Forensic nursing is the combination of forensic science and the nursing process in the investigation and collection of medical evidence following an event of abuse, violence, crime, or other trauma (Lynch & Duval, 2010). Interdisciplinary collaboration between nurses, physicians, lab technicians, and legal representation occurs in the care of victims, suspects, perpetrators of, and witnesses to violent crimes and/or traumatic events (Lynch & Duval, 2010; McEnroe-Petitte, 2020). The forensic nurse adapts the nursing process to care for the individual/family and meet legal needs via a thorough health history, forensic assessments, collection and preservation of evidence, medico-legal documentation, medical and emotional care to survivors, expert testimony in court proceedings, and ensuring client safety following the event (Island health, 2021; McEnroe-Petitte, 2020; Nova Scotia Health, n.d; CFNA, 2022).
Evidence Informed Practice
Use scientific evidence to inform practiceAdapt evidence to fit unique situationsParticipate in peer reviewed process for evaluationProfessional Knowledge
Commitment to ongoing learning Seek opportunities to build competency Participate in, disseminate, and review researchIntersection of Nursing and Law
Use medico-legal documentation Identify, collect, & preserve forensic samplesMaintain chain of custody - document location and responsible party of all samples Present and testify in legal proceedings Continue to learn about the judicial system Stay updated on case law and legislationTrauma/Violence Informed Approach
Psychosocial, Environmental, & Cultural safetyTransparency, Collaboration, Empowerment Gender-affirming care Strength-based advocacyEmotional Compartmentalization (Lyons, 2009)
Emotionally taxing (Maier, 2011)
Worrying about victims after they leave the hospital (Maier, 2011)
Not able to have any follow-up care with the victim
can be used to undermine testimony in court
worrying for safety of victims of non-stranger rape/abuse
Direct/Indirect Trauma
67% of SANEs report vicarious trauma (Maier, 2011)
listening to victims recollection of rape
treating younger victims
reminders of personal trauma (Maier, 2011)
Viewing the world as dangerous (Maier, 2011)
impact on personal life
hypervigilance
Moral Distress
Respecting cultural practice vs. following investigative protocols (Drake & Burton, 2022)
Caring for perpetrators of heinous crimes (Drake & Burton, 2022)
Reporting abuse vs. victims choosing to stay anonymous (Karakachian & Cobert, 2019)
Negative media attention (Drake & Burton, 2022)
Death Investigators are often in the public eye; Each action publicized
Short Staffing (Maier, 2011)
Struggle to find coverage for shifts
Some SANE's not on call maybe be called in
The forensic nurse works one on one with victims of sexual assault, provides emotional support, expert testimony if requested by the court, and follow-up instructions and education (Island Health, 2021; Nova Scotia Health, n.d). A medical exam would be completed involving event history, treatment (antibiotics, emergency contraception and HIV nPEP as indicated) and a general physical exam (Nova Scotia Health, n.d). A forensic exam, if requested, consists of collection of clothes for evidence, head to toe visual exam, photos of the injury, swabs and samples which are stored for up to 6 months if the client does not wish to go to the police immediately (Nova Scotia Health, n.d).
Video: Island Health, 2021The forensic nurse works with clients charged with or convicted of a crime or those being evaluated for the potential of (re)committing a crime. The nurse must remain calm, objective, neutral and detached while incorporating an investigative aspect into the therapeutic relationship that is not common in other areas of nursing (Lyons, 2009). The forensic nurse is responsible for initial mental health assessments and forensic risk assessments (Lyons, 2009). Competencies include security, crisis de-escalation, interpersonal communication, self reflection, clinical understanding of disordered thinking and behvaiour, and knowledge of criminal justice and mental health systems (Lyons, 2009).
Image: https://www.news-medical.net/health/Mental-Health-Comorbidities.aspxThe forensic nurse would respond to the location of a death and determine details or events leading to the death through the collection of medical, psychological, and social history, forensic samples from the body and biohazardous samples from the scene (Drake & Burton, 2022). The nurse is specially trained in evidence collection and interviewing family, friends, and witnesses to gain accurate information without further trauma (Drake & Burton, 2022). Using the scene, interviews, investigation, autopsy and toxicology reports the nurse collaborates with law and medical personnel to determine cause and manner of death (Drake & Burton, 2022).
Image: https://blogs.und.edu/uletter/2016/05/u-s-death-investigators-pursue-courses-through-department-of-pathology/