The nurse may desire to specialize as a child abuse nurse exam- iner, forensic nurse examiner, forensic clinical nurse special- ist or advanced practice forensic nurse, SANE, sexual assault forensic examiner, sexual assault response team nurse, nurse death examiner, or nurse coroner. Clinical Example 6-1 depicts details of violent behavior in which the forensic nurse could utilize his or her expertise.
Specialty roles will continue to develop as health care providers focus on issues of genetic therapy, genomic health care (a highly individualized plan of care that utilizes infor- mation related to phenotype responses and gene functions),
pharmacogenomics (prescribing drugs based on the client’s complete DNA structure), e-practice (use of electronic technology in the delivery of health care), and euthanasia.
Box 6-4 lists specifi c practice areas of forensic nurses. Informa- tion regarding the role of the forensic nurse as a legal nurse consultant and expert witness is found in Chapter 5. The role of the forensic nurse is also included in chapters that discuss sexual disorders, suicidal clients, and incarcerated clients.
Practice Areas of Forensic Nurses Forensic nursing sexual assault examiners
•
Forensic nursing educators/consultants
•
Nurse coroners
•
Death investigators
•
Legal nurse consultants
•
Nurse attorneys
•
Correctional nurses
•
Clinical nursing specialists in trauma, transplant,
•
and critical care nursing Forensic pediatric nurses
•
Forensic gerontology nurses
•
Forensic psychiatric nurses
•
BOX 6.4 CLINICAL EXAMPLE 6.1
Investigation of Violent Behavior
On Saturday, February 26, 2005, the Wichita, Kansas, police announced the capture of the “BTK killer”
(bind-torture-kill) who had murdered at least 10 peo- ple over the last 3 decades. He had taunted detectives with poems, word puzzles, and boastful letters, and reached out to police several times. On one occasion, he called 911 to direct authorities to his most recent victim. In March 2004, he sent a letter claiming credit for an unsolved strangling in 1986. Before his capture, he sent a word-search puzzle to a local TV station, wrote a letter to police, and left packages contain- ing various clues (eg, his autobiography, the driver’s license, and jewelry of his victims) in public areas in Wichita. The suspect was described as married, the father of two adult children, and an animal-control offi cer who also had the responsibility for citing resi- dents who violated municipal codes. He also served
as president of his church council and a Cub Scout leader.
Functions of the Forensic Nurse
The functions of the forensic nurse during the investi- gation of this case could include
1. collection of evidential material required by law enforcement or medical examiners;
2. scientifi c investigation of the death of known vic- tims;
3. crisis intervention for family or friends of the vic- tims;
4. interaction with grieving families or friends of the victims; and
5. provision of expert witness testimony regarding the client’s violent behavior.
SOURCES: Huffstutter, P. J., & Simon, S. (2005, February 7). We have BTK Killer, Kansas police say. Orlando Sentinel, p. A1, A25;
ANA & IAFN. (1999). Scope and standards of forensic nursing practice (pp. 3–4). Washington, DC: American Nurses Publishing.
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68 UNIT II Special Issues Related to Psychiatric–Mental Health Nursing
KEY CONCEPTS
Forensic nursing practice is considered to be one of the
•
fastest growing nursing specialties of the 21st century.
SANEs were trained in the mid-1970s to collect foren- sic evidence from sexual assault survivors; the formal recognition of forensic nursing occurred in 1991; the IAFN was formed during the summer of 1992; the ANA published the Scope and Standards of Nursing Practice in Correctional Facilities in 1995; and fi nally, in 1997, at the request of the IAFN, the ANA collaborated with IAFN and created the Scope and Standards of Forensic Nursing Practice. A new revision, Forensic Nursing: Scope and Standards of Practice, approved with edits in 2008, was published in 2009.
The scope of forensic nursing practice, as defi ned by ANA
•
and IAFN, encompasses three areas:
Application of the nursing-related sciences, including
•
biopsychosocial education to public or legal proceedings Application of the forensic aspects of health care in sci-
•
entifi c investigation
Treatment of trauma or death victims and perpetrators
•
(or alleged perpetrators) of abuse, violence, criminal activity, and traumatic accidents
Forensic nursing is a unique, multidimensional discipline
•
that provides direction to health care providers, educators, attorneys, researchers, and administrators, as well as other health professionals, legislators, and the public in general.
The
• Standards of Forensic Nursing Practice consist of Standards of Care and Standards of Professional Performance.
The Standards of Care describes a competent level of foren- sic nursing practice and delineates services provided to all clients of forensic nurses or practitioners. The Standards of Professional Performance describes a competent level of behavior in the forensic nurse’s role.
The
• Forensic Nurse’s Code of Ethics addresses the nurse’s responsibility to the public and the environment, obliga- tion to science, care of the profession, dedication to col- leagues, and fi delity to clients.
