Nursing Care for Victims of Violence

It is 5 o’clock in the morning and a young woman walks into an emergency department. The young woman, a college student at a local university, begins crying and states “I am not sure but I think I was raped.all I remember was having a few drinks at a party and when I woke up my underwear were on backwards and I hurt down there.” The triage nurse brings the young woman into a private area and calls the sexual assault nurse examiner on call.

This story is all too common in hospitals across the United States. Violence and crime are major issues affecting our society. According to the Bureau of Justice Statistics, in 2014, U.S. residents age 12 or older experienced an estimated 5.4 million violent victimizations and 15.3 million property victimizations.Nurses provide care to victims and offenders of violence in a variety of settings, often without specialized training. Many nurses watch and are intrigued by the criminal television shows and routinely care for patients who experience violence; however, many are unaware of the specialty of forensic nursing or that knowledge of forensic health issues can enhance their practice.

Forensic nursing is an innovative and evolving nursing specialty that addresses healthcare issues with a medico-legal component.2 In responding to the societal and healthcare needs created by increasing criminal violence, forensic nursing programs provide nurses with the necessary skills for specialized healthcare and expertise to meet the needs of victims and offenders of violence. In 1995, the American Nurses Association (ANA) recognized the specialty of forensic nursing, solidifying the future of the role of the forensic nurse. 3Since then, forensic nursing has become a fast growing specialty practice that continues to evolve. Specialized forensic healthcare may include evaluation, identification and treatment of injuries, collection of biological and/or physical evidence, legal documentation of injuries, and participation in court proceedings.2

Strong Presence
The earliest and most recognized role in forensic nursing in the United States is that of the sexual assault nurse examiner (SANE). The purpose of SANE programs is to provide victims of sexual assault with healthcare, forensic assessment, evidence collection, forensic documentation, and court testimony. The process involves completion of a 40 plus hour course, precepted training, and credentialing after successful completion of the national exam. SANE programs have proven to be an effective method of meeting the healthcare and legal needs of sexual assault victims.

Forensic nurses practice in a variety of settings with a diverse group of victims and offenders. Many forensic nurses work as part of interdisciplinary teams that investigate abuse or neglect situations with adults and children, as well as teams involved in prevention efforts. Forensic nurses in critical and emergency care and psychiatric nursing routinely interact with individuals who have experienced violence and its consequences. These nurses provide physical care while attending to the collection of evidence and documentation for legal proceedings.nurse cares for patient with bruised face

Forensic nurses may work with individuals on the medical, psychiatric, and evaluation units in prisons and jails.2 Psychiatric nurses work with victims and offenders. Other areas of forensic nursing practice include death investigation, mass disaster care/investigation, and legal nurse consulting, among others. Examples of potential employers include hospitals, community healthcare sites, law enforcement officers, coroner’s offices, and the military; potential roles are as nurse coroner and forensic nurse examiner.

SEE ALSO: Earn CE: Documentation of Child Abuse

More Training is Needed
Nursing education in forensic nursing has not kept up with the pace of violence in the U.S. Several nursing schools offer graduate nursing degrees or minors in forensic nursing. Many undergraduate programs offer courses in forensic nursing, which offer an interdisciplinary approach and collaborate with law schools, criminal justice programs, and forensic science departments to ensure that students begin the process of team collaboration necessary for effective forensic care.

In responding to the societal and healthcare needs created by increasing criminal violence, forensic nursing programs provide nurses with the necessary skills to assist clients with physical and mental health consequences of violence and crime and throughout the legal process with evidence collection, forensic documentation, and court testimony. Course topics include federal rules of evidence, crime scene analysis and processing, mechanisms of injury, criminal and civil law, expert and fact witness testimony, and criminal profiling. All of the above topics are taught using a nursing lens for how they fit into nursing practice. Through didactic course work and clinical experiences, graduates will be skilled in forensic assessment and evaluation of patients, evidence collection and preservation, and court testimony.

Continuing education is available from professional organizations such as the International Association of Forensic Nurses (IAFN), training workshops and conferences. The Journal of Forensic Nursing the official journal for IAFN is another resource, especially for access to the most recent research in forensic nursing.

Forensic nursing is an innovative and evolving nursing specialty that addresses healthcare issues with a medico-legal component. As one of the newer specialties within nursing, forensic nursing roles are expanding. Many graduates have created their own jobs within organizations. Unfortunately, too many people in our society experience violence and crime, as victim and offender, as well as affected family member, friend, or significant other. Fortunately, caring, capable, and compassionate forensic nurses are ready to help them.

References

1. Truman, J. L., & Langton, L. (2014). Criminal Victimization, 2013. Washington, DC: Bureau of Justice Statistics.

2. Amar, A., & Sekula, L. K. (2015). A Practical Guide to Forensic Nursing: Incorporating Forensic Principles Into Nursing Practice. Indianapolis: Sigma Theta Tau.

3. Burgess, A. W., Berger, A. D., & Boersma, R. R. (2004). Forensic Nursing: Investigating the career potential in this emerging graduate specialty. AJN The American Journal of Nursing, 104(3), 58-64.

Angela F. Amar, PhD, RN, FAAN is an associate professor and assistant dean for BSN education in the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta. She is co-chair of the expert panel on violence of the American Academy of Nursing and a member of the Institute of Medicine Committee on the Biological and Psychosocial Effects of Peer Victimization: Lessons for Bullying Prevention.

L. Kathleen Sekula, PhD, PMHCNS, FAAN is a professor at Duquesne University School of Nursing in Pittsburgh, where she created the HRSA-funded MSN, DNP, and PhD forensic programs. She served as president of the International Association of Forensic Nurses Certification Board, was a member of the editorial review board for the International Journal of Forensic Nursing, and is a recipient of the Virginia Lynch Pioneer in Nursing Award from the International Association of Forensic Nurses.

Amar and Sekula are the authors of new book, A Practical Guide To Forensic Nursing: Incorporating Forensic Principles Into Nursing Practice, published by The Honor Society of Nursing, Sigma Theta Tau International (STTI).

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