fore

1. FORENSICFORENSIC
Nursing EducationNursing Education
Prepared by,Prepared by,
Mrs UMA.J DEAVERMrs UMA.J DEAVER
Associate Professor, MM College ofAssociate Professor, MM College of
Nursing, Mullana.Nursing, Mullana.

2.  Why forensic nursing?Why forensic nursing?

8. Sexual AssaultSexual Assault
 Every 45 seconds a women is SexualEvery 45 seconds a women is Sexual
Assaulted.Assaulted.
 1:5 Women1:5 Women
 1:10-20 Men1:10-20 Men

10. Domestic ViolenceDomestic Violence

12. IntimateIntimate
PartnerPartner
ViolenceViolence
is an Epidemicis an Epidemic

13. The Surgeon GeneralThe Surgeon General
of the United Statesof the United States
recently declared:recently declared:
““Domestic ViolenceDomestic Violence isis
the number one healththe number one health
issue facing the countryissue facing the country
today”today”

14. Domestic ViolenceDomestic Violence
 DV is the leading cause of injury to womenDV is the leading cause of injury to women
in the world.in the world.
 DV is the leading nonobstetric cause ofDV is the leading nonobstetric cause of
death to pregnant women.death to pregnant women.
 Every 9 seconds a women is battered.Every 9 seconds a women is battered.
 1:3 women are a victim of domestic1:3 women are a victim of domestic
violenceviolence

15. Cycle of ViolenceCycle of Violence

16. Eva’s Top 5 Domestic ViolenceEva’s Top 5 Domestic Violence
Myths/FactsMyths/Facts
 MYTHSMYTHS
 Poor/unemployedPoor/unemployed
 The victim spends a lot ofThe victim spends a lot of
time running to the doctortime running to the doctor
 He would never hurt theHe would never hurt the
childrenchildren
 He only does this when heHe only does this when he
drinksdrinks
 He wouldn’t kill herHe wouldn’t kill her
 FACTSFACTS
 <15% unemployed<15% unemployed
 Only 2/3 will seek medicalOnly 2/3 will seek medical
assistanceassistance
 There is an increasedThere is an increased
incidence of child abuseincidence of child abuse
 67% report alcohol abuse67% report alcohol abuse
only 1/5 drinking at the timeonly 1/5 drinking at the time
of abuseof abuse
 2 women die each week at2 women die each week at
the hands of theirthe hands of their
husbands/Texashusbands/Texas

17. More Facts..More Facts..
 DV kills as many women every 5 years asDV kills as many women every 5 years as
the total number of Americans killed in thethe total number of Americans killed in the
Vietnam War…54,000Vietnam War…54,000
 Approximately 50% of all homelessApproximately 50% of all homeless
women and children in the U.S. are fleeingwomen and children in the U.S. are fleeing
DV.DV.
 There are 7 animal shelters for every 1 DVThere are 7 animal shelters for every 1 DV
shelter.shelter.

18. 3-10 Million Children Witness DV3-10 Million Children Witness DV
Violence in Their Homes Each YearViolence in Their Homes Each Year

19. 63% of Young Men Ages 11 to 20 Who63% of Young Men Ages 11 to 20 Who
Are Serving Time for Homicide HaveAre Serving Time for Homicide Have
Killed Their Mothers’ AbusersKilled Their Mothers’ Abusers

20. The Leading Cause of Injury to 14 YearThe Leading Cause of Injury to 14 Year
Old BoysOld Boys

21. Abuse likeAbuse like
 PhysicalPhysical
 Hitting, kicking, strangulation, weaponsHitting, kicking, strangulation, weapons
 Emotional/psychologicalEmotional/psychological
 Threats, destruction of self worth, isolationThreats, destruction of self worth, isolation
 FinancialFinancial
 Work, advancement, access to finances,Work, advancement, access to finances,
credit,credit,

26.  Now that we saw the reasoNNow that we saw the reasoN
for the Need foreNsicfor the Need foreNsic
NursiNg, lets see what isNursiNg, lets see what is
foreNsic NursiNgforeNsic NursiNg

27. The word “forensic” came from aThe word “forensic” came from a
Latin wordLatin word
““for ensis” which means meaningfor ensis” which means meaning
of or before the forum. Theof or before the forum. The
adjective forensic describesadjective forensic describes
scientific methods used toscientific methods used to
investigate crimes.investigate crimes.

