Forensic Nursing Article 21312 Admission Ticket

8/2/2019 Forensic Nursing Article 21312 Admission Ticket

1/7

Terri Ibitoye`

Admission ticket 2/13/12

Forensic Nursing Article

Although she didnt know it then, a personal trauma in 1994 changed the course ofKaren Colemans professional career. Coleman, an emergency room RN at the time,was raped by her then-husband, who had been barred from her home by an order ofprotection. When I went to the hospital after the assault, I had a physician perform theevidence collection kit and he didnt have any idea what he was doing. He had no clue,

she recalls. He wasnt sure about the process. He wasnt familiar with collectingevidence. I had to show him how to do my own rape kit.

Today, Coleman, who is African American, is the Sexual Assault Nurse Examiner(SANE) coordinator for Victims Assistant Services in Elmsford, N.Y. It was by chance,Coleman says, that she learned about the field of forensic nursing. Three years aftersurviving her assault, she came across an article about nurses being specially trained todo forensic examinations of rape victims, and she learned that a SANE program wasbeing considered in her county.

Coleman attended several meetings about the new program, which she then was asked

to coordinate. I thought it was ideal, because I felt nurses could do these exams, shesays. Having been a victim myself and receiving a less than optimal exam, I made it mymission in life to make sure no one else would ever have to go through that.

Coleman is now responsible for the recruitment, hiring and retention of SANE nurses forher program, which operates in 11 of the 14 hospitals in Westchester County. Herposition is full time but the nurses hired into the program work on call.

Forensic nurses ensure that evidence is collected appropriately and can be used in a

court of law, Coleman notes. Its important that crime victims know about us. All youhear about are the horror stories of waiting in the hospital and having physicians like theone I had who dont know what theyre doing, who are less than compassionate andwho tend to judge the victim.

Ill See You in Court


2/7

Forensic nursing is a relatively new field that combines the health care profession withthe judicial system. In 1995 the American Nurses Association officially recognized it asa specialty of nursing. In April 2002, the International Association of Forensic Nurses(IAFN) held the first international certification exam. The 71 nurses who passed theexam earned the international designation SANE-A (Sexual Assault Nurse Examiner-

Adult and Adolescent).

Coleman plans to take the exam when it is offered again in October, following IAFNsTenth Annual Scientific Assembly in Minneapolis. In addition, five states--Kentucky,Maryland, New Jersey, South Carolina and Texas--have their own certification examsfor sexual assault nurse examiners. Texas and Maryland offer separate certifications foradult and pediatric cases. While certification is not mandatory in order to work as aforensic nurse, Coleman believes it gives added credibility. This is important becauseone of the key parts of the forensic nurses role, in addition to performing the

comprehensive exam in the hospital, is to give testimony in court.

The legal system is beginning to recognize the expertise of forensic nurse examinersand we are beginning to be qualified as experts, Coleman explains. If you can saywhen you are giving your credentials that you have taken a state-approved training, thatyou have taken a state-approved or nationally approved certification exam and youpassed it, then at least you are able to say that you have met the standards for thisprofession of nurses and that you can be considered an expert with more knowledgethan the average person in the field of sexual assault.

When testifying in court, forensic nurses can be qualified as either an expert witness,

who is allowed to give his or her opinion, or a fact witness (who, as the name implies,can only state the facts). This ruling is made by the judge.

The prosecutor will present you, knowing you will discuss your background, the numberof cases you have performed, what you do and what your job is, says Jean Epps, RN,BSN, coordinator of the Sexual Assault Nurse Examiner Program at Howard UniversityHospital in Washington, D.C. Epps, who is African American, is a CFNE (a forensicnurse examiner certified by the state of Maryland).

When testifying at trials, forensic nurses are there to present information in an objectiveway. Even though the prosecution may call you, you are not there to speak for or

against the victim or the defendant. You are just there to present the facts of theexamination, states Epps, who also plans to take the IAFN SANEA examination inOctober.

