FORENSICS
In
Nursing
“Current Trends in Forensic Science”
Forensics: Pertaining to
the Law
Forensic Nursing:
Application of
Nursing to the Law
What is Forensic Nursing?
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The application of forensic science, combined
with clinical nursing practice as they are applied
to public or legal proceedings in the law
enforcement arena.
It is the application of forensic aspects of health
care combined with biopsychosocial education of
the registered nurse in the scientific
investigation and treatment of trauma, death,
violent or criminal activity, and traumatic
accidents within the clinical or community
institution (Lynch, 1991).
Forensic Nurses
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Trauma/ER
SANE/FNE/SART
Nurse Coroners/Forensic Nurse Death
Investigators
Nurse Attorneys/Legal Nurse Consultants
Psychiatric & Mental Health
Correctional Health
Domestic Violence
ER/Trauma
ER/Trauma
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Why are they needed
Identification
 Care for the Survivor
 Care for the Perpetrator
 Identification & Collection of evidence
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 Clothes
 Injury
and patterns of injury
ER/Trauma
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Documentation
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What we do v. the crime committed
Chain of custody
Measurements in centimeters
Location
Description
Photography
SANE/FNE/SART
SANE
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A registered nurse who has been specially
trained to provide comprehensive care to
sexual assault patients, who demonstrates
competency in conducting a forensic exam
and the ability to be an expert witness.
Benefits of a SANE TEAM
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Willingness
Specialty training
Comprehensive care
Fact based documentation (drop all
opinions)
Forensic issue
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evidence collection
chain of custody
courtroom testimony
SART-Sexual Assault Response Team
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Law Enforcement
Rape Crisis
Medical Response
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SANE/RN
Physician
ANP
PA
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Crime Lab
Counseling Services
Forensic Scientist
CPS/APS
Prosecution
Together Everyone
Accomplishes More
Don’t tell other members of the
TEAM how to do their jobs.
Together we can make offenders
want to relocate.
SART
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Provide victim
centered services
Provide
compassionate care
Provide community
awareness
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Where to come
How we will treat you
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Encourage reporting
of Sexual Assaults
Encourage successful
apprehension and
prosecution of guilty
offenders
Aid in the identifying
of false reporting
Sexual Assault
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Every 45 seconds a women is Sexual
Assaulted.
1:5 Women
1:10-20 Men
Screen ALL Trauma Patients (LOC,
clothing)
Sexual Assault Exam
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Sexual Assault is rarely suspected unless
an outcry is made.
History from Patient (to diagnosis & treat)
Head-to-toe Assessment
Detailed Genital Exam
Collection of forensic evidence
Treatment for injuries, STD’s & pregnancy
DFSA
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1/3 offenders convicted-alcohol
40% of 2,366 survivors urine-alcohol
Multiple drugs: Ethanol, Benzo’s (valium, xanax,
restoril, klonopin, rohypnol) Barbiturates, GHB,
Ketamine, Chloral Hydrate, Muscle Relaxants,
Opiates, Sedative Antidepressants
Challenges:
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Drugs uses
Reporting
Collection of evidence
Lab methodologies
Dosages
JPS Health Network Statistics
No. of Exams
2004
2003
2002
2001
2000
1999
1998
1997
1996
No. of Exams
500
450
400
350
300
250
200
150
100
50
0
Nurse Coroners/
Forensic Nurse Death
Investigators
Nurse Coroner/Death Investigation
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The coroner is a public official who is
primarily charged with the duty of
determining how and why people under
the coroner’s jurisdiction die (these
jurisdictions vary form state to state, but
typically include sudden, unexpected,
unexplained, or traumatic death).
Nurse Coroner/Death Investigation
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A licensed nurse who carries out the
duties of a death investigator in
accordance with the performance
standards and procedures established
under the medical examiner or coroner’s
system of death investigating and the
jurisdictional standards of practice.
Nurse Coroner/Death Investigation
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Nurses have the educational background to
understand exactly what causes death and what
happens to a body after death occurs. Death
may be a criminal event, but it is always a
medical event. Unlike law enforcement who
look at the deceased and want to know, “Who
killed you?” nurses look at a dead body and ask,
“Why are you dead?” If it is determined that the
death was due to criminal cause then it is law
enforcement’s job to determine who. Who
better to determine the manner of death than
medical personnel?
