Forensic Nursing

• Author: Sheila Early
• Pages: 527-575

527

A. OVERVIEW OF THE DISCIPLINE: FORENSIC NURSING

Forensic nursing is one of the more recent nursing specialties in North

America, having emerged as a formal entity in the early 1990s. Many def‌in-

itions have been set forth over the last two decades, but each has evolved

from the original def‌inition as described by Virginia Lynch in 1986. Lynch

has since further ref‌ined her def‌inition of forensic nursing as:

The application of the forensic aspects of healthcare that are combined

with the bio/psycho/social/spiritual education of the registered nurse in

the scientif‌ic investigation and the treatment of trauma, and/or death

of victims and perpetrators of violence, criminal activity and traumat-

ic accidents. The forensic nurse provides direct services to individual

clients, consultation services to nursing, medical and law-related agen-

cies, as well as providing expert court testimony in areas dealing with

questioned death investigation processes, adequacy of services, delivery

and specialized diagnosis of specif‌ic conditions as related to nursing.1

The most current—and considerably less detailed—def‌inition is from

the International Association of Forensic Nurses (IAFN): “Forensic nurs-

ing is def‌ined as the global practice of nursing that results when healthca re

1 Virginia A. Lynch, Forensic Nursing (St. Louis, MO: Elsevier Mosby, 2006) at 3.

CHAPTER 16

Forensic Nursing

Sheila Early

LEgAL ConTExT: CAiTLin PAkosH

528 6 Sheila Early

and legal systems intersect.”2 Prior to the formalization of the discipline,

registered nurses (RNs), rather than Forensic Nurses (FNs), testif‌ied in

criminal cases, often as medical fact witnesses who could not provide

opinion ev idence.

Gradually, as nurse examiners testif‌ied more frequently, the role be-

came recognized for its expertise and nurse examiners were qualif‌ied as

experts in both provincial and Supreme courts. Today, the nurse examiner

in sexual assault cases is routinely deemed an expert by the courts. A key

area of testimony for nurse examiners involves their expertise in docu-

menting the physical f‌indings at the time of examination of a patient. The

systematic, organized, and objective examination of the patient (with the

patient’s consent) can provide physical f‌indings that may corroborate or

refute the patient’s version of events.3

Forensic nursing in Canada has its roots in Calgary, Alberta. In 1975, Dr.

John Butt, the Interim Chief Medical Examiner for the City of Calgary at the

time, hired RNs to become the medical examiners’ investigators in his de-

partment.4 Dr. Butt conducted a f‌ive-year study into the practice, concluding,

“that it was the registered nurse who provided the qualities and professional-

ism essential to a scientif‌ic, social and cultural investigation of death.”5

Since 1975, forensic nursing science has been a slowly evolving entity

in Canada. This slow evolution can be attributed to a number of factors,

including:

 lack of awareness of the emerging specialty of forensic nursing by

the healthcare system;

 lack of educational opportunities for specialized forensic nursing

education and advanced practice;

 lack of recognition by mainstream nursing for the contributions

made by FNs in providing healthcare to victims of violence, trauma,

and crime;

 lack of funding for forensic nursing positions within acute health-

care; and

 the variety of roles that f‌it the def‌inition of forensic nursing, each

expanding and developing mostly in isolation to each other.

2 International Association of Forensic Nurses, “What is Forensic Nursing?” online:

www.forensicnurses.org/?page=whatisfn.

3 For example, see R. v. Ruddick, [1998] O.J. No. 6208 at paras. 25–26 (Ct. J.) [Ruddick].

4 Lynch, above note 1 at 371.

5 Ibid.

Forensic Nursing 6 529

Further, since forensic nursing has only been recognized as a subspecial-

ty in nursing by the Canadian Nurses’ Association since 2007, mainstream

nursing has not embraced forensic nursing as a whole. As a result, funding

for the education of FNs is not part of the general healthcare funding for

other specialties, such as emergency nursing, critical care nursing, or pedi-

atric nursing. The International Association of Forensic Nurses, however,

provides Canadian forensic educators in forensic nursing education with

documents that are global in nature and require very little adaptation for

Canadian purposes.6

The FN of today has developed the specialized body of knowledge and

skills that dif‌ferentiates forensic nursing from other specialities and sub-

specialties of nursing. A forensic nursing curriculum includes: “nursing sci-

ence, forensic science, law, healthcare and associated legal issues regarding

patient care.”7 Unlike most nursing specialties, forensic nursing is made up

of dif‌ferent subspecialties of nursing practice often identif‌ied by the popu-

lations served, including:

 clinical forensic nursing, focusing on victims of interpersonal violence;

 forensic correctional nurses, focusing on of‌fenders in federal or prov-

incial institutions or those in secure environments, such as pre-trial

detention centres;

 forensic nurse examiners and, specif‌ically, sexual assault nurse

examiners, focusing on child, adolescent, and adult post-sexual-vio-

lence incidents;

 forensic nurse death investigators, focusing on decedents; and

 forensic geriatric or pediatric nurses, focusing on geriatric or pedi-

atric victims of abuse and neglect.8

6 See, generally, International Association of Forensic Nurses, “Sexual Assault Nurse

Examiner Education Guidelines, Adult and Pediatric” (2015), online: iafn.site-ym.

com/?2015EdGuidelines; International Association of Forensic Nurses, “Forensic

Nurse Death Investigator Education Guidelines” (2013), online: c.ymcdn.com/sites/

iafn.site-ym.com/resource/resmgr/Education/Nurse_Death_Investigator_Edu.pdf;

International Association of Forensic Nurses, “Intimate Partner Violence Nurse

Examiner Education Guidelines” (2013), online: c.ymcdn.com/sites/iafn.site-ym.

com/resource/resmgr/Education/Nurse_Death_Investigator_Edu.pdf; International

Association of Forensic Nurses, “Core Competencies for Advanced Practice Forensic

Nursing” (2004), online: c.ymcdn.com/sites/iafn.site-ym.com/resource/resmgr/Edu-

cation/APN_Core_Curriculum_Document.pdf.

7 Donna Garbacz Bader & Sue Gabriel, Forensic Nursing: A Concise Manual (Boca Raton,

FL: CRC Press, 2010) at 18.

8 Virginia A. Lynch & Janet Barber Duval, Forensic Nursing Science, 2d ed. (St. Louis,

MO: Elsevier Mosby, 2011) at 20.