Forensic nursing: an aid to law enforcement.

The unidentified male is rushed to the hospital via ambulance. He is unconscious, with a gunshot wound to his chest. The trauma team has been alerted prior to his arrival. While each team member has a role in the immediate care of the victim, the forensic nurse cuts off his clothes, careful to avoid the bloody hole where the bullet pierced his shirt. The nurse puts each article of clothing in a separate container, places brown bags over the patient's hands, and searches his pockets for anything that could identify the young man. (1)

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Gunshot wounds, drug overdoses, sexual assaults, and stabbings constitute just a few cases that involve forensic nurses who administer medical attention to individuals with traumatic injuries and those involved in catastrophic accidents, as well as provide assessment and care to both victims and perpetrators of crime and to their families. (2) A relatively new field in the criminal justice arena, forensic nursing originated in the early 1990s. While not lawyers or police officers, forensic nurses provide a needed link between medicine and the law. In 1992, 70 nurses gathered in Minneapolis, Minnesota, for the first national convention of sexual assault nurses, which led to the formation of the International Association of Forensic Nurses (IAFN). (3) Three years later, the American Nurses Association officially recognized forensic nursing. (4) As of 2004, the IAFN has over 2,400 members. (5) As a result, forensic nursing has become one of the fastest growing specialties in the field of nursing.

Forensic nurses must be a registered nurse (RN), (6) a trained medical professional licensed by a state authority. (7) Once they have earned an RN license, nurses who desire to specialize can take selected courses in the field of forensic science that would cover such topics as collection and preservation of physical evidence, wound identification, law enforcement investigation, documentation procedures and chain of custody, and preparation for court testimony. (8) Various universities across the nation provide education and training for those seeking a career as a forensic nurse, presenting them with classroom lectures and discussions, laboratory experience, and internships at local hospitals. One forensic nurse indicated that she first became an RN and later decided to become a forensic nurse. She successfully completed the required courses, including evidence preservation and collection, photography, and wound identification. She also observed the functions of law enforcement by riding with a police officer for a specified number of hours and learned about the courtroom process by witnessing trial procedures. (9)

THE LAW ENFORCEMENT ASSOCIATION

The general term forensic nurse encompasses several areas of expertise that RNs can specialize in to aid law enforcement officers in many ways. These include sexual assault nurse examiners, forensic correctional nurses, forensic geriatric nurses, forensic legal nurse consultants, forensic nurse investigators, forensic pediatric nurses, and forensic psychiatric nurses.

Sexual Assault Nurse Examiners

The sexual assault nurse examiner (SANE) (10) specializes in providing care and treatment to sexual assault victims. (11) The duties of the SANE include assessing injury, objectively documenting the health history of the victim, recording information about the crime, screening for sexually transmitted diseases, collecting and preserving forensic evidence, and aiding the victim. (12)

Because SANEs frequently work closely with assault victims, most possess some education and knowledge in the field of victimology, the study of victims and crime. (13) Most SANEs follow the victim through the entire criminal justice system, often offering a sympathetic ear. SANEs operate on the belief that victims should receive thorough medical evaluations, treatment by skilled professionals, and knowledgeable support. (14)

All SANEs have to be certified through a comprehensive, usually 40-hour, training program that includes gathering medical histories from victims, conducting physical exams, identifying wounds and patterned injuries, and collecting evidence, as well as learning some interview techniques and basic forensic photography. This training also may prove valuable to law enforcement officers investigating cases of assault. (15)

Forensic Correctional Nurses

Forensic correctional nurses provide medical attention to individuals charged and convicted of a crime. They often are employed in prisons, jails, and juvenile detention centers. (16) Their responsibilities include giving prescribed medications to inmates, running the correctional facility's hospital, and treating the victims of inmate fights. Forensic correctional nurses also serve as potential negotiators. For example, an inmate barricaded himself in his room and, using a mop ringer as a weapon, threatened to kill the first person who attempted to intervene. Officials called in a forensic correctional nurse who told the prisoner that police officers were en route, and, if he did not immediately calm down, they would take corrective action. The inmate, known to tear through restraints, broke down and submitted without incident. (17)

