Forensic nurses provide care, help solve crime

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Nurses all too often see the brutal aftermath of gun shootings, sexual assault, child abuse, and other violent acts when caring for their patients, but since undergoing unique forensic training some can also see clues that trace back to the victimizers.

William S. Smock, MS, MD, professor of emergency medicine at University Hospital and Louisville Metro Police surgeon in Louisville, KY, created the voluntary program that teaches nurses how to collect forensic evidence in medical situations. The program requires nurses undergo 400 hours of training, including ride-alongs with police officers, visits to crime scenes, forensic photography training, and shifts with the state's medical examiners office. Nurses must also complete examinations and a research project, and attend weekly lectures.

"The goals of the program are to provide the highest level of medical care and also the highest level of forensic care for victims of violent crime," says Smock. "And these two are not mutually exclusive."

Four out of the eight nurses that began training in September 2008 received their official certification last week. In obtaining this new knowledge, nurses can gather crucial evidence when encountering wounded and abused patients that helps the Louisville Police Department (LPD) determine what really happened during incidents. For example, a forensic nurse can look at a wound and identify the weapon that was used, or determine when and where a bullet exited.

"I have always seen the need to have a forensic evaluation performed in the emergency department [ED] on victims of violence and crimes," says Smock, who has 25 years of living forensic evaluation experience. "It is the ideal place to provide a high level of care, but make sure evidence is preserved, injuries are recognized, and evidence is documented."

The forensic nurses are involved in a wide range of cases, such as domestic assault, elder abuse and neglect, traffic incidents, and gun shootings. It is because of this that they must complete Sexual Assault Nurse Examiners (i.e., SANE) training to be eligible for forensic training. Other qualifications include five years of nursing experience and "a commitment and sincere interest in forensic nursing," according to Smock.

The extensive training has given Rena Lopez, RN, BSN, in the coronary care unit at the hospital, a different perspective on patient care.

"Before I was just used to the procedures—trying to take care of the patient, looking at the dressing changes, and the 'now' portion," says Lopez. "Now, the history tends to make a little more sense; instead of just packing a gunshot wound, I can explain what the wound is and why it is the way it is."

The hospital's ED is currently funded to perform the forensic evaluations by the LPD and forensically-certified nurses cannot perform the evaluations at other facilities.

"The University of Louisville, the LPD, and the medical examiners office have been completely supportive of the project and all of the nurses who are going through it," says Lopez. "It has been a wonderful experience."

Smock is currently seeking grant money to fund full-time forensic nurse positions in the hospital's ED. He says his dream is to create a three-pronged approach to forensic nurse training: providing clinical service; conducting research in forensic nursing; and educating nurses about forensic medicine.

"In the long-term, I would like to establish the University of Louisville as a national training center, so that we can bring nurses in from across the country and provide this unique and much-needed training," Smock says.