1. Chapter 44 Forensic Nursing in the Community Copyright © 2016 by Elsevier Inc.

2.  Describe the specialized competencies and skills of the forensic nurse within the nursing process.  Discuss the relationship of the forensic nurse with public health professionals in addressing injury as a public health concern.  List the health risks that result from incidents of injury. Objectives 2 Copyright © 2016 by Elsevier Inc.

3.  Identify how forensic nurses deal with injuries in the three levels of prevention.  Discuss the health disparities that contribute to the occurrence and poor outcomes in marginalized groups that experience injury.  Explain the contribution of theoretical underpinnings to current models of forensic nursing practice.  Identify client populations and clinical arenas in the community where forensic nurses practice. Objectives (Cont.) 3 Copyright © 2016 by Elsevier Inc.

4.  Define the key terms and concepts within forensic nursing theory.  Identify professionals who commonly work in collaboration with the forensic nurse in addressing injury care and prevention. Objectives (Cont.) 4 Copyright © 2016 by Elsevier Inc.

5. Agnes is a forensic nurse who, though not an emergency room nurse, ends up working frequently in a variety of emergency departments around the city. Although forensic nursing takes a variety of forms in a variety of settings, Agnes’s specialty is working with victims of assault. “One of my greatest challenges,” she says, “is gathering solid legal and forensic evidence while being sensitive to an individual who has been so recently traumatized. It’s a constant, delicate balancing act.” Issues in Public Health Nursing: Forensic Nursing in the Community 5 Copyright © 2016 by Elsevier Inc.

6.  Forensic  Pertaining to the law  Forensic nursing  Synthesis of biopsychosocial and spiritual aspects of nursing care with an expert understanding of forensic science and the criminal justice process Perspectives on Forensics and Forensic Nursing 6 Copyright © 2016 by Elsevier Inc.

7.  Sexual assault nurse examiner (SANE)  Clinical forensic nurse  Forensic nurse examiner  Forensic psychiatric nurse  Forensic correctional nurse  Legal nurse consultant  Nurse attorney  Nurse coroner or death investigator Forensic Nursing Roles 7 Copyright © 2016 by Elsevier Inc.

8.  Rate of injury and crime  Lower in communities that promote good health  Disparities  Among minorities and among disenfranchised worldwide among both victims and prosecutions  National Center for Injury Prevention and Control (1997)  Focus on injury prevention and violence prevention, home and recreational safety, traumatic brain injury, injury data and statistics, injury response, motor vehicle safety, and violence prevention Injury Prevention 8 Copyright © 2016 by Elsevier Inc.

9.  The proposed goals that deal with reducing injury and violence in the United States reflect the breadth of concerns and problems that result in injury, both intentional and unintentional, in communities. Healthy People 2020 9 Copyright © 2016 by Elsevier Inc.

10.  Levels of prevention  Primary: projects that aim to prevent domestic violence, sexual assault, child abuse, and accidental injuries before they occur  Secondary: direct care to both victims and perpetrators; collection of evidence for the legal justice system  Tertiary: address rehabilitation or identify factors that have put individuals at risk Forensic Nursing 10 Copyright © 2016 by Elsevier Inc.

11. Which of the following actions that Agnes has taken over the past 6 months represents secondary prevention? A. Spoke at a seminar on sexual assault investigative assessments B. Advised organizers of a community workshop series on preventing domestic violence C. Collected forensic evidence from an assault victim D. Advocated for better assessment strategies to identify groups and individuals who are at risk Quick Recall 11 Copyright © 2016 by Elsevier Inc.

12.  Secondary prevention involves both (a) providing direct care to both victims and perpetrators and (b) collecting evidence for the legal system. Tertiary prevention involves rehabilitation or identifying factors that have put individuals at risk. By contrast, primary prevention involves strategies or programs that aim to prevent domestic violence, sexual assault, child abuse, and accidental injuries before they occur. Get That? 12 Copyright © 2016 by Elsevier Inc.

13.  Address social justice as well as care for offenders.  Look for indicators of crime and intentional injury.  Typical cases  Sexual assault, drug- and alcohol-related crimes, incidents of human trafficking, elder mistreatment, child abuse, gang violence, as well as mass disaster, automobile accidents, and work-related injuries  May have complementary specialties  For example, legal nurse consultants Forensic Nursing and Promotion of Care in the Community 13 Copyright © 2016 by Elsevier Inc.

14.  History of forensic nursing  Educational preparation  Theoretical foundations of forensic nursing  Key concepts in forensic nursing  Scope and Standards of Practice Forensic Nursing and Promotion of Care in the Community (Cont.) 14 Copyright © 2016 by Elsevier Inc.

15.  Largely propelled by early efforts to identify and prevent child abuse and neglect and sexual assault of women  Indicators of “battered child syndrome”  “Rape” kit collection  Rape trauma syndrome (Burgess, 1973)  First nurse-run sexual assault clinics opened in Memphis and Minneapolis in 1974  Protocols for sexual assault care  1986: U.S. Surgeon General identified violence as a health care issue  Integrated model of forensic nursing History of Forensic Nursing 15 Copyright © 2016 by Elsevier Inc.

16.  Three primary routes for training 1. Continuing education courses 2. Certificate programs 3. Graduate nursing academic programs The inclusion of forensic nursing content into undergraduate generalist education remains controversial. Educational Preparation 16 Copyright © 2016 by Elsevier Inc.

17.  Maslow’s hierarchy of needs and desires  Haddon’s risk of injury matrix  National Violent Death Reporting System  Rape trauma syndrome  Lynch’s integrated model of forensic nursing Theoretical Foundations of Forensic Nursing 17 Copyright © 2016 by Elsevier Inc.

18.  Safety  Injury  Justice  Presence  Perceptivity  Truth  Victimization Key Concepts in Forensic Nursing 18 Copyright © 2016 by Elsevier Inc.

19.  Scope and Standards of Practice for Forensic Nursing (1995, revised 2009)  Scientific process  Quality of practice  Education  Professional practice  Evaluation  Collaboration  Ethics  Research  Resource utilization  Leadership Scope and Standards 19 Copyright © 2016 by Elsevier Inc.

20.  Evidence-based practice and research  Scientific research in forensic nursing is in its infancy.  Certification  Certification examination for the pediatric, adolescent, and adult sexual assault nurse examiners (SANE A and SANE P) is available through the Forensic Nurse Certification Board.  Certification for legal nurse consultant, corrections nurse, death investigators, and forensic examiners  American Nurses Credential Center; advanced forensic nurse (AFN) Current Perspectives 20 Copyright © 2016 by Elsevier Inc.

21.  Unique in forensic nursing because of the implications to not only a client’s health, but in some cases, the client’s freedom  Five categories of ethical principles  Respect for person  Beneficence and non-maleficence  Distributive justice  Respect for community  Contextual caring  Forensic environments  Courtrooms, jails, prisons, and psychiatric facilities for the criminally insane Ethical Issues 21 Copyright © 2016 by Elsevier Inc.

22.  Clients routinely enter hospitals with conditions that have overlying legal implications.  Forensic nurses use their expert understanding of cause and effects of trauma and are in a position to investigate the circumstances to design a plan of care for individuals as well as special groups of clients.  Forensic nurses serve as liaisons between the hospital and the medical-legal community to reduce the effects of trauma. Future Perspectives 22 Copyright © 2016 by Elsevier Inc.