses who examine alleged rape victims may testify in court but cannot offer their opinion that a victim's injuries were caused by sexual assault. After 2002, the particular need for this profession, was established, as forensic nurses play many different roles. Forensic nurses assist rape victims, and work with other types of interpersonal abuse such as domestic violence, child and elderly abuse, neglect and physiological, as well as psychological abuse. Many forensic nurses work as examiners in hospital emergency rooms, examining victims of near-fatal or fatal traumas such as shooting or stabbing. In these cases, the forensic nurse works in collecting bullets and other debris left in the body that will assist in the investigation (Morris, 2006). They also have to photograph and measure the wounds of the patients, and in the case of death, the forensic nurse works in conjunction with the medical examiner (Morris, 2006).

Another role of the forensic nurse consists of testifying in court regarding the examination of the body or notes in a medical record. They can also testify as an expert witness and give objective opinions regarding what he or she believes occurred based on the forensic evidence. Forensic nurses also administer care to living victims and their families and to deceased victims and those left behind. Pioneers in forensic nursing are practicing in correctional facilities, in psych/mental health programs, as death investigators, as legal nurse consultants, as clinical forensic nurses in hospital settings, but the majority practice as sexual assault nurse examiners (Morris, 2006). The most popularized role of the forensic nurse is that of the death investigator, which has been the subject of several different definitions. Research indicates that the death investigator's role is to represent and advocate for the deceased (Allert & Becker, 2003). The investigator should possess scientific and experiential knowledge in order to make professional and accurate judgments on manner of death based on pre-death symptomology, history, post-mortem appearance, toxicology, and other diagnostic studies (Batchen, 2005). A death investigator must also be able to recognize and integrate other evidence, including patterned injuries and patterns of injury, revealed during the investigation.

Thus, our society needs forensic nurses for many different reasons. Some forensic nurses can assist in crimes, to build a case of what occurred when there are no witnesses. Forensic nursing can also assist in an investigation where the evidence plays a strong role in determining who is guilty of conducting the crime. In this case the work of the forensic nurse is very important because evidence such as DNA can be easily destroyed or lost during an investigation. Forensic nurses are needed to work with victims, such as rape or domestic abuse victims, who may need a representative to testify with them in court to shed light on what occurred. They are also needed in the legal profession, where they can give an expert opinion based on their medical investigation and piecing the evidence together with the victim's medical history. The investigations conducted by forensic nurses are important and needed because they provide an expert analysis of the occurrence from a medical point-of-view.

Educational Requirements and Practice of the Forensic Nurse

The education requirements of the forensic nurse are different than most specialized area of medical practice. Although forensic nursing is a specialty area such as emergency or geriatric nursing, one can become a forensic nurse fairly easily. An individual must first become a registered nurse, and then focus on practice in forensic nursing. The forensic nurse is required to complete sexual assault nursing, but there are not any other extra qualifications or educational background needed. In the past few years, more forensic educational courses are being developed around the world, due to increased media attention and increased awareness and interest in many forensic areas of practice. Forensic educational courses have traditionally focused on either the forensic sciences or on the forensic behavioral sciences. Research indicates that the broad overview of all areas of forensic practice from the perspective of the multidisciplinary team provides a greater awareness of the interface of health care and the law, and the victim/perpetrator relationship. The practice of the forensic nurse involves working with many types of offenders, including those that are mentally ill, drug addicts, sex offenders or youth. Forensic nurses also work with different types of victims, including sexual assault victims, crime victims, those involved in catastrophic accidents, trauma, and domestic violence victims. Their practice involves the families of both the offenders and the victims, whether alive or dead.

There are no formal or educational requirements about what attributes will make a superb forensic nurse, there are a few assumptions. For example, helpful attributes include a curious nature, an eye for detail, the ability to discriminate and document crucial and pertinent information in an objective manner, a strong stomach, good coping skills, mechanisms, and techniques, education, training, inductive and deductive reasoning skills, an analytical, logical nature, extensive clinical experience, intuition, an ability to compartmentalize feelings, and social maturity (Batchen, 2005). The knowledge of medical conditions and understanding of history, procedures, treatments, and pharmacology are major contributing factors in determining the direction of a scene (Batchen, 2005). In addition, the nurses' ability to analyze and assimilate health histories, the importance of writing reports and summaries in an objective format, making relevant observations and communications in a non-judgmental way, and use of interpersonal and interrelation skills will enhance difficult interviews. The forensic nurse also must be supportive when dealing with extremely emotional, distraught, and aggressive survivors, because in many cases survivors are unable to achieve closure with the decedent or offender. The forensic nurse must be able to be supportive, but strong at the same time, and leave out any personal emotions related to the particular situation. Finally, the practice of forensic nursing has several subspecialties, including forensic correctional nursing, forensic geriatric nursing, forensic legal nurse consulting, forensic death investigators, forensic pediatric nurses and forensic psychiatric nursing.

Current and Future Implications and the Relation to Healthcare Trends

Since healthcare trends shift continuously as a result of new medical advancements and the availability and application of new technologies, the role of the forensic nurse changes as well. One trend noted by recent research is the trend toward utilizing forensic nurses as death investigators. Batchen (2005) states that as nursing roles shift from the more traditional roles to the non-traditional role of death investigator, the major components of the nursing process must be re-conceptualized in order to clarify how nurses operate in the forensic environment. Batchen (2005) defines the components of the nursing process as the client, the environment, the definition of health, and the definition of the nurse's role. Another trend in healthcare to be addressed is the reduction of enrollment in Registered Nurse (RN) programs, which has led to a shortage of trained nurses. This trend is important because the role of the forensic nurse has changed as a result of the increase in a nurse's range of function, with the rise in the number of the elderly due to improved healthcare systems and the introduction of community-based preventive projects.

In the future, the role of the forensic nurse may become more specialized and considered a separate profession from the registered nurse. According to the Federal Bureau of Health professions, in 2000, the National supply of registered nurses was estimated at 1.89 million, while the demand was projected at 2 million, a shortage of 110,000, or 6% (Sterzenbach, 2005). According to Sterzenbach (2005), based on what is known about trends in the supply of RNs and their anticipated demand, the shortage is expected to grow relatively slowly until 2010, by which time it will have reached 12%. This affects the role of the forensic nurse, because these shortages in the nursing practice will in turn reduce the number of forensic nurses. One way in which the profession can deal with the predicted shortages is to make forensic nursing a specialized industry, thus appealing to more individuals that may be specifically interested in the elements involved in forensic nursing. The profession can deal with this shortage trend by increasing pay rates of those already working as qualified nurses to consider specialization.