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Forensic nursing is the link between the health care system, the investigative process and the court systems

Forensic- pertaining to the law; legal

Forensic nursing- application of nursing process to public or legal proceedings and the application of forensic health care
in the scientific investigation of trauma and/or death related to abuse, violence, criminal activity, liability and accidents

Forensic nursing includes:

 Nursing science
 Forensic science
 Medical science
 Sociology
 Psychology

Responsibilities include:
 Screening/assessment and collection of evidence
 Documentation and expert witness
 Involved in paternity suits
 Cases involving work place injury, malpractice, MVA, food/drug tampering, and medical equipment defects
 Develop and implement protocols and systems for victims/perpetrators
 Aid in research and policy changes

SEXUAL ASSAULT NURSE EXAMINER (SANE)

 SANE applies the nursing process during forensic exams to victims or perpetrators of sexual assault; work with
deceased whom sexual assault has been presumed
 Work in ED’s and community clinics

TYPES OF EVIDENCE COLLECTED: chart on pg. 617

 Document history of event
 Document injuries (photos and written)
 All clothing worn at time of event
 Trace evidence (fiber, glass, soil, etc.)
 Biological evidence for DNA comparison (victim’s blood and hair)
 Fingernail swabbing
 Swabs and smears (from mouth, anus, penis or vagina)
 Pubic hair combings
 Evidence disbursement sheet
 Any additional evidence (i.e. body piercings)

FORENSIC NURSE DEATH INVESTIGATOR

Medical examiner (licensed physicians) and coroner/justices of the peace (persons with little to no training in medicine
or science) conduct medicolegal death investigations and are responsible for issuing death certificate that state the
cause and manner of death
o cause of death- event initiated the progression of events that ended in death
o manner of death- categorization of hat related to the conditions in which the cause of death occurred
 Assist investigators, police, and homicide detectives in conducting a comprehensive death investigation
 Need minimum of 2 yrs experience prefer in critical care or emergency
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NURSE CORONER
 Responsible for ensuring that appropriate measure are taken to perform death investigations and to certify
death certificates
 Nurses can run for coroner in some states
 Receive therapeutic communication training allowing family and friends open sharing of feelings and thoughts
experienced with the death of a loved one
 Can become board certified in death investigation through the American Board of Medicolegal Death
Investigators (ABMDI)

LEGAL NURSE CONSULTANT

 Nurses who provide assistance within the legal system using specialized nursing knowledge and expertise when
interaction between law and health issues arise.
 May apply for certification through American Legal Nurse Consultant Certification Board (ALNCCB)
 Roles include:
 Review and interpret medical records and charts
 Provide objective opinions based on standards of care; possibly testify in court
 Informed opinions on the delivery of health care and its outcomes
NURSE ATTORNEYS
 Educated in law and nursing
 Practice in health care, public health, or criminal or civil law, which includes malpractice
 Help hold practitioners accountable that are dangerous and also defend the wrongfully accused of negligence
 Roles include:
 Prepare chronologies or timelines of health care events
 Identify, organize, and analyze medical records and related materials
 Identify applicable standards of care
 Evaluate causation and damage issues
 Conduct literature research and summarize medical literature
 Evaluate case strengths and weaknesses
 Serve as expert witness
 Identify plaintiff’s future medical needs and associated costs

ORGAN AND TISSUE DONATION AND TRANSPLANTATION

 Provide a detailed physical examination of patients who may be organ and tissue donors

CARE OF VULNERABLE POPULATIONS

 Children and elderly with disabilities more likely to be mistreated
 Mandatory laws to report vary from state to state
 Risk is 3x higher for disabled than with abled

1) CHILD ABUSE AND NEGLECT: advocates for victim and if a forensic nurse suspects a child is being abused or
neglected the nurse report the suspicions. The nurse ensures that abuse and neglect are swiftly identified and
reported, obtains a through hx and assessment focusing on the facets of abuse and neglect.
 use child-parent interaction, child’s appearance/behavior, child-child interaction and the environment
Definitions:
a. Neglect: failure of a parent, guardian or caregiver to provide basic needs (can be physical, medical, educational,
or emotional)
b. Sexual abuse: range of activities from noncontact indecent exposure to production of pornographic material, to
incest, rape, fondling and genital contact to actual adult-child sexual intercourse
c. Physical: intentional physical injury, including striking, kicking, burning and biting
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d. Emotional: pattern of behavior that impairs the child’s emotional development or sense of self-worth, including
constant criticism, threats and rejection.
2) ELDER MISTREATMENT:
Type of Elder Abuse:
a. Physical- intentional harm or injury
b. Psychological/emotional-mental or emotional anguish i.e. humiliating, threatening
c. Financial- exploitation when resources are used for another person’s benefit without the elder’s consent
d. Neglect – MOST COMMON-caregiver or self-neglect
e. Sexual abuse- non-consensual contact

FORENSIC PSYCHIATRIC NURSE

 Bridges the gap b/t criminal justice, legal and mental health systems
 Apply nursing process to clients who await a criminal hearing or trial; remain neutral, objective and detached
 Collect evidence by determining intent or diminished capacity in client’s thinking at time of incident
 Observe and interview client and document conversation and observations
 Can testify in mental health issue

Roles:
 Sanity or competency eval
 Assess violence potential
 Assess capacity to formulate intent
 Parole and probation consideration
 Asses racial/cultural factors in crime
 Assistance in jury selection
 Sexual predator screening
 Provision of exert witness testimony

CORRECTIONAL NURSING
 Clients are inmates where care is negotiated and provided with recognition of safety and security issues for the
nurse and the constitutional right of prisoners to receive adequate and timely care (i.e. a band aid can be used to
tighten the grip of a homemade weapon or meds can have value on the prison “black market”)
 Nurses are subject to manipulation by inmates who seek care for other than health concerns
 Nurse must maintain escape route
HEALTH ISSUES IN PRISON
 CHRONIC AND COMMUNICABLE DISEASE
 Most critical health care issue among the incarcerated
 HIV, Hepatitis and TB biggest concerns
 HIV popular due to IV drug use, unprotected sex, tattooing and other risky behaviors
 WOMEN IN PRISON
 High % of women in prison have been admitted to being abused before imprisonment
 More than half under the influence of drugs or alcohol at the time of their offense
 Drug use and victimization, combined with stress associated with being separated from their children put
incarcerated women at risk for mental and physical health problems, including HIV and other STD’s
 Routine GYN visits not consistent in prisons and screening is not done upon entry into prison system
 Institution nurses must be mindful to view incarcerated women holistically and without judgement as they
do not know their past
 ADOLESCENTS IN PRISON
 Many are incarcerated in adult facilities affecting developmental needs
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 More than five times more likely to be sexually assaulted
 Three times more likely to be beaten by prison guards
 50% more likely to be assaulted with a weapon
 Five times more likely to commit suicide in adult facility
 Eight time more likely to commit suicide in adult facility than those in a juvenile facility

MENTAL HEALTH ISSUES IN CORRECTIONAL SETTINGS

 Adjusting to prison with a mental disorder is much more difficult
 Due to # of inmates with mental health issues it is difficult to meet the needs of this population
 Nurses must always be aware of the vulnerabilities of people with mental illness
 Mental illness can be treated with medication, but the unique vulnerabilities of incarceration remain for the person

EDUCATION AND FORENSIC NURSING

 Colleges and universities offer programs for Forensic nursing specialties
 Completes minimum specified number of supervised clinical hours
 Clinical internship may be required