What Minority SANEs Bring to the Table

Because forensic nursing is such a new and rapidly growing specialty, it offerstremendous opportunities for both recent graduates and experienced RNs looking for a


3/7

career change. Moreover, there is also a strong need for better minority representationin the field.

According to Coleman, there are just not that many of us [nurses of color] working inthis area. However, approximately 50% of the victims we treat are African American.

You can probably add another 20% who are Latina.

If minority women knew that there were more forensic examiners who were also peopleof color, they would be even more likely to seek medical assistance, Coleman believes.During their experience of being a victim, they are going to be coming into contact withlaw enforcement people who, chances are, will not look like them, she says. I just thinkit adds a level of comfort. I am not saying, however, that because I am African AmericanI am any better able to take care of a rape victim. I just think it is helpful to see someonethat kind of looks like you among all the people you are gong to have to deal with.

This victims advocacy role is important to Coleman, who has become a vocal supporter

of her chosen field. She often gives talks about forensic nursing and is interviewed bythe media. She appeared in the Lifetime television documentary Fear No More, whichtold the stories of five women who were victims of violence. Rape is a conspiracy ofsilence, and those who are able to talk about it should do so, she insists. There is noshame in being a victim.

Tools, Techniques and Teams

Certifiably SANE: How to Get Certified as a Sexual Assault Nurse Examiner TheInternational Association of Forensic Nurses (IAFN) celebrated its tenth anniversary thissummer. With more than 2,400 members in the U.S. and abroad, the association

encompasses a diverse body of nursing professionals who specialize in the forensicaspects of health care--literally, nursing as it pertains to the law. The Sexual AssaultNurse Examiner-Adult and Adolescent (SANE-A) designation offered by IAFN is theonly national certification of its kind. To earn the designation, nurses must pass acertification exam consisting of 170 multiple choice items written within the framework ofthe nursing process. The exam takes approximately four hours to complete. To beeligible to sit for the examination, nurses must:

hold a current, unrestricted license as a registered nurse (RN) and have aminimum of two years full-time equivalent practice as an RN;

have completed an adult/adolescent SANE education program that includes

either a minimum of 40 contact hours of instruction or three semester hours ofclassroom instruction in an accredited school of nursing; andhave had clinical supervision until able to demonstrate competency in SANE

practice.

The SANE-A designation is one of the newest specialty certifications in nursing. IAFNheld the exam for the first time in April 2002, at 41 sites around the country. It will beoffered again in October, and more offerings are planned for multiple sites and dates in


4/7

the future. Although the exam is initially being offered only in the United States, IAFN isworking to make it available in other countries as well. Certification as a SANE-A is validfor a period of three years and re-certification will be available by examination or bycontinuing education. The current cost of sitting for the initial certification exam is $225for IAFN members and $350 for non-members. During the certification programs first

three years (2002-2004), nurses who are currently practicing as SANEs but do not meetthe established criteria can ask the IAFN certification board for special consideration totake the exam. For information about dates and locations of SANE-A exams to be heldin 2003, or to learn more about forensic nursing in general, visit the IAFN Web site athttp://www.forensicnurse.org/ or contact Kimberly Marrero, IAFN executive secretary, at(856) 256-2425, email [email protected].

What kind of background, skills and experience are necessary for a career in forensicnursing? To become a potential SANE-A, a nurse must be at least an RN and mustcomplete specialized training to meet the standards IAFN outlines for forensic nurses.Epps says the national standards include 40 hours of didactics and 40 hours of clinical

work. Nurses are trained in handling and collecting evidence, such as hairs, fibers andswabs of fluids collected for DNA testing. Additional forensic training is required to workwith children.

There are also a number of tools forensic nurses must master in order to help documenta victims injuries for court cases. This equipment can range from easy-to-use items,like a digital camera for photographing visible injuries, to such complex devices as anOmnichrome--which can detect bruising beneath the skins surface--and a colposcope(a large microscope with a camera attached that enables examiners to takephotographs of genital injuries in sexual assault cases). Operating this high-techequipment and making sure all the documentation is done correctly is one of the

challenges of the job, according to Sun Borden, RN, BSN, a SANE preceptor inMonmouth County, N.J.

