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Forensic nursing is claimed to be one of the most prospective emerging specialties in the nursing profession. The intent of forensic nursing is to fulfill the promise of quality care and allow for the effective application of nursing practices and research in legal and public proceedings (Burgess, Berger & Boersma, 2004). Since the beginning of the 21st century, forensic nursing has become one of the most critical success factors in the analysis and investigation of complex legal cases. In sensitive (read: sex) crimes, forensic nurses can collect and analyze the evidence from the victims. Of particular importance is forensic nursing in cases of sexual assault and rape, since forensic nurses are capable of delivering quality care while also minimizing victims’ physical and emotional trauma. Forensic nursing is a field, which is overfilled with ethical dilemmas and controversies, but it is through forensic nursing that victims of various crimes, including sexual assault, can receive abundant care and emotional support while also contributing to the effective investigation of the crime.
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Forensic Nursing: An Emerging Specialty
Forensic nursing has recently become one of the fastest growing trends in the nursing profession. Burgess et al. (2004) write that “forensic nursing, one of the newest specialty areas recognized by the ANA, is gaining momentum nationally and internationally” (p.59). Forensic nursing is believed to contribute to the application of nursing practices and science in legal proceedings greatly (Burgess et al., 2004). Forensic nurses help investigate various cases of morbidity and mortality in virtually all settings (Burgess et al., 2004). At times, the role of a forensic nurse is compared to that of a nursing or medical detective, since forensic nurses must have special education and training to collect crime evidence, provide legal testimony expertise, participate in criminal procedures, and serve an effective liaison between medicine and the criminal justice system (Turner, 2011).
Forensic nursing is a field encompassing diverse groups of clinicians and patient populations. Forensic nurses provide both healthcare and forensic services (Turner, 2011). Forensic nursing is present everywhere where injuries take place, and, to a large extent, every patient with a physical injury is a potential object of forensic nursing, until proved otherwise. The most common forensic nursing populations include: victims of intimate partner abuse, violence, rape, etc.; victims of human-made catastrophes, including car accidents; victims of natural disasters; and others (Turner, 2011). In all these situations, the fundamental mission of all forensic nurses is to meet the “healthcare needs of vulnerable and often disadvantaged patient populations which include children, individuals with congenital and developmental handicaps, residents of nursing homes, psychiatric patients, and individuals who are addicted, homeless, or incarcerated” (Turner, 2011, p.6). This is why most forensic nurses operate with patients and victims of physical violence at first point contact and provide their care and services in hospitals and emergency units.
It is interesting to note that the word combination “Forensic Nursing” became relevant only at the beginning of the 1990s, when the health care community became much more active in the striving to combat domestic violence and crime (Burgess et al., 2004; Turner, 2011). Earlier in 1985, the Surgeon General’s Workshop on Violence and Public Health was held, where professionals from all health care fields and professions discussed the ways in which they could improve the care provided to victims of violence (Burgess et al., 2004). Since then, nursing professionals have become the major providers of quality medical and emotional care to the victims of violence, man-made and natural incidents.
Still, it would be fair to say that the history of forensic nursing dates back to the 18th century. At that time, midwives had to participate in course proceedings and testify in cases that involved pregnancy, virginity, or rape (Burgess et al., 2004). Later in the 20th century, nurses volunteered in rape crisis centers that had to assist women in overcoming their life crises (Burgess et al., 2004). That is where most today’s forensic nurses developed the knowledge and expertise to deliver quality forensic assistance and serve the needs of victims. Today, forensic nursing is a multidisciplinary field, and forensic nurses constantly collaborate with other fields, specialties, and providers, including law enforcement. Given the growing complexity of violent crime and difficulties facing law enforcement in crime detection and investigation, forensic nurses often play the most crucial role in bringing violent crimes to the logical sentencing outcome.
Forensic nursing has a huge law enforcement potential. Most likely, the forensic nursing field will continue to evolve. Nursing professionals constantly encourage forensic nursing researchers to expand the boundaries of the nursing practice and make nurses even more influential in their cooperation with law enforcement agents. However, at present, most forensic nurses are still focused on working with the victims of sexual assault and rape. As a result, it is sexual assault and rape that constitutes one of the most common topics in forensic nursing analysis.
