Applying the Nursing Process to Death Investigation:
The Nursing Process and the Community (Part four in a series.)

By Rae Wooten, BSN, RN, ABMDI

Days and nights fade into weeks and weeks into months. As a forensic nurse whose professional life is immersed in death, I began to deal with the reality of death in a way that I never had before. As I sorted through the new reality of death, I began to realize that positive things can grow out of death, something that is usually viewed as negative. Confronted with the fact that death comes to all regardless who we are, I began to ask how death might benefit the living. Nurses have historically been taught to care for people from the cradle to the grave, and it has become apparent to me that now nurses are caring from beyond the grave.

In offices such as ours where you deal with death each day, you begin to recognize patterns; there are deaths that are expected, deaths that are preventable, and deaths that are so poorly understood that we are left wondering. Deaths that are expected, such as those due to advanced age or terminal illness, leave us feeling sad and somewhat helpless but accepting. Deaths that are preventable, such as those due to traffic accidents, drownings and drug abuse, scream for education and prevention. Those that are unexpected and unexplained, such as sudden infant death, cause us to scratch our heads and try to find answers.

As we look at the third and final track of the nursing process as it is applied to death investigation, we will briefly explore the relationship between the nursing process, death investigation and society. It is probably in this area that we can most readily identify nursing diagnoses based on assessment. Of course, planning, implementation and evaluation are critical if we are to impact the community. This is most easily explained through a true example.

Baby after baby died and it seemed that it was occurring more and more frequently. Although there were similarities with each death, there was no concrete, identifiable cause in most of the deaths. So the nursing assessment began. We reviewed the data collected through the investigation of individual infant deaths that had occurred in Charleston County for more than 10 years. We assessed the infant and the pregnancy, including the delivery, the family constellation and interaction with the infant, family history with social services, and family involvement with law enforcement. When we looked at the infant we looked at many things, a few being age, sex, race, apgars and newborn medical records. When we assessed the pregnancy we looked at prenatal care and complications of pregnancy and the delivery, to name only a few factors. We also looked at infant care, including daily schedules, the caretaker at the time of death, and where the infant slept every night.

We learned many things, but the most important were that our infants were dying in unsafe bedding situations, while co-sleeping with others and while lying on their stomachs. We arrived at numerous nursing diagnoses to include “risk of suffocation,” “altered parenting,” and “knowledge deficit.” Out of this assessment grew a plan to launch a very aggressive and wide-ranging educational campaign. That plan was implemented as we enlisted the volunteer assistance of anyone who was interested in trying to prevent infant deaths. This included nurses from many specialties, as well as pediatric nurses, public health nurses, and nurse death investigators. It also involved social workers and advocates. We met, we shared information, we scheduled events and we stuffed envelopes. The events were varied, ranging from prenatal health fairs to in-service presentations for OB nurses. We stuffed informational fliers in water bills and we produced public service announcements that were aired on TV and radio. Because of the large Hispanic population in our county, the announcements and fliers were produced in both English and Spanish. We flooded the community with information about safety related to infant sleeping, and after completion of the educational campaign we evaluated the outcome. In Charleston County we found that infant deaths declined dramatically. Was this due to our application of the nursing process to death investigation? I cannot say for sure, but numbers don’t lie. As there were no other documented, dramatic changes in population demographics, birth rates or healthcare delivery systems, I believe that the prevention campaign that grew out of the nursing process was the reason for the decline. And so you see, when nurses are death investigators, I believe that the community and society benefits, even from death.

This example can be readily adapted to help reduce preventable deaths, improve the quality of life, and promote wellness. Other examples in which we have applied the nursing process include seatbelt campaigns, infant car-seat campaigns, water safety courses, “don’t drink and drive” high school crash re-enactments, and numerous anti-drug campaigns. Whether the deaths are natural, accidental, homicides or suicides, the nurse death investigator — through the application of the nursing process — can positively impact the local community, the international community and society at large.

As I close this final article, the fourth in the series, I would like to summarize. I believe that the nursing process, when applied to death investigation, consists of three components. The first component, the investigation of the death proper, the second component, death investigation related to survivors, and the third component discussed above, death investigation related to society, spiral and twist in an interrelated, dynamic manner, not unlike a DNA helix. In such a relationship, any change in one area impacts the whole. Furthermore, I believe these interrelated components exist within a second framework of interrelated components. This second framework consists of medicine and healthcare, the law and other forensic entities, and thirdly, societal and cultural factors. This framework is also ever changing, and it impacts whenever and wherever the two frameworks touch.

I hope that sharing my thoughts and beliefs about the application of the nursing process to death investigation will raise awareness and serve to encourage more nurses to enter the field; their knowledge base, professionalism and a commitment to caring for others will serve the deceased, the survivors and society in a way that benefits them all.

In closing, I believe that nurse death investigators bring to the nursing profession and the world, invaluable contributions as they forge ahead into the future of healthcare, melding death with life in a way that improves life for the living.

Rae Wooten, BSN, RN, ABMDI, is the deputy coroner for the Charleston County, S.C. Coroner’s Office.

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