Nurse Coroner/Death Investigation
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Manner of death is the circumstances in which
the cause of death arose, i.e. natural, accident,
homicide, suicide, and undetermined. In some
cases manner of death may be difficult to
determine and may appear accidental (i.e. in a
suicide without a note). Forensic nurses possess
the skills necessary to complete a psychological
autopsy and interpret the subtle nuances of
medications, health history and circumstances
surrounding suspicious deaths.
Nurse Coroner/Death Investigation
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Mechanism of death is the physiologic
derangement or biochemical disturbance
incompatible with life, which is initiated by
the cause of death, e.g. cardiac arrest.
Forensic nurses are well educated in
physiology and are therefore prepared to
accurately distinguish between the cause
and the physiologic mechanism of death.
Nurse Attorneys/
Legal Nurse Consultants
Goals
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To establish a leadership role in health care
policy making.
To influence health care social policy, health
care legislation and nursing practice acts.
To educate the public about health law issues.
To educate the public about nurse attorneys.
To educate nurses about the legal system.
To represent the public; client advocate.
Nurse Attorneys/Legal Nurse
Consultants
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Nurses want to make fundamental change in the
way healthcare is delivered, and recognizing that
it needs to occur through legislation and political
process is a big piece of it.
Like nurses, attorneys must interact with people
who are vulnerable, who have been injured or
traumatized, and who need assistance to regain
their wholeness.
Client advocacy is the skill nurses bring to the
profession.
Psychiatric and Mental
Health
Issues and Goals
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The enhancement of appropriate care for the
severe and persistently mentally ill.
The integration of psychiatric and addictions
treatment.
Strategies for promotion of mental health and
prevention of psychiatric disorders.
The provision of appropriate care within the
criminal justice system.
The equitable provision of care for children and
adolescents.
Issues and Goals
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Ensuring access to care for older adults and
members of minority groups.
Advocacy for access to psychiatric-mental health
services as readily as access to medical services.
The development of an evidence-based
approach to teaching nursing students about
psychiatric-mental health nursing, at both the
undergraduate and the graduate levels of
education.
Correctional Health
Correctional Health Nurses
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Correctional healthcare is a unique
specialty area.
Goals:
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Facilitate an improved working relationship
between the private sector and the
correctional staff in jails, adult and juvenile
detention centers, prisons to meet the needs
of the inmate patient.
Promote correctional healthcare as part of the
public health continuum.
Domestic Violence
Intimate
Partner
Violence
is an Epidemic
The Surgeon General
of the United States
recently declared:
“Domestic Violence is
the number one health
issue facing the country
today”
Domestic Violence
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DV is the leading cause of injury to
women in the world.
DV is the leading nonobstetric cause of
death to pregnant women.
Every 9 seconds a women is battered.
1:3 women are a victim of domestic
violence
Cycle of Violence
Eva’s Top 5 Domestic Violence
Myths/Facts
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MYTHS
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FACTS
Poor/unemployed
The victim spends a lot of
time running to the doctor
He would never hurt the
children
He only does this when he
drinks
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He wouldn’t kill her
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<15% unemployed
Only 2/3 will seek medical
assistance
There is an increased
incidence of child abuse
67% report alcohol abuse
only 1/5 drinking at the
time of abuse
2 women die each week at
the hands of their
husbands/Texas
3-10 Million Children Witness DV
Violence in Their Homes Each Year
63% of Young Men Ages 11 to 20 Who
Are Serving Time for Homicide Have
Killed Their Mothers’ Abusers
The Leading Cause of Injury to 14 Year
Old Boys
More Facts..
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DV kills as many women every 5 years as
the total number of Americans killed in the
Vietnam War…54,000
Approximately 50% of all homeless
women and children in the U.S. are fleeing
DV.
There are 7 animal shelters for every 1 DV
shelter.
DV & Healthcare Costs
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3-5 billion dollars in health care claims
100 million dollars in absenteeism, high turnover and
lost productivity
Employee’s miss 1,175,000 days of work per year
because of DV alone
DV in the US costs an estimated $67 billion/year
13,000 acts of DV against women occur in the workplace
every year
Up to 52% of victims of DV have lost their jobs because
batterers typically engage in behavior that makes it
difficult to work
Types of Abuse
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Physical
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Emotional/psychological
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Hitting, kicking, strangulation, weapons
Threats, destruction of self worth, isolation
Financial
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Work, advancement, access to finances,
credit,
Lack of identifying victims
of Domestic Violence is
consistent in community
hospitals and trauma
centers.
“Justice will only be
achieved when those
who are not injured are
just as indignant as
those who are.”
King Solomon