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Forensic nursing: Giving back control to victims of abuse

How the Texas A&M College of Nursing is pioneering education in forensic nursing
Forensic nursing exam

“I’m glad you are here. In this room you are safe, and you are in control.” This is what Nancy Downing, a forensic nurse and associate professor with the Texas A&M College of Nursing, tells patients when she walks into the exam room on a sexual assault call. “I am here to focus on their needs, reassure them and give them back the control that has been taken from them in a violent way.”

Forensic nurses serve as first responders to victims of interpersonal violence, including sexual abuse, domestic violence and child or elder abuse. They provide specialized care and consultation, collect and preserve evidence, interact with law enforcement officials and even give testimony that can be used in a court of law. In a sense, forensic nurses like Downing bridge the gap between health care and the administration of justice.

READ MORE: An early look at forensic nursing

Downing has practiced the specialty for 13 years. “When I get that 2 a.m. hospital call, no matter what I’m doing, I switch gears,” she said. “Whatever I was doing at the moment is not as important as the person waiting in the hospital room. It’s very rewarding to have an influence and hopefully minimize the impact of the trauma a sexual assault victim is experiencing.”

Mandated by Texas law, all hospitals with an emergency department must have the ability to provide sexual assault exams and nurses must have two hours of training to perform such exams. Forensic nurses, on the other hand, are required to have (at the very least) 40 hours of classroom training and additional clinical training in their jurisdiction. Utilizing forensic nurses to perform such exams reduces the risk of re-victimization that can occur during the evidence collection process. And they are necessary, given that, in Texas, one rape is committed each hour, with over 8,000 cases reported per year. Unfortunately, the number of forensically trained nurses in the state, especially in rural areas, is insufficient to care for this volume of patients.

“There is a staggering shortage of nurses who are trained to perform sexual assault exams,” Downing said. “Ideally, every patient who has been sexually assaulted should be observed by a certified sexual assault nurse examiner. However, there are not many nurses who feel comfortable performing these exams.”

That’s why the Texas A&M College of Nursing—with support from the Texas Legislature—is advancing efforts to train more forensic nurses in Texas, with the development of the Forensic Health Care Education, Research and Intervention Program. The program will close gaps that currently exist between health care, law enforcement and the legal system by offering specialty training for nurses and other professionals who work with victims of violence.

The college currently offers an online forensic nursing course, but plans to expand offerings to include a graduate certificate program, unique master’s degree program, and community outreach and continuing education for health professionals, law enforcement, social workers and those in the legal system. As a result, the state will be better-prepared to provide trauma-informed care to victims and relieve the burden of too few resources on those who participate in investigations of victims of violence.

Graduate certificate in forensic health care

Launching this spring, the graduate certificate in forensic health care will equip health care workers, social workers, protective service investigators/case workers, law enforcement personnel, prosecutors and other professionals to assist victims of violence collaboratively. Drawing from evidence-based knowledge in forensic sciences, certificate graduates will be better-prepared to serve victims of violence and trauma.

“This online, multidisciplinary, academic program requires the completion of 12 credit hours and prepares any post-baccalaureate and post-master’s professional to excel in the rapidly developing forensic field with specialized forensic courses,” said Debra Wise Matthews, PhD, RN, associate dean of academic affairs for the College of Nursing. “The program allows students to take one or two courses per term through sequenced scheduling, giving working individuals career development and family balance.

Master of Nursing (MSN) in forensic nursing

When implemented, the new MSN in forensic nursing, which is undergoing approvals, will be only one of two forensic nursing master’s programs in the nation. With a tentative launch scheduled for summer 2017, students will complete 36 online credit hours (with a 39-hour optional thesis option available) and 170 clinical practice hours.

This degree will prepare advanced-level nurses with specialized training to care for victimized patients and teaches students using research-informed principles and practices for patient assessment, treatment and advocacy within diverse health, judicial and community systems.

“There is a huge need nationally, and certainly in Texas, for this type of program,” Matthews said. “Our master’s-prepared forensic nurses will be able to better interact with the legal system, provide expert testimony and minimize results of interpersonal violence. We’re here to aid the long-term needs of victims, their families and communities across Texas.”

Advancing health, advocacy and justice in Texas communities

Community outreach and education is one of the pillars of forensic education, and the college is developing a variety of resources to educate rural and mid-sized Texas communities about forensic health care topics. Important, given that rural communities are some of the most understaffed areas when it comes to forensic health care. According to Downing, many rural hospitals will not see enough patients who have experienced sexual assault for nurses to become certified or maintain competency.

“Part of the mission of the Texas A&M forensic nursing program is to train rural nurses to be competent and comfortable in conducting sexual assault exams,” Downing said. “We will do this through the creation of the two-hour online basic evidence collection course, which can be followed by hands-on clinical trainings either at a Texas A&M site or in the community.”

A pilot program will launch this fall in the communities of Mission, Texas and Snyder, Texas, focused on forensic evidence collection in the emergency room.

Perhaps one of the most widely influential, multidisciplinary programmatic efforts is the creation of an online database of continuing education courses for professionals working with victims of violence, including Child Protective Services, social workers and law enforcement. These courses will allow the individual to take a single course at a time to obtain information about a specific area in forensic health care, such as improved screening for intimate partner violence or child abuse, strangulation assessment and trauma-informed care.

According to College of Nursing Dean Sharon Wilkerson, PhD, RN, CNE, ANEF, education of all professions—health care providers, social workers, law enforcement, and those in the judicial system—will help to prevent further victimization, giving back control to victims of abuse.

“While we are painstakingly focused on advancing the education of forensic nurses across the state, we also see an opportunity to relieve the burden of too few resources on those who participate in investigations of victims of abuse,” Wilkerson said. “Our program will meet the needs of Texas health care professionals, but will also be adaptable to other disciplines. After all, we are all working together toward a common goal:  equipping the state with advocates against violence and agents of care, no matter the profession.”

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