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Forensic skills for nurses

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Dr David Sadler, MB, ChB, FRCPath, MD.

Senior Lecturer, Department of Forensic Medicine

Forensic medicine and forensic science, as portrayed in fiction and on television, are a source of great fascination to us all. However, in real life, the health professionals who have to deal with the victims of trauma are more likely to find forensic situations a source of considerable uncertainty and anxiety.

Forensic medicine and forensic science, as portrayed in fiction and on television, are a source of great fascination to us all. However, in real life, the health professionals who have to deal with the victims of trauma are more likely to find forensic situations a source of considerable uncertainty and anxiety.

These situations are stressful because staff have to contend with the associated police activity, legal investigation and court proceedings.

That health professionals encounter difficulties in these situations must be due in part to the gradual decline in forensic teaching within UK universities (Davis, 1994). An informal questionnaire circulated by the Department of Forensic Medicine at the University of Dundee revealed that nurses felt inadequately equipped to deal with various practical aspects of clinical forensic medicine. In response, a practically oriented one-day course entitled 'Forensic medicine for nurses' was run in 1992. It later ran as a three-day course from 1995 to 1999.

Forensic medicine for nurses
The course subject matter has most immediate relevance to those involved with victims of trauma. While course students mostly comprise nurses practising in accident and emergency and trauma surgery units, the content of the module also has practical relevance to health professionals confronted with the medico-legal issues arising in various other areas of health-care delivery. These include those caring for such vulnerable groups as children, elderly people, mental health patients and those with learning disabilities.

The Dundee forensic medicine module
In 2000, the module, 'Forensic medicine for health professionals: the cutting edge' was introduced as a level 3 option worth 20 ScotCAT points for those undertaking a nursing/midwifery degree. The standalone module has been made available to allied professionals such as social workers, paramedics, victim support workers, police officers and procurators fiscal (the Scottish equivalent to the coroner in England and Wales).

The purpose of the module is to teach the basics of forensic medicine and assumes no previous knowledge of the subject. While the main emphasis is on clinical forensic medicine, the important related areas of forensic science and criminal psychology are also explored (Box 1). The module addresses those aspects of forensic medicine that are most frequently encountered in practice and which most often become the subject of professional testimony in the courts.

Teaching methods
In addition to lectures, each session includes at least one practical problem-solving exercise. These typically require students to review photographs and reports relating to forensic problems. There is also the opportunity for students to handle and examine items of forensic scientific evidence.

This includes fingerprint techniques, bloodstain pattern interpretation, physical matching exercises, microscopy of hairs and fibres and ballistic comparisons. In relation to the victims of trauma, students are taught about the practical importance of recognising evidence of possible forensic significance.

Assessment
Assessment is by written assignment. The assessment strategy is designed to give students the opportunity to apply their newly acquired knowledge to realistic forensic case situations and to identify and address the clinical forensic medical and scientific issues that arise. The assignment is based on a fictional assault scenario presented on interactive multimedia CD-Rom. Students are required to explore forensic reports and photographs on screen.

Future developments
As the module becomes established as an attractive nursing/midwifery educational option in Scotland, it is hoped that the student base can be gradually widened to include students from other regions and other professions. The teaching and assessment methods used should lend themselves well to development of a complementary distance learning package. Such a multidisciplinary intake would raise more interesting and varied medico-legal issues and provide for more stimulating discussion. Professionals and their patients can only stand to benefit from closer educational co-operation (Casey and Smith, 1997). Increasing nurses' and other health professionals' awareness of the importance of clinical forensic medicine and science does much to protect the legal rights of the victims of trauma. Only by 'thinking forensic', in addition to 'thinking clinical' will we fulfil our obligation to the medico-legal needs of our patients as part of our duty 'to do no harm' (Smock, 1994).

Casey, N., Smith, R. (1997) Bringing nurses and doctors together: greater co-operation will benefit patients. British Medical Journal 314: 617-618.

Davis, N. (1994)What now - what next? The future of clinical forensic medicine in the UK. Journal of Clinical Forensic Medicine 1: 47-49.

Smock, W.S. (1994)Development of a clinical forensic medicine curriculum for emergency physicians in the USA. Journal of Clinical Forensic Medicine 1: 27-30.

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