Development of Forensic Nursing in Australia: Associate Professor Linda Saunders 4 th December 2008

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1 Development of Forensic Nursing in Australia: Associate Professor Linda Saunders 4 th December 2008

2 Working with Offenders

3 Country Total Criminal Population Population Australia 20,090,437 22,458 Canada 32,604,329 31,624 Singapore 4,425,720 25,600 United Kingdom 60,441,457 72,669 United States 1976 reinstated capital punishment United States 295,734,134 1,962,220

4 Australian Institute of Criminology The following data has been taken from Australian Crime Facts & Figures 2006, published by the Australian Institute of Criminology The full report can be accessed on :

5 Limits on Statistics No national collection of data Reliance on individual state agencies collecting material Police and correctional services use different units of measurement Not all crime is reported to police

6 Table 1: Victims of violent crimes, (number) Table 1: Victims of violent crimes, (number) Homicide Assault Sexual assault Robbery Kidnapping ,156 14,542 16, ,500 14,353 21, ,903 14,336 23, ,271 14,104 22, ,708 15,759 23, ,283 16,897 26, ,118 17,977 20, ,280 18,237 19, ,849 18,400 16, ,499 18,172 16,

7 Sentenced prisoners by most serious offence, 2005 Male Female Number % Number % Violent Homicide 1, Assault 2, Sex offences 2, Robbery 2, Property Break and enter 2, Other theft 1, Fraud Other GSJ 1, Drug offences 1, Other 2, Total 18, ,

8 Crime Trends in Australia Violent crime: assault, sexual assault, robbery and homicide, rate per 100,000 persons,

9 Justice Health

10 Prisons in Australia WA 17, max, med, low, youth, female, remand and detention centres NT 6 including remand, juvenile, prisons max SA 9, max, med, low, female, youth, remand, pre release Vic 14 high, max, remand, youth, woman ACT 1 remand, 1 detention centre Qld 14 high, max, med, low NSW 37, high, max, med, low prisons, remand centres and youth detention areas Tas 6 max, med, low security prisons& remand

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12 Prison environment Incarceration means loss of personal freedoms And, loss of choice over sanitation, diet, cellmates and choice of activities Increased risk non-consensual sexual activity Overcrowding provides an environment for stress related disorders, communicable diseases and violence induce injury

13 Nurses as advocates for better prison health care Health care for those incarcerated stirs up negative emotions Balance of community would not see $ spent on prisoners as good use of public funds Offenders often enter prison with multiple health issues due to life style and years of self neglect

14 Health Care in Prisons Considerable variation in delivery, quantity, funding effectiveness and links Medical model Not focused on health, little attention on prevention Risk increase incidence in mental health and substance abuse and suicide Large gaps in quality of health care between prisoners and rest of community in many prisons across the globe

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16 Caring for Ageing Prisoners 55 and older considered to be older Eg 2007 : 1,463 M & 78 F > 55 (Australia) 48% of > 55yr old M incarcerated for sex offences 897 life, years, yrs

17 Older Inmate Impact of changes to Statute of Limitations years 691 M and 52 F years 382 M and 17 F 65 or over 390 M and 9 F

18 Care vs Custody Little public sympathy for offenders Obligation to treat without prejudice or discrimination Access for health ageing program Distinguish between anguish, depression and ageing process dementia Forensic service inappropriate dementia patients Chronic Illness Terminally Ill offender

19 Older Offender Issues Criminal charges on residents - bailed Protective custody loss of hope Risk of injury by other inmates Reduced mobility reduced options participation in prison life Enter prison with multiple health issues

20 Emerging Roles in Australia Sexual Assault Nurse Examiners Clinical Forensic Role Elder Abuse Investigator

21 Sexual Assault Nurse Examiner Undertakes the forensic examination for victims of sexual assault Physical assessment Collection of evidence Chain of Custody Referral process Preparing legal report Qld, NSW, Vic

22 Clinical Forensic Nurse Role Not responsible for forensic investigation Assessment of client health needs Develop skills and knowledge in the identification, collection and preservation of evidence Charged Accused, Victim

23 Current Practice Needs Emergency department identify collect and store evidence Peri-operative collection of evidence eg bullets, preserve ballistic evidence Midwifery identify victims of domestic violence Paediatric nurses identification of child abuse Aged care nurses identification of elder abuse

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26 Detection of Elder Abuse Unless specifically prepared professionals and lay people are unlikely to identify abuse in all but the most extreme cases miss clues given by the older person too often assumptions are made about the behavioural/physical state of the older person being due to old age or ill health situational and psychological barriers to reporting

27 The Nurses/Carers Role in Elder Abuse We owe a duty of care to our clients We have a responsibility to become informed and skilled in identifying and managing elder abuse Criminalising elder abuse leaves inactive staff at risk of criminal charges for failing to identify and make reports

28 Competent and specific interviewing and assessment skills awareness of the legal issues involved educate other health carers empower the older person provide care for the abused older person participate in a multi institutional, inter disciplinary prevention, awareness campaign Nurses Role

29 Education focus for the development of the Forensic Nurse Work Force Maintain an index of suspicion Identify sustained patterns and patterned injury distinguish between intentional or accidental injury Blunt and Sharp Force injury identification, collection and preservation of evidence Develop skills as a witness Develop skills in documentation

30 Patient Focus Priority in emergency care - the patient But attention should also be focused on the responsibilities to preserve and protect as much evidence as possible

31 Language Terminology important as this can lead to a different account / interpretation of the event Using Forensic language Take care not to accuse ie offender, perpetrator nothing proven yet

32 Documentation Critically important that documentation is objective Facts, and not assumptions are recorded nor opinions Facts and not allegations

33 Documentation Patient s behaviour Statements made by patient Will be scrutinized under rules of evidence before admission to trial BUT may be useful in investigation process (Genell Lee, N. 2001, Legal Issues in Emergency Care. WB Saunders Company USA)

34 Take care in any interpretation of any alleged explanation of injuries by patients Patients statements might direct your assessment Particularly in medical records, preparation of police reports, giving evidence in court

35 Things to note Circumstances surrounding injury Type of weapon Length of time between injury and treatment Nature of injury Witnesses Care of clothing Chain of custody

36 Patterned and Patterns of Injury Patterned injury display particular characteristics that reflect the pattern of the wounding object Patterns of injury refer to patterns of injury inflicted over a period of time Injuries contaminated with trace evidence (when two objects touch there is a transfer of material (trace evidence) from one to the other)

37 Impact on absence of detail of wounds in case notes Good Samaritan murder trial Defeat of aggravated sexual assault trial

38 Thank you