Forensic Geriatric Nurses

Forensic geriatric nurses care for aging individuals and often handle the human rights issues of abuse, neglect, or exploitation. (18) Nursing home facilities or retirement communities usually employ these nurses who also can have their own independent practices. (19) They use their knowledge and skills most often in cases of elder abuse or neglect. In one incident, an elderly woman arrived in the emergency room of a hospital with a swollen right eye, bruises on her arms, and severe dehydration. The forensic geriatric nurse on staff took pictures of the injuries as they appeared to be possible signs of elder abuse. When the elderly woman became coherent 2 days later, she explained that her son had become frustrated with her declining health. She stated that he would tell her that she needed to try harder. If she failed to do so, he would strike her. The intervention of the forensic geriatric nurse prevented the woman from being released her back to her son. Instead, she was immediately assigned to an assisted living center where she would have minimal contact with her son. (20)

Forensic Legal Nurse Consultants

Forensic legal nurse consultants use their clinical knowledge to assist attorneys in cases where law and medicine overlap. (21) They often use their knowledge in civil, rather than criminal, cases. (22) These nurses typically have their own practices or work for major law or insurance firms. Their duties can include verifying malpractice and negligence claims, preparing and analyzing records, providing legal assistance, and serving as expert witnesses. (23) While law enforcement officers focus on criminal law, they also may have to testify in civil litigations (tort actions), such as automobile accidents and assaults. The forensic legal nurse consultant could aid officers in understanding the components of civil actions. For example, in a malpractice case where a man died as a result of a farming accident, a forensic legal nurse consultant reviewed the file information and testified that the doctor was negligent when allowing the patient to be air transported to the hospital before he was stable. (24) If police officers had arrived on the scene to assist the victim or to investigate the incident, they most likely would have been named in the lawsuit.

Forensic Nurse Investigators

Employed by medical examiners, forensic nurse investigators conduct scientific investigations of the crime scene and the circumstances surrounding the victim's death. (25) For instance, a 6-month-old baby was found dead in his crib, and the forensic nurse investigator was called to investigate the death. Upon arrival at the scene, she was told that there was no history of disease or abuse. When the nurse entered the child's room, she noticed a distinct odor of vomit. She asked the mother if the baby had been sick. The forensic nurse investigator learned that while the baby had shown no signs of previous illness, his older brother had complained of stomach problems for several days. The nurse observed green paint peeling off the steam radiator pipe that snaked across the apartment. She lifted the dead infant's lip and observed a thin, bluish lead line on the baby's gums. She then instructed the mother to have herself and her children tested for lead poisoning. The test verified the nurse's suspicions. The entire family had contracted lead poisoning from the paint flaking off the pipe. (26)

Forensic Pediatric Nurses

Forensic pediatric nurses care for children and often encounter the human rights issues of abuse, neglect, or exploitation. (27) These nurses often are in independent practices or work in the pediatric department of hospitals. (28) In one case, an 8-year-old girl was brought into the hospital one night complaining of pain in her pelvic region. The forensic pediatric nurse on staff performed a pelvic exam on the youngster and discovered several abrasions and bruises. Further investigation revealed that the father had sexually abused her. As a result of the forensic pediatric nurse's examination, the physical evidence collected, and the testimony of the child, authorities arrested the father and charged him with molestation.

