Forensic Nursing and Health Care Investigations:
A Comprehensive Review
Anandharam M1, Grace Jebakani Sweety G2
1MD Forensic Medicine, Assistant Professor, Thanjavur Medical College, Thanjavur.
2PhD (Nursing), Professor, Ganga College of Nursing, Coimbatore.
*Corresponding Author E-mail: gracesweety196@gmail.com
ABSTRACT:
Forensic nursing is an interdisciplinary specialty that merges the clinical expertise of nursing with the legal demands of the justice system. Since its formal recognition in the 1990s, the field has evolved into a critical component of healthcare investigations and legal processes. Forensic nurses play a pivotal role in documenting trauma, collecting and preserving evidence, and supporting victims of violence—often serving as key witnesses in legal proceedings. This review explores the historical evolution, core domains, and expanding functions of forensic nursing, including sexual assault response, domestic violence assessment, forensic psychiatric care, and postmortem investigations. The integration of advanced technologies such as digital documentation tools, teleforensic services, and alternative light sources has enhanced the accuracy and reach of forensic nursing, especially in underserved regions. In India, forensic nursing remains in a nascent stage, with limited institutional support and formal training pathways. This article advocates for expanded curriculum development, national policy support, interdisciplinary collaboration, and research initiatives to strengthen forensic nursing practice. Advancing this field is essential not only for improving healthcare outcomes but also for ensuring justice and dignity for victims of violence.
KEYWORDS: Forensic Nursing, Investigations, Review
INTRODUCTION:
Forensic nursing is an interdisciplinary specialty that blends the healthcare expertise of nursing with the evidentiary requirements of the legal system. First recognized by the American Academy of Forensic Sciences in the 1990s, forensic nursing has grown to play an essential role in trauma care, criminal investigations, and legal proceedings. Forensic nurses provide holistic care while preserving forensic evidence, often becoming crucial witnesses in criminal cases. Their presence ensures that victims receive both medical attention and legal support, fostering justice and healing concurrently. This review aims to explore the evolving role of forensic nursing in healthcare investigations, highlight key functions, analyze current challenges, and suggest strategies for enhanced practice through training, policy support, and multidisciplinary collaboration.
The roots of forensic nursing can be traced back to Florence Nightingale, who emphasized meticulous documentation of injuries and patient care. However, the formal recognition and development of forensic nursing began in the late 20th century. In 1992, Virginia Lynch was instrumental in advocating for the incorporation of forensic science in nursing curriculum1. Over the years, the role has expanded to include responsibilities in various forensic and clinical environments, including hospitals, sexual assault response teams (SART), correctional facilities, psychiatric institutions, and disaster zones.2
Sexual Assault Nurse Examiners (SANEs) are highly trained to perform forensic medical examinations on victims of sexual violence. They conduct head-to-toe assessments, collect DNA evidence, provide prophylactic treatments, and ensure psychological support. Their work improves the quality of care and increases conviction rates due to accurate, legally admissible documentation.3
Forensic nurses are vital in cases of domestic violence, including intimate partner violence (IPV), elder abuse, and child maltreatment. Their assessments often reveal patterns of injury and behavioral symptoms that indicate chronic abuse. Through collaboration with social services and law enforcement, they help initiate protective interventions and legal proceedings.4
In correctional and mental health settings, forensic psychiatric nurses manage individuals with dual diagnoses of mental illness and criminal behavior. They assess mental fitness to stand trial, monitor treatment adherence, and contribute to rehabilitation. Their ethical role balances patient advocacy with public safety concerns.5
Forensic nurses working as death investigators collaborate with medical examiners or coroners to evaluate deaths, especially those that are sudden, unexplained, or suspicious. Their clinical knowledge helps distinguish between natural causes and foul play, interpret postmortem injuries, and collect medical history from families or records.6
Forensic nurses function within multidisciplinary teams that include physicians, law enforcement officers, attorneys, forensic pathologists, and victim advocates. This collaboration ensures a comprehensive, victim-centered approach to care and justice. Forensic nurses often serve as liaisons, translating medical information into legal language and ensuring that victim care and evidence handling meet both clinical and legal standards.7
The use of technology in forensic nursing has expanded rapidly. Tools such as alternative light sources (ALS), digital colposcopes, and electronic health records (EHRs) are used to enhance injury visualization and evidence documentation. Digital evidence collection and storage systems also support secure chain of custody practices. Teleforensic nursing, a subfield developed through telemedicine platforms, enables remote forensic consultations in underserved or rural areas.8
Forensic nurses are increasingly required to demonstrate cultural competence in dealing with diverse populations. Trauma-informed care emphasizes respect, safety, and empowerment of patients. Forensic nurses must understand cultural contexts, gender identity, and socioeconomic factors that influence the experience of trauma and reporting of violence. This approach helps reduce retraumatization and improves health outcomes for victims of violence.9
Forensic nurses operate within a complex legal and ethical landscape. They must balance duties of confidentiality, informed consent, and mandatory reporting. Documentation must be precise and unbiased, and evidence must be collected with informed consent, even in high-stress or emergency situations. Ethical dilemmas arise particularly when a patient's legal rights may conflict with safety concerns or investigative needs.10
In high-income countries, forensic nursing is well-integrated into health systems. However, in many low- and middle-income countries (LMICs), forensic nursing is underdeveloped due to lack of training, infrastructure, and recognition. Global health organizations have advocated for the standardization of forensic nursing roles and practices to improve gender-based violence responses and medico-legal documentation globally.11
The International Association of Forensic Nurses (IAFN) offers certification for SANEs, legal nurse consultants, and other forensic roles. Continuing education is crucial, covering areas such as advanced trauma assessment, courtroom testimony, forensic pharmacology, and medico-legal ethics12. Universities are beginning to offer graduate programs specializing in forensic nursing, although widespread integration into undergraduate nursing curricula remains limited.
