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Because an epidemic of violence has been recognized as a global public health problem, nursing
has been challenged to assist police in the medicolegal management of victims of violent crime
and perpetrators of criminal acts due to inadequate resources in law enforcement and the forensic
sciences. Considering that the point of entry into the legal system for most crime victims is the
hospital emergency department where crucial forensic evidence is historically lost or destroyed,
a skilled forensic clinician is essential to protect the patient's legal, civil and human rights. The
purpose of forensic nursing science is the reduction and prevention of the abuse of women and
children specifically and of human violence in society at large. The integrated model of forensic
nursing applies clinical and scientific nursing knowledge to the delivery of care for survivors of
traumatic injury, to victims of violence or to death investigations. At any point where the
delivery of patient care and the medicolegal system intersect, forensic nurse examiners (FNE)
have an integral area of nursing practice. Forensic nurses help avoid the mishandling or omission
of forensic evidence, perform critical functions in the recognition and correct collection of
forensic evidence in all cases of violence, especially complex criminal cases. Forensic nurse
examiners are an integral, key professional in reducing and preventing violence in our society.
Interpersonal violence (person to person) comprises one of the largest case loads of forensic
patients admitted daily to the clinical environs. Such cases include domestic violence, child
abuse, elder abuse, sexual assault and other crime related trauma, which falls within this
category. Victims often fail to identify themselves as crime victims out of humiliation or fear.
Accidental trauma must be evaluated to confirm or rule out intentional from non-intentional
injury. All deaths pronounced upon arrival or within any department of the hospital must be
evaluated for a criterion that meets the legal guidelines for reporting. These legal mandates are
also included the Joint Commission on Accreditation of Healthcare Organization's guidelines.
The FNE role is one essential resource to ensure such criteria are met with reasonable certainty.
In recent years, episodes of violence have created an increasing number of victims who do
report, as well as new forms of crime. But there a system in place to provide a skilled forensic
clinician available upon admission and competent forensic evaluation with emotional support?
These violent events include not only injured or deceased individuals, but also perpetrators and
the families of both. Historically, victims were considered the sole responsibility of the criminal
justice system. Today, care of forensic patients is considered a mutual responsibility between
healthcare and the law. Due to the lack forensic knowledge in conventional nursing education,
forensic circumstances are frequently overlooked and evidence is lost or discarded resulting in a
miscarriage of justice.
Forensic nursing practice was accepted formal specialty of nursing in 1995 by the American
Nurses Association Congress of Nursing Practice, recognizing that it contains a unique
knowledge not found in any other discipline. The Scope and Standards of Forensic Nursing
Practice were approved in 1997, legitimatizing this scientific discipline equally to other
specialties of nursing such as critical care, oncology, pediatrics, geriatrics, emergency, etc. The
development of forensic nursing science has had a major impact on the proper care and treatment
of both victims and perpetrators of criminal violence. Despite a steady increase in the number of
victims treated, many hospital emergency departments (ED) do not have a forensic nurse
examiner (FNE) on staff to oversee proper attention to the legal implications of trauma care.
Nurses in all specialties, ED nurses in particular, must develop the necessary skills to
competently care for patients identified as clinical forensic cases. Considering that the term
forensic is defined as 'pertaining to the law,' all medical cases that are required to be reported to
the police mandate an investigation and may later necessitate a legal debate are forensic in
nature. This debate will determine the innocence or guilt of the accused or liability-related issues.
The most widely recognized role in the practice of forensic nursing is that of the sexual assault
nurse examiner (SANE). A sexual assault nurse examiner is a registered nurse who has
completed specialized education and training in order to provide a comprehensive forensic
healthcare response to adults, adolescents and children who are victims of sexual assault or
abuse. A SANE demonstrates competency in evidentiary exams provided for victims as well as
suspects or perpetrators of crime and due to their education, skills and forensic expertise often
provide expert testimony in criminal and civil trial proceedings. In Colorado, standardized SANE
education and training is offered through Beth-El College of Nursing and Health Sciences. The
education course, "Care and Management of the Adult, Adolescent and Pediatric Sexual Assault
Patient" is 48 classroom hours in length with CEU's awarded at the completion of the classroom
section. Following the classroom education, nurses wishing to practice as sexual assault nurse
examiners complete 90 hours of clinical experiences that include: proctored evidentiary
examinations of adults, adolescents, children and suspects done in collaboration with
experienced SANEs.
