Applying the Nursing Process to Death Investigation

Fueled by TV shows, bestsellers and highly publicized murder investigations and trials, the topic of death investigation usually elicits fascination and excitement. In contrast, the nursing process often elicits a very different response, from snarls to yawns and everything in between. After years of writing, reading and grading nursing care plans I was thrilled when I began working in an area where I was no longer required to think of them. So it was with some foot-dragging and dread that I finally forced myself to explore how the nursing process applied to my new nursing specialty, death investigation.

Initially, I planned to write a single article, and did. As I wrote, I became increasingly aware that there was a lot of information to share and I became concerned that it was too much for easy consumption at one sitting. I asked my co-workers for input and they very graciously took time to read and think about the article and give me valuable input. With their input, the decision was made to change the format and write a series of articles. I hope that you will find these articles interesting and valuable. I would be interested in any feedback, pro and con, because after all, we are on this journey together.

Before proceeding, let’s briefly review the phases of the nursing process, as they will be used for purposes of discussion in this article. I will use the terms “assess,” “plan,” “implement” and “evaluate.” I recognize that many nurses add “diagnosis” after “plan” but I believe that it is impossible to plan without having diagnosed the need or problem so I think that diagnosis is implied. In like manner I do not think that it is necessary to specify the outcome. Do not construe this to mean that I do not recognize or value nursing diagnoses; in fact I will refer to these at various times in the series. I would also like to mention that I believe that death investigation, based on the nursing process, also draws on numerous nursing theories and models.

The need to validate how the nursing process is applied to death investigation became apparent in 2002 when one state board of nursing threatened not to renew the active licenses of practicing nurse death investigators. This board of nursing’s lack of knowledge about the specialty of forensic nursing, in spite of the publication of the Scope and Standards of Forensic Nursing Practice by the ANA in 1992, astounded me. Additionally, nurses everywhere were seeking advice on how to get into death investigation, as they met resistance on many fronts; even some institutions of nursing education seemed not to be knowledgeable about forensic nursing. After lots of thought and some research, I have come to believe that part of the problem is the lack of a defined model that helps nurse death investigators clearly conceptualize what they do. As a consequence they have difficulty “selling” themselves to others who have historically controlled death investigation. After all, if the nursing profession doesn’t get it, how can we expect non-nurses to value what nurses have to offer?

What do we, as nurses, have to offer to death investigation? I believe that nurses, by virtue of their education, bring with them a tremendous knowledge base that is so suited to death investigation that it is difficult to imagine a better fit. Nurses are knowledgeable about normal anatomy and physiology, as well as deviations from normal. They are knowledgeable about pharmacology, grief and grieving, growth and development, interviewing and many more areas that are valuable to death investigation. This broad knowledge base is not typically found among those with criminal justice or law enforcement backgrounds or even among those non-nurse death investigators who frequently are employed by medical examiners.

For these reasons I think nurses, when given an opportunity, will prove themselves to be very valuable members of death investigation teams.

At first glance one may fail to see how the nursing process can be applied to death investigation, but it is important for nurse death investigators to consciously apply the nursing process to their practice in order to ensure that the expertise gained through their nursing education and experience benefits not only the investigation, but survivors and the community at large.

I believe that the nursing process approach to death investigation actually should be viewed as three separate components; one component related to the investigation of the death proper, a second related to the family and/or survivors and a third component related to the community or society. These components spiral and twist in such an interrelated and dynamic manner that, like a DNA helix, any change in one area impacts the whole. Additionally, these interrelated components exist within another framework that touches and impacts nursing and is conversely impacted by nursing. That framework is also composed of intertwining, evolving components to include medicine and healthcare, the law and other forensic entities and societal factors.

In future articles I’ll explore these components individually and in relation to each other. In the second article I will be discussing the first component and applying the steps of the nursing process to the investigation of the decedent and the circumstances surrounding the death.

We will assess the body, the immediate environment and the medical and social histories. This assessment begins when the investigator is first notified of the death and often continues well beyond autopsy or burial. The time of day, the location of the death, the weather ... may be the first bits of assessment information, out of which grows, a plan followed by implementation and evaluation.

Rae Wooten, BSN, RN, ABMDI is the deputy coroner for the Charleston County, S.C. Coroner’s Office.

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