Have you ever watched CSI and wondered who examined the evidence to solve the crime? Many people contribute to the investigation of crimes, including forensic nurses, who play a significant role collecting and analyzing data. Though in the beginning of the century, forensic nursing was not recognized as a specialty field, many nurses already began to get involved in forensic-related works, such as in rape-crisis’ and trauma victims. As the crime rate continuously rises, the need for forensic nurses correspondingly increases. Thus we will begin the examination of this field through its history, training, and ethics.What is a "Forensic Nurse"? Where and Who employs them?
Forensic nursing is a fairly new specialty in the field of nursing. Because of its constant growth, its definition is continually evolving. Forensic nursing is defined as the application of nursing science to public or legal proceedings. Nurses with degrees in forensics investigate crimes relating to abuse and sexual assault with duties ranging from gathering evidence from crime scenes to testifying in the courtroom. According to Darcy Copeland (personal communication, November 3, 2006) forensic nursing can be broken down into four different groups, due to the vast range of opportunities in this specific field. The first is a Sexual Assault Nurse Examiner, which is also known as a SANE. These nurses deal with cases of rape and abuse, and their job consists of examining the victim by collecting evidence. The sexual assault nurses have a specific rape kit, in which they collect DNA from under the nails, examine cuts or bruises, and gather samples from the mouth, vagina, or rectum. Their job requires time and meticulous precision as they store samples carefully found on the patients (D. Copeland, personal communication, November 3, 2006). Forensic nurses can also be employed as death investigators. These nurses work with a coroner or a medical investigator, such as a doctor and help investigate the cause and reason of the victim’s death. Another group is called consultant nurses. These nurses participate in the legal aspect of forensics. Their job consists of translating documents for attorneys, consultation in legal offices, or giving expert testimony in the courtroom. The final category of forensic nursing is the correctional facilitators. These nurses can work in a mental facility, a private institute, or a state locked prison. They tend to examine perpetrators and give care to those mentally challenged. No matter where or what group forensic nurses belong to, they all participate in influencing the legal system by using their background as nurses and combining it with their knowledge of forensics (D. Copeland, personal communication, November 3, 2006).
The workplace for forensic nurses is extremely broad due to the flexibility and range of their jobs. According to Darcy Copeland (personal communication November 3, 2006) forensic nurses are most commonly employed in hospitals and private agencies. Other places include morgues, prisons, legal offices, medical agencies, mental facilities, crime scenes, and other private practices. Each workplace is unique to the specific category of the forensic nurse. Sexual assault nurses tend to work in hospitals and private agencies specializing in rape and trauma. Death investigators are able to work directly on the crime scene, morgues, or medical agencies. Consultant nurses work in legal offices or courtrooms, and correction facilitators can be employed by state run agencies such as prisons and mental facilities, or private agencies.
The History of Forensic Nursing
As a relatively new field, forensic nursing was not as popular as to have its own university and education as did traditional health care professions and judicial fields until recent years. One of the earliest nursing services related to forensics appeared in the 13th century, and this was dedicated to examining women's virginity before they married into royal families and also to examine victims of sexual assault (Edward Castro, 2005). Throughout the history of forensic nursing, the first official role in the field was the SANE who worked primarily at rape crisis centers and in emergency rooms. According to Burgess, Berger, and Boersma (2004), a large number of nurses were recognized from the 1970s to 1980s for their expertise and profound skills in volunteering at rape-crisis centers. They noted that forensic nursing was finally confirmed as its own specialty field in 1995 by the American Nurse Association, after the International Association of Forensic Nurses (IAFN) was found in 1992 by 31 SANE representatives. In the mid 2002, the 74 nurses who took the first international certification exam given by IAFN earned the title as SANE-A, or examiners for adult and adolescents (Burgess, A.W., Berger, A.D., & Boersma, R.R., 2004).
One of the most recognized and dedicated forensic nurse was Virginia Lynch. According to an interview with a current forensic nurse, Darcy Copeland (personal communication, November 3, 2006), Virginia Lynch from the University of Colorado started the first forensic program for master's degree aimed for nurse practitioners in the mid 1990s. Her knowledge in launching these programs and in the field itself has brought her all over the globe, to more than eight countries worldwide (Phil McPeck, 2002). Since the emergence of the new field, "an estimated 7,500 nurses have dedicated their lives for investigating deaths or treating violent offenders at psychiatric facilities" (Forensic Nursing, 1995) In some states such as New Jersey, a SANE is required in every country prosecutor's office because violence is so pervasive (Burgess, A.W., Berger, A.D., & Boersma, R.R., 2004). Due to the higher levels of violence and crime rates, the need for forensic nurses have grown tremendously within the last thirty years that new courses and textbooks were created and designed especially for this field.