28. Forensics: Pertaining toForensics: Pertaining to
the Lawthe Law
Forensic Nursing:Forensic Nursing:
Application ofApplication of
Nursing to the LawNursing to the Law

29. Forensic nurses bridge a gap between patient
and police by providing compassionate patient
care while collecting and documenting evidence
in ways that will be useful to police and
prosecutors. Forensic nurses work with victims of
negligence, abuse, violent crimes including
sexual assault, and other crimes such as human
trafficking. Forensic nurses with advanced
education may choose to become death
investigators, legal nurse consultants and any of
several other specialties in forensic nursing.

30. DefinitionDefinition
 Forensic nursing is commonly defined asForensic nursing is commonly defined as
“the application of the forensic aspects of“the application of the forensic aspects of
health care combined with thehealth care combined with the
bio/psycho/social/spiritual educationbio/psycho/social/spiritual education
of the registered nurse in the scientificof the registered nurse in the scientific
investigation and treatmentinvestigation and treatment
of trauma and/or death of victims andof trauma and/or death of victims and
perpetrators of violence, criminalperpetrators of violence, criminal
activity, and traumatic accidents.”activity, and traumatic accidents.”

31. where Forensic Nurses arewhere Forensic Nurses are
needed?needed?
 Trauma/ERTrauma/ER
 SANE/FNE/SARTSANE/FNE/SART
 Nurse Coroners/Forensic Nurse DeathNurse Coroners/Forensic Nurse Death
InvestigatorsInvestigators
 Nurse Attorneys/Legal Nurse ConsultantsNurse Attorneys/Legal Nurse Consultants
 Psychiatric & Mental HealthPsychiatric & Mental Health
 Correctional HealthCorrectional Health
 Domestic ViolenceDomestic Violence

32. how are foreNsic Nurseshow are foreNsic Nurses
useful iN these areas?useful iN these areas?

33. ER/TraumaER/Trauma
 they are needed forthey are needed for
 IdentificationIdentification
 Care for the SurvivorCare for the Survivor
 Care for the PerpetratorCare for the Perpetrator
 Identification & Collection of evidenceIdentification & Collection of evidence
 ClothesClothes
 Injury and patterns of injuryInjury and patterns of injury

34. ER/Trauma contd…ER/Trauma contd…
 For DocumentationFor Documentation
 Details of the crime committedDetails of the crime committed
 Chain of custodyChain of custody
 Measurements in centimetersMeasurements in centimeters
 LocationLocation
 DescriptionDescription
 PhotographyPhotography

35. SANE/FNE/SARTSANE/FNE/SART

36. (SANE)(SANE)
Sexual Assault Nurse ExpertSexual Assault Nurse Expert
 AA registered nurseregistered nurse who has been speciallywho has been specially
trained to providetrained to provide comprehensive carecomprehensive care toto
sexual assault patients, who demonstratessexual assault patients, who demonstrates
competency in conducting acompetency in conducting a forensicforensic
examexam and theand the ability to be an expertability to be an expert
witnesswitness..

