Forensic Nursing: It Takes Education

By Donna Garbacz Bader, MA, MSN, RN, D-ABMDI

POPULAR CULTURE AND the media are saturated with forensic science images as we watch forensic investigators and forensic pathologists work in hit television shows "CSI: Miami" and "CSI: Crime Scene Investigation." Add to this the O.J. Simpson trial that dominated the news and entertainment media for a full year and continues to be a basis for discussion in many forensic science and law enforcement classrooms. Participants in these classrooms discuss the case as an example for collection of evidence, chain of custody, and the many social and psychological implications of the entire situation. In 2002, another high-profile case came to the attention of the media and continues to maintain public interest - the Martha Moxley murder case. It was interesting to note that the principal investigator in the Moxley case -- Mark Fuhrman -- also was the principle investigator in the O.J. Simpson case.

In the news media and the entertainment field, forensic science has acquired an aura all its own, one that is often misrepresented and misinterpreted. If one were to examine the number of programs on local television, it would be noted that every night of the week there is at least one program dealing with the topic of forensic science. Six out of the seven nights there are two, if not three, programs dealing with this topic. Just pick your time and channel.

Lack of Forensic Education

The issue is not the programs or the media content, but instead it is the interpretation of what is seen, read and heard. Misinterpretation of basic forensic information is not just an issue with the general public, but also in the areas of medicine. There is not question as to the importance of preservation, collection and handling of forensic evidence. Law enforcement and healthcare institutions throughout the United States develop rules and regulations. Every law enforcement individual is aware of the importance of accurate evidence collection and the manner in which this is obtained and stored. Every physician and nurse is required to inform law enforcement agencies when injuries are seen that are suspect of criminal trauma.

Importance of Forensic Nursing

The American Nurses Association (ANA) and the International Association of Forensic Nurses (IAFN) developed the first "Scope and Standards of Forensic Nursing Practice" in 1997. This identifies the practice of forensic nursing as an "innovative expansion of the role nurses will fill in the health service delivery system in the 21st century"¹ The standards also note the importance of forensic education in providing "safe and effective nursing practice."² Nurses have become an important asset in the area of forensic data collection; however, their full potential is not recognized. There are still many states in these United States that do not accept the nurse as a competent forensic nurse, nor do they recognize the need for education of nurses in the field of forensic science.

In many healthcare facilities, the medical and legal profession is hesitant to include the nurse in any forensic activity. The exception to this is the sexual assault nurse examiner (SANE). The SANE is required to have training and certification and is used extensively by all law enforcement organizations. The SANE is recognized as an expert witness in this field of forensics. All forensic nursing texts available today deal with sexual assault or have sexual assault as the main focus. The SANEs should be proud of all that has been accomplished in this field and the benefits that have been gained for the patients that required this assistance. This organization and its members are an invaluable resource to other forensic nurse specialties and their input should be actively sought. Nursing needs to work with each other, share and recognize each nursing area as essential to the whole. This needs to be an initiative that we as individuals need to consider.

Many law enforcement and medical personnel find it difficult to understand the importance that a nurse, educated in forensic science, can have in assisting in the accurate identification and collections of forensic evidence. Nurses can do more than chart and carry out orders. They can provide knowledgeable, efficient, and accurate assistance. Meserve³ writes, "Numerous cases have been tried in which the facts of crime were distorted by the failure of medical personnel to appreciate and anticipate police needs." "Knowledge promotes pattern recognition ... most nurses who are practicing currently received their basic nursing education through being exposed solely to the usual ways of teaching nursing, which encouraged only analytical reasoning."⁴

The role of the clinical nurse in any healthcare setting has broadened to focus on the nurse's interaction with families, visitors, and law enforcement in obtaining specific information prior to or at the time of a "forensic event." The nurse needs to be aware of not only the clinical presentation, but also the psychosocial, medical, and personal history of the patient.⁵ Goll-McGee goes on to write that too often the nurse's "attention is captured by the present immediate needs patients display, while precious evidence affecting the living forensic patient and society is lost."⁶

Nursing responsibilities have always included activities that may have legal implication with the possibility of court testimony. Participating in crisis and stress intervention, the notification of death, and in maintaining life support for potential organ donor patients are other responsibilities that were specific to the clinical nurse. The implications of maintaining a clear and complete patient record have always been a major focus of nursing education.