The Training for Forensic Nursing
With the increased popularity and interest in the field of Forensic Nursing, there are now many different options and routes for people to take in order to become a Forensic Nurse. However, there are four primary routes for obtaining training in Forensic Nursing: continuing education courses, certification programs, minor or concentration in forensics, or formal graduate study (Burgess, 2004, p.60). The first route of continuing education courses includes fulfilling the required criteria for state licensure and taking additional programs. The second route of certification programs is another option that includes taking the entrance requirements and completing a required number of clinical internships before becoming a forensic nurse. The third route is the minor or concentration in forensic at a college or university nursing program. However, students would have to take additional courses related to forensics. Lastly, the formal graduate study route is another option that one can take. After completing the four year at an undergraduate school, one can build on the foundation of baccalaureate at a graduate school concentrating on forensic nursing. These four routes are the most common; however, there are many other ways to become a forensic nurse such as through a MRC certification in Forensics course. 
In addition, there are some additional trainings before someone can become a Forensic Nurse. First, one must be a Registered Nurse (RN) in order to complete the training to become a Forensic Nurse. Afterward, the nurse must complete a specialized training that is approved and meets the standard of the International Association of Forensic Nurse (IAFN). Then, the nurse needs to complete forty hours of didactics and forty additional hours of clinical works. According to Burgess, A.W. (2004), during this time the nurse also needs to have training in handling and collecting evidences associated with forensics and DNA testing. Lastly, the nurse needs to have knowledge on how to use different tools in order to document and collect data during examinations. There are many different kinds of forensic nurses, and it is important that the nurse fulfills any other training to work in a specific field.
The Role of Forensic Nurse in Police/ Detective Work, Rape Crisis Centers, etc.
A large part of forensic nursing deals with rape crisis and treatment, and most nurses that do this have been specially trained to deal specifically to situations that include rape crisis. Nurses that deal with rape crisis must be able to treat the patient while performing a legal examination and being careful not to destroy any evidence. For this task, most places employ specially trained nurses that are in the S.A.N.E. program. The S.A.N.E. program prepares nurses on different practices such as collecting evidence and providing a good legal examination that could be used in a court trial. A large part of being a S.A.N.E. nurse deals with being able to give good pelvic examinations, and also having good communication skills to be able to work with the patients and the different law enforcement officials (Sexual Assault Nurse Examiner, 2006).According to Sexual Assault Nurse Examiner (2006), to become a S.A.N.E. nurse, registered nurses must complete 40 hours of a S.A.N.E. certification program. These nurses do not usually serve as just a S.A.N.E. nurse: they usually have jobs that a typical nurse would have and are on call for their legal abilities. In sexual assault cases, these nurses are working with patients that are at least twelve years old and claim that they have been sexually assaulted, or the doctor has reason to believe that they have been sexually assaulted. The nurse typically has a kit with about twenty procedures to follow, depending on the circumstances of the situation. Although they mostly work in the hospital setting, these nurses also testify in court, and have provided forensic evidence for conviction in many sexual assault cases.
You Decide
Fictitious Sexual assault issue
Forensic Nurse Trina is currently employed at a medical center and is handling cases related to sexual assaults. One of her first cases involves a sixteen year old rape victim, Patricia. Trina is assigned to speak with Patricia and make an inquiry about the suspected assault. After learning that Patricia had been abused more than three times, Trina immediately performs a medical assessment and treats her physical injuries. After the preliminary evaluations, Trina suspects that Patricia may be pregnant so she suggests her to seek a gynecologist to confirm her assumptions. Patricia becomes anxious and asks Trina if she could keep it as a secret in case she is pregnant. Trina agrees only because she is scared that Patricia would refuse her care. Patricia is pregnant, in addition to the possibility of carrying a sexually transmitted disease, thus putting both her and the baby at risk. After letting Patricia know what is going on with her body physiologically,Patricia is hesitant to seek anymore help because she feels ashamed to tell her family. Forensic nurse Trina is torn between the choice of respecting her client’s decision and saving her client and the baby’s lives.
Now consider the following:
What feelings, values, emotions would be involved if you were the forensic nurse handling this rape crisis?
Which choice would you make, and why?
What other factors would you consider?
A forensic nurse must consider these following ethical principles in this situation. Confidentiality plays a big role in this dilemma. Since we do not know exactly where this event occurred, in most states in the United States, they “allow a minor to consent to services without consulting his or her parents if the minor is sufficiently intelligent and mature to understand the nature and consequences of a proposed treatment.” (“Confidential reproductive,” January 12, 2007) Therefore if this event happened in a state where this law is mandated, Patricia still has the rights to confidential reproductive health care. Patricia may give an informed consent regarding to nondisclosure. If a minor is assured that a health care provider will respect their rights to confidentiality, a minor, like Patricia, is more likely to seek reproductive health care and counseling. In this way, Trina is avoiding harm by respecting her client’s autonomy. (Burkhardt, 2002, p.50) Since Patricia fears disclosure of her situation, it is very important to establish and maintain fidelity upon this case to avoid any further problems; therefore the forensic nurse must respect his/her patient’s autonomy. Also a forensic nurse needs to “anticipate and manage physical and psychological needs of the patient.”(American Association of Colleges of Nursing, 1998, p. 13) Physically, she needs to seek help because she and her baby are both in danger of the sexually transmitted disease.
