The Forensic Nurse

Many people know that the color of your skin can have an effect on almost every aspect of your life. But what about being raped?

Researchers at the University of Pennsylvania School of Nursing have released a new study that shows dramatic results when it comes to identifying injuries that may have occurred during a sexual assault depending on the color of the victims skin.

The Researchers conducted a study of 120 volunteers who were predominatly white or african-american and conducted examinations after they had engaged in consentual sex. They found that 68% of the white women had incurred at least one external injury (tearing, abrasions, or swelling), but only 43% of the darker skinned women showed the same levels of injury.

Because physical injury as a result of sexual assualt is usually the exception rather than the norm, being able to clearly show an injury often has a positive effect on people “believing” the victims story.

Being a Sexual Assault Nurse Examiner or SANE, I have heard countless times from law enforcement officers, social workers, other nurses, and even the victims own family members that they dont believe the victims story.

Sexual Assualts usually happen one on one, in a private setting with no other witnesses, cameras, or other ways to try and help determine if the sex was consentual or not.

Because most of these cases come down to a he said / she said scenario the ability to produce accurate forensic evidence is critical. There may or may not be DNA evidence and if injuries are harder to detect on darker skinned victims that puts them at a distinct disadvantage both clinically and in the criminal justice system.

Drug Faciliated sexual assaults are unfortunately a common happening in america and around the world. This video tells the story of a young woman’s experierence on a date with a friend which she had known for a while.

http://www.youtube.com/watch?v=KqF9ciGaEpI

Ways you can try to protect yourself from being slipped a drug:

• Never Accept Drinks from a stranger
• Never accept an open drink
• Never lose sight of your drink
• If you leave the table or area where your drink is, take it with you.
• if you forget to take your drink with you, get a new one
• Have trusted friends with you to help keep an eye out
• If your drink has a strange odor or color, throw it away.
• Know your limits.

Finding inspiration as a survivor, or as a healthcare provider to victims of sexual assualt or domestic violence can be difficult in times. Sometimes we can lose sight of the ever simple and often tough task of getting up when you are knocked down.

Take a look at this video, and see if you can gather the strength to get back up off the floor and move on with your life to better things.

Watch Video

The Georgia Death Investigation Act (O.C.G.A. 45-16-20) requires that the coroner or county medical examiner of the county where the body is found or the death occurs be notified and that a medical examiner’s inquiry be made in all deaths that occur in this state that meet the following criteria:

1. As a result of violence;
2. By suicide or casualty;
3. Suddenly when in apparent good health;
4. When unattended by a physician; no person shall be deemed to have died unattended when the death occurred while the person was a patient of a hospice licensed under Article 9 of Chapter 7 of Title 31 of the Georgia Code.
5. In any suspicious or unusual manner, with particular attention to those persons 16 years of age and under;
6. After birth but before seven years of age if the death is unexpected or unexplained;
7. As a result of an execution carried out pursuant to the imposition of the death penalty under Article 2 of Chapter 10 of Title 17;
8. When an inmate of a state hospital or a state, county, or city penal institution; or

9. After having been admitted to a hospital in an unconscious state and without regaining consciousness within 24 hours of admission.

The Los Angeles Daily News recently reported that the LAPD is a backlog of more than 7,000 rape kits waiting for processing by the LAPD DNA lab.  Some of these cases are nearing the ten year mark, at which time they become inadmissible as evidence due to the statute of limitations law in california with regard to evidence testing. In California, if the kit is tested within two years of the sample collection date, then there is no statute of limitations for it.

The main reason that these kits haven’t been tested yet, is simply manpower and funding. In just five years the demand for kits to be tested has doubled.  According to the article. “In about 2000, the department ordered analysts to keep every shred of cell evidence in rape cases, just in case they might need to test it. Before the change, rape kits were regularly purged from the property division, with the permission of an investigating officer.”

The City of Los Angeles recently approved the hiring of 16 addtional criminalists, but these positions have yet to be funded.

