Development of Forensic Nursing in Australia: Associate Professor Linda

Saunders4th December 2008

Working with Offenders

United States1976 reinstated capital punishment

Country Total CriminalPopulation 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 295,734,134 1,962,220http://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)

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

Table 1: Victims of violent crimes, 1996–2005 (number)

Male FemaleNumber % Number %

ViolentHomicide 1,900 10 137 11Assault 2,847 15 159 12Sex offences 2,341 12 20 2Robbery 2,090 11 85 7PropertyBreak and enter 2,414 13 129 10Other theft 1,048 6 143 11Fraud 524 3 190 15OtherGSJ 1,598 8 148 11Drug offences 1,844 10 176 14Other 2,313 12 114 9Total 18,919 100 1,301 100

Sentenced prisoners by most serious offence,2005

Crime Trends in Australia• Violent crime: assault, sexual assault, robbery and homicide, rate

per 100,000 persons, 1993-2005

Justice Health

Tas 6 max, med, low security prisons& remand

Qld 14 high, max, med, low

ACT 1 remand , 1 detention centre

NSW 37, high, max, med, low prisons, remand centres and youth detention areas

NT 6 including remand, juvenile, prisons max

Vic 14 high, max, remand, youth, woman

SA 9, max, med, low, female, youth, remand, pre release

WA 17, max, med, low, youth, female, remand and detention centres

Prisons in Australia

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

Nurses Role• 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

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