November 22, 2023/Nursing/Clinical Nursing

Behind Closed Doors: Forensic Nurses Approach Victims With Empathy and Precision

Specialized team prioritizes trauma-informed care and evidence collection

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Every day, thousands of individuals – ranging from law enforcement officials to community advocates and healthcare providers – work diligently to support and protect those affected by violent crime. Among those making a difference is a specially trained team of forensic nurses who serve at the intersection of medicine and the criminal justice system.

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Cleveland Clinic has 12 full-time and 60 on-call forensic nurses who work 24/7 at one of the main “hubs” at Mercy, Akron General, Fairview, and Hillcrest hospitals and Cleveland Clinic’s main campus. Forensic nurses who work at main campus, Fairview or Hillcrest travel to the regional hospitals as needed to see patients in the emergency department or inpatient setting. These nurses, many of whom are Sexual Assault Nurse Examiner (SANE) certified, provide specialized care for victims of trauma, focusing on the patients’ physical and psychological well-being.

SANE nurses perform medical exams, collect specimens for possible use by law enforcement (with consent), connect patients with appropriate after-care resources, consult with legal authorities and educate other healthcare providers on how to identify victims of trauma. In some cases, they are even called upon to provide medical testimony in court.

In most of these cases, patients enter the system through the emergency department, where the role of the forensic nurse is particularly crucial. “It’s here that our victim advocacy work really begins,” says Michele Reali-Sorrell, DNP, RN, SANE-A, SANE-P, manager of Cleveland Clinic’s Forensic Nursing Program.

Reali-Sorrell is part of a growing team of caregivers that provides care to patients who have experienced sexual assault, domestic violence, human trafficking, elder abuse, child abuse or neglect. She explains that forensic nursing demands specific knowledge and a deep sensitivity to what patients have experienced – and it also requires extra time that other clinicians don’t always have.

“Forensic nurses often spend several hours with a patient, depending on the specifics of each case,” she says. “Our ability to build trust with victims is a critical part of what we do, and that process simply takes time, patience and significant expertise.”

Trauma-informed care

The first priority of any forensic nurse is to ensure that patients are treated medically, if necessary. The nurse then begins the forensic exam, which may include the collection of biological evidence, documentation of the assault and current injuries, photo documentation of injuries, assistance with reporting to law enforcement and referrals for follow-up care. The overarching goal of the forensic nursing team, however, is to provide holistic, trauma-informed support to patients.

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“Trauma can happen to anyone, anytime – and the mental, physical, and emotional effects of it can last a lifetime,” says Reali-Sorrell. “We do everything we can to promote healing, and part of that involves putting patients in the driver’s seat. By involving them in the decision-making process, we hope to help them reclaim a little power.”

The forensic team’s approach, known as trauma-informed care (TIC), considers the experiences of each individual and how trauma may affect their lives. Importantly, the method is designed to prevent re-traumatization.

“Trauma-informed care provides us with a path that is focused on recognizing the signs and symptoms of trauma, integrating that knowledge into our hospital policies and procedures, preventing further harm, and providing resources for recovery,” she adds.

In recent months, Cleveland Clinic has broadened its forensic nurse program to include telehealth — a safe, private way to reach patients affected by violence. Now being piloted at main campus, the virtual model will soon be expanded to 13 other hospitals within the healthcare system.

“The need for forensic nurses continues to grow, and telehealth has proven to be an excellent way to provide expedited care,” says Reali-Sorrell. “This is especially true in rural regions, where patients may not have access to nurses with specialized training. That’s far from ideal for a person who has just been through a life-changing trauma.”

Cleveland Clinic has also introduced a new mobile forensic unit – the first of its kind in Ohio. Staffed by an emergency physician, forensic nurse and paramedic, the unit was developed in collaboration with the Cuyahoga County Sheriff’s Office and the Northeast Ohio Human Trafficking Task Force. The mobile team is prepared to triage patients, perform physical exams and collect forensic evidence on site. It is one more way to “reach victims who otherwise may not have access to specialized care,” says Reali-Sorrell.

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Ongoing support

Forensic nurses also ensure patients are “connected with the next steps” when they leave, she says. That may include lining up hospital advocates from the Victim Assistance Program or providing resources through a local rape crisis center. With initial support from the federal Victims of Crime Act (VOCA) grant program, Cleveland Clinic has established a Care After Trauma (CAT) clinic in the Greater Cleveland area. So far this year, 111 patients have scheduled follow-up appointments.

At the follow-up clinic, patients can meet with a forensic nurse who acts as their care coordinator – helping with education and assisting with the medical examination. Victim advocates provide guidance in communicating with law enforcement, applying for victims of crime compensation, safety planning, and other services that patients may require. The healthcare system’s forensic nurses also work with local agencies like the Cleveland Rape Crisis Center and help connect adult patients with law enforcement if needed.

“Our goal is to serve as a safety net by providing tangible, real-life resources,” says Reali-Sorrell. “It’s a one-stop program that starts patients on their way to recovery, both physically and emotionally. And that is, after all, at the heart of forensic nursing — showing patients that healing is possible, and that they don’t have to do it alone.”

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