Maryland Board of Nursing Forensic Nurse Examiner Training Program- Adult/Adolescent Curriculum
Lecture Topic
Overview
Course Content
Time
Frame
Presenter
Teaching
Methods
1.
2.
30 minutes
Qualified FNE/
Educator
Lecture
Handouts
Nurse Practice Act
Discussion
60 minutes
Qualified FNE/
Educator
Lecture
Discussion
Handouts
60 minutes
Qualified FNE/
Educator
Lecture
Discussion
Handouts
60 minutes
Qualified FNE/
Educator
Lecture
Discussion
Handouts
120 minutes
Representative
from the
multidisciplinary
team
Lecture
Discussion
Handouts
Optional Survivor
Panel with moderated
discussion
3.
Historical Perspective of
Forensic Nursing
1.
2.
3.
Multidiscipline Team Concept
Statistics, Myths and Barriers to
Reporting
4.
5.
1.
2.
3.
1.
2.
3.
4.
Rape Trauma Syndrome
1.
2.
3.
Define Forensic Nurse Examiner (FNE)
Review literature regarding the pre and post development of SANE
programs.
Review the educational guidelines established by the Maryland Board of
Nursing.
Define forensic nursing.
Identify types of forensic nursing practice; correctional, death investigation,
and sexual assault nurse examiners, etc.
Discuss the development of forensic nursing with the International
Association of Forensic Nurses (I.A.F.N.)
Present the historical development of SANE program across the country.
Discuss the historical development of FNE programs in MD.
Define the multidiscipline team concept.
Identify members of the multidisciplinary team (FNEs, law enforcement,
rape crisis staff, judicial staff, and crime lab)
Roles, goals and boundaries of the core members of the team.
Review current national and local statistics related to sexual assault.
Discuss misconceptions associated with sexual assault.
Identify barriers for individuals reporting sexual assault and discuss how the
barriers have been decreased due to SANE/FNE programs.
Discuss difference in how males and females are socialized to accept sexual
assault.
Discuss Post Traumatic Stress Disorder (PTSD) and the stages of rape
related trauma
Describe acute and chronic symptoms experienced by survivors.
Explain common physical and psychological reactions of sexual assault
patients and the appropriate response to them.
Advocate/Hospital Companion
Role
1. Define the role of the advocate/hospital companion
2. Review responsibilities of the advocate within the medical setting
3. Discuss services offered by the rape recovery center post-assault
60 minutes
Advocate
Lecture
Handouts
Discussion
The Role and Responsibility of
Forensic Nurse Examiners
1.
2.
60 minutes
Qualified FNE/
Educator
Lecture
Discussion
Handouts
Define the role of the forensic nurse examiner.
Discuss each component of care of the forensic nurse examiner.
a. Physical and psychosocial assessment
b. The evidentiary examination (medical/forensic interview, evidentiary
Approved by the Maryland FNE Standards and Practice Committee May 6, 2005 with recommended revisions
Revised May 18, 2005
1
Maryland Board of Nursing Forensic Nurse Examiner Training Program- Adult/Adolescent Curriculum
Lecture Topic
Course Content
3.
4.
5.
Time
Frame
Presenter
Teaching
Methods
collection of specimens and chain of custody)
c. Testimony in the court system
d. Referrals to patients for follow up care
e. Prevent and treat sexually transmitted diseases and pregnancy
Discuss the components for performing the forensic examination step by
step: components include history, head to toe examination for trauma
identification, detailed genital examination for trauma identification and
collection of evidence
Identify forensic nurse examiner role with Maryland criminal code of sexual
assault.
a. Discuss Maryland criminal code defining penetration.
Review mandatory reporting statutes.
Approved by the Maryland FNE Standards and Practice Committee May 6, 2005 with recommended revisions
Revised May 18, 2005
2
Maryland Board of Nursing Forensic Nurse Examiner Training Program- Adult/Adolescent Curriculum
Lecture Topic
Medical Forensic History
Course Content
Time
Frame
Presenter
Teaching
Methods
1.
120 minutes
Qualified FNE/
Educator
Lecture
Discussion
Role Play
120 minutes
Qualified FNE/
Educator
Lecture
Discussions
Handouts
Sexual Assault
Textbooks
120 minutes
Qualified FNE/
Educator
Lecture
Handouts
Discussion
Interactive/Participat
ory Activity
2.
3.
Head to Toe Assessment and
Forensic Documentation
1.
2.
3.
4.
5.
Review of Genital Anatomy
1.
2.
3.
Demonstrate history taking skills by:
a. Evaluating mental status, environment and non-verbal cues
b. Behavioral observations and interpretation of verbal and non-verbal
communication of the patient
c. Reactions that the examiner may encounter from individuals that have
been sexually assaulted
Demonstrate how to obtain and document the patient’s history in a nonleading manner.
