nursing judjement outcome
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Chapter33ForensicNursing1.pptxChapter 33
Forensic Nursing
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Objectives
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Define
Define forensic nursing, forensic psychiatric nursing, and correctional nursing.
Describe
Describe the educational preparation required for the forensic nurse generalist and the advanced practice forensic nurse.
Identify
Identify the functions of forensic nurses.
Discuss
Discuss the specialized roles in forensic nursing.
Identify
Identify three roles of psychiatric nurses in the specialty of forensic nursing.
Discuss
Discuss the roles of the forensic psychiatric nurse within the legal system.
Define
Define correctional nursing and its role in reducing repeat incarcerations.
Forensic Nursing
Definition: Forensic nursing is specialized nursing care that focuses on patient populations affected by violence and trauma
IAFN formed in 1992
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The International Association of Forensic Nurses (IAFN) was formed in 1992, when 74 nurses most of whom were sexual assault nurse examiners (SANEs) came together to create an organization representing nurses whose practice overlapped with key areas of forensic science and the law (Lynch, 1997). A year after its creation, the organization had more than tripled in size; by 2019, the IAFN s membership had grown to well over 5000 nurses. The group now represents nurses who are forensic nurse generalists, SANEs, forensic psychiatric nurses, death investigators, risk managers, coroners, correctional nurse specialists, and others.
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Forensic Nursing
Provides--
Education, prevention, detection and treatment of the effects of violence in individuals, families, communities, and populations
Expert court testimony in cases related to their areas of practice and expertise
Input on policy changes within forensic settings
Evaluation and diagnoses for both victims and perpetrators
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Case Study
After doing an internship in a psychiatric correctional facility, Hector became interested in becoming a forensic psychiatric nurse. While he is interested in providing direct psychiatric services to perpetrators of crime in particular, he would also like to be able to someday offer input on policy changes in the corrections setting and offer evaluation services for inmates.
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Forensic Nursing Education
IAFN recommends forensic content be included at all levels of nursing education.
Specialty Forensic Nursing Education
Associate or Diploma Registered Nurse
Baccalaureate (BSN)
Master’s (MSN)
Doctor of nursing practice (DNP)
Doctor of philosophy (PhD)
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The IAFN recommends that forensic content be included at all levels of nursing education, both undergraduate and graduate.
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Forensic Nurse Generalist
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A registered nurse who is employed in a forensic setting can be called a forensic nurse generalist if that nurse has completed further training through continuing education or graduate studies. The nurse may acquire additional knowledge and skills by completing a certificate program comprising continuing education in an area of forensic nursing. Nurses can also gain expertise by taking secondary education electives and/or pursuing a minor in forensic topics.
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Credentials
Registered nurse
Completed further training through continuing education or graduate studies
Trauma-informed care
Master’s Level
Credentials: No master’s level credentialing
Qualifications: Master’s education with credentials in another area (e.g., nurse practitioner with a specialty focus); and related coursework
Related Coursework: psychiatric assessment and intervention skills, death investigation, forensic wound identification, evidence collection, family violence, sexual assault of all types and in varied populations, introductory law, and principles of criminal justice and forensic science
Advanced Practice Forensic Nurse
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Advanced Practice Forensic Nurse (Cont.)
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Doctor of nursing practice (DNP)
May evaluate and apply evidence-based forensic practice for the improvement of education, clinical practice, systems management, and nursing leadership
Doctor of philosophy (PhD)
Prepares nurses to initiate and conduct research in an area of forensics to advance nursing science and to ultimately enhance the practice of forensic nursing
Roles of the Forensic Nurses
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Identification and assessment of victims
Creation of appropriate treatment plans
Collection, documentation, and preservation of potential evidence
Follow-up referrals
Sexual Assault Nurse Examiner
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Care of adult and pediatric victims of sexual assault
Sexual assault nurse examiner (SANE) training course is typically 5 days (40+ contact hours)
Nurse Coroner/Death Investigator
Coroner: Public official charged with duty of determining how and why people die
Deputy Coroner/Death Investigator’s judgments are based on:
History
Symptomatology
Autopsy results
Toxicology
Other diagnostic studies
Evidence revealed in other aspects of the case
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Traditionally, the coroner is a public official primarily charged with the duty of determining how and why people die. Increasingly, nurses are prepared as death investigators or deputy coroners; they work as death investigators in medical examiners or coroners offices or independently in private offices.
