In this paper, the author will outline and explain a curriculum proposal for a Master of Science degree in Nursing Forensics. This proposal would be presented to the School of Nursing for their consideration as a means of bringing more students into the Graduate Program. Forensic Nursing is a new and challenging field of practice for nurses. It has been attracting nurses from various areas of practice, such as Emergency Room, Critical Care, Women's Health and Psychiatric-Mental Health. As both academia and the public face a new nursing shortage, the School of Nursing must look to new venues as a way of attracting nurses to complete or enhance their education. This curriculum proposal should address the issues of both a decrease in student enrollment and a need for a degree based program in Forensic Nursing.
Forensic Nursing is the application of forensic science, combined with clinical nursing practice as they are applied to public or legal proceedings in the law enforcement arena. It is the application of forensic aspects of health care combined with biopsychosocial education of the registered nurse in the scientific investigation and treatment of trauma, death, violent or criminal activity, and traumatic accidents within the clinical or community institution (Lynch, 1991). The patients that are treated can be victims of sexual assault, elder, child and spousal abuse, unexplained or accidental death, trauma and assault, as well as the perpetrators of these and any other criminal activity (Nursing Spectrum, 2000).
According to Rochon (1999), the focus of forensic nursing is clearly defined and represents a unique body of knowledge that is not found in the realms of nursing, law enforcement or forensics. The forensic nurse is educationally prepared with experience in each of these knowledge bases.
The International Association of Forensic Nurses was established in Minneapolis,Minnesota in 1992 when 70 nurses gathered for the first national convention of sexual assault nurses. Their mission statement represents the concept of nurses willing to devote their energy and resources to develop a role in nursing that can have a great impact on the future of both forensic science and health care professionals. By 1998, the New Jersey chapter alone had grown to 1,500 members who practice in diverse fields of nursing forensics. The jobs range from sexual assault nurse examiners (SANEs) to nurses who specialize in such areas as domestic violence, child and elder abuse, and emergency trauma. Forensic nurses may also serve as legal nurse consultants or attorneys (Nelson, 1998).
The forensic nurse provides direct services to individual clients, consultation services to nursing, medical and law-related agencies, as well as providing expert court testimony in areas dealing with trauma and/or questioned death investigative processes, adequacy of services delivered, and specialized diagnoses of specific medical conditions (Forensic Nursing Services, 2000).
According to Lynch (1995), violence and its associated trauma are widely recognized as a critical health problem in North America and throughout the world. Forensic nursing represents a new era of nursing practice that is evolving in direct response to the sequelae of criminal and interpersonal violence. The application of the principles and standards of the forensic specialist in nursing has been recognized as a vital new role in trauma care in the 1990s. Daily, nurses encounter the results of human behavior extremes: abused children, victims of neglect, self-inflicted injury, firearm injuries, knife wounds and other assaults.
Statistics from the United States Department of Justice help to substantiate the need for forensic nursing. Each year, women are the victims of more than 4.5 million violent crimes, including approximately 500,000 rapes or other sexual assaults. Men, however, were more likely than women to experience violent crimes committed by both acquaintances and strangers. In fact, men were about twice as likely as women to experience acts of violence by strangers(Bachman & Saltzman, 1995).
Estimating rates of violence against women, especially sexual assault and other incidents committed by intimate offenders, continues to be a difficult task. Many factors inhibit women from reporting these crimes either to the police or to government interviewers. The private nature of the event, the perceived stigma and the belief that no purpose would be served in reporting the crime keeps an unknown portion of the victims from talking about the event. Thus, nurses trained as Forensic Nurse Specialists or as a part of the Sexual Assault Response Team (SART) would help by establishing a caring relationship with the victims in the emergency departments.
According to White and Murdock (2000), various researchers have listened to women victims and challenges have been set out about reshaping services to victims in order to maximize the nurses' potential to deliver gender sensitive care and treatment. Nurses have been challenged to share responsibility with the legal system to augment the resources available to patients with liability-related injuries, crime victims, and perpetrators or suspects in police custody. The injuries of these victims are the concern of society as a whole and require a complement of social systems interfacing with both health care and the law in order to provide solutions. With formal and informal education in forensic nursing, more expert clinicians are available to provide services to patients that will help to protect their legal rights.
