Examining the Core Concepts of Forensic Nursing

Nursing is a profession which works on the core concepts of empathy, communication, caring, trust, advocacy, and leadership. Every area of nursing uses these concepts and beyond to provide care to clients at times when they need it the most. Forensic Nursing too uses these concepts; however, it places more concentration on scientific objectivity rather than patient support. This is not to say, that they to provide patient support, but it is the practice that by being objective in evidence collection, they ensure successful results in trauma investigations.

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Forensic Nursing is defined as “the application of forensics with the biopsychosocial interventions of the registered nurse in the scientific investigation and treatment of trauma and/or death related medical-legal issues (Wecht, C.H., Rago, J.T., 2006). It used to be that forensic medical interventions including lifesaving interventions were withheld until a Forensic medical examiner (FME) until they arrived to the emergency department and had collected evidence (Pyrek, K., 2006). Often times, clients were even transferred to other cities which offered forensic clinical services, and even then no interventions could be provided so as not to disturb the forensic evidence (Pyrek, k., 2006). However, If a Forensic Nurse Examiner (FNE) is available at the clinical site, they are able to secure the important forensic evidence requiring timely recovery and preservation without withholding medical interventions, i.e. in sexual assault cases (pyrek, K. 2006).

It was in 1991 that the American Society of Forensic Nurses first to recognized and accepted Forensic Nursing as a specialty (Bader, D.M, Gabriel, L.S.,). Then in 1992, 72 primary sexual assault nurse examiners formed the International Association of Forensic Nurses (IAFN) (International Association of Forensic Nurses, 2006). The aim of the IAFN was to promote the education of forensic nurses. In 1997 the IAFN went on to develop the Forensic Nursing Code of Ethics and the Scope and Standards of Nursing Practice (Bader, D.M, Gabriel, L.S., 2009).

Forensic Nursing is a specialty that is still new and needs to continue developing so forensic nurses can provide the appropriate responses in trauma cases, provide a more holistic care to their clients, and advocate in an unbiased and scientifically objective manner. Where it has been that it is the emergency nurses who have been the first to come in contact with clients involved in trauma cases, emergency nurses are trained in the legal complexities that are characteristic of trauma cases, and who may not consult with the hospital legal team when such cases are presented, before going ahead and providing the necessary interventions that the client needs resulting in loss of critical evidence (pyrek, k., 2006).

Forensic nurses can provide appropriate health care response in the event that they are presented with either a victim or a perpetrator of a traumatic case. They are trained in identifying injuries, their patterns, documenting statements and injuries through written and photographic accounts, and collecting and preserving physical evidence. Linda McCracken in the forensic nurses states that” health care and the law often become enmeshed during critical moments when patient care supersedes the concern for social justice. (Pyrek, K., 2006).

Most nurses and institutions are not trained to recognize the importance of physical evidence, so in the process of providing care to the patient, key physical evidence may be lost i.e. through discardment of victims clothing, or cleansing of the wounds. When most trauma cases are presented to the Emergency department, the Emergency nurse is most often the first person to see and talk to the patient, the first to know the situation, first to deal with the family, first to deal with the patient property, and as result first to deal with the specimen and evidence (pyrek, K., 2006). In these situations, the evidence and the manner and the time in which they are collected, saved, and documented can have an impact on the turn out in the analysis and legal proceedings (Ledray, L., 2010).

Forensic nurses provide a more holistic care to their clients by including the forensic aspect within their care plan (Pyrek, k., 2006). A forensic nurse has many of the same role as any other registered nurse such as patient advocacy, however, they also have to fulfill they also work closely with the legal system, so they are active members of the investigation, are liaisons for law enforcement and facility staff, they identify, collect, and preserve the evidence, provide accurate documentation, and act as expert witnesses in courts (Bader, D.M., Gabriel, L.S., 2009).

The forensic nurse practice models include sociology, criminology, clinical and criminal investigation, and education (Hammer, R.M., Pagliaro, E.M., 2006). The forensic nurse besides being an advocate for the client, is an advocate for truth and justice, and The first priority of a forensic nurse is to ensure the safety of the living victim and the dead victim’s body, collecting and preserving evidence from the body, performing a forensic examination with the intention of identifying and collecting evidence that may have transferred from the victim, collect evidence from without bias and without causing physical and psychological stress to the living or dead victim, and documenting all evidence (Bader, D.M., Gabriel, L.S., 2009). They are also responsible for conducting interviews on the victim, suspected victimizer, convicted victimizer; family, friends, and witnesses (Bader, D.M., Gabriel, L.S., 2009).They have to pay attention to collect any physical evidence i.e. dirt, and paint chips, biological evidence i.e. saliva, and insects, and physical material i.e. fabric (Bader, D.M., Gabriel, L.S., 2009). Lastly the documentation which is perhaps the most important piece of evidence in an investigation should be accurate, descriptive, and without personal judgements.

