INTRODUCTION:

Forensic techniques are enormously useful in a wide range of fields outside the criminal justice system-Mark Walport.

Forensic nursing investigates criminal sexual or physical assaults and accidental deaths, and acts as a bridge between the health care system and the criminal justice. Thus, a forensic nurse is a unique qualified medical person trained to observe, document and preserve the evidence of the incident or happening for the subsequent public or legal proceedings.

Taking photos and making videos of the incident and injuries are very important to aid the legal and civil proceedings. The major subspecialties of forensic nursing include sexual assault investigations, forensic psychiatric nursing, accidental death evidence and medical-legal consulting¹. World over, the victims of violence, abuse, and crimes need care from a certified health professional trained to treat trauma associated with the wrong that has been done to them. Forensic nursing professionals are a critical resource for all anti-violence efforts. They play an important role in the team of forensic health professionals by collecting evidence and giving testimony that can later be used for apprehending perpetrators who commit violence and abusive acts. Violence is an ever-present and rising social and health problem and forensic nurses are the links between the healthcare system and law¹.

METHODOLOGY:

This article is derived from extensive research gathered from a diverse range of sources, including books, national and international journals, online platforms (such as WHO, Wikipedia, Biomed Central, and Healthline), and various databases like PubMed, Google Scholar, Wiley, ResearchGate, and Springer.

What is forensic nursing?

Forensic Nursing is a specialized area of nursing that integrates nursing care expertise with comprehensive knowledge of forensic medicine and the criminal justice system². This career is dynamic and multifaceted, encompassing a range of activities such as direct patient interaction, gathering evidence for legal cases, and collaborating with law enforcement, attorneys, and social service agencies. Above all, it is a meaningful role dedicated to enhancing the lives of society's most vulnerable individuals³.

What is a forensic nurse?

A forensic nurse is a Registered or Advanced Practice Nurse with specialized education and training. These professionals deliver targeted care to patients suffering from both immediate and long-term health effects related to victimization or violence, as well as addressing any evidentiary needs for those who have been victimized or accused of such actions. In addition to providing direct patient care, forensic nurses also offer expert consultation and testimony in civil and criminal cases, focusing on nursing practices, the care provided, and their professional opinions on relevant findings. Importantly, forensic nursing care is not an isolated practice; it is seamlessly integrated into the comprehensive healthcare needs of individual patients⁴.

History and Development of Forensic Nursing:

The origins of forensics and medicine can be traced back to early civilizations, where ancient Egyptian and Hindu medical practices demonstrated a grasp of poisons and toxicology (Smith, 1951). In Greece, Hippocrates contributed to the discussion of injury patterns and the ethical commitment to refrain from using poisons. The Romans also utilized injury pattern analysis to determine causes of death, as seen in the case of Julius Caesar (Smith, 1951). Furthermore, ancient Chinese texts provide evidence of medical investigations into death and the identification of wounds (Smith, 1951). Given this historical context, it is only fitting that forensics eventually became an integral part of nursing.

Published research indicates that forensic nursing practices were well established in the United Kingdom during the 1950s (Smith, 1951). Healthcare professionals, particularly nurses, often collaborated with law enforcement to deliver healthcare and forensic medicine to individuals in custody and within the “custodial environment” (Officer, 1979). This role primarily focused on individuals with mental health and substance use disorders, as well as those affected by child sexual assault (Officer, 1979).

Clinically, these nurses were responsible for collecting medical histories, administering medications, assessing mental health conditions, evaluating an individual’s capacity to be interviewed, preparing reports for law enforcement, providing testimony in court, and serving as fact or expert witnesses (Officer, 1979). Many of these responsibilities required additional training and experience, specifically in areas such as precise injury documentation and forensic interpretation, as well as the collection of forensic samples and the examination of suspicious deaths and sexual assault victims (both adults and children). In contrast, other healthcare systems have linked forensic nursing to mental health, historically referred to as “forensic psychiatry,” where individuals were termed “forensic patients” and treated in “forensic units” within the criminal justice framework (Galappathie, Khan, & Hussain, 2017).