Currently in Colorado there are 12 SANE programs located in rural as well as metro areas of the
state including: Alamosa, Aurora, Colorado Springs, Denver, Durango, Fort Collins, Glenwood
Springs, Grand Junction, Pueblo, Salida, Montrose and Westminster. SANE programs have been
operational in Colorado since 1995, when the first formalized Colorado SANE program began
providing services at Memorial Hospital, now Memorial Health System, in Colorado Springs.
Nearly twelve years later, the Memorial Health System continues to support delivery of an expert
forensic healthcare response to patients impacted by interpersonal violence. This past fall, two
'Forensic Nurse Examiner Clinician' positions were added to the team of nurses that provide an
'on call' response to victims of sexual assault. The nurses are available to provide forensic
consultation to the Emergency Department staff and patient care units as well as forensic focused
continuing education and medical-forensic exams and photodocumentation for hospitalized
patients.
Beth El College of Nursing and Health Sciences, University of Colorado at Colorado Springs
was among the first in the United States to offer a specialized curricula in forensic nursing
science in 1993. Since then it has expanded to include graduate and undergraduate programs. To
learn more about the program, visit their website atwww.uccs.edu/bethel.> In January 2004
through the combined vision of Dean Carole Schoffstahl and decades of experience in prison
health of Dr. Glenda Reimer and the long-standing global violence intervention of Dr. Jody
Glittenberg, the Violence Intervention and Prevention (VIP) Center was established and
approved by Regential approval. Val Sievers, Colorado SANE Coordinator is also a Board
member of the Center. Other faculty now involved include: Dr. Barbara Griesbach, Parish Nurse
Coordinator, Cathy Emeis, Midwifery and Women's Health in jails, and Dr. Mary Hagedorn,
Coordinator of the Doctorate of Nursing Practice (DNP). Jo Ruth, emerita faculty, is essential in
framing the organizational structure of the Center, and Dr. Anne Clark is a grants' writer for the
Center. Donah Grassman is the Administrative Assistant.

The four major foci of the Center are: education, research, service and practice. The cornerstone
of the educational focus is the national renowned forensic nursing program. Two additional
advanced forensic nursing educational programs have been added: the Correctional Nurse
Clinical Specialist and the Parish Nurse program. A psychiatric mental health program in prison
health care is in the planning stages.
The specialty of forensic nursing continues to evolve and expand while offering nurses a unique
practice option to provide a comprehensive response to victims of trauma and crime. In areas
throughout the state and the country, nurses have recognized opportunities and initiated new
roles that address gaps in the interface between healthcare and the legal system. Forensic nurses
have the potential to entertain career options as medical legal consultants for attorneys, law
enforcement agencies, insurance companies, medical examiner and coroner systems, healthcare
administration and emergency services systems. Opportunities in a variety of arenas include;
death investigation, domestic violence, child abuse, and sexual assault, psychiatric and
correctional healthcare serve to expand the nurses' role and contributions toward creating a
healthier, safer world without violence of epidemic proportion.
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COPYRIGHT 2007 Colorado Nurses Association
COPYRIGHT 2008 Gale, Cengage Learning


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Jody Glittenberg "Forensic nursing: a healthcare response to the epidemic of violence". Colorado
Nurse. FindArticles.com. 02 Feb, 2011.
http://findarticles.com/p/articles/mi_m1AIF/is_1_107/ai_n25002544/
COPYRIGHT 2007 Colorado Nurses Association
COPYRIGHT 2008 Gale, Cengage Learning
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