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The Birth of Forensic Nursing

How Virginia A. Lynch's determination to stop clinicians from unintentionally obstructing justice inspired a new nursing specialty.

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When Virginia A. Lynch, MSN, RN, FAAFS, FAAN, walked into her first crime laboratory, the Star Wars-like equipment, pulsing lights, smells of paint and formaldehyde, and evidence, such as weapons, blood and teeth didn't scare her away; it left her intrigued and inspired.

"It was a moment that will forever be imprinted in my mind," Lynch said. "Curiosity turned to fascination, and I couldn't learn enough or fast enough," Lynch said. "My interest became a preoccupation and evolved into a passion. I became a regular visitor of the crime laboratory, and the more I learned, the more I wanted to know."

Her obsession with forensics ultimately unfolded a paradigm shift, namely, a whole new nursing specialty called forensic nursing.

This unique opportunity to visit the crime lab took place in Texas in 1982 and grew out of her observations as an emergency nurse. Lynch noticed how evidence, such as clothing, specimens, records or personal items were often lost, discarded or returned to family instead of secured and handed over to authorities.

"When I asked the police if the person who abused, raped or killed these patients would be caught and punished, they told me it was unlikely because the doctors and nurses lost and destroyed the evidence," she said. "It had never occurred to me that the healthcare professions were unintentionally obstructing justice."

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'Mother of Forensic Nursing' Virginia A. Lynch, MSN, RN, FAAFS, FAAN, wrote and educated nurses on forensic nursing long before it was acknowledged as a specialty. Photo courtesy Virginia A. Lynch

World of Knowledge

Memorialization of injuries through preservation of evidence and meticulous documentation can help ascertain the level of intent and probable cause for charges to be filed against assailants.

"The investigation of trauma prior to surgical intervention or other life saving measures is essential to preserve the image and description of injury before it is lost through a sea of wound cleansing antiseptic, insertion of instruments or suturing," Lynch said. "

This requires specific skills and forensic techniques and will later assist law enforcement officers or forensic pathologists to determine if force was used, type of weapon involved, or if it was perhaps self-inflicted."

Nurses make ideal forensic professionals because of their education in subjects such as anatomy and physiology, chemistry and pathophysiology, as well as their attention to detail and thorough documentation.

Nurses are trained in psychology and crisis intervention and their interpersonal skills make them effective communicators with both patients and their families-especially when relaying sensitive information. Nurses are also trained how to handle specimens, maintain infection control and avoid contamination.

"Nurses are highly skilled in the essential tools of identifying trauma and the recovery of specimens - the two foremost responsibilities of the forensic nurse examiner, second only to preserving life," Lynch said. "Ideally, the forensic nurse is not a part of the trauma team, but rather the additional professional who has not previously been available in the trauma suite to address the necessary forensic services."

Lynch saw there was a world of knowledge out there in the forensic discipline, and if paired with perspectives of nurses, it would be a perfect marriage. She coordinated with the director of the crime lab to establish a process for evidence preservation and security in the hospital. And forensic nursing was born. In December of 2012, it became a certification specialty recognized by the American Nurses Credentialing Center.

"After 30 years of experiencing the lightning strikes of 'Aha! Moments,' in the forensic sciences and merging these concepts into the science of nursing there has been a continuous mélange of beauty and excitement in an often dark and frightening place."

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Today, Lynch is a faculty member at Forensic Nursing and Forensic Health Science, Beth El College of Nursing, University of Colorado, Colorado Springs (UCCS) and an international scholar and consultant. She is a forensic clinical nurse specialist, Fellow of the American Academy of Nursing, and Fellow of the American Academy of Forensic Sciences.

She has been credentialed as a forensic nurse sexual assault examiner, medical death investigator and even a coroner. She is a founding president of the International Association of Forensic Nurses (IAFN), which now has more than 3,000 members.

She has also received numerous awards, such as the IAFN Virginia A. Lynch Pioneer Award, an annual award for individuals who advance forensic nursing named in her honor; the Florence Nightingale Special Recognition Award for Human Caring by the Colorado Springs Chapter of the American Nurses Association; and a distinguished alumni award from Texas Christian University in Fort Worth, Tex. and the University of Texas, Arlington, to name a few.

"Virginia is considered one of the 'mothers' of forensic nursing," said Polly Campbell, BS, BA, RN, President, IAFN, and Director, Sexual Assault Forensic Examiner Program in Augusta, Maine. "She is highly respected nationally and internationally, having made tremendous contributions to the profession. For many forensic nurse,s she is a friend, mentor and colleague, supporting the field, the science, and most importantly, the profession of nursing."

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WORLD LEADER: Virginia A. Lynch, founding president of the International Association of Forensic Nurses, has traveled to several countries, such as Saudi Arabia and India, to educate others on forensic nursing. Photos courtesy Virginia A. Lynch

Investigating Death

Lynch launched her forensic career as a medicolegal death investigator in Fort Worth, Tex. in 1984. She explained she was the first nurse and woman appointed to this position and was responsible for all reportable deaths in a population of about 60,000.

"The requirement for this role was to preferably have some medical experience, skills in psychology and knowledge in the forensic sciences," Lynch said.