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Forensic Psychiatric Nursing
Credentials
Generalist or advanced practice level
Graduate education required at advanced practice level
Can complete further training through continuing education or certificate programs
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Forensic Psychiatric Nursing
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Skills in medical nursing and psychiatric-mental health nursing assessment, evaluation, and treatment of victims or perpetrators
Criminal justice system understanding
Strong communication skills
With perpetrators
With interprofessional team
Forensic Psychiatric Nursing
Subspeciality: Competency evaluator
Collect evidence
Evaluate perpetrator’s intent
Determine whether the perpetrator had diminished capacity (impaired mental functioning) at the time of the crime
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Roles and Functions of the Forensic Psychiatric Nurse
Psychotherapist
Forensic nurse examiner
Competency evaluator
Fact or expert witnesses
Consultant
Hostage negotiator
Criminal profiler
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Psychotherapist
Forensic Advanced Practice Registered Nurse In Psychiatric-mental Health
Individual, family, and group therapy
Psychiatric Mental Health Nurse Practitioner (PMH-NP) or Psychiatric Mental Health Nurse-Board Certified (PMHCNS-BC)
Have prescriptive privileges and initiate pharmacotherapy along with psychotherapy
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Forensic Nurse Examiner
Conduct court-ordered evaluations regarding legal sanity or competency in a court case
Respond to specific medicolegal questions as requested by the court
Render an expert opinion in a written report or during courtroom testimony
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Forensic Nurse Examiner (Cont.)
Legal sanity: Able to distinguish right from wrong
Assessment: Use of drugs; medical condition affecting reason; social context of the crime
Competence to proceed: Defendants mental condition at time of trial
McNaughton Rules
Irresistible impulse—knew act was wrong but could not control behavior
Guilty but mentally ill
Legal tests of sanity may include use of the McNaughton rules that includes the terms irresistible impulse and guilty but mentally ill.
Irresistible impulse acknowledges that the person may have known the criminal act was wrong. However, it stipulates that if a person could not control behavior because of a psychiatric illness or a “mental defect,” the defendant is not guilty.
Those who plead guilty but mentally ill are remanded (sent) to the correctional system where they receive treatment for their mental disorder. They are then subject to the correctional system’s parole decisions.
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Competency Evaluator
Determine Legal Competence of Defendant
Assess mental health or illness
Conduct a forensic interview
Provide documentation
Complete a formal report to the court
Testify as an expert witness
Becoming an advocate for the defendant, rather than for the process, is a breach of professional boundaries.
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Fact and Expert Witnesses
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Fact Witness
What was personally seen or heard, performed, or documented
Expert Witness
Recognized by the Court as having a certain level of expertise in a designated area
Routinely used in medical malpractice cases
Summarize and explain complex and voluminous medical records and terminology
Consultant
Interagency cooperation between mental health and law enforcement
Provide advice to mental health agencies regarding the care of the individuals with legal issues
Consult with law enforcement regarding the status and suggested treatment of individuals with mental illness
Advocate for families and patients
Focus on perpetrator’s well-being even if that results in civil detention and admission to hospital
May serve either side in a court case
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Being on call around the clock to assist law enforcement officers on the scene
Providing suggestions regarding negotiation techniques
Assessing the mental status of the perpetrator
Providing a link to mental health agencies
Participating in a critique of the hostage incident
Assessing released hostages
Providing training in communication skills to law enforcement officers
Hostage Negotiator
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Criminal Profiler
Attempts to provide law enforcement officials with specific information about the type of individual who may have committed a certain crime
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Correctional Nursing
Correctional nursing refers to the care of people who are involved with the criminal justice system. Often, this presents challenges to the way nurses think about patients, especially when viewed within the limited context of victim and perpetrator.
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Refers to the care of people who are involved with the criminal justice system
Presents challenges to the way nurses think about patients
Working in a correctional setting alone does not make a person a forensic nurse
Advanced education and clinical practice focusing on unique needs of the population
Correctional Nursing
Because of the long-term effects on recidivism (repeat offenders) and resource allocation, policy makers and legislators are beginning to recognize the importance of providing treatment for incarcerated individuals.
Especially critical within this population is a history of trauma or posttraumatic stress disorder (PTSD). However, the correctional setting is not conducive to the intensive therapy required to treat these issues adequately. Unfortunately, the needs of the vast majority of people in the correctional system with PTSD and/or a history of trauma are not adequately addressed.
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Custody versus caring debate
Role of correctional nurse defined by location of the work or legal status of the patient
Correctional nursing provides treatment and services for inmates with chronic psychiatric conditions
Care for inmates in a cycle of homelessness, psychiatric hospitalization, and imprisonment
Importance of treatment for incarcerated individuals
Quick Quiz
A person charged with murder was found guilty but mentally ill. This individual
will spend the rest of his life in a psychiatric facility.
will spend the rest of his life in a prison.
will most likely face the death penalty.
may be eligible for parole.
ANS: D
Those who plead guilty but mentally ill are remanded to the correctional system, where they receive treatment for their mental disorder. They are then subject to the correctional system’s parole decisions.
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