Development of Forensic Nursing in Australia: Associate Professor Linda Saunders 4 th December 2008
Working with Offenders
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 http://www.homeoffice.gov.uk/rds/pdfs2/r188.pdf
Australian Institute of Criminology The following data has been taken from Australian Crime Facts & Figures 2006, published by the Australian Institute of Criminology 2007. The full report can be accessed on : http://www.aic.gov.au
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
Table 1: Victims of violent crimes, 1996 2005 (number) Table 1: Victims of violent crimes, 1996 2005 (number) Homicide Assault Sexual assault Robbery Kidnapping 1996 354 114,156 14,542 16,372 478 1997 364 124,500 14,353 21,305 564 1998 332 130,903 14,336 23,801 707 1999 386 134,271 14,104 22,606 766 2000 363 138,708 15,759 23,336 695 2001 346 152,283 16,897 26,591 767 2002 365 160,118 17,977 20,989 706 2003 341 157,280 18,237 19,709 696 2004 293 156,849 18,400 16,513 768 2005 295 166,499 18,172 16,787 730
Sentenced prisoners by most serious offence, 2005 Male Female Number % Number % Violent Homicide 1,900 10 137 11 Assault 2,847 15 159 12 Sex offences 2,341 12 20 2 Robbery 2,090 11 85 7 Property Break and enter 2,414 13 129 10 Other theft 1,048 6 143 11 Fraud 524 3 190 15 Other GSJ 1,598 8 148 11 Drug offences 1,844 10 176 14 Other 2,313 12 114 9 Total 18,919 100 1,301 100
Crime Trends in Australia Violent crime: assault, sexual assault, robbery and homicide, rate per 100,000 persons, 1993-2005
Justice Health
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
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
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
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
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, 533 20+ years, 688 15-20 yrs
Older Inmate Impact of changes to Statute of Limitations 55-59 years 691 M and 52 F 60-64 years 382 M and 17 F 65 or over 390 M and 9 F
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
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
Emerging Roles in Australia Sexual Assault Nurse Examiners Clinical Forensic Role Elder Abuse Investigator
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
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
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
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
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
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
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
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
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
Documentation Critically important that documentation is objective Facts, and not assumptions are recorded nor opinions Facts and not allegations
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)
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
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
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)
Impact on absence of detail of wounds in case notes Good Samaritan murder trial Defeat of aggravated sexual assault trial
Thank you