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Fifteen years ago, Critical Care Nursing Quarterly published the first special issue dedicated to forensic nursing. Since then, much has changed within health care, nursing practice, education, patient acuity levels, technology, and forensic nursing science. The evolution has brought about the need to highlight these changes and to discuss the multiple intersections between forensic patients and critical care nurses.


In the first forensic edition, the articles were focused on evidence and various scenarios for crime scene investigation. Now, health care professionals have a broader understanding of forensic science and its application in many health care scenarios. Today forensic nursing encompasses a variety of specialty roles and clinical responsibilities that meet the needs of patients while supporting the quest for truth through judicial processes. The contemporary forensic nurse possesses a broader range of skills and knowledge as results of nursing education that emphasizes important topics such as prompt identification of forensic patients, evidence collection, and providing testimony and documentation practices.


Today's forensic nurses work within the acute care and community settings as clinical forensic nurse specialists, nurse death investigators, sexual assault nurse examiners, forensic photographers, legal nurse consultants, forensic nurse educators, expert witnesses, and psychiatric forensic nurses. Such role diversity brings these nurses into frequent contact with the hospital's critical care areas as well as with other health care, law enforcement, and legal disciplines.


A forensic patient can be described as an individual with a medical condition, diagnosis, or complaint that intersects with the law or has the potential to do so. This description is broad, but link this description with the increasing amount of violence across the nation, and the commonality of the forensic patient population becomes more apparent.


Because of the medical and legal complexities forensic patients bring into the health care setting, it is imperative that nurses caring for this patient population have the latest knowledge and skills to provide comprehensive patient care. Therefore, the focus of this journal issue is to provide articles that will improve the critical care nurse's awareness of legal perspectives associated with forensic patient populations.


The issue begins with "Forensic Patients Hiding in Full View," a report summarizing 2 research-based studies. The authors expound upon the variety of forensic patient categories that have been identified as a result of multinational data gathering. The work of Pasqualone and Michel firmly establishes the broad range of forensic scenarios encountered within the contemporary critical care setting.


The article by Akiyama involves a comprehen-sive and detailed discussion about one of the forensic patient categories, gang-related injuries. "Confronting Youth Gangs in the Intensive Care Unit" provides the critical care nurse with insight into the identification, particular practices, and behavior by a myriad of gangs. The usefulness of this information is obvious when considering the care and safety issues that surround this forensic patient category.


Continuing the theme of discussing specific forensic patient categories is the article titled "When the ICU becomes a Crime Scene" by Sackman. This article emphasizes the importance of observing and reporting suspicious behavior of health care workers. Rigorous policies and procedures should be established to guide investigations of all unexpected or suspicious deaths. With illustrative case studies of notorious hospital serial killers, Sackman demonstrates characteristics personality traits of these killers and their expressed motives and explains why hospital administrators are reluctant to pursue leads and disregard evidence about potential criminal activities of personnel.


Pasqualone highlights the importance of the relationship nurses have with the multidiscipli-nary team, especially law enforcement. Her article, "The Relationship Between the Forensic Nurse in the Emergency Department and Law Enforcement Officials," offers critical care nurses insight into the thought processes and perspectives that law enforcement professionals bring into the health care setting. The article advocates for mutual respect, support, and open communication among all forensic team members.


Technology and highly sophisticated hospital equipment are vital components of the critical care environment. The contribution by Quail, "Technology in Health Care: Forensic Implications," provides a candid and often alarming view of how technology can impact the critical care area and its personnel. This article provides valuable information about the utility of technology and how networked information, tracking systems, communication devices, and internal storage devices associated with medical equipment can assist in forensic investigations.


"Forensic Nursing Science Knowledge and Competency: The Use of Simulation" by Drake et al reports findings of a study designed to appreciate the effectiveness of 2 different education approaches for delivering forensic content to students. Medium fidelity simulation was compared with face-to-face lectures. Both techniques used identical online content. The authors work summarizes study results, offers alternative content delivery options for nurse educators, and outlines best practice approaches for achieving the desired outcomes in knowledge acquisition and clinical competencies.


McNeil and Koppel's article, "Managing Quality and Compliance," illustrates how one software platform can be used within a hospital or a health care network to monitor organizational perfor-mance and generate reports. The authors use case examples to illustrate the design characteristics and utility of such a system to achieving benchmarks with quality indicators and meeting mandatory reporting requirements.


Finally, "Perianesthesia Implications of Obstructive Sleep Apnea" by Benedik outlines the several steps in identification and management of this common risk factor for patients undergoing surgery. It has important implications for both pre- and postoperative management in the intensive care unit to avoid life-threatening complications.


The Editors believe that readers will find each article interesting and useful for their practice. Furthermore, a heightened awareness of forensic issues and their management will contribute immeasurably to competent patient care as the quality goals of the facility.


- Christine Michel, PhD, BSc, FNC-AP,


DABFN, RN - Georgia Pasqualone, MSFS, MSFN, RN,


CFN, FABFN Issue Editors