Identify questions that need exploration during the history taking process;
(decline vs. refuses, subjective vs. objective and body language)
Review primary assessment- airway, breathing, circulation/triage
Review secondary assessment- detailed head to toe assessment including
injury identification
a. Past/recent medical history
b. Head to toe examination for trauma identification, includes oral
examination for injury assessment to the lip, frenulum, inner aspects of
the lip, tongue and pallate and collection of forensic evidence
c. Detailed genital examination for trauma identification and collection of
forensic evidence
Discuss forensic injury documentation
Discuss the need for physician consultation as indicated
Define types of injuries most commonly seen in victims of sexual assault
a. Physical injuries
b. Genital injuries
Discuss the genital anatomy and developmental stages through the lifespan.
Review the physical anatomy of both male and female:
a. Tanner stages
b. Mons Pubis
c. Labia Majora
d. Labia Minora
e. Clitoris
f. Hymen
g. Penis
h. Scrotum
i. Anus
Identify advanced genital examination techniques:
a. Inspection
Approved by the Maryland FNE Standards and Practice Committee May 6, 2005 with recommended revisions
Revised May 18, 2005
3
Maryland Board of Nursing Forensic Nurse Examiner Training Program- Adult/Adolescent Curriculum
Lecture Topic
Course Content
4.
5.
6.
7.
Time
Frame
Presenter
Teaching
Methods
b. Separation
c. Traction
d. Knee chest
e. Foley Catheter Balloon Technique
f. Toluidine Dye
g. Speculum
h. Colposcope/Medscope/Camera
Identify techniques for the anal examination of the sexual assault client
a. Positioning patient for the examination
-side lying position
-knee-chest position
-lithotomy position
b. Visualization of the anal area
c. Anal dilatation techniques
-gluteal separation
Discuss types of common anal injuries seen.
Review controversy of the Human Sexual Response
Return demonstrate knowledge of genital anatomy
Approved by the Maryland FNE Standards and Practice Committee May 6, 2005 with recommended revisions
Revised May 18, 2005
4
Maryland Board of Nursing Forensic Nurse Examiner Training Program- Adult/Adolescent Curriculum
Lecture Topic
Adult Genital Variations
Course Content
Time
Frame
Presenter
Teaching
Methods
1.
60 minutes
Qualified FNE/
Educator
Lecture
Handout
Sexual Assault
Textbooks
120 minutes
Qualified FNE/
Educator
Lecture
Handouts
Photographs/Slides
Case studies
Discussion
Sexual Assault
Textbooks
30 minutes
DHMH or
Qualified FNE/
Educator
Lecture
Discussion
Handouts
2.
Discuss normal variations found in adult male and female patients.
a. Surgical
b. Age-related changes
c. Dermatological variations
Discuss abnormal genital variations found in adult male and female patients.
a. Diseases
b. Non-sexually related trauma
Congenital
Female Genital Mutilation
Genital Ornamentation
Circumcised male vs. uncircumcised male
Review types of trauma seen in patients of sexual assault.
a. Blunt
b. Sharp
c. Penetrating
Discuss mechanisms of injuries.
Describe techniques utilized by the nurse examiner for assessing, identifying
and documenting trauma in patients of sexual violence.
a. Gross visualization
b. Clock Orientation documentation
c. Toluidine dye application
d. Colposcope/medscope, zoom digital
e. Use of alternate light sources (i.e. infrared, wood’s lamp)
f. Photographic documentation
Discuss patterns of injuries
a. Various stages of healing
Patterned injuries (e.g. ligature marks, foot prints, belt marks)
Review process for reimbursement of forensic exams
a. Review DHMH forms
b. Review reimbursement regulations
Discuss fiscal concerns of programs
1.
2.
3.
4.
Review Victim and Suspect Sexual Assault Evidence Collection kits
Discuss contents and paperwork in the kit.
Informed Consent
Discuss kit expiration.
60 minutes
Qualified FNE/
Educator
Lecture
Small group
demonstration
Sample Kits
2.
Trauma Identification
3.
4.
5.
6.
1.
2.
3.
4.
Payment of Exams and Funding
Needs
Introduction to the Sexual
Assault Crime Lab Kit
5.
1.
Approved by the Maryland FNE Standards and Practice Committee May 6, 2005 with recommended revisions
Revised May 18, 2005
5
Maryland Board of Nursing Forensic Nurse Examiner Training Program- Adult/Adolescent Curriculum
Lecture Topic
Evidence Collection and
Preservation
Course Content
Time
Frame
Presenter
Teaching
Methods
1.