In India, forensic nursing is an emerging specialty that is gradually gaining recognition in academic and healthcare sectors. While few nursing institutions have integrated forensic nursing into their curricula, there is a growing push from educators and healthcare professionals to formalize training at both undergraduate and postgraduate levels13. The Indian Nursing Council has begun exploring avenues to incorporate forensic nursing into professional nursing education, though standardized certification programs remain limited.
Currently, most forensic nursing knowledge is acquired through workshops, seminars, and short-term training courses offered by medical colleges and legal bodies. Professional development in this field faces challenges such as lack of awareness, limited clinical training opportunities, and minimal institutional support. However, increased advocacy, the rise in medico-legal cases, and the growing involvement of nurses in legal proceedings are driving demand for structured education and certification pathways, signaling the need for more comprehensive policies and programs in India.14
To advance the field of forensic nursing and maximize its impact on health care investigations, several strategies are recommended:
· Curriculum Development: Incorporate forensic nursing modules into nursing school programs.
· Policy Advocacy: Develop national policies that mandate forensic services in emergency departments.
· Research Initiatives: Encourage empirical studies to evaluate outcomes of forensic nursing interventions.
· Global Training Programs: Establish training and exchange programs in LMICs to build capacity.
· Technological Integration: Expand teleforensic services and invest in mobile forensic kits for rural settings.15
Forensic nursing plays a crucial and multifaceted role in health care investigations, offering not only expert clinical care but also vital contributions to legal processes. From sexual assault examinations to death investigations and psychiatric evaluations, forensic nurses serve as key intermediaries between patients and justice. Despite growing recognition, challenges related to training, ethical complexity, and global disparity in practice remain. Strengthening forensic nursing through education, policy, and collaboration can enhance its contribution to health systems and legal frameworks worldwide. As violence, trauma, and healthcare complexity continue to rise, the need for skilled forensic nurses becomes not only relevant but urgent.
REFERENCES:
1. Lynch, V. A. Forensic nursing: A new specialty. Journal of Psychosocial Nursing. 1993; 31(8): 7–11.
2. Hammer, R. M., Moynihan, B. J., and Pagliaro, E. M. Forensic nursing: A handbook for practice. Jones and Bartlett Learning. 2011
3. Campbell, R., Patterson, D., and Lichty, L. F. The effectiveness of Sexual Assault Nurse Examiner (SANE) programs: A review of psychological, medical, legal, and community outcomes. Trauma, Violence, and Abuse. 2005; 6(4): 313–329.
4. Sheridan, D. J., and Nash, K. R. Acute injury patterns of intimate partner violence victims. Trauma, Violence, and Abuse. 2007; 8(3): 281–289.
5. Dyer, C. B., and Heisler, C. J. Forensic markers of elder abuse. Clinics in Geriatric Medicine. 2009; 25(1): 47–60.
6. Clark, S. C. The forensic nurse and the coroner system. Journal of Forensic Nursing. 2005; 1(2): 65–68.
7. Ledray, L. E. Sexual assault nurse examiner (SANE) development and operation guide. U.S. Department of Justice, Office for Victims of Crime. 2001.
8. Goyal, M., and Canfield, C. Teleforensic nursing practice: A new frontier in forensic healthcare. Journal of Forensic Nursing, 2020; 16(1): 42–47.
9. Substance Abuse and Mental Health Services Administration. Trauma-informed care in behavioral health services. Treatment Improvement Protocol (TIP) Series. 2014; 57.
10. Lynch, V. A., and Duval, J. B. Forensic nursing science. Elsevier Health Sciences. 2011
11. World Health Organization. Strengthening the medico-legal response to sexual violence. WHO Press. 2015
12. International Association of Forensic Nurses. Certification programs. Retrieved from https://www.forensicnurses.org/page/certification. 2023
13. Sharma, B. R. Forensic nursing in India: Current scenario and future perspective. Journal of Forensic and Legal Medicine. 2010; 17(8): 498–501.
14. Indian Nursing Council. Curriculum reforms and innovations: Annual report. INC. 2020
15. Haeseler, L. A. Advancing forensic nursing: Strategic priorities and practice integration. Journal of Forensic Nursing. 2017; 13(3): 128–134.
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Received on 01.07.2025 Revised on 19.07.2025 Accepted on 04.08.2025 Published on 18.08.2025 Available online from August 30, 2025 A and V Pub Int. J. of Nursing and Med. Res. 2025;4(3):183-185. DOI: 10.52711/ijnmr.2025.34 ©A and V Publications All right reserved
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