The origins of forensic nursing in the United States can be traced back to the 1970s (Speck & Aiken, 1995; Clark, 1976), with a significant focus on caring for victims of sexual assault (Clark, 1976). Pioneering research by Nurse Ann Burgess and sociologist Lynda Holstrom played a crucial role in this field, as they studied the experiences of sexual assault victims and contributed to the development of concepts such as rape trauma syndrome and their related treatments (Burgess & Holstrom, 1985). During this time, nurses were integral to the functioning of sexual assault centers, where they provided counselling, assisted victims throughout their emergency visits, and offered guidance and support during initial encounters and subsequent care.

The formal recognition of forensic nursing emerged in the early 1980s, thanks in part to the advocacy of Virginia Lynch (Lynch & Duval, 2011). Soon after, the Scope and Standards of Forensic Nursing Practice were established to standardize the profession, coinciding with the formation of the International Association of Forensic Nurses (IAFN). Initially rooted in death investigations, forensic nursing in the United States has since expanded into various nursing specialties, leading to the emergence of specialized forensic nurses equipped with distinct degrees and certifications⁵.

SCOPE OF FORENSIC NURSING:

1. Forensic nurses are actively engaged in hospital settings and also serve the community:

Forensic nurses play a crucial role at the intersection of healthcare and the legal system. In hospital settings, they provide specialized care to victims of violence, trauma, or abuse, often collecting forensic evidence to aid in legal investigations. Their expertise helps ensure that patients receive appropriate medical treatment while also documenting injuries and gathering information that may be vital in court.

In addition to their hospital roles, forensic nurses also extend their services to the community. This includes outreach programs, education on topics like sexual assault, domestic violence, and substance abuse, and collaboration with law enforcement and legal professionals. By working within the community, they aim to raise awareness, provide support to victims, and contribute to prevention efforts, ultimately improving overall public health and safety.

2. Forensic nurses identify issues that could have significant legal implications for society:

Forensic nurses play a crucial role in the intersection of healthcare and the legal system. They are specially trained professionals who provide care to patients who have experienced trauma or violence, often in the context of criminal cases, such as sexual assaults or domestic violence incidents.

By identifying and documenting physical evidence, such as injuries or signs of abuse, forensic nurses contribute to the investigation and prosecution of crimes. Their observations and reports can significantly influence legal proceedings and outcomes. Furthermore, they can spot trends or patterns related to public health, such as increases in specific types of violence, which can lead to broader societal discussions and policy changes on prevention and intervention strategies.

Through their work, forensic nurses help ensure that victims receive appropriate medical care while also safeguarding legal integrity, ultimately shaping how society responds to and addresses issues of violence, crime, and public safety.

3. They document injuries and unite communities to address challenges such as violence, sexual abuse, and inadequate care:

The phrase "They document injuries and unite communities to address challenges such as violence, sexual abuse, and inadequate care" refers to a proactive approach taken by individuals or organizations to tackle serious social issues.

· Documenting Injuries: This involves gathering evidence and recording incidents of harm, whether physical or psychological. This documentation is crucial for raising awareness about the prevalence and impact of issues such as violence and sexual abuse. It can also serve legal and advocacy purposes, helping to hold perpetrators accountable and ensuring that victims receive the necessary support.

· Uniting Communities: This aspect emphasizes the importance of community collaboration. By bringing people together, different stakeholders—including survivors, activists, healthcare providers, and local organizations—can share their experiences, resources, and insights. This collective effort helps to build a stronger response to the issues at hand.

· Addressing Challenges: The phrase specifically mentions violence, sexual abuse, and inadequate care as key challenges. By focusing on these areas, the goal is to create safer environments, provide better support systems for victims, and improve overall care and resources available to those affected. Through community engagement, advocacy, and education, those involved can work towards meaningful change and healing.

Overall, the statement highlights the interconnectedness of documentation, community action, and social justice in tackling complex societal issues.

4. They consistently support families dealing with sudden loss when death occurs unexpectedly:

This statement highlights the ongoing commitment of certain individuals or organizations to help families who experience an unexpected death. It implies that they provide emotional, practical, and possibly logistical support to those who are navigating the complexities of grief and loss. When death comes without warning, families often face a range of challenges, including shock, disbelief, and the need for immediate decisions regarding funerary arrangements or legal matters. The support referenced in the statement may include counselling, assistance with planning memorial services, helping to communicate with other relatives, or providing resources for coping with grief. Overall, it underscores the importance of compassionate care during one of life’s most difficult moments.

