Forensic nursing is the application of healthcare practice to the science of investigation into violence-related trauma and death resulting from criminal activity, abuse and accidents. The foundations of forensic nursing practice include the identification of crime victims, recovering and documenting evidence, and reporting this evidence, abuse and suspicious behavior to the relevant legal agencies.
The 1980s saw the beginning of a movement inspired by Virginia Lynch, who advocated for a specialty in nursing that would cater for the evaluation and treatment of a victim of violence, combined with the preservation of evidence required to build a legal case. Prior to this, important forensic evidence was lost in the process of initial patient care by healthcare workers.
The urgency of the treatment — such as the swift application of anti-bacterial substances and the closing up of wounds before taking photographs — destroyed evidence of the crime. Without training, emergency healthcare personnel did not know what to look for or how to document the evidence, while law enforcement officers generally depended on the medical staff to report such evidence.
The addition of law to nursing practice was not intended to turn nurses into investigators but rather to combine proper medical care with forensic tasks when working with victims. The resulting forensic evidence is then handed over to the criminal justice system for further investigation. Forensic nurses (FNs) have become a valuable link in the relationship between medical practice and the justice system.
A forensic nurse will receive a subpoena to testify in a court of law. The nurse may testify as a factual witness who will describe the procedure taken during the examination of the victim, as well as observations made during and after the examination. Alternatively, they may appear as an expert witness, testifying based on their educated opinion. FNs must always remain unbiased, and not allow their compassion for the patient to interfere in their role as impartial witnesses in the case.
A qualified nurse who is fascinated by the science of forensics, with compassion for people in traumatic circumstances and a calm nature, is an ideal candidate for the forensic nursing online programs at Cleveland State University. This program will combine your nursing skills with forensic science and will expand your role to promote recovery, health and justice.
Training and duties of forensic nurses
The International Association of Forensic Nurses (IAFN), founded in 1992, has become the primary professional association for forensic nursing standards and training, striving to increase the number of FNs in practice across the world.
FNs can specialize in a particular field of work, such as sexual assault cases in adults or children, child abuse, death investigations or abuse of elderly people. They can work in psychiatric hospitals or correctional facilities, hospitals, coroners’ offices and medical examiners offices. They can also be called upon to assist in disaster or crisis situations.
Various kits and guidelines are available for specific investigations such as sexual abuse and non-fatal strangulation. In addition, the United States Department of Justice sets national training standards, specifically for sexual assault cases. Individual states, too, have set guidelines and standards for forensic practice.
Traumatic injury is not always obvious to the untrained eye, but forensic nurses learn to identify signs such as subcutaneous bleeding, loss of bladder or bowel control, changes in voice and other nervous reactions.
Documentation of evidence is aided using cameras, voice recorders, swabs, rape kits and high-powered lights that detect fluids such as saliva and semen, or minor bruises that are not visible to the naked eye. In cases where witnesses are not available, FNs can assist in providing insight into the cause of injuries.
Trauma patients have a higher incidence of post-traumatic stress disorder (PTSD), depression, suicidal tendencies and other stress-related medical complications, which means that — in addition to the documentation of evidence — forensic nurses are required to treat trauma victims with sensitivity and compassion.
Forensic nurses help patients understand their legal rights in terms of undergoing medical examinations and pursuing legal action. Prior to treating a patient, FNs must obtain consent from the patient or a family member.
FNs are trained to appear as expert witnesses in a court of law, working with attorneys on civil matters as well as criminal defense cases. Their training includes the fundamentals of testimony, preparation for trial, and how to handle direct and cross examination and redirection by the prosecutor.
The forensic nurse as part of a multi-disciplinary team
Because forensic nursing is a fairly modern science, the ethics and boundaries surrounding FNs’ interactions with professionals in other disciplines — such as law enforcement officers, lawyers and judges — are still relatively new. There is a need for a collaborative relationship and mutual respect between forensic nurses and law enforcement officials when interacting in the emergency department and in the courts. Patient care is a priority in nursing and should remain the focus of the FN, regardless of whether the patient is a victim, an accused or an offender.
As part of a multidisciplinary team consisting of healthcare workers, forensic scientists and law enforcement agencies, the FN is involved in establishing a holistic approach to the evaluation and treatment of violence-related trauma.
Protocols for patient handling
Protocols exist to facilitate victim-centered care by prioritizing patient privacy and safety during examinations, the presence of support personnel, explanations of the patient’s legal rights and confidentiality, as well as their access to physical comfort.
Social justice is about respecting people’s rights, regardless of their race, economic status, ethnicity, age, gender, sexual orientation, religion, disability, health status or spirituality. Forensic nurses are encouraged by the IAFN to advocate for human rights and equity within communities. They are also encouraged to screen patients for potential abuse at home such as corporal punishment, for example, leading to child abuse.
An honorable profession
The forensic nurse witnesses all the horrors that humanity is capable of, but the ability to help and care for people with a dire need for comfort and reassurance is certainly rewarding. The ability to keep a cool head while testifying in court, and the satisfaction of seeing perpetrators placed behind bars, certainly adds to the job satisfaction.