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Forensic nurses have to be unbiased and scientifically objective. Forensic nurses don’t come only in contact with victims of violence, but also with the victimizers. While many nurses when faced with a suspect or accused of a crime may be more concentrated on finding out why the suspected or accused perpetrator may have committed the act. While the question may be important, forgetting to concentrate on the evidence can be perilous. As forensic nurses they need to concentrate on what they are seeing, and what needs to be collected for the purposes of analysis. According to Janet Baber, MSN, FN, “in the beginning forensic nursing was based on helping people in need…Now forensic nursing has evolved to where we must compartmentalize our desire to nurture, console – any nurse would do that because caring for and protecting human being is instinctive (pyrek, K., 2006). The advocacy component is not unique to forensic nursing…the forensic nurse cannot be get overtly involved in advocacy. This nurse must stay within an objective, scientific framework, because if a nurse allows advocacy to supersede concern about the evidence, he or she will become diverted from the purpose of forensic nursing (Pyrek, K., P. 29, 2006).” Concentrating on the evidence will help more in uncovering the truth of the crime and revering justice than being embroiled in emotions of the case and the client. This is what will help the forensic nurse when it comes time for them to provide the evidence in court, where they are going to have prove that they were objective in their evidence collection and that they were not deterred and entangled in the circumstance of the case. In the book forensic nurse, Sharon Crowley, RN, MN, and California forensic examiner says that, “What I do as a forensic nurse is going to be dissected in a court, or in a crime lab. Forensic nursing practice is mandated by science, and I don’t have a problem with that because I see my advocacy come through science (Pyrek, K., P. 30, 2006).

The reason behind the origin of forensic nursing was that forensic pathologists believed that pertinent legal questions were not being addressed, and inspite of resistance the specialty has grown significantly (Hammer, R.M., Pagliaro, E.M., 2006). As forensic nursing continues to grow, there will have to be increased interprofessional collaboration, communication, and sharing of information and knowledge to achieve justice. Currently, there are not many hospitals, clinics, if any, that have a forensic nurse in place, because not many institutions believe that it is necessary to have them, not to mention there is already a poor patient to nurse already. Some challenges that the specialty will face will probably include – job opportunities, funding, education and training, professional development mandates, and continuing acknowledgment of importance and respect from other health care colleagues (Pyrek, K., 2006). Forensic nurses have to be self-directed, and be confident in their abilities.

I have been interested in forensic science for a long time, and took a full year course at University of Toronto as an elective about 3 years ago. We were introduced to different areas of forensics, but forensic nursing was not one of them. It was very interesting to research this topic and learn about the roles of forensic nurses. Having had done a placement in long term care, I have heard of many of elder abuse, and realize that the issue is probably not getting the attention it deserves. I like that forensic nurses extend the roles of registered nurses to include the forensic aspect in their care. I realize that it would be very challenging to pursue a career as a forensic nurse, and hope that it will continue to grow.

Since its establishment, forensic nursing has gained a lot of attention, and continues to grow. A Forensic Nurse is important because they can provide an appropriate response in trauma cases, the appropriate response being, collecting, preserving and documenting the evidence. A Forensic nurses extends the role of a registered nurse by including the forensic aspect in their care plan. While as nurses we are trained to provide caring for our client is one of our primarily responsibility, in forensic nursing, the evidence and documentation take the priority because without them, it is hard to prove legitimacy in court cases. Lastly, they fufill their roles in a manner that is unbiased and scientifically objective. The whole purpose of forensic nurses is to aid their law enforcement and forensic science colleagues in analyzing the evidence, and to do that, it must be important that they take out their emotions about the victim, victimizer, and case, to collect what they see without bias and utmost objectivity to ensure justice. Forensic nursing is a speciality that face many challenges in its growth mainly in terms of job opportunities, especially in today’s clients where institutions hardly are able to keep a good nurse to client ratio, it will probably be hard to establish the need for forensic nurses, however, until there is a high profile case that increases concentration on forensic nursing, they will just have to be more self-directed in their career (pyrek, K., 2006).