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We all have parts to play in nursing victims of violence

Why nurse executives should meet patients’ forensic needs

Nurse executives are key to providing quality care to patients affected by violence, with the growth in crime being a critical consideration in designing patient care and fostering collaboration across teams.

Forensic care
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Injured survivors often have long-term physical, mental and financial issues, and so clinicians must adopt a systematic approach to meet their needs. Care can be provided by the advanced practice (AP) forensic nurse as well as the generalist nurse who has basic forensic knowledge. 

Many hospitals employ AP forensic nurse specialists. However, even the most recognised role, sexual assault nurse examiner, is not supported in most healthcare institutions.

Forensic nurse specialist

It is important that all nurses understand the significance of forensic knowledge as every nurse will encounter patients with forensic issues at some point. Nurse executives, as the architects of patient care, are responsible for ensuring forensic needs are met.  

While the sexual assault nurse examiner plays an important part, the roles and capabilities of the AP forensic nurse are broader. The AP forensic nurse works at the intersection of healthcare and legal needs, and is trained to assess for history of victimisation, collect evidence, provide expert care and function as an expert in the legal system.

Core skills and competencies of forensic nursing practice are useful to all nurses. The Institute of Medicine’s 2010 report on the Future of Nursing calls for nurses to practise to the full extent of their education and training. 

All nurses should have a basic knowledge of forensic care to assess patients for current and past histories of abuse, understand its impact on health, know how to collect and preserve evidence, how to photograph and preserve photographs, and work with the legal system.

Trauma response

One evidence-based strategy to ensure patient needs are met is implementing trauma-informed care. How clinicians respond to trauma can impede healthcare; indeed, many practices can re‑traumatise.

All clinicians should learn about trauma and its consequences, understand responses and devise care that does not cause further harm. 

First and foremost, nurses should learn and use strategies to assess for violence. Current practice, including assessing trauma history, is often inconsistent.

Questions can be glossed over due to discomfort of the nurse, omitted due to uncertainty how to respond, or asked in an intimidating way. Training helps provide nurses with the ability to screen for violence effectively.

Legal issues

The skills of specialist forensic nurses justify their cost. More patients will disclose to a trained forensic nurse versed in the criminal justice system.

When, where, and how to collect evidence, then preserve the chain of custody of that evidence until it is in the hands of law enforcement, should be basic practice.

It is important nurses work together to provide the best care for patients with legal issues related to their care, be they sexual assault patients, child abuse victims, offenders with traumatic histories, victims of fraud, victims of healthcare malpractice or victims of false accusations of healthcare malpractice.

We owe patients the best care. Nurse executives can make this happen for patients affected by violence.

Kathleen Sekula is a professor at the Duquesne University School of Nursing in Indianapolis, US

Further information

Amar FA, Sekula LK (2015) A Practical Guide to Forensic Nursing: Incorporating Forensic Principles into Nursing Practice. Sigma Theta Tau International, Indianapolis IN

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