37. Benefits of a SANE TEAMBenefits of a SANE TEAM
 WillingnessWillingness
 Specialty trainingSpecialty training
 Comprehensive careComprehensive care
 Fact based documentation (drop allFact based documentation (drop all
opinions)opinions)
 Forensic issueForensic issue
 evidence collectionevidence collection
 chain of custodychain of custody
 courtroom testimonycourtroom testimony

38. SART-Sexual Assault Response TeamSART-Sexual Assault Response Team
 Law EnforcementLaw Enforcement
 Rape CrisisRape Crisis
 Medical ResponseMedical Response
 SANE/RNSANE/RN
 PhysicianPhysician
 ANPANP
 PAPA
 Crime LabCrime Lab
 Counseling ServicesCounseling Services
 Forensic ScientistForensic Scientist
 CPS/APSCPS/APS
 ProsecutionProsecution

39. Together EveryoneTogether Everyone
Accomplishes MoreAccomplishes More
Don’t tell other members of theDon’t tell other members of the
TEAM how to do their jobs.TEAM how to do their jobs.
Together we can make offendersTogether we can make offenders
want to relocate.want to relocate.

40. SARTSART
 Provide victimProvide victim
centered servicescentered services
 ProvideProvide
compassionate carecompassionate care
 Provide communityProvide community
awarenessawareness
 Where to comeWhere to come
 How we will treat youHow we will treat you
 Encourage reportingEncourage reporting
of Sexual Assaultsof Sexual Assaults
 Encourage successfulEncourage successful
apprehension andapprehension and
prosecution of guiltyprosecution of guilty
offendersoffenders
 Aid in the identifyingAid in the identifying
of false reportingof false reporting

41. Sexual Assault ExamSexual Assault Exam
 Sexual Assault is rarely suspected unlessSexual Assault is rarely suspected unless
an outcry is made.an outcry is made.
 History from Patient (to diagnosis & treat)History from Patient (to diagnosis & treat)
 Head-to-toe AssessmentHead-to-toe Assessment
 Detailed Genital ExamDetailed Genital Exam
 Collection of forensic evidenceCollection of forensic evidence
 Treatment for injuries, STD’s & pregnancyTreatment for injuries, STD’s & pregnancy

42. Nurse Coroners/Nurse Coroners/
Forensic Nurse DeathForensic Nurse Death
InvestigatorsInvestigators

43. Nurse Coroner/Death InvestigationNurse Coroner/Death Investigation
 The coroner is a public official who isThe coroner is a public official who is
primarily charged with the duty ofprimarily charged with the duty of
determining how and why people underdetermining how and why people under
the coroner’s jurisdiction die (thesethe coroner’s jurisdiction die (these
jurisdictions vary form state to state, butjurisdictions vary form state to state, but
typically include sudden, unexpected,typically include sudden, unexpected,
unexplained, or traumatic death).unexplained, or traumatic death).

44. Nurse Coroner/Death InvestigationNurse Coroner/Death Investigation
 A licensed nurse who carries out theA licensed nurse who carries out the
duties of a death investigator induties of a death investigator in
accordance with the performanceaccordance with the performance
standards and procedures establishedstandards and procedures established
under the medical examiner or coroner’sunder the medical examiner or coroner’s
system of death investigating and thesystem of death investigating and the
jurisdictional standards of practice.jurisdictional standards of practice.

45. Nurse Coroner/Death InvestigationNurse Coroner/Death Investigation
 Nurses have the educational background toNurses have the educational background to
understand exactly what causes death and whatunderstand exactly what causes death and what
happens to a body after death occurs. Deathhappens to a body after death occurs. Death
may be a criminal event, but it is always amay be a criminal event, but it is always a
medical event. Unlike law enforcement who lookmedical event. Unlike law enforcement who look
at the deceased and want to know, “Who killedat the deceased and want to know, “Who killed
you?” nurses look at a dead body and ask, “Whyyou?” nurses look at a dead body and ask, “Why
are you dead?” If it is determined that the deathare you dead?” If it is determined that the death
was due to criminal cause then it is lawwas due to criminal cause then it is law
enforcement’s job to determine who. Who betterenforcement’s job to determine who. Who better
to determine the manner of death than medicalto determine the manner of death than medical
personnel?personnel?