5. Forensic nurses play a vital role in disaster preparedness and response efforts:

Forensic nurses are specialized healthcare professionals who apply their nursing skills within the legal and criminal justice systems. Their role in disaster preparedness and response is essential for several reasons:

· Assessment and Care: Forensic nurses are trained to assess and treat injuries, which can be particularly important in the wake of a disaster. They can identify trauma and provide immediate care to victims, ensuring that emergencies are addressed quickly.

· Evidence Collection: In disaster situations, there may be violent incidents or criminal activities associated with the event. Forensic nurses have the expertise to collect evidence, maintain the chain of custody, and document injuries, which is crucial for any potential legal proceedings.

· Mental Health Support: Disasters can lead to significant psychological trauma. Forensic nurses can provide support and referrals for mental health services to individuals affected by the disaster, addressing both physical and emotional needs.

· Education and Training: Forensic nurses can help educate other healthcare providers and emergency responders about the best practices for managing disaster situations. They can offer training on recognizing signs of trauma and dealing with victims of violence or abuse during chaotic situations.

· Interdisciplinary Collaboration: In disaster response, teamwork is vital. Forensic nurses often collaborate with law enforcement, emergency medical services, and public health officials to create a comprehensive approach to disaster care and investigation.

· Crisis Planning: During the disaster planning phase, forensic nurses can help develop protocols and procedures to ensure that the healthcare system is prepared to handle potential crises effectively. They bring insight into how to manage both victims and perpetrators in emergency situations.

· In summary, forensic nurses contribute significantly to disaster response efforts by providing immediate care, preserving evidence, supporting mental health, educating other professionals, collaborating across disciplines, and participating in crisis planning, making them an invaluable asset in emergency situations.

6. They engage in discussions about legal cases, aiding attorneys in understanding complex medical terminology and the methods of care provided to the community.

This sentence describes a collaborative effort between healthcare professionals and attorneys in the context of legal cases. Here's a breakdown of its components:

· Engage in discussions about legal cases: This indicates that the individuals involved are actively participating in conversations regarding legal matters, which could involve the analysis of case details, evidence, and relevant laws.

· Aiding attorneys: This suggests that the primary purpose of these discussions is to support lawyers. The healthcare professionals might be providing insights that help attorneys prepare for cases, understand legal implications, or develop arguments.

· Understanding complex medical terminology: Medical cases often involve nuanced and technical language that can be difficult for those without medical training to comprehend. This aspect of the collaboration focuses on ensuring that attorneys grasp the specific terms and concepts that are pertinent to the healthcare aspects of the cases.

· Methods of care provided to the community: This refers to the various healthcare practices, treatments, and services available to the public. Understanding these methods is crucial for legal professionals, especially in cases related to medical malpractice, patient rights, or health regulations.

Overall, the sentence highlights the important intersection of legal and medical fields, emphasizing the need for clear communication and understanding between attorneys and healthcare experts to effectively navigate legal cases that involve medical issues.

7. Wherever there is an injury, there is an opportunity for a forensic nurse specialist to take action.

The phrase "Wherever there is an injury, there is an opportunity for a forensic nurse specialist to take action" highlights the critical role that forensic nurses play in situations involving injuries, particularly those that may be related to criminal activity or abuse.

Forensic nurse specialists are trained to assess, document, and treat injuries while also collecting evidence that may be vital for legal proceedings. Their expertise is essential in various contexts, such as:

· Victim Support: Forensic nurses provide care to victims of violence, sexual assault, or trauma, ensuring their physical and emotional needs are addressed.

· Evidence Collection: They are skilled in gathering and preserving physical evidence from injuries in a way that maintains its integrity for potential legal cases.

· Thorough Documentation: Forensic nurses document findings meticulously, creating detailed reports that can be used in court and may play a crucial role in the justice process.

· Interdisciplinary Collaboration: They often work closely with law enforcement, legal teams, and social services to ensure a comprehensive approach to care and investigation.

· Education and Prevention: Forensic nurse specialists also participate in community education and preventive measures, raising awareness about issues such as domestic violence and sexual assault.

In essence, the statement underscores the important intersection of healthcare and law enforcement, emphasizing how forensic nurses serve as vital advocates for victims while also contributing to the broader justice system⁶.