Forensic nursing's scientific knowledge base emerges from theories of nursing, forensic science, criminal justice, police science, and legal studies. The theoretical model of forensic nursing evolved from the role of the police surgeon or police medical officer in the United Kingdom and Europe. This practitioner is hired by the local police department and is responsible for facilitating the management of the victim from the crime scene and on through the legal process (Lynch, 1995).
As a public service profession, nursing has a responsibility to maintain standards of practice while processing victims of human violence. Frequently cases are won or lost based on the handling of evidence. If health care professionals fail to incorporate forensic guidelines, misinterpretation or omission of evidence may result in a miscarriage of justice.
Clinical forensic nursing is designed to provide a solution to medicolegal-related problems in trauma departments. In addition to medicolegal issues, sensitivity to victims and families has historically been an exclusive concern of victim advocates from the perspective of basic human rights. As a patient advocate,it is a concern for the clinical forensic nurse.
According to McCracken (1999, b), health care and the law often become enmeshed during the critical moments when patient care supersedes the concern for social justice. Physicians, though supportive of the patient, focus their interventions on immediate lifesaving measures and in doing so, often unwittingly destroy crucial evidence. Due to the nature of the emergency room clientele and the emergency care setting, there is a forensic opportunity for the emergency room nurse to play an important role in the pursuit of justice in areas of crime and victimization.
The emergency room nurse is usually the first to see the patient, first to talk with the family, first to handle the patient's property and first to deal with lab specimens. The emergency nurse must be proactive in recognizing that any patient admitted to the emergency room with potential liability-related injuries, whether victim or victimizer, living or dead, is a clinical forensic patient (Lynch, 1995).
According to Authur and Baumann (1996), rapid changes in health sciences necessitate frequent revision of nursing curricula. A program that prioritizes health issues by such factors as magnitude, quality of life, duration of illness, case fatality rate, and concurrent burdens can help determine essential curriculum content. The caring aspects of nursing are often overshadowed by a scientific-technical emphasis. Nursing curriculum should demonstrate a balance of empirical, aesthetic, personal, and moral knowledge (Lafferty,1997). Thus, a program in forensic nursing would not only meet the challenge of an emerging field of nursing practice, but would also reintroduce the caring principle into the delivery of nursing care while still maintaining the legal rights of the victim.
The audience to which this proposal would be directed would initially be the Graduate Program Committee of the School of Nursing of Widener University. This committee is composed of the Associate Dean for Graduate Studies and most of the faculty that teach in the Graduate program of the school. If approved by the Graduate Program Committee, a recommendation for acceptance would be presented to the Full faculty of the School of Nursing (both Undergraduate and Graduate faculty) for their consideration and vote. A time frame for implementation would be considered at that time.
The student population targeted for this degree would be nurses with Psychiatric, Emergency/trauma, Critical Care or Women's Health backgrounds. They must possess a willingness to work or deal with patients exhibiting extremes of human behavior. A bachelor of science in nursing would also be required for consideration in this program.
The Master of Science in Nursing degree program is designed for registered nurses who wish to pursue advanced leadership positions in both the community and health care systems.
The specialty in Forensic Nursing prepares nurses to:
The program is planned on a part-time, two-year calendar through evening,weekend, or summer courses. The course sequence is flexible, but is designed to combine the core nursing courses with the clinical specialty courses. The program is capped with a practicum where students also apply the research component to their practice.
A. Core Nursing Courses
|NURS 611||Conceptual Models||3 credits|
|NURS 623||Nursing Leadership||2 credits|
|NURS 638||Issues in the Underserved Population||3 credits|
|NURS 652||Statistical Analysis||3 credits|
|NURS 665||Issues in Advanced Nursing Practice||2 credits|
Scholarly Inquiry Requirements
|NURS 653||The Research Process||3 credits|
|NURS 702||Epistemology||3 credits|
|NURS 815||Qualitative Research||3 credits|
B. Required Cognates in the Forensic Nursing track
|LAW 797||Advanced Forensic Evidence||2 credits|
A minimum of one course from the Psychology offerings
|DPSY 622||Substance Abuse||3 credits|
|DPSY 710||Basic Psychopathology||3 credits|
|DPSY 762||Child Sexual Abuse||3 credits|
One of the following courses:
|CJ 688||Law and Society||3 credits|
|LAW 505||Criminal Law||3 credits|
C. Required Nursing Courses in the Forensic Nursing track:
|CJ 609||Domestic Violence||3 credits|
|NURS 860||Introduction to Forensic Nursing||2 credits|
|NURS 861||Scientific Foundations for Forensic Nursing||2 credits|
|NURS 862||Role of the Forensic Psychiatric Nurse||3 credits|
|NURS 866||Practicum in Forensic Nursing||3 credits|
Total credits: 43 credits
The goals of this curriculum is to provide the graduates with challenging opportunities to combine nursing knowledge with investigative and counseling skills. Forensic nursing is the cutting edge issue in education, practice,and research as the profession of nursing prepares for critical issues in health care in the twenty-first century (New Jersey Association of Forensic Nurses, 1999). This curriculum allows the nurse to become part of a new and emerging specialty.
