1. Winfrey, Marion E. EdD, RN

Article Content

Forensics describes the relationship between law and health care. In truth, law has been part of health care ever since physicians and nurses were required to obtain certain publicly acceptable credentials in order to be recognized as members of their professions. Later, licensure requirements, equipment regulations, or the determination of whether an agency was a Level I, II, or III trauma center codified and clarified society's health care delivery systems.


In terms of trauma and critical care, many of the great strides in these subspecialties occurred in response to war. Today, however, terrorism has replaced war as the ultimate in man's inhumanity to man. The science of mass casualty care, for example, has been redefined by our studies of the World Trade Center and Oklahoma bombings. What a sad commentary it is that the health care industry must struggle to keep pace with man's homicidal ingenuity.


Society's attempts to create order and control resulted in laws that everyone, including nurses, physicians, and patients, are expected to abide by as citizens. When regulations are ignored, civil rights abrogated, and laws violated, forensic nursing comes to the forefront. Recognition of deviations from legally acceptable behavior and nursing's responses are clarified and made actionable by forensic nursing. Although capable of standing on its own, this subspecialty deserves recognition as a valued adjunct to critical care nursing as well. Accordingly, this issue of Critical Care Nursing Quarterly (22:1) serves as a vehicle for discussing the interaction of forensics and critical care because, in truth, our mandate is the same: to provide comprehensive nursing care to our patients. Comprehensiveness, however, is based on the depth and breadth of one's nursing knowledge and assessment of patient care needs. The articles presented in this issue will add to the critical care nurse's knowledge base and assessment ability in both general and specific ways.


Among available nursing assessment tools are algorithms, critical pathways, and that inner voice of experience that says, "Something is wrong." Winfrey and Rex Smith validate a critical care nurse's innate intuition and its role in forensic nursing. Although conceptual, the theoretical underpinnings of a profession must be explored, debated, and expanded if a discipline is to have validity. But what is forensic nursing and its role in critical care? Goll-McGee describes the many intersections of forensics and critical care nursing in clinical practice and research. In elaborating on the specifics presented by Goll-McGee, Hoyt discusses how to use and adapt material commonly found on nursing units for evidence handling. Hopefully, the removal of some of the barriers to integrating forensics into critical care may occur when nurses understand how to properly collect and handle evidence.


Obstacles to meeting the forensic obligations inherent in the emergency department setting are explored by Ellis. This article relates the finding of Ellis' research, in which Ellis discovered how little screening for domestic violence actually takes place in one Level I trauma center's emergency department. In trying to discover why, Ellis also offers remedies ranging from education to providing a domestic violence policy template that incorporates current Joint Commission on Accreditation of Healthcare Organizations (the Joint Commission) guidelines for this situation.


Suppose a nurse does discover a case of domestic violence or a crime that has been committed. From the previous articles, the critical care nurse has acquired certain knowledge and skills in terms of assessment and evidence collection, but must a nurse always act on his or her suspicions? Is he or she an advocate for the patient or for the law? Cochran clarifies these points and you may be surprised by the answers. Cochran interweaves the fabric of case and statutory law into illustrative case studies that many trauma and critical care nurses will find applicable to their own critical care practice.


In two companion articles, the complexities of Munchausen syndrome by proxy are examined. Pasqualone's thorough review and case study of Munchausen syndrome by proxy is amplified further by Morrision, who explains and clarifies some of the legal issues raised by Cochran as they apply to Munchausen syndrome by proxy.


You may note that Pasqualone and Morrision do not agree on the name of the singular disease they discuss. This occurs because the medical community constantly is reevaluating diagnoses and their underlying pathophysiology. Law, however, must use the terminology that exists when a legal action is initiated, hence the difference. Regardless, the reader should come away with a renewed sense of empowerment in dealing with this disease and its attendant legal entanglements. Readers are cautioned, however, to consult appropriate policies, statutes, and law enforcement agencies before taking action in specific situations.


Although Munchausen syndrome by proxy situations may not come always under the purview of critical care nursing, certainly the trauma of gunshot wounds will. Silvia dispels some of the misconceptions surrounding gunshot wounds from their appearance to a bullet's ability to incapacitate and kill. Media-contrived terms such as "cop-killer bullet" and "bullet-proof vests" are clarified in order to give nurses a better idea of the kinds of injuries bullets can actually cause and why.


Finally, Z. G. Standing Bear offers critical care nurses a rare glimpse into the handling of crime scenes. This article, which complements those of Hoyt and Goll-McGee, describes how crime scenes are approached, dissected, and preserved. Hopefully, such knowledge will encourage nurses to involve themselves more effectively in forensic incidents that arise during the course of their clinical practice.


Certainly, if there is one constant in nursing, it is the desire to do what is right. But often what is right is waylaid and obscured by a lack of applicable nursing knowledge and persistent misconceptions regarding the law. Forensic nursing is offered as a means of advancing nursing knowledge and resolving issues arising when health care and the law intersect. Indeed, our profession now has its own "Do the right thing" consultants-it has forensic nursing.