FORENSIC NURSING - Penrose-St. Francis

FORENSIC NURSING
A Healthcare Response to the Epidemic
of Violence
Valerie Sievers MSN, RN, CNS, CEN, SANE-A, SANE-P
Forensic Clinical Nurse Specialist
Coordinator Forensic Nursing & Correctional Health Education
Beth-El College of Nursing & Health Sciences
University of Colorado-Colorado Springs

“Violence is a PUBLIC
HEALTH issue”
C. Everett Koop MD (1984)
Former U.S. Surgeon General
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VIOLENCE IN AMERICA
• In 2001, there were approximately 21,000
homicides and 31,000 suicides; and nearly
1.8 million people were assaulted, while
about 323,000 harmed themselves and were
treated in hospital emergency departments.
(Surveillance for Fatal and Nonfatal Injuries, 2001) (Centers for
Disease Control and Prevention National Vital Statistics System)
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VIOLENCE IN AMERICA • In 2005, firearms were
the mechanism of injury
in approx. 84% of
homicides & 46% of
suicides among children
& adolescents aged 5-19
years ( National Center
for Injury Prevention,
2008).
• In 2006, more than
33,300 suicides
occurred in the U.S.
• 5.3 million incidents of
IPV occur annually in
women >18. (CDC 2005).
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SEXUAL ASSAULT-RAPE
• Every 2 minutes someone in the U.S. is sexually
assaulted.
• 248,300 victims of sexual assault in 2007
• 60% of sexual assaults are NOT reported to police.
• 38% of rapists are a friend or acquaintance
• 80% of those who are sexually assaulted are < age 30
Rape Abuse & Incest National Network
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VIOLENCE IN AMERICA
• In 2002, CPS agencies verified reports involving
maltreatment of just under 1 million children (CDC
2005).
• 61% suffered neglect, 19% physical abuse,
remaining psychological, sexual and emotional
abuse.
• The U.S. child homicide rate, 2.6/100,000 for
children < 15 is 5 times greater than the combined
rate of 25 other industrialized countries (CDC,
1997).
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THE REALITY OF ABUSE & VIOLENCE
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FORENSIC HEALTHCARE
•What is the focus of
education and clinical
preparation in
healthcare
professions
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What about our
patients who are
victims of crime
and interpersonal
violence
FORENSIC HEALTHCARE
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FORENSIC NURSING
Forensic is defined as ‘pertaining to the law.’
Forensic Nursing is the application of nursing science
and practice to the care and treatment of patients
impacted by crime, violence and accidental injury.

IDENTIFICATION & ASSESSMENT IN TRIAGE
• Victims of abuse, neglect or exploitation
are identified using the criteria
developed or adopted by the
organization at entry into the system
and on an ongoing basis (JCAHO).
“Are you safe at home”
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ABUSE ASSESSMENT SCREEN
1.Have you ever been emotionally or physically abused by your
partner or someone important to you _____
2.Within the last year, have you been hit, slapped, kicked,
pushed or shoved, or otherwise physically hurt by your partner
or ex-partner _______
If YES, by whom______________________________
Number of times______________________________
3.Does your partner ever force you into sex _____
4.Are you afraid of your partner or ex-partner _____
+ assessing for strangulation…..
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PATIENTS WITH FORENSIC HEALTHCARE NEEDS
• Trauma Patients
• Elder Abuse
• Child Maltreatment
• Intimate Partner Violence-
Domestic Violence
• Sexual Assault
• DFSA
• Strangulation
• Human Trafficking
• Drug Exposed Children
• Suicide Attempts
• Physical Assaults
• Suspect Evidentiary
Collection
• Organ Donation
• Inmate Violence & Abuse
• Mental Health Emergencies
• In Custody Injuries
• Mandated Reporting
• In-Facility Falls & Injury
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COLORADO LAW
• Physicians & other licensed
healthcare professionals who attend
or treat any injuries believed to have
been intentionally inflicted or any
injury which there is reason to
believe involves a criminal act have
a legal obligation to report such
injuries to law enforcement
(Colorado Revised Statutes).
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Forensic Responsibilities
The term forensic, means
“pertaining to the law.”
What are your FORENSIC
responsibilities as a licensed,
healthcare professional
•Patient History
•Mandated reporting
•Concern for evidence collection
•Referrals & resources
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MANDATED REPORTING
In Colorado, we are required to report
a suspicion of physical/sexual abuse
to 1) Law Enforcement and/or
2) Child Protective Services
Registered Nurses are mandated
reporters!
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NURSING RESPONSIBILITIES FOR PATIENTS
IMPACTED BY VIOLENCE
• Screening in all patient care areas
• Recognition
• Assessment
• Mandated Reporting
• History ‘in the exact words of the patient’
• Documentation to include injury photography
• Referrals & Resources
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WHO PRACTICES FORENSIC NURSING
• Trauma & Emergency
Nurses
• Surgical Nurses
• Critical Care Nurses
• Sexual Assault Nurse
Examiners
• Legal Nurse Consultants
• Nurse Coroners

WHO PRACTICES FORENSIC NURSING
• Forensic Psychiatric Nurses
• Nurse Attorneys
• Pediatric Nurses
• Nurses in Correctional Facilities
• Home Care Nurses & Community Health
• Gerontology Nurses
• Nurse Educators & Researchers
• Forensic Clinical Nurse Specialists

Sexual Assault Nurse Examiner
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Sexual Assault Nurse
Examiner Programs
provide services in
Colorado hospitals!
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SANE & MAGNET® STATUS
Five Model Magnet Components
1) Transformational Leadership; best practices, health care
reformation, commitment to excellence while fostering new
ideas & innovative care models.
2) Structural Empowerment: evidence based resources &
education that improves competency & quality outcomes
3) Exemplary Professional Practice: provision of high
quality, culturally competent patient care & education for
patients & families.
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SANE & MAGNET® STATUS
Five Model Magnet Components
4) New Knowledge, Innovation & Improvements; visible
contributions to the science of nursing & new models of
care.
5) Empirical Quality Results; a measurable improvement in
clinical, patient & organizational outcomes.
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Sexual Assault Nurse Examiner Program
Forensic Nurse Examiner Program
In house team response, as opposed to ‘on call’
Providing forensic healthcare to a variety of patients
Standardized response by FNE , the amount of time nurses &
physicians would need to commit to forensic issues
Response to subpoena & testimony
Reimbursable services
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Beth-El College of Nursing & Health
Sciences @ the University of Colorado
Colorado Springs
www.uccs.edu/bethel
Sexual Assault Nurse Examiner Education Course
Advanced Forensic Nurse Examiner Course
Forensic Nursing Certificate
Correctional Health Certificate
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“Justice will only be achieved when those
who are not injured by crime feel as
indignant as those who are."
King Solomon, 635-577 BC
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