140 minutes
Qualified FNE/
Educator
Lecture
Video
2.
3.
4.
5.
Crime Lab Trace Analysis
1.
2.
3.
4.
5.
6.
Demonstrate step-by-step technique for evidence collection of the sexual
assault client (video).
Review types of specimens collected based on gender and orifice penetrated.
Discuss ultraviolet light source in evidence collection.
Demonstrate proper packaging and preparation of specimens.
a. Physical findings
b. Clothing
c. Hair
d. Bite mark/Licking
e. Fingernail scrapings
f. Fluoresced exudates
g. Foreign material
h. Blood spatter
i. Swabs, smears (oral, vaginal, penile, rectal and other dried body fluids)
j. Whole blood specimen in Lavender top tube with EDTA preservative
1) Transfer to FTA blood card (if applicable)
2) Check expiration date on blood tube
k. Saliva specimens
l. Toxicology blood/urine screen
Explain purpose of laboratory tests performed and the impact they have on
sexual assault cases.
a. Serum pregnancy
b. Serum alcohol
c. Urine toxicology/serum toxicology
d. Sexually transmitted infections
e. HIV
Discuss role of the Crime Lab
Identify types of evidence specific to sexual assault cases.
Describe techniques and procedures for trace analysis.
Discuss challenges related to the evidence gathering process, including the
evidence integrity and chain of custody.
a. Evidence gathering process
b. Evidence labeling process
c. Documentation
d. Cross contamination
Review the use of CODIS in sexual assault cases.
Review current DNA Legislation.
Role play
Small groups
Discussion
Sexual Assault
Textbooks
90 minutes
Crime Lab
representative
Approved by the Maryland FNE Standards and Practice Committee May 6, 2005 with recommended revisions
Revised May 18, 2005
Lecture
Handouts
Discussion
6
Maryland Board of Nursing Forensic Nurse Examiner Training Program- Adult/Adolescent Curriculum
Lecture Topic
Police Roles and
Responsibilities
Course Content
Time
Frame
Presenter
Teaching
Methods
1.
Differentiate the role of the uniform officer versus the detective when
responding to sexual assault cases.
Discuss the elements of a sexual assault crime.
75 minutes
Law Enforcement
Representative
1. Discuss types of sexual assaults and impact on victim:
a. Stranger
1. Define the four phases of a sexual crime:
 Antecedent/Fantasy
 Victim selection
 Commission of the crime
 Post offense behavior of the perpetrator
2. Discuss approaches commonly used by perpetrators (con, blitz,
surprise)
b. Non-stranger
1. Discuss common characteristics of non-stranger perpetrators
2. Discuss approaches commonly used by perpetrators
c. Marital/ Intimate Partner Violence (IPV)
d. Incest
e. Internet/computer crimes
f. Gang
2 Review rapist typologies of sex offenders
a. Power reassurance
b. Power assertive
c. Anger retaliatory
d. Anger sadistic
1. Identify special populations of sexual assault and their special needs based
on:
a. Race and Culture
 Review oppression and power dynamics
b. Mental and Physical challenges/impairments
c. Religion
d. Age (Elderly, children, adolescents)
e. Gender (male, lesbian, bi, gay, transgendered)
f. Prostitution and substance abuse
g. Human trafficking
90 minutes
Law Enforcement
Representative or
Qualified
Educator
Police Best Practices
Lecture
Discussion
Handouts
Lecture
Handouts
Discussion
Case Review
2.
Profiling of Sex Offenders
Special Populations
Law Enforcement
Textbooks
90 minutes
Advocate or
Qualified FNE/
Educator
Approved by the Maryland FNE Standards and Practice Committee May 6, 2005 with recommended revisions
Revised May 18, 2005
Lecture
Handouts
Discussion
Interactive activities
7
Maryland Board of Nursing Forensic Nurse Examiner Training Program- Adult/Adolescent Curriculum
Lecture Topic
Sexual Assault and Domestic
Violence
Course Content
Time
Frame
Presenter
Teaching
Methods
1.
2.
3.
Define domestic violence.
Describe the dynamics of abusive relationships.
Identify physiological and behavioral signs and symptoms of domestic
violence.
Identify barriers that prevent victims from leaving abusive relationships.
120 minutes
Advocate or
Qualified FNE/
Educator
Lecture
Discussion
Handouts
Discuss STIs exposure and other patient concerns.
Describe current CDC treatment recommendations for STIs:
a. Chlamydia
b. Gonococcal infections
c. Syphilis
d. Bacterial Vaginosis
e. Hepatitis
f. HIV/AIDS
g. Other
Reportable diseases to Health Department
Discuss pregnancy risk and emergency contraception.
