
Raising the Forensic Antenna
By Janet M. Barber, MSN, RN, CEN
It's all about relevancy. In , the American Nurses Association granted specialty status to forensic nursing. But are we specialty practitioners who care for a certain population of patients, or are we nurses who embrace concepts and principles at the very core of the nursing process and apply them to the care of all patients? Although by definition, forensic nurses care for individuals whose illness or injury is known to have stemmed from an act of violence, maltreatment, abuse, neglect or exploitation, forensic nurses also distinguish themselves by using their unique knowledge and skills to tease out occult forensic issues encountered in their everyday experiences. Clients of forensic nursing are not always victims. They may be perpetrators as well, or individuals falsely accused of a wrongdoing. It is imperative that forensic nurses maintain objectivity, and thus distance themselves from the emotional backlashes that accompany the image of working only for the crime victim or the Prosecutor. The ideal forensic nurse must be a scientist, ferreting out the truth through use of the forensic nursing process, and letting the facts of a forensic investigation speak for themselves within the criminal justice system.
In today's world, punctuated by episodic terror, aberrations of human behavior and the stressors of a fast-paced lifestyle, we are compelled to understand the relevancy of forensic nursing in our environment. Every nurse needs to be "tuned in" to forensic issues, especially in their work setting. This specialty is not confined to the emergency department, the sexual assault examination suite, the prison or the morgue. It is relevant wherever nurses interface with people who have actual or potential forensic issues, so every nurse is going to be a forensic nurse sometime, irrespective of the job requirements or work setting. It is therefore imperative that nursing education integrate forensic nursing content throughout its curricula, ensuring that every nurse develops a forensic nursing antenna.
What in the world is a forensic antenna you ask? Connie Darnell, a respected forensic nurse educator from New Mexico uses these words to explain it. "The forensic antenna is an ever-vigilant perspective that pervades all patient encounters." Connie believes that the core task of forensic nursing education is to help healthcare providers at all levels to develop their antennae by gaining the knowledge and skills required to identify and manage individuals with forensic needs. She says, "Your ability and willingness to be tuned in to your patient is the essence of the antennae. It is through being tuned in that you will hear, smell, touch and experience the often subtle clues that overlie serious forensic issues."
There are countless forensic cases yet to be discovered by nurses. The sexually abused child who is not progressing in school, the depressed elder who is being neglected or assaulted by a caregiver, the unexplained stillborn whose mother suffered intrauterine trauma from an abusive spouse, the hospital co-worker who tampers with drugs and skims the patient's dose to feed their personal addictions, the mental health patient who is inappropriately restrained or neglected or the staff member who makes false entries in medical records or tampers with entries of others. The list goes on. What about the victims of domestic violence who you may encounter in the pre-natal clinic? Think again about the diabetic or cardiac patient who is non-compliant with medications and is admitted to your unit. Is there a possibility that their Social Security check is being appropriated for other family bills, or the responsible caretaker is using the funds for their own personal benefits? This is exploitation-another legitimate forensic issue. Almost all nurses have experienced a sudden, unexplained death in a hospital. What really happened? Suicide, homicide, a medical error or therapeutic misadventure, failure of a life-support device due to faulty manufacturing; these are all possible factors to consider. In order to detect which scenarios have forensic implications, one must possess a sensing device or forensic antenna. The nurse with a forensic antenna will be able to identify the apparent problem and set the wheels in motion to find the root cause. In the meantime, the scene (including the patient's body) needs to be protected and photographed. The evidence must be gathered and preserved for analysis by experts, all details surrounding the event must be flawlessly documented, and witnesses to the events need to be identified for subsequent depositions and courtroom testimony. By now it should be transparent ... forensic scenarios and patients are everywhere, and all specialties in nursing need to be alert to potential issues. The basic principles of evidence collection, forensic photography, documentation, courtroom testimony, crisis management, death investigation, and identification and management of abused and neglected patients are among those highly prized bits of forensic education.
One of the many challenges of today's nursing education program is relevancy. What is more relevant than forensic nursing considering the events of Sept. 11 still reverberating and impacting our everyday life? Last year, when conference speakers talked about terrorism involving anthrax, smallpox, botulism, and nerve gas, the message typically was met with skepticism and disbelief that these could be real threats for us. The content lacked temporal relevancy. Today, however, the same lecture would be delivered to "standing room only" audiences with ears straining to take in every word. Why? The message is now relevant. There has never been a more relevant time for every nurse to possess a forensic antenna. Forensic nursing is gaining rapid momentum because its time has come. Its message is right for the problems we face today, both in healthcare and in society at large.
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Janet Barber, MSN, RN, CEN has more than 30 years of experience in clinical nursing and education. She is a clinical nurse specialist for Hill-Rom Co. |
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