Question-If you were the SANE (Sexual Assault Nurse Examiner) providingcare to this patient, what wo

Question-If you were the SANE (Sexual Assault Nurse Examiner) providingcare to this patient, what would be your priority? What evidence would you collect and why? -What documentation will be most important? -What forensic principles need to be considered as the nurse cares for Daisy?References:Forensic nursing science: Global strategies in health andjusticeVirginia A. Lynch *University of Colorado, Colorado Springs, 514 Hopi Circle, Divide, CO 80814, USAKEYWORDSForensic nurse examiner;Sexual violence;Death investigation;Evidence recoveryAbstract Forensic nurse examiners (FNE) are becoming integral partners in contemporary med-icolegal systems worldwide. Existing forensic services have been proven inadequate to sufficientlyaddress the vast crimes against women and children, victims of sexual and domestic violence, socio-cultural crimes, abusive religious rituals, and atrocities that accompany armed conflict. Consideringthat nurses comprise the largest group of healthcare providers worldwide, forensic nurse examinersrepresent a previously unrecognized resource in universal healthcare and embody an ideal group toadvance international considerations in global healthcare and social justice. Although specific legalconcerns within the healthcare communities vary from country to country, all nations struggle withissues of public health and safety. A comprehensive multidisciplinary forensic education and train-ing program for nurses will facilitate improved management of existing interpersonal and sexualviolence crises while reducing an unnecessary back log of cases for forensic physicians. The additionof a forensic specialist in nursing science will provide a valuable resource to assist in the substan-tiation of prosecutors’ claims or aid in the exoneration of suspects who are falsely accused. Theirunique contributions increase coordination and cooperation, share medical/forensic expertise,enhance the care of victims of crimes while augmenting forensic services, and act as a liaison inapplicable responsibilities between healthcare institutions and law enforcement agencies. The rele-vant literature indicates that once the Forensic Nurse Examiner Response Team is trained, specialistsin forensic nursing science practice independently under the auspices of a Director of Clinical Foren-sic Medicine or Chief Medical Examiner. This new generation of health and justice professionals* Tel.: +1 719 687 8087 (office); mobile: +1 817 805 8182.E-mail address: f..s@aol.com2090-536X ª 2011 Forensic Medicine Authority. Production andhosting by Elsevier B.V. All rights reserved.Peer review under responsibility of Forensic Medicine Authority.doi:10.1016/j.ejfs.2011.04.001Production and hosting by ElsevierEgyptian Journal of Forensic Sciences (2011) 1, 69-76Forensic Medicine AuthorityEgyptian Journal of Forensic Scienceswww.sciencedirect.comwill produce affirmative outcomes where the science of forensic nursing is practiced. The positivetreatment of victims of gender based crime, an increase in successful prosecution, and the assuranceof best specimens in evidence recovery will provide confidence in the community at large that justicehas been served through these combined forensic services…medicine, nursing and the law.ª 2011 Forensic Medicine Authority. Production and hosting by Elsevier B.V. All rights reserved.1. IntroductionThe science of forensic nursing represents an emerging world-view in the future of the forensic sciences as crime and violencebring together the two most powerful systems affecting thelives of people throughout the world – health and justice. Theneed for policies to address critical issues related to violenceand its associated trauma is a multidisciplinary concern. Theseconcerns require a joint endeavor involving physicians, nurses,police officials, attorneys, magistrates, sociologists, psycholo-gists, social workers, forensic and political scientists, advocatesand activists, and other criminal justice practitioners to reduceand prevent social injustice. Effective forensic case manage-ment is an area lacking in sufficient policy and legislation toensure protection of the legal, civil and human rights of boththe victims and the accused.1 An identified shortage of skilledforensic physicians has resulted in serious deficits of qualityforensic services. Recent strategies to augment and improveglobal standards of care for victims of crime, the falsely ac-cused and those wrongly convicted necessitate the applicationof forensic science to nursing practice.2. New strategies for health and justiceConsidering that nurses comprise the largest group of health-care workers worldwide, forensic nurse examiners (FNE) rep-resent a previously unrecognized resource in universalhealthcare and signify a model program to advance interna-tional considerations in health and justice. With the continu-ously evolving synthesis of mobility, advanced technologyand unbridled sciences, forensic nursing has accelerated as ascientific discipline. Forensic nursing science combines theprinciples and philosophies of the traditional forensic sciencesand those of contemporary nursing science in the clinical inves-tigation of crime related trauma and death. Forensic nurseexaminers serve as a clinical liaison to medical and legal agen-cies, supplementing the need for vital forensic services to pro-vide fair and equal justice