Forensic nursing is the nursing care of crime victims and people who are accused or convicted of committing crimes. The term forensic nurse came into use in 1992 after a group of about 70 sexual assault nurses met in Minneapolis and started the International Association of Forensic Nursing. Forensic nursing is defined as the application of the medicolegal aspects of health care in the scientific investigation of trauma and/or death related issues. Forensic nursing practice is as old as the interface between the legal and health care systems and has been considered a subspecialty of nursing since 1995.
Forensic Nursing Practice
Clinical forensic nurses do many of the same things other nurses do: conduct health interviews, perform physical assessments, conduct medical tests, collect specimens, help people manage crises, document information, and prevent problems. Unlike other nurses, however, forensic nurses are involved with the patient specifically because there is an interface between the health care and legal systems, and that influences what the nurses do. For instance, a forensic nurse may collect specimens, an ordinary nursing function. Specimen collection becomes a forensic function when the specimens come from a suspect in a reported sexual assault. In the same way, forensic psychiatric nurses may use the familiar tools to evaluate mental status, but the information may be used in court rather than in a discharge planning conference.
Forensic nurse researchers add to the body of scientific knowledge that supports forensic nursing practice, education, and administration. The National Institute of Nursing Research has funded over 40 violence-related research studies since 2001, most focusing on sexual violence or interpersonal violence. Forensic nurse education is provided in 32 master’s and post-master’s certificate programs nationwide, 13 of which are offered exclusively online. Forensic nurse administrators manage Sexual Assault Nurse Examiner programs in every state in the United States, some of which also incorporate services to victims of domestic violence.
The Forensic Nursing Workplace
Forensic nurses work in hospitals and clinics, just like other nurses do. The difference is that the hospital might be in a prison, or the clinic might be in a jail. Forensic nurses who are death investigators go to crime scenes. Forensic psychiatric nurses work in mental health facilities and advocacy organizations. Sexual assault nurse examiners work in hospital emergency departments and freestanding clinics.
Forensic nursing is a role rather than a job description, so forensic nursing principles are useful in any setting. If, for example, a nurse is focused on intimate partner violence and its effect on women and children, he or she might work in a prenatal or pediatric clinic. Legal nurse consultants help both the prosecution and defense in their search for truth and justice; they often own their own businesses and may have additional training as attorneys or paralegals.
Bibliography:
- Benak, L. (2006). Forensic nursing: A global response to crime, violence and trauma. On the Edge, 12(4), 9–10.
- Lynch, V. A. (1993). Forensic aspects of health care: New roles, new responsibilities. Journal of Psychosocial Nursing, 31, 5–6.
Foster Care
Foster care is a social service providing temporary care to children whose homes are unsafe because of child maltreatment or parent or caregiver incapacity. When the substitute caregiver is related to the child, foster care may be referred to as kinship care. Typically, the term foster care includes only children in the legal custody of the state or county child welfare agency, while kinship care may refer to any child in a relative’s care, whether or not the state or the relative has legal custody.
If a child welfare agency has placed a child in foster care, it must justify to the dependency court that the child would be at imminent risk of harm in the home from which he or she was removed. The state is required to make “reasonable efforts” to prevent the need for foster care, to reunify the family, and to find permanent family alternatives for children who cannot return home. Rules about circumstances that make foster care placement justifiable, as well as criteria for licensing and monitoring foster homes, are established through state laws and regulations. In most states, a parent may also place a child in foster care voluntarily. Federal law provides a national framework regarding the care of dependent children in foster care.
The foster care system has its roots in colonial period practices in which impoverished or orphaned children were indentured to families who could care for them and teach them a trade. Systems of indenture were later replaced by orphan asylums and then succeeded in the late 1800s by systems of “placing out” impoverished children from urban slums to host families in the countryside. These systems evolved with changing societal standards regarding appropriate living conditions for children and accepted practices related to child labor, as well as with the professionalization of the social work field. Over time, the focus of foster care shifted from orphans and destitute children to maltreatment of children by parents and caregivers.
Foster Care Settings and Foster Parents
Nearly half of children in foster care in the United States live in nonrelative family foster homes and another quarter live in foster care with relatives. The use of relatives as foster parents varies widely by state. About one in ten foster children live in institutions and a similar proportion live in group homes.
Foster parents are usually recruited, licensed, and trained by state or county child welfare agencies. They are paid a stipend as reimbursement for the child’s room and board, but are not salaried employees. Foster care payment rates vary with the child’s age and needs for specialized care. Foster parents tend to be older than biological parents and about 40% are employed full time outside the home. While the median level of experience of foster parents is about 3 years, there is a great deal of turnover in the population of foster parents, and state and local agencies face difficulties recruiting and retaining them.
Children in Foster Care
At the end of 2004, there were 518,000 children in foster care in the United States and 800,000 had spent some time that year in foster care. The number of children in foster care in the United States has risen nearly every year since national data collection began in the 1960s. Foster care is intended as a short-term service for families in crisis, although some children experience extended foster care stays. The median length of stay of children in foster care during 2004 was 18 months, and the median age at the time of entry to foster care was 8.3 years. Approximately half of children in foster care have a case goal of reunification with the parent or principal caretaker. Another fifth have adoption as their case goal, with the remaining children having case goals such as guardianship, long-term foster care, or emancipation.
Most children who enter foster care do so after a state child protection agency verifies or “substantiates” a report of child abuse or neglect, although relatively few substantiated maltreatment reports result in children’s placement in foster care. The National Survey of Child and Adolescent Well-being (NSCAW), a nationally representative, longitudinal study of children in foster care and children investigated by child protective services, reveals that of children in foster care for 1 year, 60% had entered foster care primarily as a result of child neglect. Ten percent of children in foster care had experienced physical abuse as their most serious type of maltreatment, and 8% were victims of sexual abuse. Approximately 8% of children in foster care had not experienced abuse or neglect, but had been referred for reasons such as their own mental health needs or domestic violence in their families. Parental mental illness, substance abuse, and other serious impairments are associated with many children’s foster care placements.
Rates of entry into foster care are highest for infants. The rates drop dramatically for 1-year-old children, and the risk of entry continues to decrease until children reach adolescence, at which point the risk rises again. Entry rates are higher for African American children than for White or Hispanic children. Children living in poor and urban communities are also much more likely to enter foster care than children living in other environments.
Many children in foster care have physical, emotional, and behavioral issues that warrant specialized treatment. The NSCAW study found that, on average, children in foster care scored somewhat below national norms on a variety of developmental measures. Of particular concern was that one third of children in foster care for a year demonstrated significant cognitive and/or behavioral problems.
Bibliography:
- Mallon, G. P., & Hess, P. M. (Eds.). (2005). Child welfare for the 21st century. New York: Columbia University Press.
- NSCAW Research Group. (2005). National Survey of Child and Adolescent Well-Being research brief no. 1: Who are the children in foster care? Retrieved July 7, 2006, from http://www.ndacan.cornell.edu/NDACAN/Publications/ NSCAW_Research_Brief_1.pdf
- NSCAW Research Group. (2005). National Survey of Child and Adolescent Well-Being research brief no. 2: Foster children’s caregivers and caregiving environments. Retrieved May 27, 2017, from https://www.acf.hhs.gov/sites/default/files/opre/caregivers.pdf
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