Part 2. Inside Forensic Nursing

Forensic Psychiatric Nurse

Paul Clements, PhD, APRN, BC, interacts with children who have experienced emotional trauma of the most unimaginable kind: witnessing the murder of a parent or other family member. In the aftermath of homicide, children are at significant risk to develop posttraumatic stress disorder.^[10] Developmentally appropriate drawing tools and a simple, open-ended request to draw what they know about the death of their family member is a nonthreatening way to begin interactions with bereaved children. This activity enhances the child's sensory memory (what the child saw, heard, and felt) and establishes a helping relationship with reluctant or nonverbal children.^[11] The child's drawing and the accompanying narrative storytelling provide a platform for deeper exploration of events, insight into the child's experience of trauma and bereavement, and guidance for assessment and intervention.^[12]

"When one parent murders the other, the child suffers a double loss," explains Dr. Clements, an Assistant Professor at Old Dominion University School of Nursing in Norfolk, Virginia. "Children are the invisible victims." Because these children may also be important witnesses, Dr. Clements helps police officers learn how to talk to and question children who have experienced a family homicide. Questions must be worded carefully to avoid frightening the already traumatized child into thinking he or she is guilty or responsible for the death. Dr. Clements also counsels the other family members, who often do not appreciate the degree of trauma suffered by the child, about their interactions with the bereaved child.

"What has become evident during interviews with these children is that the things adults think are helpful and important are usually not what the children think are important. Children often believe that they are the equivalent of 'damaged goods,' that they are no longer normal like other kids. Adults keeping silent or whispering about the murder to protect the child only reinforces the stigma of guilt." Dr. Clements helps these children not to forget the loved one or what happened, but to remember the deceased and put what has happened into an adaptive perspective. He helps the child find an anchor for safety to get through the acute phase of trauma, and helps surviving adults in the child's life understand puzzling delayed responses, such as regressive behavior.^[13]

As a forensic psychiatric nurse, Dr. Clements works with both the offenders and survivors of a wide array of violent offenses, including interpersonal violence, sexual assault, child molestation, elder abuse, stalking, suicide, homicide, arson, motor vehicle accidents, industrial and occupational deaths, sudden infant death syndrome, and gang violence. Believing that forensic nurses must also work to prevent violence, Dr. Clements has recently become a certified gang specialist.

Gaps remain, however, in the continuity of care across different forensic specialties. "Ideally, forensic nurses will refer patients to other forensic nurses for continuing care," suggests forensic nurse Paul Clements. For example, when a SANE nurse makes a referral for ongoing psychiatric care for a victim of rape, the ideal professional to provide this care is a forensic psychiatric nurse.

Cite this: Forensic Nursing: Part 2. Inside Forensic Nursing - Medscape - Apr 15, 2008.

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