as questions of innocence orcriminality arise. It must be emphasized that the practice offorensic nursing is not limited to victims, but includes court or-dered evidence recovery from the suspect, the accused and theincarcerated offender. With the founding of The InnocenceProject, a US litigation and public policy organization dedi-cated to exonerating wrongfully convicted individuals throughDNA testing, the need to reform the criminal justice system toprevent further injustice has been recognized. Critical aware-ness of false accusations, eye witness identification and con-taminated evidence has led to a reevaluation of currentforensic practices and procedures in healthcare. This policyhas had a profound impact on the scientific standards for theproper collection of biological, trace and physical evidencesand meticulous preservation of medical specimens to includeDNA sources such as blood and bloodstains, semen and sem-inal stains, tissues and cells, bone and organ fragments, andteeth.2 In 1996, Jay Miller, Director of the CODIS project(Combined DNA Identification System), US Federal Bureauof Investigation (FBI), recognized the forensic nurse examiner(FNE) as the ideal clinician to provide sexual assault examin-ations, and to recover and preserve biological evidence forinclusion in the CODIS data bank.3 Although healthcare inter-vention must always supersede that of evidence recovery, theFNE (who is not part of the trauma team) can provide selectedforensic services secondary to life saving intervention.3. The health of a nationThe devaluation of human life is inherent in the genesis of vio-lence. The World Health Organization (WHO) has recognizedviolence as a major public health problem as perilous as micro-bial diseases worldwide. Global violence is widely recognizedwithin the domain of public health and safety. In addition toimmediate physical and psychological trauma, the pervasivenature of violence affects the basic and profound aspects of life:culture, tradition and religion. An abrupt intensity of the dra-matic economic, political, and societal crisis combined withinterpersonal crime and terrorist-related violence in global soci-eties demands an overwhelming accountability for health andjustice operatives to collaborate on solutions. Violence is nolonger considered solely within the purview of law enforcementagencies but rather is viewed as a mutual responsibility ofhealthcare and the law. Strategies for improving a nation’shealth image must address priority areas involving interpersonaland sexual violence as important contributors to morbidity andpremature mortality. A healthy world cannot be achievedmerely within highly industrialized nations. Antiquated lawsand social policies, restrictive family values and human inequal-ities affect access and delivery of healthcare throughout variouscountries. The dynamics of archaic cultural traditions and reli-gious practices will continue to impact and pose threats to themost vulnerable subjects, namely, women, children, the elderly,the disabled, and those in extreme poverty.44. Violence and the forensic nurse examinerThe US Department of Health and Human Services has recog-nized the inevitable outcomes of violence (injury, disability,and death) as the primary benchmarks of public health status.Healthcare professionals have been challenged to assumeaccountability along with law enforcement officials for thecause and effects associated with human violence. This chal-lenge has resulted in propelling the evolution and applicationof forensic nursing science. Every injury, illness, or death canhave forensic implications. Forensic nursing demands superbassessment skills, second only to a high degree of suspicious-ness. Therefore, a solid forensic education for nurses providesa vital link in the development of clinical acumen required forresponding to these forensic circumstances. Increasingly, the70 V.A. LynchUnited States and a significant number of other countries areturning to forensic nurse examiners with the expectation toaugment the often insufficient resources that have resulted inthe destruction of evidence, long delays in medical responsetime, the loss of human lives, and inadequate prosecutions.Among the core challenges that face health and justice provid-ers is protection of the patient’s legal, civil, and human rights.5Past history indicates that each medical specialty has longhad corresponding nursing disciplines to assist and support phy-sicians with the exception of one…forensic medicine. By andlarge, forensic physicians have had to rely on police as an asso-ciate to relay medical information, recognize medical evidenceand sensitive communication to grieving and bereaved persons.It is not only difficult but unfair for police, who are not medicallyeducated, to be expected to perform both criminal and medicalinvestigation. Shared responsibilities between forensic physi-cians, law enforcement officers and forensic nurses have becomean essential partnership in order to address the current demandsof social transgressions. It is well to remember that all traumapatients are regarded as forensic cases until suspicion of crimi-nality or questions of liability are confirmed or ruled out. Vic-tims of aggression and abuse are frequently unrecognized andremain unreported by non-medical investigators of crime-re-lated trauma. As perhaps the first point of contact in the imme-diate post-trauma period, the FNE is in an ideal position