The Discovery Channel show New Detectives sparked Bordens interest in forensicscience, she says. In March, she took the first step toward becoming a forensicexaminer by completing a 42-hour course on forensic nursing at Rutgers University.Before she can begin working independently, she must work three cases as apreceptor. She has already observed one case and has worked another case inconjunction with a SANE nurse.

Borden, who is of Korean descent, reports that the experience has been a good one. Ilike how the SANE nurses work with [assault] survivors, she says. It is a very positiveexperience.

Borden also takes satisfaction in knowing that nurses are playing such an important rolein forensic science. I think it is a step ahead for nurses. It used to be that the physiciansdid the exams and the nurses role was to assist them, she points out. Historically, sheadds, the victim could be in the emergency room for hours waiting to be seen, whichcan prolong or add to a survivors trauma. Now, with the SANE nurses, it is different.


5/7

When the SANE team is activated, we go to the site right away and we handle the caseand the interview as soon as possible, so there is no waiting time.

The examination and interview take place in a private area, away from the emergencyroom. We try to give the victims as much privacy as possible, Borden explains.

Assault survivors do not want to sit in an ER waiting room, because [they feel]someone they know might come in and recogn ize them.

Borden also enjoys the experience of working on a team, which can typically include lawenforcement officers and the victims advocate as well as the nurse. We all sit down asa group and we start doing the interview, she says. You have everyone looking at adifferent aspect of it, but we are all there for one person--the survivor. Any questions thesurvivor has we can answer from three different perspectives. We get the whole story,so we can do the examination appropriately.

The entire process can take a significant amount of time, Borden continues. From the

beginning of the exam to the end takes about three or four hours. Traditionally, thedoctors in the emergency room were so busy with all the other cases they had to look atthat they didnt have much time to spend with the victim. But with the nurses, we arethere the whole time with them.

The SANE program Epps directs at Howard University Hospital opened in October2000. Prior to that, she says, the sexual assault exams were performed by personnelwho were in the ER, usually physicians. Like Borden, Epps sees the progression to anurse-focused program as very positive: You have nurses who are specifically trainedin how to collect forensic evidence, to listen to the victims and to hear was it is thatmaybe theyre notsaying.

Helping More Than Just Rape Victims

While much of the focus of forensic nursing is on the sub-specialty of sexual assault,forensic nurses are not limited to working on these types of cases. Many forensicnurses work with victims of other types of interpersonal abuse, including domesticviolence, child and elder abuse/neglect and physiological/psychological abuse. Forensicnurses can examine victims of near-fatal or fatal traumas, such as shootings orstabbings. Some even work as death investigators.

Lucretia Braxton, RN (top row, far right), and her forensic nursing team

Lucretia Braxton, RN, sees a wide range of patients in her role as a forensic nurseexaminer in the emergency room at the Medical College of Virginia at VirginiaCommonwealth University. Braxton, who is African American, trained at the VirginiaState Police Academy in Fredericksburg, first as a SANE and then as a Forensic NurseExaminer (FNE). She earned state certificates in both areas at the academy, butVirginia doesnt certify nurses in these areas.The emergency department where Braxton works is the leading trauma center for the


6/7

state of Virginia. In a typical month, Braxton estimates that the departments forensicnurses handle 20 sexual assault victims and ten homicide victims. The murder victimseventually go to the medical examiners office, but while the ER team is working to try tosave the persons life, the forensic nurse collects evidence. The nurse may even followthe victim up the operating room to complete the evidence collection. The center also

sees quite a few domestic violence victims. These victims dont always report it, so it ishard to quantify how many there are, she adds.

Objectivity is a key part of being a forensic nurse, Braxton believes. You have to knowwhen to draw the line between being an empathetic nurse and being there just to collectyour evidence, she explains.

