This nursing specialty is challenging because it incorporates not only nursing knowledge but knowledge in criminal justice and forensic science. The nurse applies her nursing experience and knowledge in forensic science in the care and treatment of victims and families of trauma and violence.
The Harris County Institute of Forensic Sciences is the first in Texas to establish a full-time Forensic Nursing Program. The forensic nurse death investigator is a Registered Nurse who applies the nursing process to the death investigation across the lifespan. The nurse collaborates with interdisciplinary agencies identifying trends related to injury and death. Conducting and participating in research is another component of the role (IAFN, 2004). The forensic nurse brings to the death investigation a vast knowledge base in nursing, anatomy, physiology, pharmacology and family interaction (Vessier-Batchen, 2003). Investigations emphasize the medical aspects of cases because approximately 70% 80% of the deaths occur due to natural causes. It is in this respect that the forensic nurse can impact. The natural death is more thoroughly investigated by nursing staff which may reveal that the death may have been unnatural. The forensic nurse also interacts with grieving family members and assists them with understanding the cause and manner of death.
In 2001, after extensive discussions, the Harris County Commissioner's Court approved the development of one forensic nurse position. The nurse was hired and started work in spring 2002. Initial duties included overseeing the medical record aspect of the medicolegal investigation, being an adjunct to pathology and investigative staff, and attending the Child Fatality Review Team meetings. After much success, additional positions were approved by the end of 2002. With the additional staff, nursing services were able to provide coverage for evening and night shifts. The nurses began to assist with physician review of organ/tissue recovery requests and also concentrated on the natural and infant/child death investigations. The focus of the Forensic Nurse Investigator Program was redirected from exclusively assisting division staff to incorporating a more community-oriented approach.
Various medical examiners' and coroners' offices were surveyed to determine what role, if any, nurses played in the medicolegal death investigation. It was shown that forensic nurses working in this unique setting were rare. However, in jurisdictions which utilized their services, their role was not as extensive as it is at HCIFS. Dr. Luis A. Sanchez, chief medical examiner, approached the Harris County Commissioner's Court with a proposal to increase the nursing staff with the vision of further expanding the role and increasing community outreach.
Currently, several nurses and physician assistant investigators have joined the staff, and their duties include the following:
- Conduct medicolegal death investigations as outlined by Texas CCP 49.25
- Respond to death scenes to document findings and conduct physical assessments
- Assist in the investigation of natural and infant/child deaths
- Provide case management for attending pathologists and fellows
- Collect evidence and document injuries in adult and child sexual assault examinations
- Collaborate with organ and tissue procurement agencies
- Perform eye assessments in order to release corneas for pre-autopsy recovery
- Provide community education
- Attend committee meetings for Child Fatality Review, Adult Violent Death Review, Elder Fatality Review, and Trauma Morbidity and Mortality
- Assist with documenting pathological findings in external examinations
Forensic nurses and physician assistants provide staffing 24 hours a day, 7 days a week and are located in the Forensic Investigations Division. For further information, please call 713 796 9292.
References:
- Harris County Institute of Forensic Sciences. (2004). Forensic nurse/ Physician assistant investigator II. Job description. Found at http://www.co.harris.tx.us/.
- International Association of Forensic Nurses. (2004). Forensic Nurse Death Investigator Standards of Practice. Draft copy.
- Lynch, V. (1993). Forensic nursing: Diversity in education and practice. Journal of Psychosocial Nursing, 31(11), p. 7-14.
- Vessier-Batchen, M. (2003). Forensic nurse death investigators. The Web Mystery Magazine. Found at the Forensic Nurse Investigator PowerPoint Presentation.