"My responsibilities included responding to the scene of death, taking charge of the body and any medical evidence pertaining to the cause of death, arranging for transportation of the body to the medical examiner's office, preparing a detailed report of the scene, the body, photography and of interviews with the police, firefighters, other first responders, obtaining medical records and making notification of death."

After working as a medical death investigator, Lynch was introduced to the chief medical examiner and discovered the importance of forensic pathology.

She wanted to learn more about forensics, but there were no such university courses in existence. Instead, she chose courses in science, law and medicine. When she discussed this program proposal with the head of the Southwestern Institute of Forensic Sciences, he asked her what she should call the program.

"Without hesitation I stated, 'forensic nursing', as a complimentary role to forensic medicine," Lynch recalled. "I knew I wanted to maintain my major status as a nurse, but with a specialty practice in the forensic sciences. Such a field did not exist."

The new movement of forensic nursing was explored with Lynch's original research and master's thesis entitled, "Clinical Forensic Nursing: A Descriptive Study in Role Development," She has lectured and shared her integrated model of forensic nursing science with others for years, even in the company of the White House physician during the Clinton Administration.

"This was an inordinate opportunity to bring this emerging specialty to the attention of military medicine," Lynch said. "I was treated like a visiting dignitary and provided a tour of the White House. The physician was most attentive and asked numerous questions related to the practicality and value of maintaining a cadre of forensic nurse examiners in military treatment centers worldwide. Although it has taken almost two decades to see the slow evolution of a new paradigm, today this role exists in growing numbers in the Air Force, Army and Navy."

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After obtaining the first master's degree in nursing with a clinical specialization in forensic nursing from the University of Texas, Arlington in 1990, Lynch was invited to expand her skills in an internship in homicide investigation at the Office of the Chief Medical Examiner in New York City at the Manhattan morgue.

"I soon learned the basic tenets of my job also applied to the survivors of crime and violent acts," Lynch said. "The categories of injuries were the same, but it was the extent of injury that differed in whether or not the patient survived."

In 1994, she became a certified coroner in Georgia and was on-call to respond to suspicious and questioned deaths along with her husband, also a certified coroner.

"Often the scene of death was the hospital clinical environs," Lynch said. "This made me realize that my patient was the same patient of the emergency nurses once they had stopped breathing."

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Global Advocate: Virginia A. Lynch has presented on forensic nursing in multiple countries and in just about every continent, including India. Photo coourtesy Virginia A. Lynch

International Influence  

Lynch has authored a plethora of articles and the first forensic nursing textbook, Forensic Nursing (2005); and Forensic Nursing Science (2010). She is a lecturer and remains active with IAFN.

"I remember years ago Virginia came to San Diego to do a day-long training on wounds and injury," said Diana Faugno MSN, RN, CPN, SANE-A, SANE-P, FAAFS, DF-IAFN, Board Director/Treasurer EVAW International. "I could not get over how much I learned from her, and how she made me want to learn more. She had such a passion for forensics."

Lynch was named one of the world's 250 outstanding forensic scientists by the Agrawal Journal of Forensic Medicine in New Delhi, India, and was awarded the Fulbright Scholar grant in forensic nursing science to spread forensic nursing across India.

She has presented on forensic nursing in multiple countries and in just about every continent.

"There is no place on earth, no culture, no country that cannot benefit from the development of this science," Lynch said.

"The benefits of educating the existing nursing resources to include a cadre of specialists cross-trained in nursing science, forensic science and the mutual aspects of criminal justice science will expand existing resources for the medico legal management of natural and social disasters, communicable disease epidemics and the genocide of human existence encountered in domestic and foreign terrorism."

Lynch credits the colleagues, nurse scientists, criminalists, forensic pathologists, prosecutors, and the deans of graduate nursing, among others, who shared and contributed to her vision-making a challenging transition a reality.

"Indeed, what has emerged from virtually nothing has evolved into a moving force whose time has come," Lynch said.

"Now, my fondest wish is to see the science of forensic nursing accepted as a valuable resource to healthcare and the forensic sciences, to be integrated into all aspects of nursing curricula and applied to the care of forensic patients worldwide. This accomplishment is up to the next generation of forensic nurse scientists, the students of forensic innovation and those who put forth the inspiration of a new era of nursing practice."

Daria Waszak is registered nurse and freelance writer.


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I am eager to know are there any colleges in india which offers masters in forensic nursing.

priscilla fernixiya,  asst.lecturerJune 06, 2014
coimbatore



Hello ladies,

After reading your comments, I wanted to share with you that there are graduate programs available for forensic nursing. I am currently finishing up my MSN in forensic nursing at Monmouth University in West Long Branch, NJ- it is entirely online so you can complete the degree from whereever you live. I believe Quinnipiac University in CT also has a forensic nursing masters program as well. Hope this helps & best of luck to you all!

Emily Phillips,  RN, BSN,  Froedtert HospitalMarch 14, 2014
Milwaukee, WI



I am a RN who has been working in critical care for 14 years and I want to become a death investigator with the coroners office. I am going to advance my degree to a MSN but I want to specialize in forensics. I am having a difficult time figuring out what classes I should take to get me to that point. I am finding there are no specific programs just for that. Is there any advice you could give me? Should I take a combination of forensic and law classes?

Please help.
Sincerely,
Karen Petrach RN

Karen Petrach,  RN,  McLaren-Bay RegionJanuary 19, 2014
Bay City, MI



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