According to McCracken (1999, a), "it's time that emergency care providers do their part in narrowing the gap in the chain of the medicolegal process of evidence collection in the ER/Trauma setting. When the law and health care coincide, a multidisciplinary approach is activated. There needs to be a coordination and collaboration among all those who come in contact with the client" (p. 1).
The nurse must assume a mutual responsibility in protecting the legal,civil, and human rights of the victims of violent crimes, as well as the constitutional rights of the perpetrator. A standard form of practice will enhance investigations with the resulting increase in expediting of conviction in areas where a crime has been committed or the presentation of evidence that will exonerate the innocent.
This curriculum will provide a standard of practice based on consistency(recognition of potential evidence and comprehensive data documentation), competency (proper collection and preservation of evidence), and credibility (performance as an expert witness and member of a multidisciplinary team).
This degree program is being proposed to the School of Nursing as a means of generating revenue through increased enrollment. Oesterle and O'Callaghan (1996) looked at the problems associated with the rapidly changing health-care system and the anxiety caused by it. They suggested that a shift in nursing education is necessary in order to provide competent primary health-care practitioners. Dandino-Abbott (1999) showed that forensically trained nurses working on Sexual Assault Response Teams(SARTs) were able to reduce the length of stay of sexually assaulted patients in the Emergency Departments, while at the same time improve the documentation and coordination of intra-agency services. This improvement was attributed to o an increase in nursing confidence through expanded education.
A degree in Forensic Nursing can provide new arenas of employment for its graduates. According to Nelson (1998), "Forensic nursing is a new and upcoming specialty. The day may be coming when every hospital needs a forensic nurse on staff. Hospitals don't like to hear this, but it is becoming necessary because of the increase in crime" (p. 3). Forensic nurses are especially needed in the emergency room to gather and package evidence. "Nurses are taught to cleanse a wound, but if it's a suspect in a criminal case, we are washing away valuable evidence. Hospitals need to learn that throwing away valuable evidence is costing taxpayers a lot of money." (p. 3).
Practice roles for forensically trained nurses include: Sexual Assault Nurse Examiner (SANE), nurse coroner, nurse investigator, correctional nurse,forensic psychiatric nurse, pediatric/geriatric educator, researcher, and consultant (Nursing Spectrum, 2000). They can be employed in acute care facilities, correctional institutions, county prosecutor and coroner's offices, medical examiner's office, insurance companies, and psychiatric facilities.
Forensic nurses' responsibilities vary from performing death investigations and working with criminals in prison to counseling school children on firearms safety. The salaries of these nurses are as diverse as their roles. Forensic nurses who work as independent consultants may be on call 24 hours a day and earn high hourly rates. Those employed full time in emergency rooms or the medical examiner's office may work regular shifts and earn lower salaries. Many nurses use forensics as a springboard into their own businesses that help to set up sexual assault response teams and offer educational programs within the community (Nelson, 1998).
Forensic Nursing is gradually gaining visibility. The American Nurses Association (A.N.A.) recognized it as a subspecialty in 1995 and the International Association of Forensic Nurses (IAFN) is working to establish a core curriculum. National certification will follow. Therefore, a Master of Science in Forensic Nursing will be essential for these nurses.
Upon investigation, there are few colleges or universities offering a complete degree program in Forensic Nursing. Fitchburg State College in Massachusetts currently offers a Master's degree in Forensic Nursing through a two year, part-time program. Other colleges, such as Beth-El College of Nursing and Health Science in Colorado offers a post Baccalaureate and a post Master's certificate in adult health with only a clinical emphasis on forensics. Locally, the University of Pennsylvania and Rutgers University offer continuing education seminars on Forensic Nursing. These seminars are offered only one weekend (either Spring or Fall semester) per academic year. For those students experienced with distance learning courses, Mount Royal College in Calgary, Canada offers courses on forensic nursing (not degree completion) through the Internet.