60 minutes
Qualified FNE/
Educator
Lecture
Handouts
Discussion
60 minutes
Toxicologist, Law
Enforcement
Officer or other
Qualified FNE/
Educator
Lecture
Hand-outs
Discussion
2.
Discuss the incidence of voluntary and involuntary use of substance and
relationship to sexual assault.
a. Types of substances abused.
-Alcohol
-Ecstasy
-Prescription Drugs
-Other illegal drugs
b. Types of “date rape” drugs.
-Alcohol
-GHB
-Rohypnol
-Benzodiazepines
-Opiates
-Ketamine
Review current drug testing options
1.
2.
3.
Discuss new evidence based research
Discuss new laws impacting practice
Discuss changing practices across the country
30 minutes
Qualified
FNE/Educator
Lecture
Discussion
Handouts
4.
Sexually Transmitted Infections
and Pregnancy
1.
2.
3.
4.
Drug Facilitated Sexual Assault
Current Research and National
Trends
1.
Approved by the Maryland FNE Standards and Practice Committee May 6, 2005 with recommended revisions
Revised May 18, 2005
8
Maryland Board of Nursing Forensic Nurse Examiner Training Program- Adult/Adolescent Curriculum
Lecture Topic
Continuum of Care, Referrals
and Discharge Instructions
Documentation and its Impact
on Testimony
Course Content
Time
Frame
Presenter
Teaching
Methods
1.
60 minutes
Qualified
FNE/Educator or
Advocate
Lectures
Handouts
Discussion
100 minutes
Qualified
FNE/Educator
Lecture
Handouts
Discussion
60 minutes
Qualified FNE/
Educator
Lecture
Discussion
Handout
Role Play/Modeling
2.
1.
2.
Courtroom Testimony,
Application of the Medical
Forensic History, and Personal
Presentation
1.
2.
3.
4.
5.
6.
7.
8.
Discuss information FNEs should offer to prepare the patient for discharge
a. Follow typical hospital procedure for discharge
-Review discharge instructions
b. Anticipatory teaching on what to expect in terms of emotional response
(if not already done by the advocate)
c. Referrals
-Health Department for HIV testing and follow up care
-Private physician for follow up and ongoing medical care
-Rape recovery center for counseling services
-Emergency contraception information
-Prophylaxes given
Review sample discharge and referral paperwork.
Maintaining congruency between evidence collection, documentation, and
medical forensic history.
a. Forensic history
b. Body Maps/ Diagrams
c. Injury documentation
d. Medical/forensic photography
e. Exam findings
Detailed documentation process including:
a. Objective vs. subjective
b. Avoiding pejorative documentation
c. Detailed vs. minimal narrative
Discuss preparation for court
a. Review of the medical/forensic documentation.
Discuss courtroom structure and etiquette.
Review process of being qualified as an expert witness
Review process of being qualified as a fact witness
Review exceptions to hearsay
Demonstrate testimony skills of genital knowledge articulated at jury level
(Vaginal vs. vulva vs. genital and anus vs. rectum)
Review us of visual aids and medical terminology translation into lay
language.
Discuss the rules of testifying as an expert witness.
Approved by the Maryland FNE Standards and Practice Committee May 6, 2005 with recommended revisions
Revised May 18, 2005
9
Maryland Board of Nursing Forensic Nurse Examiner Training Program- Adult/Adolescent Curriculum
Lecture Topic
Establishing Credibility as a
Witness
The Judicial system and Laws
Mock Courtroom
Testimony
Clinical Requirements
Course Content
Time
Frame
Presenter
Teaching
Methods
1. Define for the court the expertise of the FNE
2. Review how to prepare you CV
a. MD Board of Nursing approved FNE Curriculum, including didactic
and clinical requirements
b. Clinical experiences
c. Other training and continuing education
d. Additional certifications (National SANE-A)
1. Discuss Maryland laws pertaining to rape and sexual offenses
2. Review the criminal justice system process
3. Review levels of proof in legal proceedings
a. Criminal Court
b. Civil Court
4. Review rape shield doctrine according to Maryland Law.
1. Review a simulation of actual court proceedings that include all parties
involved.
2. Witness an expert being cross-examined
1. Review clinical requirements
2. Review FNE Certification application
3. Review SAFE Program resource list
45 minutes
Qualified FNE /
Educator
Handouts
Discussion
Lecture
135 minutes
Attorney
Lecture
Maryland Laws
120 minutes
Attorney
45 minutes
Qualified FNE/
Educator
Mock Trial
Role play
Discussion
Handouts
Approved by the Maryland FNE Standards and Practice Committee May 6, 2005 with recommended revisions
Revised May 18, 2005
10