1. Developments in Current Nursing Practice
Barbara Bellfield
Joseph T. Catalano

2. Fire Escape

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. Bioterrorism Effective response Identification Management
Response training
Activation and deployment

26. 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”

27. 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

28. 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

29. 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

30. “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)