Forensic Nursing and Sexual Assault
With the rapid expansion of the forensic nursing trend, the role of the sexual assault nurse examiner (SANE) is still the most common (Burgess et al., 2004). SANEs’ primary mission is to provide care to victims of sexual abuse, collect and analyze available forensic evidence, provide relevant information to pursue a criminal case, and participate in court proceedings (Burgess et al., 2004). For many years, nurses, who had to deal with the victims of sexual assault and violence, had had no special education and training (Kent-Wilkinson, 2011). The results of Kent-Wilkinson’s (2011) review suggest that long waiting lines for sexual assault victims became an impetus for the rapid evolution of the forensic nursing specialty and turned nurses into direct participants of the criminal investigation process. Since the end of the 1970s, the U.S. witnessed the rapid increase in the number of SANE training and education programs to enhance the provision of quality emotional and physical care to victims of sexual assault.
The results of the most recent studies suggest that SANE training programs help nurses balance their multidisciplinary roles and guarantee effective law enforcement collaboration without damaging the quality of patient care (Campbell, Greeson & Patterson, 2011). Moreover, Campbell et al. (2011) found that high-quality patient care provided by forensic nurses could have positive impacts on victims’ decision to participate in criminal justice processes. At the same time, nurses should not forget that their primary mission is to care, not to judge. Consequently, maintaining role boundaries is one of the most controversial tasks facing forensic nurses. Many of them have difficulty explaining to the community that their primary role is that of caregivers and, only when quality care is provided, they can devote time to participation in case investigation and law enforcement processes (Campbell et al., 2011).
Forensic nurses working with the victims of sexual assault also experience many other ethical issues and dilemmas. One of the main difficulties is to decide whether or not forensic medical examination needs to be performed (Downs & Swienton, 2012). The fact is that not all victims of sexual assault want to report their case to law enforcement. In this context, forensic nurses must provide examination and care required in such cases, while also monitoring the most recent trends that allow for a more effective investigation of the case (Downs & Swienton, 2012). Simultaneously, forensic nurses can play a role in persuading the victim that reporting the case to law enforcement is vital for his/her health and justice. Unfortunately, forensic nurses cannot always obtain patients’ informed consent to provide forensic examination, especially when the patient is either intoxicated or unconscious. Working with adolescent patients also requires a great deal of training and legal (ethical) knowledge.
Barriers to Forensic Nursing Development
At present, the forensic nursing trend is facing many difficulties. Based on what Campbell et al. (2006) write, not all forensic nursing programs for victims of sexual assault provide the fullest range of care and crime investigation services. Reasons why many SANEs do not offer emergency contraception, HIV testing, STI culture testing, and other free service options are numerous: from simple financial constraints to the difficulties balancing legal prosecution with quality medical care (Campbell et al., 2006). Nonetheless, forensic nursing is an essential specialty that greatly contributes to the rapid development of the entire nursing field. Burgess et al. (2004) suggest that SANEs have made a profound difference in the quality and efficiency of care provided to victims of sexual assault. At present, forensic nurses should focus on the development of other care models, including quality care to infants and children, as well as victims of natural disasters.
Forensic nursing is one of the most promising specialties in the nursing profession. The history of forensic nursing dates back to the 18th century. However, it was not until the latter half of the 20th century that forensic nursing became an essential element of healthcare and law enforcement. Since the 1970s, numerous programs have been developed to train forensic nurses. At present, forensic nurses’ main function is to provide quality care to victims of physical violence, accidents, and natural and man-made disasters while also collaborating with law enforcement professionals to investigate each case. In this situation, many forensic nurses can fail to define their role boundaries or balance their medical and investigative functions. Moreover, forensic nurses face numerous ethical dilemmas. Financial, legal, and administrative constraints often impede the provision of quality forensic nursing services. Nonetheless, forensic nursing was found to have greatly contributed to the quality of patient care provided to victims of sexual assault. Today’s forensic nurses should focus on the development of new models of care for infants, children, and victims of natural disasters.