FORENSIC NURSING: A Challenge for Nursing Education
By Yvonne D. McKoy, PhD, RN, CS, DABFN
The growing interest in forensic nursing as a nursing subspecialty is not by happenstance. Increased reports of violent acts are a constant reminder of the violence in our society. Violence is a multifaceted problem that is intimately interwoven into our relationships, homes, schools, workplaces and communities. The individuals seen by forensic nurses primarily are victims of violence, but they may also be perpetrators, survivors, individuals falsely accused of violent acts, or as one patient put it, an "overcomer" of violence. Consequently, the responsibilities, roles and functions of the forensic nurse are in part the nursing profession's response to the sequelae of criminal and interpersonal violence in society.
According to the International Association of Forensic Nurses (IAFN), forensic nursing is "the application of nursing science to public or legal proceedings; the application of forensic aspects of healthcare combined with the bio-psychosocial education of the registered nurse in the scientific investigation and treatment of trauma and/or death of victims of abuse, violence, criminal activity and traumatic accidents."1
Although forensic nursing is an exciting and emerging concept in nursing, the scientific investigation of death and crime is not. The new millennium has brought more attention to nurses who have decided to go beyond more traditional nursing roles. Forensic nurses have become the "Daniel Boones" of today and are driven by a passion that has enabled them to carve out their own niche in the healthcare delivery system. Nurses are provided with opportunities to expand their roles, increase their independence and redefine their scope of practice in healthcare. Forensic nurses are fulfilling vital functions and responsibilities in homes, hospitals, schools and communities. Forensic nurses assume diverse roles as expert witnesses, sexual assault nurses, educators, trauma and death investigators, correctional nurses, forensic psychiatric nurses, abuse specialists, coroners, nurse attorneys and researchers. They are also trained and involved in evidence collection and human rights violations.2-3
Generally, most service industries and professions are steeped in forensic issues due to the high degree of contact with the public. Barber4 emphasizes that all nurses need to be "tuned in" since the potential or actual occurrence of some type of forensic problem is possible regardless of the nurse's workplace setting. Nurses should understand the relevancy of forensic issues since they are sometimes the victims of violent acts or can be at risk for violence when providing care to victims, perpetrators, bystanders and witnesses.
Often students in all nursing specialties must provide care to crime victims. For this reason, the need to assist students in developing knowledge and skills in assessment, care, treatment and documentation of forensic concepts in each nursing program is paramount. It is important that clinical faculty assign patients that will provide learning opportunities that will assist students in sharpening their skills and understanding of forensic cases throughout their nursing education.
The unique knowledge and special skills necessary for advanced nurses in forensic nursing are becoming evident as more nurses become involved in taking care of individuals and families affected by violence. The increased demand and call for nurses highly trained and knowledgeable in the forensic sciences has gained support for this subspecialty within the nursing profession.
Forensic nursing requires a collaborative approach used in intervening in the care of individuals, families and communities. Forensic nursing interfaces with medicine, law, criminal justice, forensic science and public health. Forensic nursing has evolved from the public health framework and includes coursework related to medico-legal issues, criminal justice, psychopathology, investigational techniques and family issues involving violence. (Beco & Worley, ). Consequently, a qualified multidisciplinary faculty of nurses, attorneys, physicians, forensic preceptors, criminologists, law enforcement officers, psychiatrists, psychologists and forensic pathologists are involved to provide educational opportunities and expert supervision.
As roles of the forensic nurse are clarified, many nurses have recognized the need for specialized training and in-depth understanding of various sciences and disciplines. Even though there is a need for more educational institutions to develop and implement programs that provide understanding of forensic protocols, direct patient care training, legal proceedings and administrative functions, they often not widely available. Formal programs that are needed to provide quality courses to prepare nurses in this advanced specialty are just beginning to move beyond the infancy stage. Presently, only a few colleges of nursing throughout the country offer graduate education and courses that include investigation of injury and death, courtroom proceedings, criminalistics and advanced practice in dealing with victims and perpetrators. Other approaches that offer forensic nursing courses may be obtained through distance education, the Internet, internship programs, securing mentors and attending conferences and workshops.
The essence of forensic nursing is to be able to provide patients, victims, survivors, overcomers and perpetrators with competent nursing care. It is crucial that the forensic nurse provides critical, calculated and creative thinking interwoven into practical clinical experiences. If forensic nurses are to provide effective responses to the growing incidence and extent of violence and trauma resulting from criminal and interpersonal violence, the education and clinical practice of nurses in this subspecialty must also reflect additional and unique preparation that is beyond that of more traditional nursing roles. The accountability and responsibility of forensic nurses brings this new specialist in contact with a wider range of professionals. Training must include experiences that will prepare nurses to provide continuity of care of victims from areas such as an emergency room and/or crime scene to courts of law and may include continued follow-up in the home or other facility.
Forensic nurses are demonstrating a wide range and quality of services than ever before. Forensic nurses must have an understanding of nursing theory and concepts, advanced clinical skills, understanding of the legal and judicial system, skilled in substantive and procedural concepts and trained to communicate with diverse populations. Forensic nurses must also practice within the guidelines of the standards of care. These standards are used on a daily basis in all aspects of nursing care and together are the "yardstick" that the legal system uses to measure the actions of a nurse in a malpractice suit.5
The educational preparation of forensic nurses is challenging and provides an opportunity to reconceptualize traditional teaching. Educators play vital roles in the preparation of forensic nurses in developing high-level cognitive skills and mental processes including thoughtful analyses, strategic planning, observation, decision-making, monitoring and evaluation. Teaching forensic nursing requires a general knowledge in the use of special equipment, media creativity, ability to maintain a high level of interaction in the classroom as well as onsite instruction at the scene of a crime. It is important that a climate conducive to innovative instructional techniques are employed early since the classroom may be may be at the crime scene.
Teaching in less familiar ways will be necessary since students will learn to collaborate with lawyers, coroners and investigators. Faculty must be willing to redefine their role as the chief dispensers of knowledge and reframe their role in order to provide optimum learning experiences for student. Faculty must be willing to facilitate rather than orchestrate what and how information is acquired. Toombs6 indicates that the days where the teacher is "the sage of the stage" are gone and being replaced by teachers who are have insight into the idea of facilitating discovery learning for students. Consequently, faculty members who guide students in forensic courses are able to enhance each student's individual development and understanding of forensic concepts and at the same time provide a rich environment for the emergence of other useful skills, e.g., research. As more nurses enter this exciting subspecialty, nursing programs will be challenged to integrate more forensic concepts and advanced courses into the curriculum. Bold new ideas and better ways to educate forensic nurses will ensue from continued collaboration and exploration of approaches between nursing faculty and other disciplines. This will provide a forum for increased support of forensic nursing programs and potential growth of this unique and much needed subspecialty.
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Yvonne D. McKoy, PhD, RN, CS, DABFN, is assistant professor in the department of nursing at Xavier University in Cincinnati, Ohio. |
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