46. Nurse Coroner/Death InvestigationNurse Coroner/Death Investigation
 Manner of death is the circumstances in whichManner of death is the circumstances in which
the cause of death arose, i.e. natural, accident,the cause of death arose, i.e. natural, accident,
homicide, suicide, and undetermined. In somehomicide, suicide, and undetermined. In some
cases manner of death may be difficult tocases manner of death may be difficult to
determine and may appear accidental (i.e. in adetermine and may appear accidental (i.e. in a
suicide without a note). Forensic nursessuicide without a note). Forensic nurses
possess the skills necessary to complete apossess the skills necessary to complete a
psychological autopsy and interpret the subtlepsychological autopsy and interpret the subtle
nuances of medications, health history andnuances of medications, health history and
circumstances surrounding suspicious deaths.circumstances surrounding suspicious deaths.

47. Nurse Coroner/Death InvestigationNurse Coroner/Death Investigation
 Mechanism of death is the physiologicMechanism of death is the physiologic
derangement or biochemical disturbancederangement or biochemical disturbance
incompatible with life, which is initiated byincompatible with life, which is initiated by
the cause of death, e.g. cardiac arrest.the cause of death, e.g. cardiac arrest.
Forensic nurses are well educated inForensic nurses are well educated in
physiology and are therefore prepared tophysiology and are therefore prepared to
accurately distinguish between the causeaccurately distinguish between the cause
and the physiologic mechanism of death.and the physiologic mechanism of death.

48. Nurse Attorneys/Nurse Attorneys/
Legal Nurse ConsultantsLegal Nurse Consultants

49. GoalsGoals
 To establish a leadership role in health careTo establish a leadership role in health care
policy making.policy making.
 To influence health care social policy, healthTo influence health care social policy, health
care legislation and nursing practice acts.care legislation and nursing practice acts.
 To educate the public about health law issues.To educate the public about health law issues.
 To educate the public about nurse attorneys.To educate the public about nurse attorneys.
 To educate nurses about the legal system.To educate nurses about the legal system.
 To represent the public; client advocate.To represent the public; client advocate.

50. Nurse Attorneys/Legal NurseNurse Attorneys/Legal Nurse
ConsultantsConsultants
 Nurses want to make fundamental change in theNurses want to make fundamental change in the
way healthcare is delivered, and recognizingway healthcare is delivered, and recognizing
that it needs to occur through legislation andthat it needs to occur through legislation and
political process is a big piece of it.political process is a big piece of it.
 Like nurses, attorneys must interact with peopleLike nurses, attorneys must interact with people
who are vulnerable, who have been injured orwho are vulnerable, who have been injured or
traumatized, and who need assistance to regaintraumatized, and who need assistance to regain
their wholeness.their wholeness.
 Client advocacy is the skill nurses bring to theClient advocacy is the skill nurses bring to the
profession.profession.

51. Psychiatric and MentalPsychiatric and Mental
HealthHealth

52. Issues and GoalsIssues and Goals
 The enhancement of appropriate care for theThe enhancement of appropriate care for the
severe and persistently mentally ill.severe and persistently mentally ill.
 The integration of psychiatric and addictionsThe integration of psychiatric and addictions
treatment.treatment.
 Strategies for promotion of mental health andStrategies for promotion of mental health and
prevention of psychiatric disorders.prevention of psychiatric disorders.
 The provision of appropriate care within theThe provision of appropriate care within the
criminal justice system.criminal justice system.
 The equitable provision of care for children andThe equitable provision of care for children and
adolescents.adolescents.

53. Issues and GoalsIssues and Goals
 Ensuring access to care for older adults andEnsuring access to care for older adults and
members of minority groups.members of minority groups.
 Advocacy for access to psychiatric-mental healthAdvocacy for access to psychiatric-mental health
services as readily as access to medicalservices as readily as access to medical
services.services.
 The development of an evidence-basedThe development of an evidence-based
approach to teaching nursing students aboutapproach to teaching nursing students about
psychiatric-mental health nursing, at both thepsychiatric-mental health nursing, at both the
undergraduate and the graduate levels ofundergraduate and the graduate levels of
education.education.