Forensic Nurse and its Involvement with the Courtroom
A forensic nurse’s job in the courtroom is usually as an expert witness. Forensic nurses are sought out by prosecution and defense teams. Attorneys hire forensic nurses to testify about procedures, standards of care, and other evidence. In the courtroom, the decision makers usually do not have thorough knowledge or background in medical evidence. An expert witness is called upon to interpret the evidence and educate the decision makers. The expert witness has a huge task. They are in charge of educating the decision makers so they will be able to make intelligent and correct decisions. A forensic nurse is a perfect candidate for the job as an expert witness when the trial involves sexual assault, domestic violence, child abuse, elder abuse/neglect and other traumatic violence. “Forensic nurses cannot only help put bad guys in jail. We can get innocent folks out” (Labrecque, 1995). A forensic nurse, Sheridan, was involved with a case where a couple was suspected of neglecting an elderly family member. The police had found discolorations all over one side of her body. Sheridan, the forensic nurse, went in and examined the elderly woman and determined that she had not been neglected. She had a disease that caused the discolorations. Because of Sheridan’s knowledge in nursing, she was able to keep the couple away from unnecessary legal charges.
Forensic nurses can also assist attorneys with their cases. Forensic nurses are needed in the law offices when medicine and the law overlap. The nurse’s clinical knowledge and background effectively smooth out the cases and educate the attorneys in medical knowledge. The nurse has to be able to educate the attorney so they feel comfortable and educated with the issues brought up in their case.
A fictitious case study
Sixty-year old Nate is found dead, drowned in water on June 20, 2006 after being suspected by the local police that he was being molested by his 25-year old stepson Josh because of strange discolorations found on his right leg. Josh pleaded not guilty; moreover there was no evidence to prove this accusation besides the discoloration of Nate’s skin. Tyler, a forensic nurse is currently investigating this crime and is asked totestify related to his findings in legal proceedings. Based on Tyler’s findings, Nate had a sudden cardiac arrest that might have provoked his unconsciousness. Johnson also added that if he had a heart attack while walking by the pool in the backyard, the discoloration could have occurred from falling into the pool. Johnson did not find any signs of abuse in O’Malley’s body. Instead, he found out that Nate had an aneurysm on his right leg that resulted in a huge blood clot. The accusation towards Josh was proven wrong. The role of a forensic nurse is very essential in this fictitious scenario. While deciding where to base a decision, a forensic nurse must consider and apply his or her ethical principles. Veracity is the main concept that should be considered because it is beneficial to the case. Without the findings from the forensic nurse, an innocent person wouldhave been imprisoned. Through the analysis of forensic nursing, it is apparent that the field has received great recognition as the need for forensic nurses increase. Even though forensic nurse’s hands-on tasks are extremely important, they must keep in mind the ethical principles when dealing with the victims of rape crisis, trauma, and courtroom procedures. As the field contains many different aspects, the training must incorporate not only intricate nursing education but also have the familiarity with the judicial system. Conclusively forensic nurses play a major role in crime scene investigations by collecting evidence, counseling victims, and solving problems in the courtroom.
References
- American Association of Colleges of Nursing (1998). The Essentials of Baccalaureate Education For Professional Nursing Practice. Washington, DC: author.
- April 2006. The Latest Developments in the Massachusetts Nursing Environment. When you find yourself in the role of Sexual Assault Nurse Examiner. Retrieved November 10, 2006, from http://www.massnurses.org/news/2006/04/massnurse7.htm
- Burgess, A.W., Berger, A.D., & Boersma, R.R. (2004). Forensic nursing: Investigating the Career Potential in this Emerging Graduate Specialty. American Journal of Nursing, 104 (3), 58-64.
- Burkhardt, Margaret A., & Nathaniel, Alvita K. (2002). Ethics & Issues in Contemporary Nursing. (2nd). Clinton Park: Delmar Learning.
- Castro, E. The History of Education if Forensic Nursing. Retrieved November 28, 2006, from http://www.healthcare-programs.com/articles/the-history-of-education-in-forensic-nursing.php
Forensic Nursing. Retrieved November 28, 2006, from http://www.learninghaven.com/articles/forensic-nursing.html
Jones, R., Boonstra, H., (2004). Confidential reproductive health services for minors: the potential impact of mandated parental involvement for contraception. January 12, 2007, from http://www.findarticles.com/p/articles/mi_m0NNR/is_5_36/ai_n6335814.
Labrecque, Jeff. (1995).When Injuries Speak Who Will Listen. Retrieved November 31, 2006, from http://www.son.jhmi.edu/JHNmagazine/archive/spring2003/pages/fea_forensics.htm
McPeck, P. Paving the Way- Origins of Forensic Nursing. Retrieved November 28, 2006, from http://www.nurseweek.com/news/features/02-01/forensic_web.asp
Sexual Assault Nurse Examiner (S.A.N.E. Nurse). Retrieved November 12, 2006, from http://www.ga.unc.edu/NCCN/recruitmentandretention/youth/roles/sane.htm
Wetther Kl. Forensic Responsibilities of the Legal Nurse Consultant. Retrieved November 31, 1993, from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8.
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