Developments in Current Nursing Practice Barbara Bellfield Joseph T. Catalano

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New Roles for the Nurse The profession of nursing is dynamic and ever-changing Nursing roles evolve and develop in response to societal needs

Forensic Nursing Forensic nursing is a field of health care that unites nursing, law enforcement, and the forensic sciences The generic term forensic means anything belonging to or pertaining to the law

Forensic Nursing Forensic nurses provide a continuum of care to victims and their families beginning in the emergency room or at the crime scene and, when necessary, participating in the criminal investigation and the courts of law In 1992 the term forensic nursing was coined to cover many of the activities that ER nurses had done for years

Forensic Nursing Sexual assault nurse examiner (SANE) Most SANEs work in a hospital or emergency room with other members of a sexual assault response team (SART) Functions include: Offering compassionate care Preserving the victim’s dignity and reducing psychological trauma Assessing the victim and collecting evidence Testifying in court

Forensic Nursing Sexual assault nurse examiner requirements: Must be an RN Must complete an adult/adolescent SANE education program: 40 hours classroom (3 college credit hours) with clinical supervision until shown to be competent Must pass the certification examination

Forensic Nursing Legal nurse consultant The legal nurse consultant is a licensed RN who critically evaluates and analyzes healthcare issues in medically related lawsuits Work settings: attorneys’ offices, independent practices, hospital setting as risk management, health insurance companies

Forensic Nursing Legal nurse consultant responsibilities: Draft legal documents under the supervision of an attorney Interview witnesses Provide education to attorneys and other involved parties on healthcare issues and standards Research nursing literature, standards, and guidelines Review, analyze, and summarize medical records Identify and confer with expert witnesses Assess causation and issues of damages relating to the case Develop case strategy with the legal team Provide support during the legal proceedings Educate and mentor other RNs in the practice of legal nurse consulting

Forensic Nursing Medical examiner nurse death investigator Other titles: Forensic nurse investigator Death investigator Deputy coroner Role is to advocate for the deceased

Forensic Nursing Medical examiner nurse death investigator responsibilities: Respond to scene of death or accident Work in collaboration with law enforcement Examine the body Pronounce death Take tissue, blood samples, pictures, evidence Recognize and integrate other evidence, such as patterns of injury Keep records Arrange transport of body to morgue or coroner’s office Work with the forensic pathologist

Forensic Nursing Medical examiner nurse death investigator education: Must be an RN Each region of the country specifies the requirements in its own jurisdictions Currently no required credentialing or education standards for nurse death investigators in the United States

Forensic Nursing Forensic psychiatric nurse Works with individuals who have mental health needs and who have entered the legal system Generally practices in state psychiatric institutions, jails, and prisons

Forensic Nursing Forensic psychiatric nurse responsibilities: Perform physical and psychiatric assessments Develop plans of care Assist clients with self-care Administer medical care and treatment Monitor effectiveness of treatment Promote coping skills Improve mental health in a therapeutic environment

Forensic Nursing Forensic psychiatric nurse education: Must be an RN Advanced practice level (master’s degree in psychiatric-mental health nursing; clinical nurse specialists or nurse practitioners) Prescriptive authority

Forensic Nursing Forensic correctional nurse Forensic correctional nurses provide health care for inmates in correctional facilities such as juvenile centers, jails, and prisons Have a high level of autonomy compared to that of other nursing roles

Forensic Nursing Forensic correctional nurse responsibilities: Manage acute and chronic illness Develop healthcare plans Dispense medications Perform health screenings Provide health education Perform psychiatric assessments Respond to emergency situations

Nurse Entrepreneur An entrepreneur is someone who establishes and runs his or her own business A nurse entrepreneur starts a business by combining nursing experience and knowledge with business knowledge Traditional roles: Temporary staffing agencies, nursing educator or consultant, nurse attorney, nurse case manager, nurse death investigator, nurse midwife, nurse paralegal, psychiatric nurse, legal nurse consulting, and sexual assault nurse

Nurse Entrepreneur Getting Started: Assess your own skills Find an area of health care where there is a need Research the need Borrow start-up money Build client base

Case Management Case management: a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality, cost-effective outcomes

Case Management Nurse case managers act as advocates for clients and their families by coordinating care and linking the client with the physician, other members of the healthcare team, resources, and the payer The goal of the nurse case manager is to help the client obtain quality, cost-effective care while decreasing the duplication and fragmentation of care

Case Management Factors that indicate the need for a nurse case manager include: A complex treatment plan that requires coordination, or a plan that is unclear An injury or illness that may permanently prevent the client from returning to a previous level of health A pre-existing medical condition that may complicate or prolong recovery A need for assistance in accessing healthcare resources Environmental stressors that may interfere with recovery

Bioterrorism Bioterrorism is the use of microorganisms with the deliberate intent of causing infection in order to achieve political goals Biologic weapons are relatively easy and inexpensive to produce Microorganisms are effective: their release can go undetected for days because their effects are not immediate—allows for person-to-person spread before they are detected

Bioterrorism Early recognition is key to treatment May be difficult because many of the weaponized agents mimic respiratory viruses or common bacterial infections early in their symptoms Look for: Increased numbers of clients with same symptoms Commonalities (workplace, eating, travel, etc.) among clients Unusual course of disease—doesn’t respond to common treatments

Bioterrorism Effective response Identification Management Response training Activation and deployment

Disaster Nursing American Red Cross defines a disaster as “...an occurrence such as a hurricane, tornado, storm, flood, high water, wind-driven water, tidal wave, earthquake, drought, blizzard, pestilence, famine, fire, explosion, building collapse, commercial transportation wreck, or other situations that cause human suffering or create human needs that the victims cannot alleviate without substantial assistance”

Disaster Nursing Many roles for the nurse Every disaster poses its own unique challenges The role of the nurse in specific disaster care depends upon the nature of the particular disaster and the type and numbers of injuries Nurses may function outside their usual practice setting when confronted with a disaster

Disaster Nursing The National Disaster Medical System (NDMS) is the agency responsible for mobilizing disaster relief and works closely with local fire, police, and emergency medical services to provide comprehensive disaster relief The International Medical/Surgical Response Teams (IMSURTs) are volunteer disaster response teams used anyplace in the world where there a few resources

Disaster Nursing Other areas in which nurses can provide assistance during disasters include Disaster Medical Assistance Team (DMAT) Medical Reserve Corps, part of the USA Freedom Corp American Red Cross Commission Corps Readiness Force

“The past is history The future is a mystery Today is a gift That is why we call it the present” (Lundin, Paul, & Christensen, 2000)