togather information and physical evidence related to the crime.Forensic nurses must be able to recognize patterned injuriesindicative of human abuse, to skillfully interview patients andevaluate the nature and scope of these injuries.5. Forensic nursing definedNursing science has merged with the forensic sciences and crim-inal justice systems to provide this distinctive discipline at a cru-cial time in social and criminal hostility to improve policies thathelp meet the expectations of victims, the accused and their fam-ilies through accessible and cost-effective programs.6 Forensicnursing was first recognized as a scientific discipline in 1991 bythe American Academy of Forensic Sciences and originally de-fined by Lynch as: the application of the forensic aspects ofhealthcare combined with the bio/psycho/social/spiritual edu-cation of the registered nurse in the scientific investigation andtreatment of trauma or death of victims and perpetrators of vio-lence, criminal activity and traumatic accidents. It provides di-rect services to individual clients and consultation services tonursing, medical, and law-related agencies, and provides expertcourt testimony in areas dealing with questioned death investi-gative processes, adequacy of services delivery, and specializeddiagnoses of specific conditions as related to nursing.7,8The International Association of Forensic Nurses (IAFN)was established in 1992 and further defines forensic nursingas the global practice of nursing, where healthcare and legalsystems intersect. It has, by its nature, a strong associationwith both physical and social sciences as they apply to publicor legal proceedings. This specialty combines the forensic as-pects of healthcare with the scientific investigation and treat-ment of crime or liability-related cases.9 The concept of aforensic specialist in nursing has sparked an innovative devel-opment of a new discipline in the forensic and clinical sciencesthat has been replicated across the United States and in othercountries. Despite the number of medicolegal concerns, manyUS hospital emergency departments (ED) do not have a foren-sic clinician on duty at all times to oversee proper attention tothe legal implications of trauma care.Although, healthcare personnel should not refuse involve-ment in forensic case assessment as reported in some countries,forensic patients are often forced to await the arrival of the clin-ical forensic medical examiner (FME). This forensic clinician,who is not in residence, is notified to respond and recover evi-dence prior to emergency care. In spite of hospital policies andlegal mandates, if the FME is not readily available the patientis often transferred to another hospital (which may be in anothercity) to obtain forensic services prior to life saving intervention.Consequently, it is not uncommon for the patient to die duringtransport as cited in a leading Pakistan newspaper’s editorialtitled Death by Red Tape. The presence of the forensic nurseexaminer (FNE) on each shift can eliminate an unnecessary de-lay, loss of life and/or evidence. Nurses in all specialties, EDnurses in particular, must develop the necessary skills to compe-tently care for patients classified as clinical forensic patients. Re-search has identified a minimum of 28 forensic patientclassifications routinely admitted to the ED.10 These cases in-clude domestic violence, child abuse, elder abuse, neglect, sexualassault, and rape, among others. All cases reported as accidentsmust be evaluated to confirm or rule out intentional from non-intentional injury. Cases of inter-personal violence (IVP) com-prise one of the largest numbers of forensic patients, who oftenfail to identify themselves as crime victims out of humiliation orfear. The primary responsibility of the FNE is to recognize sus-picious trauma, display appropriate sensitivity while interview-ing the patient, and ask direct questions pertaining to how theinjury occurred, to accurately document findings, recover evi-dence, coordinate with police, and testify if required.In October 1998 the US Emergency Nurses Association(ENA) issued a position statement that clearly outlines theresponsibility of ED nurses in forensic cases that should notonly provide physical and emotional care, but should focuson the identification, collection and documentation of forensicevidence. Prosecutors, police, homicide detectives, and forensicpathologists, who work with FNEs concur that forensic nurs-ing services are superior to those provided in the past by non-forensic healthcare professionals. Forensic nursing servicesare practiced strictly within the scope and practice of nursingaccording to the regulating body of nursing in each country.It does not involve the medical practice of physicians. One mustconsider that the identification of trauma and the recovery ofevidence has long been a nursing responsibility; however, itwas commonly referred to as wound documentation (nurse’snotes) and collection of specimens. These same specimens be-come criminal evidence once the case is reported to a legalagency. However, due to the absence of forensic knowledgein traditional nursing education, forensic circumstances are fre-quently overlooked and evidence is lost or discarded in the ab-sence of a resident FME. Therefore, an FNE on each shift willprovide an immediate forensic response to trauma/emergencycases and eliminating long delay or transfer of the patient.6. The forensic nurse examinerThe