DIFFERENT ROLES AND RESPONSIBILITIES OF FORENSIC NURSES SPECIALIST

1. Patient Support Services:

Forensic nurse specialists deliver holistic care to individuals affected by trauma or violence, integrating comprehensive nursing practices that address the body, mind, and spirit with specialized knowledge in legal and forensic matters. This unique combination ensures that the medical and evidentiary requirements of patients are effectively addressed. Forensic nurses handle various trauma cases, including those resulting from sexual assault, domestic violence, and other violent crimes. Their practice is consistently trauma-informed, prioritizing patient safety and support throughout the entire care process.

2. Evidence Collection:

A vital responsibility of forensic nurses is the meticulous collection and preservation of evidence. This process is governed by stringent protocols to guarantee that the evidence is admissible in legal contexts. Forensic nurses are trained in effective techniques for documenting injuries, gathering biological samples, and ensuring the chain of custody for all evidence collected. Their thorough attention to these procedures ensures that the evidence obtained can endure rigorous examination in court.

3. Legal Testimonies:

Forensic nurses fulfil dual roles in court as both fact and expert witnesses. In their role as fact witnesses, they share insights only on their direct observations and the actions taken during their professional responsibilities, which may include specifics of the forensic examination and adherence to established protocols. As expert witnesses, they can offer opinion testimony grounded in their specialized knowledge and experience, addressing topics like the interpretation of medical findings, victim behaviour observed during examinations, and the implications of certain injuries. Their testimony is highly regarded for its perceived impartiality and professional expertise. Throughout legal proceedings, forensic nurses are expected to uphold a strong standard of professionalism and objectivity, providing their findings in an honest and unbiased manner, thus playing a vital role in the pursuit of justice.

4. Providing Care to Victims and Perpetrators:

Forensic nursing specialists are vital in providing care to both crime victims and perpetrators. They deliver medical assistance, emotional support, and ensure that patients receive the necessary follow-up treatments. Their expertise is key to connecting the healthcare and legal systems effectively.

5. Evidence Collection and Documentation:

A primary duty of a forensic nursing specialist is to gather and record evidence meticulously. This involves capturing photographs, collecting samples, and detailing observations with precision. Thorough documentation is essential for legal processes and can greatly influence the results of a case.

6. Collaboration with Legal Authorities:

Forensic nursing specialists frequently collaborate with law enforcement and legal professionals. They may be asked to testify in court, offer expert opinions, and support investigations. This partnership ensures that both the medical and legal facets of a case are comprehensively addressed, ultimately aiding in the pursuit of justice⁷.

The Forensic Nursing Process:

Forensic nursing is a unique discipline that merges healthcare expertise with criminal justice principles. This field takes a holistic approach to patient care, emphasizing the importance of understanding the context surrounding patient injuries, offering evidence-based nursing assistance, and facilitating the criminal justice system. In this article, we will explore the key elements of the forensic nursing process, such as patient evaluation, documentation and evidence gathering, providing testimony, and fostering collaboration. Additionally, we will delve into the advantages and challenges faced within this specialized area.

1. Patient Assessment:

A crucial initial step in the forensic nursing process is the comprehensive assessment of the patient. This involves gathering an in-depth medical history, conducting a meticulous physical examination, and considering the psychological and environmental factors that may influence the patient's situation. Unlike standard nursing assessments, forensic nursing requires a heightened awareness to identify potential indicators of abuse, violence, or criminal behavior. Given the complexities of their cases, forensic nurses must undergo specialized training in clinical evaluation, forensic examination techniques, and trauma-informed care to ensure a thorough and effective patient assessment.

For instance, in situations involving sexual assault or domestic violence, forensic nurses play a crucial role in meticulously identifying and documenting physical injuries, including bruises, cuts, and abrasions, while also collecting essential evidence to aid in a criminal investigation. Additionally, they may inquire about relevant aspects of the patient's life related to the case and direct them to suitable support services.

2. Documentation and Evidence Collection:

Documentation and evidence collection are crucial elements of the forensic nursing process, playing a vital role in the legal system. Forensic nurses must have a comprehensive understanding of local laws and regulations that pertain to patient care, privacy, and consent. They should also be well-versed in the proper procedures for managing and preserving evidence, including clothing, bodily fluids, and tissue samples. After securing any necessary consent, the nurse is responsible for adhering to strict documentation protocols. This includes photographing injuries, labeling and packaging evidence appropriately, and utilizing forensic examination forms that maintain the integrity of the chain of custody.

