Outline

Learning objective
• Forensic Broadest definition: In the clinical setting:
The use of science and technology to investigate and establish facts in
criminal or civil courts of law. (American Heritage Dictionary)In the
clinical setting:Every injury, illness, or death can have forensic
implications.
Forensic Nursing
 Forensic nursing is defined as the application of the 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.

 The forensic nurse provides direct services to individual clients, consultation

services to nursing, medical and law-related agencies, as well as providing expert
court testimony in areas dealing with questioned death investigative processes,
adequacy of services delivery and specialized diagnoses of specific conditions as
related to nursing.”
Historical Perspectives
 The first forensic nurses served in Canadaaround1975 as medical
examiners’investigators in the field of deathinvestigation.•The role of
forensic nursing has expanded from concerns solely with death
investigationto include the living—the survivors of violentcrime—as well as
the perpetrators of criminalacts

 Violence is epidemic and is considered a major public health issue.

 The health care system and the legal system have joined in an effort to
respond to the increasing needs of crime victims.
The Context of Forensic
NursingPracticePractice
Areas within which a forensic nurse may intervene:

 Interpersonal violence

 Sexual assault

 Death investigation

 Mass disasters

 Forensic mental health–Correctional nursing

 Legal nurse consulting

 Public health and safety

 Emergency/trauma services
Forensic Nursing Specialties
 Clinical Forensic Nursing

 Sexual Assault Nurse Examiner (SANE)

 Forensic Mental Health Nursing

 Forensic Correctional Nursing

 Legal Nurse Consultant

 Forensic Nurse Death Investigator

 Nurses in General Practice

Clinical Forensic Nursing

 The management of crime victims from trauma totrial includes

 Collection of evidence

 Assessment of victims

 Investigation of death that occurs in the clinical setting

The Sexual Assault Nurse
Examiner (SANE)
 Specialized training to care for sexual assaultvictims

 Physical and psychosocial examination of victims

 Collection and documentation of physical evidence

 Testifies as expert legal witness

 May offer opinion as to whethera crime occurred

Forensic Mental Health Nursing
 Assessment of sociocultural influences on clients

 Assessment and care of mentally ill offenders

 Help victims of crime cope with emotional wounds.

 Help perpetrators and victims deal with the criminal justice system.

 Assessment of inmates for fitness, criminal responsibility, disposition, and

early release

 Provide mental health treatment for convicted offenders and those found
not criminally responsible.
Forensic Correctional Nursing
 The nurse works in secured settings, such as jails, prisons, and halfway
houses.

 The nurse provides treatment, rehabilitation, and health promotion to

individuals convicted of crimes.
Forensic Nurse Death
Investigator
 A registered nurse with specialized education who can accurately
determine the cause of death

 Responds to scenes of deaths or accidents andworks in collaboration with

law enforcement

 Works with forensic pathologists to collectadditional evidence in the lab

during autopsy.
Nurses in General Practice
 Forensic applications in the acute care setting,particularly in emergency
rooms and in criticalcare units.

 Assessment, documentation of care, and reporting ofinformation to police

or other law enforcement agencies.

 Collection and preservation of evidence.

The Nursing Process: Trauma
Care
Assessment of:

 Victims of sexual assault, abuse and neglect,accidental trauma, and death investigation

 All traumatic injuries in which liability is suspectedare considered within the scope of
forensicnursing.

Preservation of Evidence:

 Crime-related evidence must be safeguarded in a manner consistent with the

investigation.

 Such evidence may include:-Clothing, bullets, gunshotpowder on the skin,bloodstains,

hairs, fibers, grass, and small pieces ofmaterial such as fragments of metal, glass,
paint,and wood.
The Nursing Process: Trauma
Care
Investigation of wound characteristics :
 The nurse should be able to identify types of undiagnosed trauma injuries and the possible weapon
involved.

 Types of wounds:
 Sharp injuries
 Blunt
 force injuries
 Dicing injuries
 Patterned injuries
 Bite mark injuries
 Defense wounds
 Hesitation wounds
 Fast-force injuries
The Nursing Process: Trauma
Care
Assessment of deaths in the emergency department:

 Documentation of the appearance, condition,and behavior of the victim on

arrival at the hospital iscritical.

 In the emergency department, a determination must be made as to

whether the cause of death was natural or unnatural.
The Nursing Process: Trauma
Care
Nursing Diagnosis:
 Impaired tissue integrity

 Risk for post-trauma syndrome

 Fear and anxiety

 Risk for self-mutilation

 Risk for suicide

 Risk for complicated grieving.

The Nursing Process: Trauma
Care
Planning/Implementation:
 Preservation of Evidence-Medical stabilization

 Examination of wounds

 Careful preservation of clothing.

 Treatment and documentation of injuries

 Maintaining the proper chain of evidence

 Treatment and evaluation of STDs and pregnancy risk evaluation

 Crisis intervention and arrangements for follow-up counseling

The Nursing Process: Correctional
Facilities
Assessment:
 Care of the mentally ill offender population is ahighly specialized area of nursing practice.

 Psychiatric diagnoses commonly identified at the time of incarceration:

 Schizophrenia

 Bipolar disorder

 Major depression

 Personality disorders

 Substance use disorders

 Dual diagnoses
The Nursing Process: Correctional
Facilities
Assessment:
 Common behaviors observed among thementally ill incarcerated include:

Hallucinations

Suspiciousness

Thought disorders

Anger/agitation

Impulsivity

Denial of problems
The Nursing Process: Correctional
Facilities
Assessment:
 Detoxification frequently occurs in jails andprisons.

 Special concerns

 Overcrowding and violence-Sexual assault

 HIV infection in the prison population

 Female offenders
The Nursing Process: Correctional
Facilities
Nursing Diagnosis:
 Risk for self-mutilation
 Defensive coping
 Risk for suicide
 Complicated grieving
 Risk for other directed
 Anxiety/fear
violence
 Disturbed thought processes
 Ineffective coping
 Powerlessness
 Risk for infection
 Low self-esteem
 Rape-trauma syndrome
The Nursing Process: Correctional
Facilities
Planning/Implementation:
 Development of a Therapeutic Relationship

 Preinteraction phase: Nurse must examine own feelings, fears, and anxietiesabout working
with prisoners —possibly violent offenders.

 Orientation (introductory) phase : Nurse works to establish trust with the client and sets
limits on manipulative behavior

 Termination phase: Closure is difficult in a setting where prisoners may be transferred from
one institution to another on short notice. When possible, nurses may institute assistance
fortransition to the community setting.
References