In reflecting on major world events, the nurse is likely to care for patients as a result of domestic terrorism. These patients may not only be the victims, but some may be the perpetrators.⁷ Consider also the example of the victim involved in a motor vehicle accident or a patient who suffers a crushing pelvic injury as the result of a fall from a scaffold that disengages. Accurate record keeping will provide documentation that may assist law enforcement and/or workers compensation efforts. What does the nurse do when caring for a patient, discovers that the patient passed a small plastic bag filled with a powdered substance? Also, will the nurse receive the proper guidance as to the deposition of this material? There may or may not be written policies and procedures written as to the action that is necessary in this event.

Nurses in many areas are not provided educational programs, which focus on basic forensic knowledge. Many of the forensic programs deal with topics of collection, preservation and recognition of forensic data. As a practicing nurse, forensic scientist and educator, this is truly, "putting the cart before the horse." This approach does not allow the nurse to critically apply forensic science knowledge to more than one issue. The lack of understanding why certain procedures in forensic cases are necessary and exactly what differentiates a forensic case or situation leaves the nurse in a precarious legal position.

Individual Responsibilities

Virginia Lynch describes forensic nursing as a "formal specialty" and writes, "As nurses begin to apply their unique forensic skills in the justice, they must be knowledgeable about the correct interpretation of data."⁸ In addition, "today's nurse frequently encounters forensic patients. It should be the nurse's professional responsibility to seek out or recommend programs and continuing education that perfect skills in identifying battering and trauma of medico legal significance."⁹

Not all nurses have the desire to become forensic nurses, but all nurses have the desire and willingness to do the best for the patients they serve. Offering regular programs in basic forensic science will promote confidence in nursing practice when dealing with forensic issues. This would allow for fewer errors in recognition, collection, and preservation of forensic evidence. The area of forensics does not belong to a certain group of individuals. The highly-trained forensic specialist could benefit in working with nurses that have an understanding of forensics and are able to identify their limits in this area. There are specialists in every area, and depending on others' assistance when dealing with forensic issues in the healthcare facility is a service that the victim should deserve and expect.

I encourage nurses to request and attend continuing education programs in basic forensic science and to be offered the opportunity to increase this knowledge in an atmosphere of respect and cooperation. The "bio-psychological education of the registered nurse"¹⁰ allows the nurse to understand the scientific principles involved in the field of forensic science. A nurse, no matter what their major interest, should always investigate avenues to increase their knowledge base and be able to apply this in the provision of providing the patient, client, victim, accused, or any individual whom we are fortunate to care for.

Donna Garbacz Bader, MA, MSN, RN, D-ABMDI, is a faculty member of Bryan LGH College of Health Sciences in Lincoln, Neb. She has assisted with developing a certificate course in forensic science, as well as the master's degree program in forensic science at Nebraska Wesleyan University in Lincoln, Neb.

References
Goll-McGee, Barbara. (1999). "The Role of the Clinical Forensic Nurse in Critical Care." Critical Care Nursing Quarterly, 22(1), page 9.

Hoyt, Constance A., & Spangler, Katherine A.(1996). "Forensic Nursing Implications and the Forensic Autopsy." Journal of Psychosocial Nursing, 34(10), page 31.

International Association of Forensic Nurses, American Nurses' Association. (1997). "Scope and Standards of Forensic Nursing Practice," pp. V, 20.

Lynch, Virginia A. (1996). "Advances in Forensic Nursing: New Dimensions for the 21st Century." Journal of Psychosocial Nursing, 34(10), page 6.

Meserve, K. (1992). "Preserving medicolegal evidence: A guide for emergency care providers." Journal of Emergency Nursing, 18(2), page 20.

Winfrey, Marion E., & Smith, Amy Rex. (1999). "The Suspiciousness Factor: Critical Care Nursing and Forensics." Critical Care Nursing Quarterly, 22(1), pp. 2 and 5.

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