For instance, in an assault case, a forensic nurse might take swabs of the patient's injuries to check for DNA, gather any damaged or blood-stained clothing, and meticulously map the injuries using annotated body diagrams. This thorough evidence collection and documentation not only strengthen the prosecution's case but also provide crucial legal and emotional support to the patient as they navigate their recovery.

3. Testimony and Collaboration:

Forensic nurses frequently work alongside interdisciplinary teams comprising law enforcement officials, social workers, attorneys, and other healthcare professionals to offer holistic support to patients affected by violence or abuse. As integral members of these teams, forensic nurses are often tasked with delivering expert testimony in court during the criminal justice proceedings. Their meticulous documentation and evidence collection play a vital role in building a legal case and securing convictions.

For instance, a forensic nurse who performed a sexual assault examination on a survivor may be summoned to provide testimony in court regarding their observations. The nurse would outline the specifics of the examination, such as the injuries sustained by the patient and the evidence gathered during the process. Additionally, they would offer their professional insights into these findings to help the jury grasp the context of the incident⁸.

IMPORTANCE OF FORENSIC NURSING:

Forensic nursing is a specialized and intricate field that demands thorough training. Inadequate training can hinder forensic nurses from delivering the necessary care and may compromise their ability to collect and preserve critical evidence. Furthermore, without appropriate training, these professionals may struggle to testify effectively in court.

Investing in forensic nursing education is essential for ensuring that patients receive high-quality care while also upholding justice in the legal system. This training equips nurses with the essential knowledge and skills to provide holistic care to individuals who have experienced trauma. Additionally, it prepares them to accurately collect and maintain evidence, which is vital for achieving successful legal outcomes⁹.

BENEFITS AND CHALLENGES IN FORENSIC NURSING:

1. Impact on Legal and Healthcare Systems:

Forensic nursing provides significant advantages to both the legal and healthcare sectors. With their specialized knowledge and training, forensic nurses play a crucial role in the precise identification, documentation, and preservation of evidence necessary for the effective prosecution of criminal cases, while also aiding the recovery of victims of violence or trauma. Their participation in interdisciplinary teams facilitates enhanced communication and collaboration among various agencies and professionals focused on the well-being of patients.

However, forensic nurses encounter a range of challenges, including the complex emotional toll of working with individuals who have faced trauma or violence. The processes of accurate documentation and evidence collection can be labor-intensive, requiring substantial training and skill refinement. Additionally, navigating the ethical and legal aspects of patient confidentiality and consent can present obstacles in certain situations.

2. Ethical Considerations:

Forensic nurses encounter a range of ethical challenges as they navigate the complexities of their profession, balancing patient care with legal requirements. Upholding patient autonomy, safeguarding confidentiality, and securing informed consent for evidence collection and usage are critical elements of ethical forensic nursing practice. Additionally, these professionals must adhere to principles of beneficence, non-maleficence, and justice when interacting with patients and collaborating with other healthcare and legal practitioners.

Consider the scenario of suspected child abuse. In these situations, forensic nurses must carefully consider the importance of maintaining confidentiality and respecting the desires of the child's caregivers, while also addressing the potential harm or ongoing risk to the child. This ethical dilemma may necessitate the involvement of child protective services or law enforcement, even if such actions contradict the wishes of the caregivers.

3. Emotional and Mental Health:

Forensic nursing demands a high degree of emotional and mental resilience, as professionals in this field frequently face cases of violence, abuse, and trauma. The intensity of these experiences can lead to secondary trauma or burnout, which can adversely affect the nurses' well-being and their ability to deliver quality patient care. It's crucial for organizations employing forensic nurses to recognize the emotional and mental health challenges inherent in this profession and to provide comprehensive support. This includes access to employee assistance programs, opportunities for debriefing sessions, and resources for self-care and stress management.

For instance, a forensic nurse assigned to a case involving a severely abused child may experience profound feelings of sadness, anger, or helplessness. Engaging in debriefing sessions with colleagues and utilizing the support services provided by their employers can help these professionals effectively cope with the emotional toll of their work and uphold the highest standards of patient care¹⁰.

