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An eye for detail

From conducting forensic medical exams to appearing in court as an expert witness, forensic nursing is a unique and emerging specialty. Linda Belardi talks to one nurse working in the field.

It was in the years spent working in accident and emergency departments in Victoria’s major hospitals that Adele O’Hehir first developed an interest in forensic medicine. Through her encounters with victims of crime, she became fascinated with forensic evidence and supporting victims.

In 2008, after many years working in emergency health and critical care, she completed postgraduate qualifications in forensic nursing and is now forensic nurse co-coordinator at the Victorian Institute of Forensic Medicine (VIFM) in Melbourne, where she oversees a team of more than 50 forensic nurse examiners and nurses carrying out biological specimen collection across the state.

Still in its infancy in Australia, forensic nursing grew out of a shortage of trained medical officers available to perform forensic medical examinations, especially in regional and remote areas.

Forensic nurse examiners have been trained to undertake a range of forensic medical tasks, including collecting samples for forensic analysis and assessing the injuries of victims of sexual and physical assaults. Last year, the institute conducted 482 adult physical and sexual assault examinations.

Despite significant demand for forensic nurses across Australia, expansion of the workforce is limited by education and training opportunities. There are only two courses available in Victoria and Western Australia. Exacerbating the problem, the graduate certificate delivered by Monash University and the VIFM has been suspended due to a lack of student enrolments.

NR: What are the significant challenges of your role?

Adele: The initial challenge for me was learning to write a medical report which is a very different skill from taking nursing notes in a hospital and clinical setting. You have to address legal issues in the report and because the evidence is scrutinised in a court of law everything you put down with regard to opinions has to be verified by research journals. This required a lot of training in appropriate terminology and legal definitions. Being called to give evidence in court has been one of the most exciting and rewarding aspects of the job.

NR: What skills do you need to be successful in this role?

Adele: To consider this sort of work you need two or three years’ experience in emergency nursing to gain a good grounding in the type of patients you would encounter. We also deal with the assailants and that’s the darker side of life, as I call it. Those situations can certainly be very challenging because as a clinician you are taken outside of the traditional hospital setting, for example to attend a police station or custodial centre. It can be a significant learning curve to be able to deal with a lot of other issues such as security and safety concerns.

NR: What is the experience like of working with victims of crime? What are the issues around gaining client consent?

Adele: It can be a very challenging experience especially if you are caring for a victim who has been through a harrowing ordeal and a very traumatic event, but that’s where I draw on my emergency nursing skills. Being an experienced nurse has helped me apply all of those skills that I have learned over the years to someone who is in a state of distress. As a nurse I feel well equipped to deal with patients who have experienced emotional and physical trauma. But performing a clinical exam can be quite difficult when you are dealing with a lot of emotions and often a lot of acute injuries that have to be addressed before the forensic examination can begin. Sometimes it can take time to gain a person’s consent but if the process is explained to them in a logical and clear manner and you choose your language carefully then a patient will generally understand the importance of the examination.

NR: Does forensic nursing need to have a stronger profile in Australia?

Adele: I’d love for it to have one, especially in the education and training of future nurses. I’m writing an article for an Australian journal on forensic evidence collection and I lecture at several universities in Melbourne at a masters and undergraduate level. When I teach second- and third-year students I have often observed a genuine interest and passion for forensic nursing and a willingness to learn more. It would be great to see more students introduced to this specialty at an undergraduate level and onwards.

NR: Is there a level of unmet demand for forensic nursing services?

Adele: Across Australia and particularly in regional areas there is an absolute need for more clinicians. If you look at the American model, nurses are expanding the role even further to legal nurse consultants, death investigators and transferring their skills in the examination of sexual assault to other crimes. The skills of DNA sampling and assessing injuries can be applied to other crimes and assaults but I think we are a long way off from that happening in Australia.

NR: What are you looking for when you conduct an exam?

Adele: Firstly we’re looking for any life-threatening injuries; in particular throat injuries, which are common in violent sexual assaults. Our main concern is airway. We also look for any acute injuries that are bleeding or genital injuries. We then document all other injuries as well. Once we’ve made sure the patient has received any necessary medical treatment, we can perform a forensic exam and document any abnormalities. HIV risk, contraception and STI management issues are also assessed and referrals made.

NR: At a professional level, how does this work differ to your previous nursing roles?

Adele: Often when your shift in the accident and emergency department ended so did your contact with the patient, but as a forensic nurse examiner the nurse is not only involved in the clinical aspect but also in the legal component of the actual event. To be involved in the case as a whole – along with the police and legal personnel – is a satisfying process.

NR: Is the expansion of the forensic nursing workforce leading to more prosecutions by police?

Adele: If nurses weren’t in these positions, victims would have to travel long distances or wait for a medical officer to become available. The presence of forensic nurse examiners has improved access to a forensic medical examination for victims, and nurses are being subpoenaed to appear in court quite frequently, especially in the past two and half years.

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