FNE is identified as an exceedingly skilled healthcare pro-fessional educated in the concepts of the nursing and forensicsciences. Roles once limited to physicians, politicians, police,Forensic nursing science: Global strategies in health and justice 71or attorneys have now become roles – although not replace-ments – available to forensic nursing personnel. Such rolesare recognized by prosecutors to provide critical thinkingand forensic assessments involving rape, torture and custodialabuse among other significant medicolegal concerns. Rolesthat were once strictly within the purview of non-medicalagents of government, military, and police are now viewed asupgrading appropriate roles by employing nurses with forensiccredentials. These roles include nurse death pronouncementlaws, forensic assessments of refugees for the immigrationcourts (according to the Istanbul Protocol), clinical forensicinvestigations of clustered deaths in veteran’s hospitals, sexualassault examinations in public, private and military hospitals,consultants to attorneys, testifying in federal cases, employ-ment by crime laboratories, and for digital evidence recoveryin the clinical environs.The role of the forensic nurse examiner (FNE) educated atboth a basic and advanced level has unlimited potential in theglobal healthcare market. Leadership and management skillsprepare the FNE to fill essential roles as forensic nurse scien-tists, examiners, educators, investigators, administrators, andconsultants are employed in local, state, or federal governmentand nongovernment institutions and organizations fill thisneed. The forensic nurse provides a scientific and humanitarianimage to those who suffer amid the chaos and crises of ourtimes. Thus, women and children, the damaged and disabledwho represent the most vulnerable populations, will be offeredgreater protection in the challenge to shield them from harm.Forensic nurse examiners practice in a variety of profes-sional roles, in which they may further specialize in a varietyof specific subspecialties. Roles and responsibilities, althoughunique to each subspecialty within the forensic nursing genre,have common characteristics according to the basic conceptsof forensic nursing science and include the following: Forensic Clinical Nurse Specialist/Practitioner Forensic Correctional (US) or Custody Nurse (UK andAustralia) Forensic Nurse Coroner/Death Investigator Tissue and Organ Donation/Recovery Specialist Sexual Assault Nurse Examiner (Adult and/or Pediatric) Forensic Healthcare Services Administrator Forensic Nurse Photographer Forensic Geriatric Nurse Forensic Academic/Educator Healthcare Risk Manager Forensic Nursing Researcher Legal Nurse Consultant Forensic Psychiatric Nurse Forensic Nurse Attorney/Nursing JurisprudenceThe purpose of forensic nursing science is to assist in thecreation of positive change in the inappropriate medicolegalmanagement of detainees, asylum seekers, mentally disorderedoffenders, living and deceased persons, to prevent victimiza-tion and reduce the fear of crime. Forensic nurses, who goto law school and become practicing attorneys have a uniqueadvantage in medicolegal jurisprudence. The FNE is trainedto provide forensic services while facing the challenging cir-cumstances of civil unrest, political crisis, war, torture, mutila-tion, starvation, and summary executions in a world filled withviolence.7. Forensic nursing servicesForensic nursing services offer direct forensic care to victims,suspects, perpetrators, and those who witness violence. Theclinical forensic nurse investigator documents, secures and pre-serves evidence while providing forensic consulting services toclients and interdisciplinary partners in healthcare and law-re-lated agencies.11 Examples of primary services are briefly de-scribed below:7.1. Sexual violenceSexual assault assessment and examination is one of the primaryapplications of forensic nursing services. These forensic patientsinclude the adult and pediatric, male and female, the living andthe deceased victims of sexual violence. Sexual assault nurseexaminers (SANE) programs were first established in 1974 bya committee of physicians, prosecutors and law enforcementagencies, who determined the registered nurse was the ideal cli-nician to provide rape examinations. This program establishedimproved patient care, reduced an unnecessary burden on emer-gency physicians, and increased successful prosecutions. Thepractice of the sexual assault nurse examiner, once limited toproviding rape examinations, has now expanded to the broaderrole of the forensic nurse examiner (FNE), which incorporatesthe role of the SANE nurse, in the assessment, examination, evi-dence recovery, and photo documentation of all categories offorensic patients where medical treatment is not required. TheFNE who is certified in sexual assault examination applies thelatest state-of-the-art technology and guidelines. Increasingly,forensic pathologists are employing the FNE to provide rapehomicide medical/forensic evidence recovery prior to autopsy.The American College of Emergency Physicians have endorsedthe concept of the FNE, specifically in cases of sexual violence,and have assisted in developing protocol for the FNE.12 USprosecutors agree that forensic nurses make formidable wit-nesses in the courtroom.7.2. Scientific investigation of deathAs early as 1975, forensic pathologist Dr. John Butts in Alber-ta, Canada was the first to recognize