Forensic nursing education can be obtained through
•
colleges and universities that offer a variety of programs online, by distance learning, or on-campus. These pro- grams may focus on continuing education, certifi cation, or undergraduate or graduate studies that specialize in the fi eld of forensic nursing.
According to Standard III of the
• Standards of Professional
Performance, forensic nurses are expected to acquire and maintain current knowledge in forensic nursing practice and to integrate the learning into daily practice.
Forensic nurses practice in settings whenever and wher-
•
ever a medical–legal interest and forensic issues interact, such as in the primary care setting, hospital, clinics, legal arenas, businesses, and the like.
For additional study materials, please refer to the Student Resource DVD-ROM located in this textbook.
Critical Thinking Questions
1. Review the Forensic Nurse’s Code of Ethics with a peer.
Analyze the fi rst code, Responsibility to the public and the environment. Discuss what activities a forensic nurse could perform to serve the public welfare, especially disadvan- taged citizens. Cite examples of environmental problems or degradation that the forensic nurse might oppose.
2. Refl ect on your observation and assessment skills. In what way would you be able to assist a forensic nurse in the collection of data on a client who complained of being physically abused during hospitalization? Cite examples of evidential material that would be collected.
3. Visit the Web site of at least three of the forensic nursing programs listed in Box 6-3. Do any of the programs offer a forensic nursing specialty that is of interest to you? If so, what additional educational preparation would you need to pursue this specialty?
Refl ection
Refl ect on the quote at the beginning of the chapter about forensic nursing. Articulate your understanding of this statement. Do you
think forensic nurses should be able to function as a nurse coroner or death investigator? Explain the rationale for your answer.
NCLEX-Style Questions
1. The forensic nurse is incorporating information about a client’s phenotype and gene function in the client’s plan of care. The nurse is involved with
a. genomic health care.
b. genetic counciling.
c. pharmacogenomics.
d. genetic fi ngerprinting.
2. Which of the following is least descriptive of forensic nursing practice?
a. wide-ranging client population serviced b. independent yet collaborative practice role c. responsibilities independent of the legal system d. collection of necessary evidence
3. Which of the following must a forensic nurse do to main- tain the standards of professional performance?
a. seeking clarifi cation of confusing information b. seeking experience to maintain competence
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CHAPTER 6 Forensic Nursing Practice 69
REFERENCES
American Nurses Association. (1995). Scope and standards of nurse practitioners in correctional facilities. Washington, DC: American Nurses Publishing.
American Nurses Association & International Association of Foren- sic Nurses. (1999, February, 3rd reprint). Scope and standards of forensic nursing practice. Washington, DC: American Nurses Publishing.
Burgess, A. W., Berger, A. D., & Boersma, R. B. (2004). Forensic nurs- ing. American Journal of Nursing, 104(3), 58–64.
Doerfl er, R. E. (2004). Embracing the E-Revolution: How technology can maximize your practice. ADVANCE for Nurse Practitioners, 12(6), 35–42.
Grady, P. A., & Collins, F. S. (2003, March/April). Genetics and nursing science: Realizing the potential. Nursing Research, 52(2), 69.
Horner, S. D. (2004). Ethics and genetics. Clinical Nurse Specialist, 18(5), 228–231.
Huffstutter, P. J., & Simon, S. (2005, February 7). We have BTK killer, Kansas police say. Orlando Sentinel, p. A1, A25.
c. treating associate providers with respect d. maintaining client confi dentiality
4. When describing the specifi c activities related to forensic nursing, which of the following would the nurse be least likely to include?
a. reviewing the medical record of a victim of assault and battery
b. testifying as an expert witness in a criminal court proceeding
c. providing emotional support to a victim of intimate partner violence
d. providing direct care to a hospitalized patient who was injured in an automobile accident
5. According to the Standards of Professional Performance, the forensic nurse must demonstrate competent behavior by engaging in which of the following practices?
a. provision of cultural services b. performance appraisal
c. maintenance of a safe environment d. planning for continuity of care
6. Forensic nursing is considered one of the fastest growing nursing specialties in the 21st century. Place the follow- ing events in the development of forensic nursing in the proper sequence from earliest to most recent.
a. formal recognition of forensic nursing practice b. publication of Scope and Standards of Nursing Practice
in Correctional Facilities
c. establishment of SANE programs d. formation of the IAFN
e. creation of the Scope and Standards of Forensic Nursing Practice
International Association of Forensic Nurses. (2005a). Code of Ethics.
Retrieved August 16, 2006, from http://www. forensicnurse.org/
membership/membershipEthics.cfm
International Association of Forensic Nurses. (2005b). History.
Retrieved February 15, 2005, from http://www. forensicnurse.
org/about/history.html
International Association of Forensic Nurses. (2005c). Mission.