Forensic Psychiatric Nurses

Forensic psychiatric nurses handle offenders who are mentally ill. They often work in forensic psychiatric practices, state hospitals, and psychiatric facilities within correctional institutions. (29) One of their major roles involves determining the competency of offenders. These nurses must have a thorough understanding of the criminal justice system, as well as the necessary elements for competency. (30) Forensic psychiatric nurses often testify in court regarding competency issues. In one instance, a judge asked a forensic psychiatric nurse to determine the competency of a subject who had brutally murdered his mother. After conducting an extensive interview with the son, the forensic psychiatric nurse determined that he exhibited signs of mental illness and required hospitalization and, therefore, was not competent to stand trial. (31)

THE EVIDENCE CONNECTION

Documentation of evidence proves critical to any investigation, including ones where forensic nurses have become part of the effort. These nurses should adhere to all evidence collection and preservation techniques without exception and maintain the chain of custody to ensure that no evidence is ruled inadmissible in a court of law.

Collecting Evidence

Forensic nurses may prove invaluable to investigators, particularly when a victim is transported to an emergency room. In that setting, forensic nurses on staff should document all proceedings pertaining to the victim, including a complete medical report that covers all treatment administered and the location of any bruises, cuts, scrapes, or lacerations. (32) Photographs of all of the victim's injuries also are essential for proper documentation and should include close-up, mid-range, and full-body images. (33) When practical, they should contain a photographic scale or ruler for comparison. (34)

When collecting physical evidence, forensic nurses should wear gloves to minimize contamination and follow basic techniques and procedures. Law enforcement investigators attempting to collect evidence from victims may seek assistance from forensic nurses who could swab for saliva or semen, collect bullets and gunshot residue from the body, and bag the victim's clothing for future analysis. (35)

Handling Evidence

Once they have collected the evidence, forensic nurses should place each sample in a separate container and seal it to prevent contamination. The victim's name, date, time, and case number should appear on the label accompanying the evidence, along with the forensic nurse's name, identification number (if any), and location where the evidence was recovered. It would prove helpful to law enforcement officers to assist in training forensic nurses, particularly when requesting forensic evidence and adhering to the proper chain of custody. Failure to maintain proper evidence and chain of custody may jeopardize a case. In a hypothetical situation, a forensic nurse collected evidence, but, in a rush to treat another victim arriving in the emergency room, failed to include the date and time. This type of action would break the chain of custody and cause the court to rule the evidence inadmissible.

In addition to maintaining a proper chain of custody, forensic nurses must be careful in handling evidence. For example, a victim with a single gunshot to the head arrived at a hospital. In the emergency room, the forensic nurse removed the bandages from the victim's head that the emergency medical technicians had applied at the scene of the shooting. Unknown to the forensic nurse, the bullet had dislodged into the bandages. While the projectile was later discovered in the trash, the evidence was inadmissible because it could not be traced to the victim. (36)

Testifying in Court

Forensic nurses also may serve as expert witnesses in court. Sometimes, this poses problems. When a doctor and forensic nurse provide contradicting information, attorneys can use this to their advantage. If a nurse and doctor provide conflicting information, the testimony of the doctor most likely will be believed over that of the nurse. For example, a SANE had performed an examination on a sexual assault victim. The doctor on call deemed it necessary that he be there to sign off on the case, even though he did not conduct the examination. As both the doctor and the forensic nurse were present during the examination, both were subpoenaed to court. When providing their testimony, both the doctor and the SANE identified the same injuries but in different locations on the body. The judge considered the doctor's testimony, which later proved incorrect, as more accurate. The defense counsel noticed the discrepancy in the two testimonies and used it to win the case. (37)

CONCLUSION

While a relatively new profession, forensic nursing already has successfully helped bridge the gap between the two fields of law and medicine. The high demand for forensic nurses will likely continue as doctors and law enforcement officials recognize the need for their valuable expertise. Those not currently employing forensic nurses can contact their local hospital or the nearest forensic nurse program by accessing the International Association of Forensic Nurses' Web site at http://www.iafn.org/resources/default.html. Bringing the two worlds of medicine and law enforcement together can help both fulfill their different, yet complementary, missions.

Endnotes

(1) Karla A. Knight, "The Real CSI: Forensic Nursing in the ED," Nursing Spectrum, September 20, 2004; retrieved on May 11, 2005, from http://www.community.nursingspectrum.com/MagazineArticles/article.cfm?AID=12758.