the aptitude of the regis-tered nurse as a medical death investigator within a medicalexaminer system.13 Registered nurses with a specialized foren-sic education have proved to be exceptional death investigatorsas opposed to non-medical investigators. Nurses are educatedto understand anatomy and physiology, medical terminology,physicians progress records, surgical intervention, natural dis-ease processes, pharmacology, as well as the complexities ofbrain death. Advances in the forensic and medical sciencesare persuading a greater number of nurses to attain advanceddegrees in order to supplement the level of professionalism inview of the shortage of forensic pathologists. As in any othercareer, the trend to maintain quality continuing educationand formal credentials impacts the professional benefits ofthe forensic nurse and will provide unlimited potential yet tobe imagined and fulfilled. Forensic physicians will help todetermine the next role and level of expertise for the FNE asthey identify areas where quality forensic assistance is needed.With rapid progress moving the role of the forensic nurseexaminer forward into the frontiers of global healthcare, newroles, qualifications, and skills will require the sophisticated72 V.A. Lyncheducational experiences available through institutes of highereducation.7.3. Crimes against women and childrenOne of the most pernicious overlooked, areas of universal vio-lence and abuse familiar to every country is violence againstwomen. Ban Ki Moon, United Nations Secretary General sta-ted that ”Violence against women continues to persist as oneof the most heinous, systematic and prevalent human rightsabuses in the world. It is a threat to all women and an obstacleto all our efforts for development, peace, and gender equalityin all societies”.14 It inflicts devastating physical and psycho-logical trauma on women and has wide-ranging implicationsfor their families, communities and societies. Violence againstwomen includes rape and sexual violence, female genital muti-lation, forced marriage, stalking, commercial sexual exploita-tion such as prostitution, pornography and trafficking, wifebattering, domestic homicides, honor killing, gender discrimi-nation, female infanticide and sexual harassment. Violenceagainst women is never normal, legal or acceptable and shouldnever be tolerated or justified. Everyone – individuals (bothmen and women), communities, governments, and interna-tional bodies – has a responsibility to help eliminate interper-sonal violence and to redress the suffering it causes.According to the Egyptian Centre for Women’s Rights(ECWR) report on harassment and violence against womenand children found that 98% of foreign women and 60% ofEgyptian women are beleaguered on a daily basis.15 The studywas conducted on a sample of over 2000 women in four govern-orates in the country, including Cairo and Giza. An Egyptiangovernment report in November 2008 found 47% of marriedwomen between 15 and 49 are subjected at least once to physicalviolence. Among married women, 33% are physically abusedand 7% are sexually abused before marriage. The report alsofound 18% of Egyptian women subjected to psychological vio-lence in the form of name calling and demeaning and intimidat-ing behaviors by a man. Egypt is not alone in its attempt tocombat gender based violence. Sexual violence, harassmentand abuse of women and children are foremost concernsthroughout developed and developing countries.16Comprehensive forensic healthcare education should offerprofessionals current tools and knowledge that will make a dif-ference in their practice, promote collaborative community re-sponses to violence and design strategies for violenceprevention. Forensic nurses should be aware of their role ofsafeguarding human rights as defined by the InternationalCouncil of Nurses.17 The United Nations and the Interna-tional Committee of the Red Cross and Red Crescent Societiesindicate that nurses must be familiar with their responsibilitiesfor caring for prisoners and detainees, and understand that it isunethical to participate in acts of torture or execution in anysetting. Forensic nurses also participate in disaster manage-ment involving mass fatalities, human rights missions, massgrave exhumations, identification of human remains in theaftermath of armed conflict, research into the epidemiologyof violence and its consequences in times of peace and at war.7.4. Military forensic nurse corpsThe application of forensic nursing within the US ArmedForces has expanded forensic services to become available inUS military medical treatment facilities worldwide. Militaryforensic nurses are well educated in a variety of forensic sciencespecialty areas today and have achieved their primary recogni-tion as sexual assault nurse examiners (SANE) and forensicnurse examiners (FNE), as well as clinical investigators of hu-man abuse and neglect, and intimate partner violence. Allbranches of the military have identified certain active forensicnursing roles within hospital emergency departments, clinics,security police forces, mortuary services, family advocacyand other social services in the US Air Force Office of SpecialInvestigations and Hospital Risk Management. Although, allbranches of military services have sexual assault nurse examin-ers in larger facilities and overseas, few installations currentlyhave the resources to permit FNEs to function in a full-timerole. Military leadership is currently