Forensic Victimology 2nd Edition Chapter Five: Forensic Nursing - Objective Victim Examination

Forensic Nursing Forensic nursing is a subspecialty of forensic science and nursing where the science of nursing is applied to the resolution of legal matters. Forensic nurses are registered nurses with additional education and training in forensic science and evidence collection.

Getting to the Truth The criminal investigation of a sexual assault is accomplished by proper crime scene investigation; interviews with complainants, the accused, and any witnesses; and the reconstruction of physical evidence. Reconstruction establishes what did and did not happen during an event by virtue of an objective examination of the physical evidence. A scientific examination investigates the evidence to learn the facts, seeking to support or refute the elements of crime-related behavior.

The Forensic Nurse The forensic nurse functions as an objective finder of fact; to utilize scientific principles and methodology in the recognition, documentation, collection, and interpretation of physical evidence related to disease, injuries, and crimes that may be suffered by all manner of victims. Registered Nurses wishing to practice forensic nursing are generally required to obtain specialty training and certification. Forensic nurses must be available to work when crime occurs and to respond to a case within approximately an hour.

Consent Forms Consent to treat must be obtained before any evidence collection or treatment takes place. Consent forms may vary from one institution to another, but often include consent to conduct a forensic medical examination. Not every victim will react the same way to the procedures involved in the forensic medical exam. Victim’s perceptions and reactions may be influenced by a variety of circumstances, including: age, gender, health history (physical and mental), history of previous victimization, prior relationship with the suspect, etc.

The Intake Form The intake form establishes the informational foundation upon which to start prioritizing different aspects of an eventual forensic medical exam. Intake information includes biographical data about the patient, those involved in the case, and a thumbnail sketch of the crime and the alleged perpetrator.

The Intake Form The intake form establishes the following baseline information: The time and date of the exam The name of the forensic nurse examiner and anyone who assisted The patient’s name and other identifying information How to reach the patient if needed, including contact numbers and mailing address The patient’s family and/or guardian information The patient’s insurance information

The Intake Form Continued: Date of referral and referral source Collaborating law enforcement agencies responsible for investigating the case Suspect information; this may or may not be available Brief history of sexual assault exams; some victims receive more than one medical examination related to their injuries, the forensic medical exam being secondary

The Forensic Interview Medical History Medical history is a significant component of the evaluation in the context of any suspected sexual assault, child molestation, or domestic assault. It provides a baseline of information for the examiner so that recent trauma and injury can be discriminated from past conditions and events. It must be noted that evidence of injury observed in relation to the alleged victim of crime scene may not be the result of criminal activity. Such evidence of injury may, in fact, be the result of some previous and unrelated activity or event.

The Forensic Interview Drug and Alcohol Use Drug use, most commonly alcohol, is a vital consideration in the interpretation and reconstruction of evidence related to an alleged sexual assault. It is a standard forensic protocol to collect blood and/or urine from both complainants and suspects during an investigation. The number one drug associated with sexual assaults is alcohol. In more than 50% of reported sexual assaults, the victim, the offender, or both had been consuming alcohol.

The Forensic Interview History of Behavioral or Emotional Symptoms and Menstruation It is important to gather information regarding the patient’s mental health, usual sleep patterns, eating patterns, any behavioral problems at school or work, recent mood, as well as any history of sexually transmitted diseases and treatment or lack thereof. It is also important to document the last time the patient had consensual sex and the forensic examiner needs to ask all female patients at what age they started their menstrual cycle; when was their last menstrual period; and what their menstrual cycle is normally lie.

The Physical Examination The physical examination of the patient is the act of examination of the body by auscultation, palpation, percussion, inspection, and smelling. It also includes the act of investigating the victim and his or her clothing for signs of defect, disease, injury, and potential transfer evidence. The resultant findings are referred to as physical evidence.

The Physical Examination The physical examination generally involves: Search for and identify any physical injuries or conditions that require treatment Document physical findings at the time of examination. This may include utilizing photographs, notes, and/or drawings Obtain laboratory specimens and diagnostic studies when indicated Collect and preserve forensic evidence Provide appropriate treatments directed at restoring health when findings or conditions are present Reassure patients and family of ways to attain or restore health and well-being Provide appropriate health education and teaching to promote health and wellness

The Physical Examination The physical examination generally includes the following: Full body photos – including negative documentation Obtaining vital signs – height, weight, BMI, blood pressure, pulse, temperature, and respiration Mental status Evidence of injury

Sexual Assault Examination After the head-to-toe physical examination, the forensic nurse examiner will examine the genitalia. This examination typically involves the use of a colposcope and the process of examining the tissues of the vagina with this instrument is referred to as colposcopy.

False Positives Forensic nurses must be fully aware of the differential diagnosis for any finding before making firm conclusions about its origin. This involves taking into account the possibilities that injuries and symptoms may have more than one cause, or a cause unrelated to the assault. Absence of differential diagnoses considerations lead to false positives and, in any forensic medical exam, it the absence of science and the scientific method.

Documentation and Findings It is advised that the entire physical examination be at the very least audiotapes and transcribed for investigative, reconstructive, and court purposes. Forensic nurses must conduct and document every examination they perform thoroughly, as though it will go to trial, even though many will not. Examination reports should provide interpretations about whether and how findings may be consistent with sexual assault, abuse, or the patient’s accounts provided in the forensic interview.