Forensic Psychiatric Nursing -- A Legal Affair: An Expert Interview With Angela Frederick Amar, PhD, RN, and Paul Thomas Clements, PhD, APRN-BC, CGS, DF-IAFN

Elizabeth McGann, DNSc, RN

October 21, 2010

October 21, 2010 — Editor's note: Forensic nursing is nursing care with a legal component. Nurses who specialize in forensic nursing assist victims, offenders, and families in dealing with the criminal justice system and the associated mental health consequences of violence.

A group of forensic nurses gathered for an interactive panel, led by 2 experts, to discuss key issues. This discussion was featured at the American Psychiatric Nurses Association 24th Annual Conference held in Louisville, Kentucky, October 13 to 16.

To find out more about forensic nursing, Medscape Medical News interviewed Angela Frederick Amar, PhD, RN, and Paul Thomas Clements, PhD, APRN-BC, CGS, DF-IAFN.

Dr. Amar is associate professor of nursing and director of the advanced practice forensic nursing program at the William F. Connell School of Nursing at Boston College, Massachusetts. She has practiced as a psychiatric nurse at both the generalist and advanced practice levels. Her research deals with interpersonal violence, mental health consequences, and reporting. Currently, she is working on a funded research project that explores violence and the policies and procedures on college campuses that influence the reporting of violence.

Dr. Clements is associate clinical professor at the College of Nursing and Health Professions at Drexel University in Philadelphia, Pennsylvania. He has been a forensic psychiatric nurse for 17 years and has provided counseling and crisis intervention to more than 1500 families of murder victims, as well as to many surviving family members in the aftermath of suicide, industrial and occupational deaths, motor vehicle accidents, sudden infant death syndrome, and other types of sudden violent death. Dr. Clements is also a certified gang specialist. Currently, he is developing an online forensic healthcare certificate at Drexel University.

Medscape: What is forensic nursing?

Drs. Amar and Clements: Forensic nursing is nursing care with a legal component. Often times, this can mean that a crime has been committed and the client is involved with the criminal justice system as a victim, offender, or an involved family or significant other. Common practice situations include sexual assault, intimate partner violence, child maltreatment, death investigation, correctional nursing, forensic psychiatric nursing, legal nurse consultant, and forensic psychiatric liaison nursing.

Medscape: What is the state of the science for this specialty practice?

Drs. Amar and Clements: Forensic nursing, recognized as a specialty by the American Nurses Association in 1995, is a newer specialty and in the early stages of nursing science development. Beginning with the pioneering research of Dr. Ann Burgess, much of the forensic nursing research initially explored sexual assault, responses to sexual assault, and the role and efficacy of the sexual assault nurse examiner. The contemporary era of forensic nursing research has expanded to the pervasive public health issues of intimate partner violence, child maltreatment, and elder abuse. As the practice of forensic nursing continues to expand, so does the research.

Medscape: What types of common psychopathologic conditions do forensic nurses manage?

Drs. Amar and Clements: The common mental health consequences of experiencing violence include depression, posttraumatic stress disorder, acute stress disorder, somatization, substance abuse, and anxiety. Many offenders exhibit the above disorders as well as Axis II disorders, such as antisocial personality disorder.

Medscape: What are some typical responses to trauma and victimization?

Drs. Amar and Clements: The common responses to trauma and victimization are the symptoms listed above. However, nursing research has provided evidence of variation in victim responses. There is no "typical" response for either victims or offenders. It is within this frame that the role of the forensic psychiatric nurse can be of significant importance; specifically, as nurses, educated within the bio-psycho-social assessment and intervention paradigm, their expertise with examination of mental health and behavioral components enhances the capacity to maximize successful intervention with victims and legal proceedings with offenders.

Medscape: What is unique about forensic nursing practice?

Drs. Amar and Clements: Forensic nursing always has an inherent legal component. The differentiating factor in practice is that forensic nurses are involved in evidence collection and the provision of court testimony. Nurses may testify as fact witnesses who collected evidence and as expert witnesses who can speak to the characteristics of victims and offenders of violent crime.

Medscape: What strategies are important in forensic interviewing and evaluation?

Drs. Amar and Clements: Nurses are very skilled at assessment and gathering information from clients. Forensic interviewing includes the use of unbiased or objective questions to gather information about the facts of the crime, related events in the person's history, and responses to the violence. Forensic psychiatric nurses may interview victims to determine damages incurred [as a result of] violence.

The nurse is not serving as an advocate; rather, the nurse serves as an expert, evaluating the individual for mental health disorders that have resulted from victimization. Expert nurses may also relate the facts of the case to the current body of scientific literature on victims and offenders of violence, and they may draw scientific conclusions from the forensic evidence.

Medscape: Are there evidence-based national guidelines for forensic nursing?

Drs. Amar and Clements: The American Nurses Association, in conjunction with the International Association of Forensic Nursing, has established the scope and standards of forensic nursing practice.

Medscape: Was there consensus reached by the forensic nursing panel?

Drs. Amar and Clements: The interactive panel met to discuss the issues and challenges related to forensic psychiatric nursing, an area often overlooked in the big picture of forensic nursing. Given the serious immediate and long-term mental health consequences of violence, it is important that psychiatric nurses are knowledgeable about aspects of forensic nursing.

There were actually several points on which the panel reached consensus. These included:

  • increasing the visibility of forensic psychiatric nursing by promoting awareness and education in forensic nursing with practicing nurses

  • the necessity to expand undergraduate and graduate psychiatric nursing education to include aspects of forensic nursing within curricula

  • the development of violence prevention strategies.

Over the next year, the Forensic Psychiatric Nursing Council of the American Psychiatric Nursing Association will be developing strategies to address the above areas.

Drs. Amar and Clements have disclosed no relevant financial relationships.

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