54. Correctional HealthCorrectional Health

55. Correctional Health NursesCorrectional Health Nurses
 Correctional healthcare is a uniqueCorrectional healthcare is a unique
specialty area.specialty area.
 Goals:Goals:
 Facilitate an improved working relationshipFacilitate an improved working relationship
between the private sector and thebetween the private sector and the
correctional staff in jails, adult and juvenilecorrectional staff in jails, adult and juvenile
detention centers, prisons to meet the needsdetention centers, prisons to meet the needs
of the inmate patient.of the inmate patient.
 Promote correctional healthcare as part of thePromote correctional healthcare as part of the
public health continuum.public health continuum.

56. Lack of identifying victims ofLack of identifying victims of
Domestic Violence isDomestic Violence is
consistent in communityconsistent in community
hospitals and traumahospitals and trauma
centers.centers.

58. ““Justice will only beJustice will only be
achieved when thoseachieved when those
who are not injured arewho are not injured are
just as indignant asjust as indignant as
those who are.”those who are.”
King SolomonKing Solomon

59. STEPS TO BE A FORENSICSTEPS TO BE A FORENSIC
NURSENURSE
Step 1 -- Get Your RNStep 1 -- Get Your RN
 The first step in becoming a forensic nurseThe first step in becoming a forensic nurse
is to become a licensed, registered nurseis to become a licensed, registered nurse
and complete two to three years ofand complete two to three years of
general nursing studies.general nursing studies.

60. Step 2 -- Get "SANE"Step 2 -- Get "SANE"
 Many RNs get started in forensic nursing byMany RNs get started in forensic nursing by
serving as Sexual Assault Nurse Examinersserving as Sexual Assault Nurse Examiners
(SANE) and/or serving on a Sexual Assault(SANE) and/or serving on a Sexual Assault
Response Team (SART). To serve in this capacityResponse Team (SART). To serve in this capacity
you'll need to complete about 40 hours ofyou'll need to complete about 40 hours of
classroom training and 40 or more hours ofclassroom training and 40 or more hours of
supervised clinical training. If you have enoughsupervised clinical training. If you have enough
nursing experience, this training may also qualifynursing experience, this training may also qualify
you to apply for certification.you to apply for certification.

61.  Step 3 -- Advanced EducationStep 3 -- Advanced Education
To go beyond SANE/SART work, you'll need toTo go beyond SANE/SART work, you'll need to
complete a post-graduate degree such as a master ofcomplete a post-graduate degree such as a master of
science in forensic nursing. This will include courseworkscience in forensic nursing. This will include coursework
and practical training in such areas as identifyingand practical training in such areas as identifying
traumatic wounds and patterned wounds, and how totraumatic wounds and patterned wounds, and how to
recognize such injuries at different stages of healing.recognize such injuries at different stages of healing.
After finishing your forensic MSN degree -- andAfter finishing your forensic MSN degree -- and
depending on your specialization, if any -- you'll bedepending on your specialization, if any -- you'll be
equipped to enter some of the more advanced rolesequipped to enter some of the more advanced roles
open to forensic nurses such as nurse coroner, deathopen to forensic nurses such as nurse coroner, death
investigator or legal nurse consultant.investigator or legal nurse consultant.

62.  Step 4 - Voluntary CertificationStep 4 - Voluntary Certification
 As of April 2011, only three nationalAs of April 2011, only three national
credentials were available to forensic nurses.credentials were available to forensic nurses.
These are the Sexual Assault NurseThese are the Sexual Assault Nurse
Examiner - Adult/Adolescent (SANE-A) andExaminer - Adult/Adolescent (SANE-A) and
the Sexual Assault Nurse Examiner -the Sexual Assault Nurse Examiner -
Pediatric (SANE-P), both if which are offeredPediatric (SANE-P), both if which are offered
by the International Association of Forensicby the International Association of Forensic
Nurses, and the Certified Forensic Nurse orNurses, and the Certified Forensic Nurse or
CFN, offered by the American College ofCFN, offered by the American College of
Forensic Examiners International.Forensic Examiners International.