Funding for this degree program would come from the School of Nursing. Implementing the degree program will increase the number of students in the program and subsequently generate revenue for the School. A bulk of the courses required for this degree completion are currently offered by either the School of Nursing or by other schools within the Widener University system. No new faculty within the School of Nursing would be needed to teach this course, as Graduate faculty that currently teach in the Critical Care track or the Family Nurse Practitioner track could teach the Forensic Nursing Courses.
Additional funding, if needed, may be sought from Federal government sources, such as the Violence Against Women Act. The Office for Victims of Crime under the Federal Department of Justice also fund grants for institutions interested in providing education to woman on the topic of Sexual Assault Resource Services.
Faculty within the School of Nursing may also apply for grants to various Nursing organizations and agencies for funding for this curriculum. Possible agencies that could also be utilized are the National Organization for Women(NOW), International Association of Forensic Nurses (IAFN) and Planned Parenthood. Forensic Nursing Services of Santa Cruz, California also offers technical and monetary assistance in setting up programs that train and educate nurses to become SANEs or a part of a SART.
The life, health and safety of each patient comes first. Evidence collection is important but secondary. The efforts that the nurses make on the patients' behalf in both areas may affect them for the rest of their lives. The Index of Suspicion is the nurse's intuitive (gut) feeling based upon their professional experience, speed of reasoning, and most importantly, his/her education. According to McCracken (1999, c), this intuition signals that a particular patient or situation has potential forensic consequences. The RN must train his/her mental processes to include the possibility that any patient is a clinical forensic patient.
It is important to remember that all patients have an emotional-psychological-spiritual side. It is true not only of victims of trauma/crime, but also true of the perpetrators. The RN must treat all patients with dignity and respect. Therefore,the degree proposed should include courses based on psychology and sociology.
Courses in criminal justice and law are an integral part of the degree program. Preparation for court begins as soon as the RN is aware of a potential criminal or civil legal action. Attention to evidence and its accurate and proper documentation will serve as his/her memory, making the RN a more confident, competent, and reliable witness. They must be prepared to explain and teach the court, within the limits of their individual experience.
NURS 611 MODELS AND THEORIES FOR ADVANCED PRACTICE NURSING
An examination of selected models and theories that influence advanced practice nursing and the development of nursing science. Development and evaluation of models and theories from nursing and other disciplines will be discussed, and issues in theory development will be explored. Selected models and theories will be analyzed for their utility to advanced nursing practice. Application of models and theories to nursing practice, research,administration, and education will be evaluated.
NURS 623 NURSING LEADERSHIP: THE ADVANCED PRACTICE ROLE
This course provides an overview of leadership behaviors in systems of care, including health care providers and professional organizations. Emphasis placed on shaping practice; organizational design and structure; culture,values, and climate; and theories of motivation, leadership, communication,power, conflict and change. Information from this course provides the framework for graduate nursing students to implement an advanced practice role.
NURS 638 ISSUES IN HEALTH CARE FOR UNDERSERVED POPULATIONS
This course explores issues surrounding the medically underserved populations in the United States. Societal influences, lifestyles, health care needs,and beliefs and solutions to problems of the medically underserved are emphasized.
NURS 653 THE RESEARCH PROCESS
This course addresses the application of inquiry to nursing problems. The focus of the course is on the critique of nursing research, the planning and development of a research proposal, and the use of appropriate models for dissemination and utilization of nursing research findings. Current nursing research literature will be examined and evaluated.
NURS 665 ISSUES IN ADVANCED NURSING PRACTICE
This course focuses on analysis of issues inherent in current and emerging advanced nursing practice roles and implementation of strategies to solve these issues. State, national, and international health policy processes and strategies for influencing outcomes are emphasized. Students develop strategies for enhancing the role of advanced practice nurses in political decision making. In addition, career planning as a component of continuing professional development is considered.
NURS 702 EPISTEMOLOGY
Examines the nature of knowledge based on ideas, the senses, and scientific information. Knowledge development is explored through a variety of ways of thinking and ways of knowing. Logical thinking, reasoning, and argument are discussed and practiced.
