Changing how the world thinks about nursing

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October 6, 2006 -- Today Newsweek posted a web exclusive by Anne Underwood headlined "'CSI' Nursing." The piece gives a short introduction to forensic nursing, followed by an interview with New Jersey sexual assault forensic nurse Beryl Skog. The "CSI" hook is understandable, though ironic, since that CBS show is among the many Hollywood products that tend to ignore or denigrate the contributions of nurses. In general, Underwood's piece is a thoughtful look at skilled forensic nursing. She gives Skog a good deal of space to explain how she cares for sexual assault victims and gathers vital evidence for criminal prosecutions. We thank Underwood and Newsweek.

The piece continues the "CSI" theme in its subhead and first paragraph, suggesting that "[s]hows like 'CSI' have boosted interest in forensic specialties." Of course, that's not all "CSI" has done. Many criminal justice professionals argue that it has persuaded career seekers that CSI's do the work of several different real life professionals, and influenced criminal juries to expect scientific evidence well beyond what real law enforcement can provide. Moreover, some have argued that "CSI" treats nursing badly, with plotlines presenting nurses as predators or sex-crazed physician chasers, and little hint of the critical work nurses actually do in forensic science.

In any case, Underwood's introduction notes that forensic nursing "combines nursing with detective work." It explains that a group of ED nurses started the field in the 1970's as an effort to give better treatment to rape victims who came to emergency rooms that were unequipped for the kind of care and evidence collection required. It notes that the "brusque treatment [victims] received only compounded [their] trauma." Today, the International Association of Forensic Nurses has 2,600 members. The piece reports that more than half specialize in sexual assault, while the remainder handle homicide, child abuse or domestic violence cases.

In the interview, Skog explains in some detail what forensic nurses actually do to help sexual assault victims. They are on call to local EDs, responding quickly to care for and examine victims. Skog says that the forensic nurse, the detective, and the rape-crisis advocate interview the patient. Skog gives the patient 'control' of the narrative, but also asks necessary questions, and uses techniques to help victims cope with what amounts to reliving the trauma. Skog also gives "prophylaxis for sexually transmitted diseases" and a morning-after pill. She explains that rape victims present special issues for EDs because their bodies are "the crime scene," which means that evidence collection is painstaking and difficult. It can take hours and is not something most ED nurses have time to do.

Forensic nurses document injuries and collect evidence, though as Skog explains, this can be challenging because many victims wash thoroughly before going to the ED. Ironically, Skog notes that "rapists have learned from 'CSI' and other TV shows to wear gloves and use condoms." Skog explains how she uses technology like black lights to search for DNA and other evidence that might confirm a victim's account, such as carpet fibers. She uses a culposcope (a "very fancy magnifying glass") and toluidine glue to examine the vaginal area for tears. Later, she may testify in court as to the evidence.

In response to open-ended questions by Underwood, Skog says that she sees her job as a "privilege," knowing that she can help someone recover from a situation in which "an untrained person can unintentionally do a lot of damage," such as by "insinuat[ing] blame." She also notes that the support she can provide makes this an "excellent job" for her, asserting that nursing has become an "assembly line" in which so much energy goes into technology that "nurses don't have time for hands-on care." She also notes that she doesn't do her job for the money, but to help those in need.

We hear Skog. Short-staffed nurses can feel like they're on a desperate assembly line, and the rapid growth in health care technology can lead to an environment that feels impersonal. But we're also somewhat uneasy with what some readers may draw from these last comments: that nursing care is virtuous work that's all about comfort and support, whereas more technology-driven nursing is somehow less worthy, or perhaps not really "nursing" at all. In fact, nurses improve outcomes in tangible ways, and they need the resources that any skilled professionals do. We'll take nursing technology, however impersonal, if it will save lives. Fortunately, the rest of the piece shows that nurses like Skog are highly skilled, and of course, that they themselves use high technology to help patients.

The piece might have briefly addressed the special training forensic nurses need to do their jobs. And it might have noted that some forensic nurses work at the cutting edge of research and policy.

But on the whole, we thank Anne Underwood and Newsweek for this very good piece.

See the article "‘CSI’ Nursing: Meet a member of an unusual but growing field, thanks in part to the popularity of TV crime shows." by Anne Underwood in the October 6, 2006 edition of Newsweek.

You can contact Anne Underwood at:

Anne Underwood
Newsweek
251 W. 57th St.
New York NY 10019

or send comments to Ms. Underwood via Newsweek's web editors at:

WebEditors@newsweek.com

 

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