63. Contd……..Contd……..
 All three are voluntary, meaning that theyAll three are voluntary, meaning that they
signify expertise but may not be requiredsignify expertise but may not be required
by state nursing boards.by state nursing boards.
 A 4th national credential appears to be inA 4th national credential appears to be in
the works, as the American Nursesthe works, as the American Nurses
Credentialing Center (ANCC) beganCredentialing Center (ANCC) began
developing an Advanced Forensic Nursingdeveloping an Advanced Forensic Nursing
Portfolio Recognition credential in 2010,Portfolio Recognition credential in 2010,
but as of April 2011, is not yet acceptingbut as of April 2011, is not yet accepting
applications.applications.

64.  Final StepFinal Step
 The last -- but definitely not least -- step inThe last -- but definitely not least -- step in
forensic nursing is to obtain work in yourforensic nursing is to obtain work in your
new field! You'll achieve this experience innew field! You'll achieve this experience in
a number of ways, which may include buta number of ways, which may include but
are not limited to internships, fellowshipsare not limited to internships, fellowships
and residencies.and residencies.

65. Where can you do forensicWhere can you do forensic
nursing?nursing?
 India Institute of Medical Sciences - New Delhi, DelhiIndia Institute of Medical Sciences - New Delhi, Delhi
Master of Science (Nursing) - Psychiatric NursingMaster of Science (Nursing) - Psychiatric Nursing
Master of Science(Nursing) - Neurological NursingMaster of Science(Nursing) - Neurological Nursing
 West Bengal University of Health Sciences - Salt Lake, West BWest Bengal University of Health Sciences - Salt Lake, West B
Diploma in Forensic MedicineDiploma in Forensic Medicine
Doctor of Medicine- Forensic MedicineDoctor of Medicine- Forensic Medicine
 Institute Of Medical Sciences - Varanasi, Uttar PradeshInstitute Of Medical Sciences - Varanasi, Uttar Pradesh
Doctor of Medicine in Forensic MedicineDoctor of Medicine in Forensic Medicine
Doctor of Philosophy in Forensic MedicineDoctor of Philosophy in Forensic Medicine
 Kempegowda Institute of Medical Sciences - Bangalore,Kempegowda Institute of Medical Sciences - Bangalore,
KarnatakaKarnataka
Doctrate in Medicine - Forensic MedicineDoctrate in Medicine - Forensic Medicine

66. Contd………Contd………
 All India Institute Of Physical Medicine & Rehabilitation -All India Institute Of Physical Medicine & Rehabilitation -
Mumbai, MaharashtraMumbai, Maharashtra
Post graduate Diploma in Rehabilitation for NursesPost graduate Diploma in Rehabilitation for Nurses
Certificate Course in Psychologist and VocationalCertificate Course in Psychologist and Vocational
CounselorCounselor
 All India Institute of Speech and Hearing (AIISH) -All India Institute of Speech and Hearing (AIISH) -
Mysore, KarnatakaMysore, Karnataka
Post Graduate Diploma - Forensic Sciences andPost Graduate Diploma - Forensic Sciences and
TechnologyTechnology
 Deep Institute of Nursing & Medical SciencesDeep Institute of Nursing & Medical Sciences
Bathinda, PunjabBathinda, Punjab
 Shadan Institute Of Medical Sciences College Of NursingShadan Institute Of Medical Sciences College Of Nursing
Hyderabad, Andhra PradeshHyderabad, Andhra Pradesh
 Private Physiotherapy Nursing & Para MedicalPrivate Physiotherapy Nursing & Para Medical
Institutions Society of JaipurInstitutions Society of Jaipur

67.  You also do forensic nursing online inYou also do forensic nursing online in
india and abroad.india and abroad.

68. Thank you
Thank youThank you