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Forensic Nursing: Defending
Justice for All? Forensic: 1. of, characteristic of, or suitable for a law court, public debate, or formal argumentation. 2. specializing in or having to do with the application of scientific, esp. medical, knowledge to legal matters, as in the investigation of crime. — Webster’s New World Dictionary Because of television programs such as CSI: Crime Scene Investigation, many people are surprised to learn the word “forensic” doesn’t just refer to the investigation of homicides. If it did, “forensic nursing” would be a misnomer. In the nursing world, forensics comes into play any time medical matters intersect with the legal system. “Forensic nursing is the application of the science of nursing to the administration of justice,” explains Sherry Arndt, RN, MPA, president of Forensic Nursing Services in Comfrey, MN. “Most often, forensic nurses work where there is some kind of criminal allegation involved, such as sexual assault, domestic violence, or child abuse. But forensic nurses also specialize where there’s a civil legal element, such as workers’ compensation, medical malpractice, or organ-donation issues.” Protecting Evidence Once a little-known specialty, the field of forensic nursing has recently exploded, due in no small part to the increasingly violent nature of today’s society. One of the forensic nurse’s most important responsibilities is the gathering of evidence following an alleged crime, and protection of that evidence from contamination or tampering through the chain of custody until it can be handed over to law-enforcement officials. The rise of forensic nursing has led to increased prosecution rates for guilty offenders, but also a reduction in wrongful imprisonment of the innocent. “Nobody should be imprisoned because of the lack of or incorrect evidence collection,” says Faye Battiste-Otto, RN, SANE, president of American Forensic Nurses in Palm Springs, CA. “If there is a crime, it saves taxpayer money if the evidence is collected in a timely manner and nobody is wrongly imprisoned. The introduction of forensic nursing and evidence collection is a tremendous advantage for victims and suspects because if the evidence is collected properly, they will not go to prison without cause.” It was not always so. In the past, Battiste-Otto has seen many cases of improper evidence collection, and even the inadvertent destruction of evidence, such as the disposal of a rape victim’s clothing or improper collection and storage of samples. “You will see a time very soon when JCAHO will establish guidelines that require a forensic nurse at every hospital,” she predicts, citing the increase of societal violence as the causative factor. Battiste-Otto prefers to collect evidence at the source — the law-enforcement agency. “An emergency room is no place for crime suspects,” she says. “When the evidence is collected at the law-enforcement agency, it can be collected in a more timely manner and there is less chance of contamination. It is more timely because law-enforcement officers aren’t kept waiting for other patients to be seen. In an ER, if a heart attack victim comes in, he is given priority over the crime suspect.” Getting Organized To publicize and promote the science of forensic nursing, the International Association of Forensic Nurses was formed in 1992. Its mission: “To develop, promote, and disseminate information about the science of forensic nursing internationally. IAFN establishes and improves standards of practice and strives to foster growth and development of forensic nursing as an emerging area of nursing expertise. IAFN promotes the exchange of ideas and transmission of developing knowledge among its members and to a wide variety of professionals who are dedicated to the development of forensic nursing for the advancement of humanity.” IAFN President Patricia Speck, ARNP, BC, MSN, FAAN, SANE-A, DF-IAFN, uses the acronym WHEEL to explain the forensic nurse’s role: “Wounding, healing, ethics, evidence, and legal are the areas that encapsulate what a forensic nurse is. We are registered nurses first, with all the legal rights and responsibilities defined by our licenses, and on top of that we have additional education in these legal principles.” Speck says the increasing awareness of the importance of proper evidence collection and victims’ rights means that “no longer are healthcare providers forgiven for not knowing what to do for victims. It’s a good reason for hospitals, clinics, and other healthcare organizations to have a specialist on staff who can address forensic issues.” Forensic nursing has greatly benefited from recent advances in technology, making it an especially exciting time to enter the field, according to Battiste-Otto. DNA testing is on the increase, and new techniques are being developed. Brain fingerprinting is among the most recent. This patented procedure uses a process in which words or pictures relevant to a crime scene are shown to the suspect along with irrelevant text or images. The subject’s electroencephalographic responses are read by a sensor-imbedded headband and analyzed by a computer, which is able to determine if the suspect has knowledge of the crime. The inventor claims a 100% accuracy rate, although more testing is needed. Expanding Opportunities As the practice of forensic nursing rapidly spreads throughout the country, educational opportunities are expanding with it. Virginia Lynch, RN, MSN, FAAFS, who originally coined the term “forensic nursing,” explains that “with increasing emphasis on the forensic aspects of trauma, schools of nursing are responding with formal and informal arrangements for education and clinical experiences that incorporate forensic science; death investigation; criminal law; court procedures; and testimony; as well as an exploration of new roles, new responsibilities, and new occupational opportunities for nurses in these violent times. Professional knowledge that qualifies nurses to undertake medico legal work continues to expand the boundaries of nursing beyond tradition.” To eliminate a nationwide backlog of untested DNA samples, Attorney General John Ashcroft recently announced a proposal to spend $1 billion on crime-related DNA analysis over the next five years, including millions in additional funds for training and educating sexual assault nurse examiners. Speck anticipates a sizeable influx of forensic nursing students as a result. If you’re interested in learning more about the specialty, Arndt suggests first visiting the IAFN website, where a wealth of career information can be found, as well as a list of educational venues. She also suggests attending the annual IAFN scientific assembly. “It’s a good way to meet and hear nurses in various subspecialties of forensic nursing,” she explains. “You can find out which area you’re most interested in, talk to forensic nurses about how they got into their current jobs, and what they did to become qualified.” Speck recommends calling your local school of nursing to find out if it offers any forensic-emphasized classes. Speck says there are many distance learning opportunities available online through various colleges and schools of nursing. She also advises contacting your local law-enforcement agency to find out if there are any forensic nurses currently practicing in your community. “Forensic nurses provide the definitive information that’s necessary for the court to arrive at a just decision,” Speck says. “It’s important to make sure that justice is even-handed and without bias.”
Nanette Lavoie-Vaughan, ARNP-C, MSN, is a Raleigh, NC-based nurse practitioner who specializes in geriatric medicine. Mark Cantrell is a freelance writer. |