Violence and trauma affecting people is front-page news every day. Historically when the term forensic was used most people thought medical examiner or death of a patient. In the early 1990’s SANE (Sexual Assault Nurse Examiner) was introduced across the country and was identified as a type of forensic care that managed a health issue of living patients. 

In the most recent (December, 2024) issue of Oklahoma Nurse an excellent article described the nurse response to domestic violence (IPV), long been considered a public health crisis, and forensic issue. Studies have indicated that approximately 10% of all violent deaths are IPV-related, and of those approximately 39% are homicides, 17% are corollary victims, 11% suicide in a suicide/homicide event, nearly 30% are suicides, and 2% are legal intervention.¹   Gun violence was recently proclaimed a public health crisis.  In the September 2024 issue of Oklahoma Nurse, Dr. Carr highlighted the work of the Domestic Violence Fatality Review Board.  How many of those deaths might have been prevented if there was more forensic knowledge?

It is common that most nurses do not have any formal forensic education in their basic nursing courses.  Every nurse, no matter the area of practice, will encounter a forensic patient making it important that the care of these patients not only adhere to the standards of nursing care but also the important aspects of the forensic and legal worlds. 

 The knowledge gap may be different depending on the setting i.e.; emergency room, correctional facility, psychiatric facility, or patient set i.e.: victim, offender or community but the solution is the same. Most of the shortcomings are related to a lack of education. There have been many bullet holes cut through, bags of clothing containing evidence thrown away or given to perpetrators that were not even suspected by healthcare.

 Basic knowledge in forensic nursing applies the nursing process and provides compassionate care promoting health while at the same time ensuring that sound forensic and legal principles are simultaneously applied to that care. When all nurses are aware of the incidence of trauma and the need for trauma informed practices, patient care will be improved. 

Forensic nurses apply their knowledge to patients with intentionally inflicted trauma as well as accidentally inflicted trauma. Trauma could be physical and obvious, or it could be more difficult to recognize as in emotional trauma. Health consequences of violence with its many dimensions require a multidisciplinary approach.

As a relatively new specialty, forensic nursing blends nursing science, forensic science and the law. A nurse with this knowledge is proficient in identifying injuries, understanding mechanisms of injury, piecing together patterns of injury and identifying patterned injuries. This all leads to a suspicious awareness that gets a nurse to think outside what initially appears to be obvious. As some examples: consider that the family that was just admitted from a severe auto accident, it wasn’t an accident at all but an attempt to annihilate the entire family in an IPV situation. Consider a 65-year-old female patient brought in by their significant other. The patient is not saying much about what happened, but the significant other insists she had a seizure and that she has had “mental” issues for years. IPV with strangulation? Or is the female child that comes in with genital bleeding experiencing sexual abuse or could it be urethral prolapse or a viral condition?

 It becomes the duty of the nurse to apply the forensic nursing process to provide the appropriate trauma informed patient centered care to the patient. The need for documentation of care provided, injuries, and evidence observed and collected is an essential element of the forensic nursing examination.  Nurses are not typically prepared for giving courtroom testimony, thus making it a frightening experience for many. Forensic nursing education acknowledges that preparation for the courtroom begins with documentation at the time of the examination. It is important to be precise in writing the victims’ words exactly as they state them. When documenting injuries, color, shape and appearance as well as the location and size with measurements should be included. Different disciplines will be reading the record and what an abbreviation or jargon might mean for one discipline is different in another. An example: r/o could mean rule out to a medical person but responding officer to law enforcement. 

Another important area of forensic nursing practice is self-care. Knowledge of practices that prevent compassion fatigue and burnout is necessary. 

Forensic healthcare education provides a basic understanding of the complexities of forensic patients and knowledge that will lead to a better ability to provide safety planning and to assimilate what has happened to them in a healthy way. For more information contact kathy.bell@okstate.edu

Reference

Kafka, Julie M., et al. “Fatalities related to intimate partner violence: towards a comprehensive perspective.” Injury prevention 27.2 (2021): 137-144.