Forensic Odontology employs the use of several different descriptions to help clearly identify the type, depth, and severity of a bite mark on a victim. These types of descriptions may include:

Hemorrhage - Small Bleeding Spot

Abrasion - non damaging mark on the skin

Contusion - ruptured blood vessel, bruise

Laceration - punctured or torn skin

Incision - neat puncture of the skin

Avulsion - removal of skin

Artifact - bitten off piece of the body.

Using accurate terms to depict the severity of a victims injuries is import part of documentation. Failure to accurately show what level of injury was sustained can lead to a jury thinking that you are unqualified or that your professional opinion is just wrong. It could even lead to your entire testimony being stricken from the record if the court finds that you are not a qualified expert medical witness.

While most people in the industry know the acronym IAFN, as the International Association of Forensic Nurses, is also as a same industry acronym “Imaging And Forensic Networking“. This phrase was coined by the SDFI Telemedicine group. SDFI stands for Secure Digital Forensic Imaging.

The SDFI camara system is meant to be a colposcope replacement, offering increased clarity, file encryption, and secure sharing of images across organizations.

I was recently asked about a case in which an adult male was raped and during the sexual assault had an ejaculation. Often the topic of male rape is forgotten when we talk about sexual assaults.

While rarely reported, male rapes do actually occur.  Perhaps it is male pride or ego, but reporting statistics for survivors of male sexual assault are even lower than that of women. One FBI statistic estimated that close to 3% of adult males will be raped at some point in their lives.

As for why the reporting statistics are so low, it may be due to the fact that this type of event may be even more shameful and traumatic to men than it is to women. Society in general tells men that in order to be respected and seen as desirable that they must be seen as strong, tough, and powerful.

All the experts agree that rape is almost never about the sex. Its about power and control. Excercising your will over someone elses. Essentially proving that you are the one in control. That you are stronger than the other person.

Bringing this type of shame to a man can be exceptionally devastating to their emotional self concienience. By not being able to fend off an attackers the victim may view himself as weak, undesireable, or even homosexual. 

These feelings of homosexuality can be even more confusing if the victim experiences an erection or even ejaculates. Both of these situations are very common and are often used as tools of shame by an attacker to make the victim think that they wanted or enjoyed being raped. In reality these types of reactions are more physiological than anything.

Often people believe that an erection equals sexual arousal. There are many reasons why a man may experience an erection during a sexual assault. The simple friction of touching the millions of tiny nerve endings on the penis could cause an erection, even if the touch was unwanted or unpleasant.

Being penetrated anally can also cause an involuntary erection. The application of pressure on to the prostate gland from digital, penile, or foreign object insertion to the anus can often cause an erection. Any proctologist will tell you that this type of reaction is very typical while performing a Digital Rectal Exam for prostate screening.  

Bringing the victim to the point of ejaculation is also quite common. Rapists will often make every effort possible to ensure that the victim does ejaculate to add the the feelings of guilt, shame, and homosexuality. This can add another layer of power, and dominance, and even increased pleasure for the rapist for having such control over the other person. Remember in most cases its about power not the actual sex.

Often we field many requests from interested readers who are asking, “What does it take to become a forensic nurse?” or “what are the requirements to become a forensic nurse?”.

There are various designations that can also be acheived. a CFN, a  

 The problem is, there is no one right answer currently. While there is a national standard that is currently being considered, each state currently makes its own rules for its licensing. So what requirements there are in New Jersey  to become a forensic nurse are not necessarily the same as the requirements in say Georgia or Michigan.

But for the sake of conversation. In general, you must complete / possess the following requirements to become a forensic nurse:

• A valid and active nursing license (without any restrictions)
• successfully complete a formal didactic educational program in forensic nursing. This should include a minimum of 40 contact hours in the core areas of forensic nursing. These core areas include; the history of forensic nursing; the forensic nursing process; violence and victimology; injury identification, interpretation, and documentation; criminalistics and forensic science; and nursing and the interdisciplinary process with law enforcement / and legal process.