NURS 815 QUALITATIVE RESEARCH
An overview of research designs and methodological approaches commonly encountered in conducting qualitative research, such as ethnography, hermeneutics, field research, and phenomenology.
(Widener University, School of Nursing, 1999)
LAW 505 CRIMINAL LAW
This course studies the general principles that underlie statutory criminal liability, including a consideration of their judicial application in the context of selected offenses and defenses.
LAW 797 ADVANCED FORENSIC EVIDENCE
This is an advanced course in evidence, with primary emphasis on cutting edge scientific developments, taught by an experienced trial lawyer anda Ph.D. scientist, with many guest lecturers.
(Widener University, School of Law, 1996)
609 DOMESTIC VIOLENCE AND THE JUSTICE SYSTEM
The main objective of the course is to introduce students to the subjec tof family violence, especially as it relates to the legal system in the United States. This will be accomplished by exploring: a). the historical roots of domestic violence; b). the social science theoretical perspectives; c). the roles and the players; d). the typical criminal prohibitions; e).the experiences of victims who seek help from court, religious, and medical authorities; and f). efforts at developing prevention and intervention strategies.In addition, the course will seek to develop skills in students to find and evaluate information on family violence, especially as it is found in sociological sources and court records.
CJ 688 LAW AND SOCIETY
This seminar focuses on selected issues and problems confronting criminaljustice and the legal system.
(Widener University, School of Criminal Justice, 1999)
DPSY 622 SUBSTANCE ABUSE
This course is intended to introduce students to the field of substance abuse. The course will attempt to acquaint students with general theoretical orientations to the identification, assessment, and treatment of substance abuse.
DPSY 710 BASIC PSYCHOPATHOLOGY
A survey of the etiology, diagnosis and treatment of different typesof psychopathology of adult life. The course integrates and extends previous material in abnormal behavior, assessment techniques and different modes of intervention.
DPSY 762 CHILDHOOD SEXUAL ABUSE: CLINICAL & LEGAL CONSIDERATIONS
Material from court cases involving neuropsychological evaluation and testimony. The entire progression from referral through outcome is discussed in detail. Cases range form young children through geriatrics and involve fields of personal injury, malpractice and civil rights.
(Widener University, Institute for Graduate Clinical Psychology, 2000)
NURS 860 INTRODUCTION TO FORENSIC NURSING
This course establishes the foundation for forensic decision making in advanced nursing practice with an emphasis on a holistic approach to living victims and perpetrators. The relationship between sociocultural factors and violence is explored. This course also includes an incisive exploration of the principles and philosophies of clinical forensic nursing as well as the role of the forensic nurse in the scientific investigation of violence,trauma, medical-legal and ethical-legal issues. Topics include assaults, accidents, homicides, suicides, custody, documentation, expert witness testimony, and anatomical gifts. Students learn basic forensic health assessment.
NURS 861 SCIENTIFIC FOUNDATIONS FOR FORENSIC NURSING
This course provides a comprehensive overview of specialized topics in clinical forensic practice and pathology. It furnishes a foundation for the advanced nursing role in the collection of data and the scientific investigation of injury and death. Topics include the advanced role in medical-legal investigative systems, preservation of evidence, identification of wounds due to trauma, domestic violence, and sexual violence. Additional topics covered are laws and definitions, time of death considerations, deaths due to natural causes, asphyxia, and environmental, toxicological and iatrogenic deaths.
NURS 862 ROLES OF THE FORENSIC PSYCHIATRIC NURSE
This course focuses on the nursing process for clients who have psychiatric disorders which cause involvement with the legal system. The process for working with substance abusers, as well as the reciprocal relationships between the clients and their families and communities are also explored. Primary, secondary, and tertiary prevention of mental illness and addictions is stressed with emphasis on the care of clients with dual diagnoses and on the development of problem behavior in the school-age population.
NURS 864 PRACTICUM IN FORENSIC NURSING
In this capstone course, students select one (or more) area(s) of nursing practice to pursue in greater depth. After prior consultation with the program faculty, students find a clinical placement that gives them the opportunity for role negotiation and role development in the forensic nursing practicum. During the practicum, priority is placed on the development of leadership roles and interpersonal and psycho-motor skills needed to serve a selected client population under the preceptorship of an expert nurse. Nursing competence in primary, secondary, and tertiary prevention activities is a required outcome.
(Adapted from Fitchburg State College, 2000)
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