engaged in strategic plan-ning to ensure that its members have the benefits and protec-tion afforded by the various forensic sciences, includingnursing.One of the most comprehensive US Department of Defencesexual assault training programs is provided by the ArmedForces has been the Sexual Assault Response Team (SART)training course, hosted by the Armed Forces Institute ofPathology (AFIP): Office of the Medical Examiner. This40 hour course was planned, developed and organized bytwo military forensic nurse corps officers from the US AirForce and US Navy. Utilizing their subject matter expertiseand experience in forensic nursing and sexual assault care theyhave instructed many aspects of the course. Since 2005, thiscourse has trained over 500 joint military and civilian person-nel on the military management of sexual assault medical,advocate, legal, investigative, and psycho-social issues. Itincluded laboratory sessions to introduce to participants tosexual assault forensic examination techniques, forensic pho-tography, documentation of injuries, and physical evidencecollection. Its program continues to be the gold standard ofsexual assault examiner training in the Armed Forces and willserve as a model for future related joint service training.188. Education and trainingCompetencies necessary for nurses to provide highly skilled andquality care of victims of violence include the science of forensicnursing. For nurses who want an advanced professional degreerepresenting the highest level of competency, forensic nursingprovides new options (Fig. 1). The educational preparation forforensic nurses incorporates a variety of pathways for bothundergraduate and graduate programs, certificate and contin-uing education courses and doctoral degrees in this field.19 Pro-gressive academic institutions are currently providing theopportunity for innovative programs of study for nurses, whowish to attain a bachelors, masters or doctorate degree in foren-sic nursing science. The education and experience of the forensicnurse specialist provide a distinctive knowledge base and clinicalskills appropriate for an advanced role in sexual assault exami-nation, death investigation and other clinical forensic services.The most common model for the existing forensic nurse seekinga formal degree is the post-licensure education. Nurses, whohold a registered nursing license and later become involved inthe forensic aspects of patient care, often return to college or uni-versity programs to advance their skills and gain credentials asforensic nurse examiners. This is the most opportune and timelymethod to achieve a forensic education in nursing. It requiresForensic nursing science: Global strategies in health and justice 73less time and investment for the returning nurse with 2 years ofeducation and a license to become a practicing FNE than thenursing student in a 4 year degree program. The practicingRN also has the clinical experience to advance basic forensic ser-vices as opposed to the novice student without practicalknowledge.Where no formal forensic education programs for nursesexist, the local clinical forensic physician or forensic patholo-gist can initiate an introductory course as an elective withinthe existing nursing curricula. Once the impact of forensicmedicine is recognized it becomes a powerful influence onnursing practice. It is interesting to note that the primary re-source for establishing forensic nursing practice has beenforensic medical examiners, human rights organizations andpolice agencies in the medicolegal care of forensic patients.The nursing process is a natural design for the clinical forensicinvestigation of trauma, injury, illness, torture, and death.Nurses, who have attained an advanced forensic practice de-gree will provide a greater utilization of nursing skills suchas communication, interviewing, hostage negotiation, biomed-ical investigation, multidisciplinary team coordination, re-search, interpretation of trauma, exhumations, disastermanagement, sexual assault education and examination, eval-uation of complex circumstances involving political victimsand prisoners of conscience among other multidisciplinaryneeds and responsibilities.5 Correctional healthcare is anotherimportant area of forensic nursing in the prison systems as wellas in jails and detention centers. Australia was the first to pro-vide a three tiered system of forensic nurses as early as 1993.9. Forensic nursing science curriculumCourses are designed to provide participants with a detailedunderstanding of the role and impact of forensic nursingpractice. Many universities offer a variety courses for theforensic nursing degree or certificate programs in the onlineformat. Examples may include the following:Practice Paradigms in Forensic NursingScientific Investigation of Trauma and DeathForensic Markers of Child MaltreatmentSexual Assault, Abuse and ExploitationViolence and Human RightsInvestigation of Trauma throughout the LifespanAdvanced Forensic NursingForensic Health Policy, Ethics/Legal AspectsMental Health in Correctional InstitutionsCorrectional Healthcare Ethics and LawSubstance Abuse: Forensic ImplicationsIntroduction to Correctional Healthcare InjuryCorrectional Healthcare of the Older AdultPublic Health/Infectious Disease in Corrections10. Board certificationIn 1992, the International Association of Forensic Nurses(IAFN) was established to represen

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