(2) "Forensic Specialties"; retrieved on September 27, 2005, from http://www.forensiceducation.com/forensic_files/specialties.htm.

(3) Valerie Nelson, "Shattering the Myths About Forensic Nursing," Nurseweek/Healthweek; retrieved on March 2, 2005, from http://www.nurseweek.com/features/98-7/forensic.html.

(4) Javacia N. Harris, "Forensic Nursing: Fast-Growing Field," Seattle Times, 4th edition, July 5, 2004; retrieved on March 22, 2005, from http://www.archives.seattletimes.nwsource.com.

(5) Ibid.

(6) "Forensic Files: FAQs"; retrieved on April 17, 2005, from http://www.forensiceducation.com/forensic_files/faq.htm.

(7) New Standard Encyclopedia, 1963 ed., s.v. "nursing."

(8) American Forensic Nurses; retrieved on April 17, 2005, from http://www.amrn.com.

(9) Interview by author, April 13, 2005.

(10) Serita Stevens, Forensic Nurse: The New Role of the Nurse in Law Enforcement (New York, NY: St. Martin's Press, 2004), 44.

(11) Supra note 2.

(12) Supra note 10, 45.

(13) Supra note 10, 48.

(14) Supra note 10, 48.

(15) Supra note 10, 48.

(16) Supra note 6.

(17) Supra note 10, 206.

(18) Supra note 2.

(19) Supra note 6.

(20) Supra note 10, 183-184.

(21) Supra note 2.

(22) Sue E. Meiner, "The Legal Nurse Consultant," Geriatric Nursing 26, no. 1 (January/February 2005): 34-36.

(23) Ibid.

(24) Supra note 10, 148-149.

(25) Supra note 2.

(26) Supra note 10, 157-158.

(27) Supra note 2.

(28) Supra note 6.

(29) Supra note 2.

(30) Supra note 10, 212.

(31) Supra note 10, 210-211.

(32) Serita Stevens, "Cracking the Case: Your Role in Nursing," Nursing 2005 34, no. 11 (November 2004): 54-56.

(33) Ibid.

(34) Ibid.

(35) Ibid.

(36) Supra note 10, 22-23.

(37) Supra note 10, 130-131.

Mr. Yost is an honor's undergraduate senior at Radford University in Radford, Virginia.

Dr. Burke, a former police officer, is a professor of criminal justice at Radford University in Radford, Virginia.

By Joseph R. Yost and Tod W. Burke, Ph.D.

RELATED ARTICLE: Forensic Nursing Programs in the United States 

General Forensic Nursing

Beth-El College of Nursing, Colorado Springs, CO

Bossier Parish, North Bossier City, LA

University of Pennsylvania, Philadelphia, PA

University of Scranton, Scranton, PA

Graduate Level

Duquesne University, Pittsburgh, PA

Gonzaga University, Spokane, WA

John Hopkins University, School of Nursing, Baltimore, MD

Monmouth University, West Long Branch, NJ

Source: http://www.iafn.org/resources/educational.html

RELATED ARTICLE: Specialties in Forensic Nursing

* Sexual assault nurse examiners (SANE) are specially trained to treat and care for victims of sexual assault.

* Forensic correctional nurses provide medical attention for individuals charged with and convicted of a crime.

* Forensic geriatric nurses care for aging individuals with an emphasis on the human rights issues of abuse, neglect, or exploitation.

* Forensic legal nurse consultants use clinical knowledge to help attorneys in cases where the law and medicine overlap.

* Forensic nurse investigators, employed by medical examiners, conduct scientific investigation of the crime scene and the circumstances surrounding the death of a victim.

* Forensic pediatric nurses care for children, with an emphasis on human rights issues of abuse, neglect, or exploitation.

* Forensic psychiatric nurses administer aid to offenders with mental abnormalities.

Source: http://www.forensiceducation.com/specialties.html