In cases of stabbings or shootings, forensic nurses collect such things as bullets andany debris that is on the body, such as leaves that may have clung to the body from thecrime scene. They are also in charge of removing the bloody clothes the victim waswearing and putting them in a special wrapping. These nurses also photograph and

measure wounds. If the victim dies, the forensic nurse examiner will often collaboratewith the medical examiner on the case, answering any questions he or she may haveregarding what the nurse saw.

Braxton says a background in emergency nursing is helpful for nurses who want tomove into the forensic field. It gives you the experience you need in how to work withtrauma victims, she explains. When the victims are brought into the ER, you see thevery initial trauma right there. If you are trained and experienced in emergency nursing,you know how to react to what you are seeing, what you need to do, what the doctorneeds, what he is going to call for. As a forensic nurse, she adds, you are also trainedto know what things not to touch, so that evidence is not accidentally destroyed.

A Ground-Floor Opportunity

Not only is forensic nursing an exciting and rewarding career, there is also a growingdemand for nurses with these specialized skills. Forensic nursing is expanding, moreso than it used to be, Braxton reports. Forensic nurses are being incorporated into theemergency room setting now. In the past, hospitals felt that if evidence needed to becollected, any nurse could do that. Today we are finding out that the more expertise anurse has in knowing exactly what should be collected, the better the evidence turnedover to the detectives will be. And that can help lead to a better outcome in catching theperpetrator.Nursing schools are starting to recognize this trend as well. In September, JohnsHopkins University School of Nursing in Baltimore began offering an MSN--ClinicalNurse Specialist, Forensic Nursing Focus program. The school tapped Daniel Sheridan,RN, PhD, a forensic clinical nurse specialist at Johns Hopkins Hospital Department ofEmergency Medicine, to create the new program.

SANE Preceptor Sun Borden, RN, BSN


7/7

I convinced them that there was a need for it, says Sheridan. I have been a forensicnurse for many years, and Hopkins School of Nursing realized there is a growing needand a growing interest in this whole area. Since the field is in its infancy, he adds,forensic nurses often have the advantage of helping to create their own positions, andeven whole forensic nursing departments.

Prior to joining Johns Hopkins, Sheridan worked as a full-time employee for the state ofOregon, investigating abuse of institutionalized people who were mentally andcognitively impaired. He was the only member of the team who was a nurse. This is abrand new area and people are still carving out new and innovative roles for the forensicnurse, he emphasizes. You have to really go out and be able to market yourself, toexplain that you have specialized experience and training that are going to help aninstitution. This field really is at the ground level.

Karen Coleman agrees, adding that the satisfaction her job brings her is amazing.People often ask her how she can work in such a difficult and traumatic field. But once

you get into this work, you know that everything you do is going to help a victimizedperson, and hopefully lead to a conviction in a court case, she says.

Coleman adds, however, that helping to convict criminals is not her primary goal. Myfocus is to help that victim get through that medical experience, she maintains. I hopethat as we get better at taking care of victims, collecting evidence, providing support andlinking them up with services, more victims will come forward and cooperate with lawenforcement and there will be better outcomes in court.

Forensic nursing Minority nurses

Nursing careers Sexual Assault Nurse Examiner (SANE)

Source URL: http://www.minoritynurse.com/forensic-nursing/case-forensic-nursing
http://www.minoritynurse.com/forensic-nursinghttp://www.minoritynurse.com/minority-nurseshttp://www.minoritynurse.com/nursing-careershttp://www.minoritynurse.com/sexual-assault-nurse-examiner-sanehttp://www.minoritynurse.com/forensic-nursing/case-forensic-nursinghttp://www.minoritynurse.com/forensic-nursing/case-forensic-nursinghttp://www.minoritynurse.com/sexual-assault-nurse-examiner-sanehttp://www.minoritynurse.com/nursing-careershttp://www.minoritynurse.com/minority-nurseshttp://www.minoritynurse.com/forensic-nursing

Documents

Forensic Nursing Article 21312 Admission Ticket