Forensic and Correctional Nursing Chapter 31 Forensic and Correctional Nursing Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Forensic Nursing Combines disciplines of nursing science, forensic science, medical science, sociology, and psychology with law enforcement and the criminal justice system. One of the newest specialty areas recognized by the ANA (1995). Scope and Standards of Practice for Forensic Nursing were published in 1997. International Association of Forensic Nursing (IAFN) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Forensic Nurses … Practice in multiple areas and settings of the public health system. Responsibilities may include: Screening Assessment and collection of evidence Documentation and expert testimony from victims and perpetrators in settings such as hospitals, community clinics, or death scenes Involvement in paternity disputes Involvement in cases involving workplace injuries, malpractice, vehicle accidents, food or drug tampering, and medical equipment defects Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Subspecialties of Forensic Nurses Sexual Assault Nurse Examiner Forensic Nurse Death Investigator Nurse Coroner Legal Nurse Consultants and Nurse Attorney Clinical Forensic Nurse Examiner Forensic Psychiatric Nurse Correctional Nurse Forensic Nursing Educator/Consultant Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Sexual Assault Nurse Examiner (SANE) Collects forensic evidence related to a reported crime and frequently testifies as a witness at subsequent trials Conducts a thorough examination and history Crisis intervention referral Evaluation of the victim for STIs Pregnancy risk assessment and care Client referral for additional support SANE is certified through IAFN Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Forensic Nurse Death Investigator Evaluates the death scene from a holistic nursing perspective Possesses essential knowledge of anatomy, physiology, pharmacology, growth and development, physical examination, and health history interviewing techniques Might interpret the scene differently than professionals without medical or scientific knowledge Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nurse Coroner Responsible for ensuring that appropriate measures were taken to perform death investigations and certify death certificates Uses nursing knowledge to identify disease processes that the lay coroner may not recognize or may misinterpret as foul play Utilizes crucial communication skills when dealing with grieving families May become board certified by American Board of Medicolegal Death Investigators Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Legal Nurse Consultant (LNC) Provides assistance within the legal system using specialized nursing knowledge and expertise Evaluates, analyzes, and renders informed opinions on the delivery of care and its outcomes Reviews and interprets medical records/charts Provides objective opinions based on standards of care Testifies in court if needed as an expert witness Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Services and Activities of LNCs Identify, organize, and analyze medical records and related materials Prepare chronologies or timelines of health care events Identify applicable standards of care Evaluate causation and damage issues Conduct literature research and summarize medical literature Evaluate case strengths and weaknesses Serve as an expert witness Identify plaintiff’s future medical needs and associated costs – American Association of Legal Nurse Consultants (2013) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Nurse Attorney Educated in both the law and in nursing Often involved in malpractice cases May be involved in licensure disciplinary action or agency oversight Serves as legal consultant Helps hold accountable poor practitioners who are dangerous to clients Meticulous practitioners who are wrongfully accused of negligence will be defended Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Clinical Forensic Nurse Examiner Emergency and Critical Care Delivers care to both living and deceased clients Identifies forensic cases Initiates the proper collection, preservation, and chain of command of evidence Provides accurate documentation for this unique population Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Clinical Forensic Nurse Examiner Organ and Tissue Donation and Transplantation Conducts and provides a detailed physical exam and collects any evidence that may be required Identifies acceptable candidates and potential organs and tissues for harvest Must be knowledgeable about legal specifications related to organ donation and have familiarity with agency policies and procedures for determining brain death Has excellent communication skills as well as the ability to relate empathetically to grieving families Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Clinical Forensic Nurse Examiner Child Abuse and Neglect Prevention and Treatment Act (CAPTA) and DHHS define and include: Neglect Sexual abuse Physical abuse Emotional or psychological abuse Ensures that abuse and neglect are swiftly identified and reported to proper authorities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Clinical Forensic Nurse Examiner Elder Mistreatment Elder mistreatment is thought to be one of the most underdiagnosed and underreported crimes in the United States. (Pearsall, 2011) Forms of elder mistreatment Physical Psychological or emotional Financial Neglect Sexual Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Clinical Forensic Nurse Examiner Disabled Population Well documented that children and elderly with disabilities are more likely to be mistreated. Across the lifespan, the risk for one or more forms of mistreatment triples compared with the risk for individuals without disabilities. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Forensic Psychiatric Nurse Connects the gap between the criminal justice, legal, and mental health systems Applies nursing process to clients pending a criminal hearing or trail Determines the intent or diminished capacity in the patient’s thinking at the time of the incident May be called on in court to testify as an expert witness in mental health cases Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Roles of the Forensic Psychiatric Nurse Sanity or competency evaluation (for legal purposes) Assessment of violence potential Assessment of capacity to formulate intent Parole and probation considerations Assessment of racial or cultural factors in crime Assistance in jury selection Sexual predator screening Provision of expert witness testimony Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Correctional Nursing A specialized subset of forensic nursing in which clients are inmates Primary goal is to maintain a safe, secure, and humane environment for the inmates Recognize safety and security issues for the nurse; always maintain an escape route Understand the prison culture Inmates manipulate nurses Environment is highly isolated Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Health Issues in Prison Populations Addressing health issues in prison populations Screen each inmate upon entry into the facility Health care triage process includes physical and mental health history Care includes chronic and communicable diseases HIV, hepatitis, and tuberculosis (TB) Women in prison Impact of drug use and victimization Stress associated with separation from children Adolescents in prison Often incarcerated in adult facilities that are ill equipped to deal with the challenges of adolescent development Must be aware of their individual vulnerability Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Mental Health Issues in Correctional Settings Adjustment to incarceration is extremely difficult for many mentally ill individuals. Deinstitutionalization led to what amounts to the “criminalization of the mentally ill.” Access to mental health treatment and medication is a right for prison inmates. Nurses must always be aware of the vulnerabilities of people with mental illness who are incarcerated. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Education and Forensic Nursing Specialty education needed to obtain a certificate in forensic nursing, a minor or concentration, or a graduate degree Specialized curriculum Fundamentals of forensic nursing Forensic law Forensic science A minimum number of supervised clinical hours A clinical internship may also be required Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.