Retrieved February 15, 2005, from http://www. forensicnurse.
org/about/mission.html
International Association of Forensic Nurses. (2005d). What is foren- sic nursing? Retrieved February 15, 2005, from http://www.
forensicnurse.org/about/default.html
Muscari, M. E. (2004). Forensic techniques. Retrieved September 11, 2004, from http://nursing.advance-web.com/common/
Editorial/Editorial.aspx?CC=40302
Shendon, D. J. (2002). Forensic nursing: Mixing law with science.
Retrieved January 2, 2009, from http://www2.nursingspectrum.
com/articles/article.cfm?aid=6946
SUGGESTED READINGS
Cole, J., & Logan, T. K. (2008). Sexual assault response teams’
responses to alcohol-using victims. Journal of Forensic Nursing, 4(4), 174–181.
Hammer, R., Moynihan, B., & Pagliaro, E. M. (2006). Forensic nursing:
A handbook for practice. Sudbury, MA: Jones & Bartlett Publish- ers, LLC.
International Association of Forensic Nurses. (2003a). Council report of the IAFN. On the Edge, 9(4), 24.
International Association of Forensic Nurses. (2003b). Nurses. SANE- A certifi cation exam. On the Edge, 9(1), 13–14.
Keefe, S. (2006). Forensic nursing. A valuable resource for sexual assaults, death scenes and other health consequences of vio- lence. ADVANCE for Nurses, 7(5), 33–34.
Koehler, S.A. (2008). Sudden infant death syndrome deaths: The role of forensic nurses. Journal of Forensic Nursing, 4(3), 141–142.
Lawson, L. (2008). Forensic nursing: The maturing of a discipline.
Journal of Forensic Nursing, 4(4), 147–149.
McKoy, Y. D. (2005). Forensic nursing: A challenge for nursing education. Forensic Nurse. Retrieved February 26, 2005, from http:// www.forensicnursemag.com
Plichta, J. E. (2008). Exploring ethical, legal, and professional issues with the mentally ill on death row. Journal of Forensic Nursing, 4(3), 143–146.
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7
71
7 7
Advance care planning Advance directive Anticipatory grief Bereavement Disenfranchised grief Durable health care
power of attorney Dying declaration
exception to hearsay The Dying Person’s
Bill of Rights Dysfunctional grief End-of-life care
Grief Grief process Health care directive Health care proxy Hospice care Living will Loss Mourning Palliative care
Patient Self-Determination Act
Suffering Unresolved grief
KEY TERMS LEARNING OBJECTIVES
After studying this chapter, you should be able to:
1. Discuss the concepts of loss, grief, mourning, bereavement, and end-of-life care.
2. Describe at least three types of losses that an individual with a psychiatric disorder or medical illness can experience.
3. Explain the grief process.
4. Differentiate normal, unresolved or dysfunctional, and disenfranchised grief.
5. Defi ne advance care planning.
6. Compare and contrast the focus of palliative and hospice care.
7. Demonstrate an understanding of the importance of cultural competence when providing palliative or hospice care.
8. Recognize at least three barriers to receiving palliative and hospice care.
9. Construct a list of common responses associated with suffering at the end of life.
10. Articulate the needs of dying persons and their survivors.
11. State the rationale for The Dying Person’s Bill of Rights.
12. Compare the perceptions of death by children during various growth stages.
Loss, Grief, and End-of-Life Care
In this sad world of ours, sorrow comes to all… It comes with bittersweet agony… [Perfect] relief is not possible, except with time. You cannot now realize that you will ever feel better… And yet this is a mistake. You are sure to be happy again. To know this, which is certainly true, will make you feel less miserable now.
—ABRAHAM LINCOLN
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72 UNIT II Special Issues Related to Psychiatric–Mental Health Nursing People are complex, biopsychosocial beings. When they
experience the onset of a psychiatric disorder or medical illness, undergo diagnosis for altered health states, experience a loss, or progress into the end stage of life, their responses may range from mature to psychotic. Coping styles (see Chapter 2) depend on medical, psychological, cultural, and social factors as well as the individual’s personality and experiences. Caring for clients who experience a loss or who are terminally ill is an integral part of nursing; but, because we live in a culture marked by dra- matically different responses to the experiences of loss and grief, nurses often feel inadequate in planning interventions to facili- tate grief management and the healing process, or accompany clients through the process of dying. Today’s fast-paced health care environment conditions us to view death as a physiologic event, not as the sacred passage of a life and as a failure, not as part of the human cycle (Rushton, Roshi, & Dossey, 2007).
This chapter provides information to familiarize the stu- dent with the concepts of loss, grief, and end-of-life care as they are experienced by individuals, families, and/or their sig- nifi cant others.