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Nurses Add Detective Work to Their Job

As Maureen Fogarty approached her patient at University of Louisville Hospital, his dressing gown slipped, revealing the imprint of a tire running across his chest.

In the past, Fogarty might have seen that tire mark only as the nasty aftermath of being a crime victim.

But after special training as a forensic nurse, Fogarty recognized that print as evidence - possibly the missing link to finding out who had run over her injured patient in June before fleeing the scene - and she alerted police.

Across the country, forensic nursing programs are pairing nursing care with training in evidence collection so that nurses can try to preserve evidence of a crime at the same time they provide medical treatment.

Forensic nursing dates back to the 1970s. It was recognized officially by the American Nurses Association as a specialty field in 1995. In most states, there are nurses who have been trained to document carefully the medical conditions of victims of rape and sexual assault, according to Carey Goryl, executive director of the International Association of Forensic Nurses.

In cities including Louisville, Colorado Springs and Houston, nurses are being trained to expand their skills to help victims of crimes other than sexual assaults, including abuse, shootings and traffic incidents.

Bill Smock, a professor of emergency medicine at the University of Louisville School of Medicine and a police surgeon, began a program at the university's hospital in September 2008.

Certification to perform forensic exams

The nurses there, who receive no extra pay, have spent more than 400 hours in lectures, going to crime scenes, shadowing medical examiners, participating in mock trials and doing other coursework in order to get certified to perform forensic exams at the hospital, he says.

Eight nurses are in the program and seven have already been certified, he says. Skills will be kept current through ongoing training.

The nurses act as consultants when emergency room physicians or police request it. A forensic nurse can look at a wound and help find clues about the weapon that was used, Smock says. Many times, the forensic nurse is involved with collecting gunshot residue, or with sex crimes, bodily fluids left.

"We're basically doing a living autopsy," says Smock, who adds he is seeking grant funding to pay the nurses to consult on cases.

Rena Lopez, who is in Smock's program, says she believes the forensic nurse training makes her better at treating her patients. Before, she says, she might have only dressed a wound, but now she can see how it may have occurred and may be able to provide carefully documented details that could lead to answers about what happened. "I've always been a puzzle solver," Lopez says. "It's nice to have the base of knowledge."

The nurses are also trained during mock trials on how to testify in court proceedings about what they found during their exams and treatment. "A lot of evidence can be lost or just documented poorly," Goryl says.

Expanding to include abuse, domestic violence

Since 1991, the number of Sexual Assault Nurse Examiner programs has grown from only 20 to more than 500 in the United States and Canada, Goryl says.

Though some programs nationwide have begun to expand beyond sexual assault evaluations, she says it has been a slow process because most federal and state grants are earmarked for that type of evaluation. Still, some systems are expanding their services.

In Colorado Springs, nurses who work hospitals in the Memorial Health System have begun evaluating trauma patients who are victims of elder abuse or domestic violence, says Jennifer Pierce-Weeks, who coordinates the program and is the president of the International Association of Forensic Nurses. @"There's a natural progression," she said.

Pierce-Weeks pointed to the case of a 12-year-old girl who came to the emergency room saying that her father had tried to strangle her. The girl told Pierce-Weeks that she remembered blacking out twice. During the exam, nurses found pinpoint hemorrhages in her eyes and a contusion on her forehead, Pierce-Weeks said.

Because of that documentation and the ensuing investigation by police, Pierce-Weeks says the girl's father was charged with attempted homicide.

"Helping that girl is why I do the work," Pierce-Weeks said. "Often the patients we see are not believed, or the actions of the offender are justified by others. I would like to think that my actions at the time of a patient's trauma will save them from enduring some devastating health consequence down the road."

Jamie Ferrell, clinical manager of forensic nursing services at Memorial Hermann Healthcare System based in Houston, says giving patients detailed documentation improves their overall care because better information about the trauma improves the chances for a legal resolution, which can help victims cope with the long-term impact of a crime.

Halladay reports for The (Louisville) Courier-Journal

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