DISCUSSION:

Violence has been a part of human existence since prehistoric times, and today it remains a significant global health challenge. It manifests in numerous forms, each influenced by a complex array of factors, and is recognized as a leading cause of death worldwide. Violence can be categorized into three main types based on its impact.

Firstly, self-directed violence refers to action’s individuals take against themselves, including suicidal behaviours and self-harm. The second type, interpersonal violence, affects a wide range of individuals and includes issues such as intimate partner violence, rape, child abuse, and elder abuse. Lastly, collective violence involves actions perpetrated by larger groups, such as terrorism and mob violence.

Addressing the healthcare needs of violence victims can be incredibly challenging, requiring specialized training to effectively manage the physical, psychological, and sexual consequences of such experiences. As primary caregivers, nurses frequently encounter victims of violence and crime in clinical settings, making it essential for them to be equipped with the skills and knowledge necessary to provide comprehensive support¹¹.

CONCLUSION:

Forensic nursing positions combine specialized nursing knowledge with principles of criminology, serving both patients and law enforcement while contributing to the pursuit of justice. These nurses excel in evidence collection techniques and are adept at delivering tailored care to individuals who have been subjected to violence. With comprehensive sensitivity training, they offer invaluable support to survivors and their families dealing with the aftermath of physical and psychological trauma. The role of forensic nurses is pivotal in addressing cold cases, providing medical care to incarcerated individuals, aiding in the exoneration of the wrongfully convicted, and helping survivors find closure after difficult experiences¹².

ACKNOWLEDGEMENT:

We extend our heartfelt gratitude to our parents for their unwavering love and support. We also sincerely recognize the contributions of the original authors whose research findings and insights have informed our work.

CONFLICTS OF INTEREST:

None.

REFERENCE:

1. https://www.ivyleaguenurse.com/courses/forensic-nursing/

2. https://online.xavier.edu/what-is-forensic-nursing/

3. https://online.regiscollege.edu/blog/what-is-forensic-nursing/

4. https://www.forensicnurses.org/page/WhatisFN/

5. https://connect.springerpub.com/content/book/978-0-8261-3867-5/part/part01/chapter/ch01

6. https://doi.org/10.46376/ijmr/04.12.2023:2442-2444

7. https://aihcp.net/2024/07/15/forensic-nurse-specialist-and-their-role-in-healthcare/

8. https://online.xavier.edu/what-is-forensic-nursing/

9. https://aihcp.net/2023/03/30/the-importance-of-forensic-nursing-training/

10. https://online.xavier.edu/what-is-forensic-nursing/

11. https://www.sciencedirect.com/science/article/abs/pii/S1752928X22000191

12. https://onlinelearning.csuohio.edu/blog/forensic-nursing-jobs-explained-through-famous-forensic-cases

13. https://www.google.com/search?sca_esv=d5be2ea9143ccd98&rlz=1C1CHBF_en__924__924&sxsrf=AHTn8zo-Ct18mBe70imBh_LQJyNUoy-f7w:1740238674254&q=forensic+nursing&udm=2&fbs=ABzOT_CWdhQLP1FcmU5B0fn3xuWpA-dk4wpBWOGsoR7DG5zJBjLjqIC1CYKD9D-DQAQS3Z49oR1qp-GHVCzRMbvBmBq7OFtewNtA3E-D2J-3qSQV1MNNZXv_6LyA7vWTKVb8ATO8CLVw-EBB8LBX6JzzdHYZa0EVhw3EhcMNCoh1yC4EmuzIz5r-L_popJBMoginccdzeVIpw8iueU64-1a4UHlI_nnANw&sa=X&ved=2ahUKEwis_IKgzteLAxXmlFYBHQrFEI04FBC0qAt6BAgOEAE&biw=1242&bih=552&dpr=1.1#vhid=akBJ-75prjAy4M&vssid=mosaic (Image Reference)

Received on 22.02.2025 Revised on 28.03.2025

Accepted on 26.04.2025 Published on 17.05.2025

Available online from May 20, 2025

Int. J. Nursing Education and Research. 2025;13(2):127-133.

DOI: 10.52711/2454-2660.2025.00028

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.