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William F. Connell School of Nursing

The Connell School Introduces Advanced Practice Forensic Nursing

making it better - fall/winter 2008

angela danny holly standing

By Joshua Jensen

In the spring of 2007, Assistant Professor Angela Amar and Clinical Assistant Professor Holly Fontenot attended a conference focused on domestic violence. Afterwards, they began a casual conversation about the connections between their violence prevention work, the work of their colleagues, and how this work could fit into a forensic nursing program at the Connell School of Nursing. For many junior faculty—Amar was in her first year at Boston College at the time—the conversation would have ended there, their collective time consumed by their teaching and research obligations.

Instead, Amar and Fontenot kept talking and also brought others into the conversation, including Connell School Professor Ann Burgess, a pioneer of forensic nursing. In short time, they pulled together an impressive coalition of Boston-area community leaders across a range of fields related to forensics. Amar channeled this energy and expertise into a grant proposal that she submitted to the Health Resources and Services Administration (HRSA), part of the U.S. Department of Health and Human Services. Amar asked HRSA for funding to start an advanced practice forensic nursing specialty at Boston College.

The story that Amar told in her proposal was straightforward but compelling: given increasing violence, coupled with an increasing understanding of its physical and mental health impacts, there is a clear need for advanced practice nurses who are able to address the broad health needs of individuals who have experienced violence, as well as assist individuals throughout the legal process with evidence collection, forensic documentation, and court testimony. In short, there is an emerging need for advanced practice forensic nurses.

As part of their proposal, Amar and her team outlined an advanced practice forensic nursing curriculum that would be available both as an additional specialty certificate for advanced practice nurses and as an additional specialty concentration in the master's program. Their hard work was rewarded with a nod to move forward from HRSA, creating an advanced practice specialty in forensic nursing for the Connell School, which will formally launch in 2009.

DEVELOPMENT OF THE FORENSIC NURSING FIELD

The development of Boston College's advanced practice forensic specialty comes at a point when the field of forensic nursing is still relatively early in its development. The first forensic nurses in clinical practice were sexual assault nurse examiners (SANEs), a role that came about in the mid to late 1970s to address the needs of women who were the victims of rape and sexual assault. At this time, legal evidence was collected in the emergency rooms where women received treatment, and nurses were often the only female healthcare professionals. These nurses developed SANE programs to train other nurses for this role, creating the first forensic nurses.

Since the 1970s, the scope of forensic nursing practice has expanded. According to the International Association of Forensic Nurses, forensic nurses work with individuals experiencing a broad range of interpersonal violence including domestic violence, sexual assault, child and elder abuse and neglect, physiological and psychological abuse, occult and religious violence, and human trafficking. Forensic nurses work in such settings as forensic mental health, correctional nursing, legal nurse consulting, emergency and trauma services, public health and safety, and death examination. In short, wherever nurses can combine their healthcare expertise with a legal component, they have done so under the broad umbrella of forensic nursing.

Advanced practice forensic nursing is an even more recent development, with certification as an advanced practice forensic nurse currently under development. Boston College is on the leading edge of this development, with only a handful of these advanced practice programs offered in the United States. Advanced practice promises to take the field of forensic nursing to the next level, giving nurses the skills and tools to participate in clinical research, and use existing research to impact their own practice as forensic nurses. These nurses will have the skills necessary to address the broader health needs of victims of violence.

Forensic science at Boston College

While advanced practice nursing forensics may be new to Boston College, the study of forensic nursing here is well established, rooted in the leading-edge work of Ann Wolbert Burgess, a professor at the Connell School since 2001. Burgess's relationship to Boston College goes back even further however, to 1972, with her early victimology research in collaboration with Boston College sociologist Professor Lynda Lytle Holmstrom. This work would lead Burgess down a path that eventually would form the scientific foundation of the field of forensic nursing.

Burgess has continued to lead research in forensic science. Currently, she is co-primary investigator on a collaborative grant project with the Justice Resource Institute and Villanova University. The purpose of this two-year project is to advance empirical research related to combating online sexual victimization of children and adolescents and to improve Internet safety strategies.

Burgess has also been an innovator in the teaching of forensics, leading a number of popular undergraduate courses on the subject. Students from across the university give Burgess's courses high marks, in part due to her ability to bring concepts alive through real-world examples drawn from her own experience as an expert witness on countless high profile court cases, including the recent Duke lacrosse case, as well as the infamous Menendez brothers trial. In addition, Burgess has leveraged her work with the FBI, bringing FBI agents into the classroom to discuss their forensics work.

Burgess continues to innovate in the classroom. Most recently, she collaborated with faculty from Boston College's biology department to offer a "forensic science lab" course, where students use equipment and techniques from the field of forensics to process and evaluate evidence from mock crime scenes. Burgess has also developed courses with the Connell School's continuing education program, including courses in forensic science, forensic mental health, and victimology. A recent addition is a one-day "forensics summer camp" for practicing nurses.

Burgess is thrilled to see young faculty building off the foundation that she has created through her research and teaching. "When my work on rape trauma syndrome was published, I never dreamed that 35 years later there would be enough research to provide graduate students with an evidence-based curriculum in forensic nursing," she says. "Yet the time has come and the Connell School is ready for graduate students who will continue to advance forensic science and forensic nursing practice."

Building connections in the community

As a relatively young profession, advanced practice forensic nursing is not something that is familiar to the broader public. While forensic nurses may have an ideal skill set to meet the needs of individuals and communities experiencing violence, for many, it is not yet second nature to turn to forensic nurses for this expertise.

