DEVELOPMENT IN CURRENT NURSING PRACTICE

 The profession of nursing is dynamic and ever changing. Nursing roles evolve and develop in response to societal needs.

Forensic Nursing

It is a newly emerging field that forms an alliance between nursing, law enforcement and the forensic means anything belonging to or pertaining to, the law.

An Emerging Discipline 

Forensic nursing as defined by the International Association of Forensic Nurses (IAFN). is "the application of nursing science to public or legal proceedings, the application of the forensic aspects of healthcare combined with bio psycho social education of the registered nurse in the scientific investigation and treatment of trauma and death of victim and perpetrators of abuse, violence, criminal activity and traumatic accidents". Nurses, particularly emergency room nurses, have long provided care to victims of domestic violence, rape and other injuries resulting from criminal acts. They have collected, preserved and documented legal evidence without any formal training. It was not until 1992 that the term forensic nursing was coined. IAFN group includes legal nurse consultants, forensic nurse death investigators, forensic psychiatric nurses, as well as forensic correctional nurses. Forensic nurses specializes in several diverse roles and are beginning to find employment in variety of setting, these roles include the Sexual Assault Nurse Examiner (SANE), the forensic nurse death investigator, the forensic correctional nurse, and the legal nurse consultant.

Legal Nurse Consultant 

The legal nurse consultant is a licensed registered nurse who critically evaluates and analyzes health care issues in medically related law suits. They work in collaboration with attorneys and other legal and health care professional. They may have independent practices, work in the hospital setting in risk management or be employed by law firms or health insurance companies.

Medical Examiner Nurse 

Death Investigator

The roles of the death investigator is to advocate for the deceased. A death investigator is a professional with experiential and scientific knowledge who can accurately determine the cause of death. At the death scene, the forensic nurse death examiner examines the body, pronounces death, and takes tissue and blood samples. They take picture of the body and evidence at the scene. They are responsible for record keeping and arrange for the transport of the body to the morgue for autopsy of further examination. She works with the forensic pathologist to collect evidence in the lab during the autopsy.

Forensic Psychiatric Nurse

They work with individual who have mental health needs and who have entered the legal system. These nurses generally practice in state psychiatric institutions, jails and prisons. 

Forensic Correctional Nurse

The nurses provide health care for inmates in correctional facilities such as juvenile centers, jails and prisons. They manage acute and chronic illness, develop health care plans, dispense medications, perform health screenings and health education. 

Nurse Entrepreneur  

A nurse entrepreneur starts a business by combining nursing experience and knowledge with business knowledge. They can include nurse attorneys, nurse case managers, nurse educators, nurse death investigator, nurse midwives, psychiatric nurses and sexual assault nurses.

Case Management 

A Care Co-ordinator 

Nurse case managers act as advocates for clients and their families by coordinating care and linking the client with the physician, other members of health care team, resources and the payer. The goal of the nurse is to help the client obtain high quality, cost effective care while decreasing the duplication and fragmentation of care.  

Bioterrorism 

An Acute Health Issue 

Bioterrorism is the use of microorganism with the deliberate intent of causing infection to achieve political goals. The use of microorganisms is particularly effective because their release can go undetected for an extended period of time because their effects are not immediate. This allows for person to person spread before they are detected. 

Early Recognition 

The key to an effective response is training in the early recognition of a bioterrorist attack. 

Clinical Presentation 

One of the first indications of a biological attack will be an increase in the number of individuals seeking care from primary care providers and emergency rooms. Hospitals, doctors, nurses and public health professionals will be on the front lines of any attack.

Biological Agents 

The centers for disease control (CDC) developed a list of biological agents that are considered the most likely to be used in a bioterrorist attack. Ineffective agents were included based on their ability to produce widely disseminated infections, high mortality rates, potential for major health impact, ability to cause panic and social disruption. 

Effect Response

Identification and management 

Once appropriate notifications have been made, nurses will use their skills of clinical evaluation and history taking to identify the infective organism, mode of transmission, and source of exposure. In addition, nurses play a critical role in managing post exposure prophylaxis and its complications, as well as psychological and mental health problems brought on by event.

Response Training

Included was the recommendation that all basic nurse education programs include information on how to respond to mass casualty events. The task force includes self study modules and other specialty programs developed for ER nurses on detection and management of bioterrorism. 

Activation and Development 

In the event that the president declares a bioterrorism state of disaster, the National Nurses Response Team (NNRT) will be activated to respond by providing mass immunization or chemoprophylaxis to a population at risk. The NNRT under the auspices of the Department of Health and Human Services, will be quickly deployed in response to a major national event. 

Disaster Nursing

A disaster is a catastrophic event that leads to major loss. The American Red Cross defines a disaster as "an occurrence such as hurricane, tornado, storm, flood, high water, wind driven water, tidal wave, earthquake, drought, blizzard, pestilence, famine, fire, explosion, building collapse, commercial transportation wreck, or other situation that cause human suffering or create human needs that the victims cannot alleviate without substantial assistance". The disaster nurses have various short term and long term goals ranging from providing emergency medical assistance as well as mobilisation of necessary resource such as food, water, shelter, medication and water till providing assistance with resettlement programs and psychological, economic and legal needs.

Conclusion 

Florence Nightingale wrote in 1859 that "no man", not even a doctor, ever gives any other definition of what a nurse should be than this "devoted and obedient". This definition would do just as well for a porter. It might even do for a horsel!" nursing is constantly evolving and defining itself as it strives to include expanded roles of practice. Of the many new and exciting roles for nurses forensic, bioterrorism, disaster, entrepreneur, case management, and legal consultant have developed in response to the needs of the society.

Although nurses have practices in these areas for many years, they are only now beginning to be recognized for the unique skills and qualities they bring to these roles. As more nurses seek the specialised training that is now available for many of these roles and obtain nationally recognized certification as a demonstration of their knowledge, they will gain acceptance as highly qualified and valuable members of these specialized health care teams.



 

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