BACKGROUND

The inception of forensics and medicine has been noted to go back as far as the days of early civilization, with evidence suggesting Egyptian and Hindu medicine showed an understanding of poisons and toxicology (Smith, 1951). Greek civilization and Hippocrates would discuss injury patterns as well as an understanding and an oath of not using poisons. The Romans used injury pattern identification in determining the cause of death, such as in the case of Julius Caesar (Smith, 1951). Ancient Chinese documents also revealed evidence in medical death investigations and wound identifications (Smith, 1951). It was only natural for forensics to find its way into nursing.

Published documents have demonstrated clear forensic nursing practice in the United Kingdom in the 1950s (Smith, 1951). In the United Kingdom, healthcare professionals, including nurses, often formed partnerships with law enforcement so that they could provide healthcare and forensic medicine to those in the custody of law enforcement and within the “custodial environment” (Officer, 1979). The role was specific to individuals with mental health and substance use disorders or dealt with child sexual assault (Officer, 1979). Other clinical duties included obtaining medical histories, administering medications, assessing mental health, determining the individual’s ability to be interviewed, providing reports to law enforcement, giving court testimony, and appearing as a fact or expert witness (Officer, 1979). Some of the responsibilities would be included after the nurse had additional training and experience in making precise injury documentation and forensic interpretation, taking forensic samples and giving an opinion on suspicious deaths, and conducting examinations of victims (adults and children) of sexual assault. In other healthcare systems, forensic nursing derived from mental health where it was known as “forensic psychiatry” and patients were often referred to as “forensic patients” who were on “forensic units” and were involved in the criminal justice system (Galappathie, Khan, & Hussain, 2017).

Earliest documented aspects of forensic nursing in the United States date back to the 1970s (Speck & Aiken, 1995; Clark, 1976). Much of the forensic nursing involved nursing and victims of sexual assault (Clark, 1976). Nurse Ann Burgess and sociologist Lynda Holstrom conducted extensive research with victims of sexual assault and developed the rape trauma syndrome and treatment for victims of sexual assault (Burgess & Holstrom, 1985). Nurses worked in sexual assault centers that were established during this period. They were also often the ones who counseled victims of assault, helped to navigate their emergency visit, and offered advice and support during the initial encounter and follow-up care. Formal recognition of forensic nursing began in the early 1980s, largely from the work done by Virginal Lynch (Lynch & Duval, 2011). The Scope and Standards of Forensic Nursing Practice was first developed to help standardize the practice of forensic nursing, shortly after the International Association of Forensic Nurses (IAFN) was created. Forensic nursing in the United States was established in death investigations and soon made its way into different aspects of nursing where there are specialized forensic nurses with different degrees and certification.

NOTABLE FORENSIC NURSES

FORENSIC NURSING

In several clinical settings, nurses use forensic skills with are often not identified as forensic yet have their roots in forensic science. Forensic nursing is practiced by nurses who work in different clinical settings, such as hospital, schools, correctional institutions, and mental and psychiatric healthcare settings (Lynch & Duval, 2011). Forensic nursing is used to provide care to victims of all ages who have sustained trauma, including those who were victims of intimate partner violence, sexual assault, child maltreatment, elder abuse, human trafficking, strangulation, and trauma (both intentional and nonintentional). The forensic nurse interviews the patient, obtaining information about the person’s health history and the crime or trauma to guide his or her assessment. Prior to treating victims, consent is obtained, and the extent of their forensic medical exam and what it can and cannot show is discussed.

This is typically followed by an extensive head-to-toe physical examination for identifying injuries and obtaining forensic evidence that is collected and preserved, maintaining chain of custody. Documentation of injuries is often very detailed, utilizing body maps and diagrams as well as forensic photography when indicated. Injures will often need to be treated after the forensic medical examination. If patients were victims of sexual assaults, they may be affected by sexually transmitted infections, urinary tract infections, infertility issues, vaginal and rectal trauma, and unintended pregnancies that may require treating with prophylactic medications and/or referring patients for further medical treatment and follow-up. Some victims will suffer cardiovascular and respiratory conditions, back pain, dehydration, malnutrition, poor hygiene, or neglect, which can lead to a myriad of medical conditions that may need to be addressed. Lastly, the forensic nurse must resolve any safety issues, implement crisis interventions and advocacy, and file mandatory reports to local reporting agencies.

The forensic nurse’s responsibilities extend beyond direct patient care and may include duties such as providing education or outreach to the community in which they work. Forensic nurses are the bridge between healthcare and justice and are often called to testify in legal and criminal cases. The forensic nurse is also often involved with larger teams and networks and often interfaces with other medical professionals, law enforcement agencies, criminal justice, victim advocacy, and external agencies that provide additional services to victims.

TYPES OF FORENSIC NURSES AND EDUCATIONAL PREPARATION

SCOPE AND STANDARDS OF FORENSIC NURSING PRACTICE

The Scope and Standards of Forensic Nursing Practice (2018) details the core components of forensic nursing. It covers the educational preparation necessary for different forensic nursing roles. Core competencies are highlighted regarding forensic nursing care and how it is delivered.

Examples of competencies of the forensic nurse from the Scope and Standards of Forensic Nursing Practice (2018) include the following:

INTERNATIONAL ASSOCIATION OF FORENSIC NURSES

The IAFN is the professional nursing association for forensic nurses. It is an international organization and has members from all over the world. Their mission is to enhance the work of forensic nurses by setting standards and fostering the work forensic nurses are doing through developing, promoting, and disseminating information (IAFN, 2018, “Our Mission”). They achieve this through their publications, conferences, educational activities, resources, and member involvement. The IAFN’s Journal of Forensic Nursing focuses on different aspects of forensic nursing and forensic science and education. The yearly conference meeting hosts various presenters who discuss the latest in forensic science and research. The organization has a member community where forensic nurses from other states and countries can connect and discuss various topics. They have detailed protocols and guidelines for nurses and educational opportunities.

CONCLUSION

Forensic nursing is an ever-growing science that has demonstrated a significant impact on the medical, nursing, and legal systems. Despite a lack of forensic nursing education in entry-level nursing education, nurses working in different sectors will encounter patients for whom forensic nursing skills are used and required. Nurses can stay current on forensic nursing by attending conferences, taking additional continuing education courses, and becoming active members of the forensic nursing community. Until forensic nursing is mandated for all nursing curriculums, nurses should be proactive and seek out educational activities that cover the vast topics of forensic nursing and which patients would benefit from forensic nursing. This will allow nurses to gain insight, knowledge, and skills in caring for patients who would benefit from forensic nursing.

References