Aware of this challenge and determined to address it proactively, Amar has developed a collaborative, community-based strategy that has the potential to meet the needs of forensic nursing students, and perhaps as importantly, be a catalyst in Boston to integrate advanced practice nurses into the fabric of forensics science and practice. Simple yet bold, Amar approached an impressive list of community leaders, building an advisory committee that reads like a "who's who of forensic leaders" in the Boston area.

To head up this group, Amar tapped Lucia Zuniga, director of the Massachusetts Sexual Assault Nurse Examiner (SANE) Program. Zuniga sees many benefits in a strong collaborative relationship between the SANE program and Boston College and is personally excited by the opportunity. In a letter of support for the program, she indicated a particular excitement for the opportunity to collaborate with Amar in the development of the forensic nursing specialty.

Violence prevention: Amar's personal drive

While Amar has always been committed to working collaboratively and across disciplines, she came to forensics and violence prevention work as many do, as a witness to the suffering of others.

She relates an eye-opening story that transformed her thinking about interpersonal violence. "Learning about it in nursing school in the late 1980s, I couldn't put a name or face to violence against women. Today the memory book of my mind is filled with names, faces and stories that have made intimate partner violence a personal concern for me." One of those faces belongs to a patient Amar met while working in admissions in the psychiatric unit of a hospital.

"She could barely look me in the eye as she recounted how badly she wanted to run into oncoming traffic and kill herself. One side of her face was swollen. She told me that her on-again off-again boyfriend hit her. 'Nothing new', she said. This was the first person who ever told me so much detail. A young black woman—we could have been the same age—was sitting across from me discussing life events I couldn't even fathom."

To Amar, even more unexpected was the reaction of colleagues to this experience. "I was stunned to have a colleague tell me that she had been experiencing physical violence from her boyfriend, soon to be husband, for a few years. My mouth dropped open and I asked, 'How come I never knew?' She replied, 'Well, you never asked.'"

Through her own research, Amar would come to realize that these experiences are far from unusual. Intimate partner violence is a hidden problem, often because the victim fears blame or being looked down upon.

"My own research interests derive from this place of trying to make sense of a social problem that affected women I knew from my professional practice and personal life," says Amar. "Armed with an understanding that anyone may walk into a violent relationship but getting out of it isn't as easy, I set out to understand more about the experience of partner violence and its effects on health."

Amar's research trajectory would lead to her current work to understand what motivates women who are experience violence in a dating relationship to seek help. "Realizing that young women experience dating violence and do not report it to helping professionals inspired me to study help seeking. Using the Theory of Planned Behavior, I have explored the attitudes and beliefs associated with reporting dating violence. I hope to evolve my research trajectory into the development and testing of intervention programs. I would love nothing more than to 'put myself out of a job' by developing an effective prevention strategy."

For the moment, it doesn't look likely that Amar will find herself out of work, as violence continues to plague our society. However, through teaching and research innovation, it is a sure bet that forensic nurses will do transformational work that improves the lives of those experiencing violence.


Courses

The advanced practice nursing forensic specialty is designed to be completed in one year of full-time study, either as a post-master’s certificate for those who have already completed a master’s degree in nursing, or as a second specialty concentration for master’s students. Students will complete 500 clinical hours in addition to classroom work. Courses include:


Forensics I: Fundamentals of Forensics in Nursing and Health Care

Examines the historical, sociopolitical and cultural perspectives of personal, professional, and societal issues related to victimization and perpetration of violent crime. Students examine the interface of the health care, social services, and legal systems in providing care to victims and perpetrators. Emerging roles in forensic nursing practice and issues unique to such practice will be explored.


Forensics II: Psychosocial and Legal Aspects of Forensic Practice in Nursing and Health Care

Provides a comprehensive examination of the behavior, emotional responses, and cognitive decision making of both victims and perpetrators of a crime. Students examine the ethical and legal responsibilities for health care providers and health care agencies from both a legal and ethical perspective with special emphasis on sociocultural context of victimization and perpetration.


Forensics I: Practicum

Prepares students to provide comprehensive care to victims, their families, and perpetrators in settings within the health care or criminal justice systems. Students will engage in beginning application of clinical subspecialty and functional role concepts.


Forensics III: Forensic Nursing and Health Care of Vulnerable Populations

Focuses on the role(s) of forensic nurses in providing assessment, diagnosis, treatment, and advocacy services to patients. Students will learn how to understand, organize, and respond to and prevent violence and abuse. The course focuses forensic role behaviors in violence against women, elder abuse, and forensic psychiatric-mental health. Students will be prepared to advance forensic nursing science in healthcare application.


Criminal Law and Scientific Procedures for Evidence Collection in Nursing and Health Care

Provides a broad overview of the legal process and the roles of the lawyer, forensic nurse, and forensic specialist and the rules of conduct that guide them. Students are introduced to definitions and classifications of crime and their application to the criminal justice system. Students will examine principles, concepts, purposes and the nurse’s role regarding substantive criminal law.


Forensics II: Practicum

Prepares students to integrate advanced knowledge of forensic care in assessing and managing the symptoms of those experiencing violent crime as victims, family members, and perpetrators within the forensic care focus. Complex psychological, ethical, social and spiritual issues and emotional reactions will be the focus of the clinical practicum.


Click here to learn more about forensic nursing at Boston College.