Government Institute of Medical Science, College of Nursing, Uttar Pradesh, India
Forensic nursing, formally recognized by the ANA is a relatively young nursing specialty. Although ethical concerns and dilemmas abound there remains a paucity of published research studies on the ethical dimensions guiding forensic nursing practice. In addition, there is a lack of educational resources related to ethics from sources such as the forensic nursing society’s professional organization, academic texts, and journals. Yet, forensic nursing practice occurs in an environment where providers are at substantial risk for role confusion and role conflict. Forensic nurses may also experience conflicts of interests or conflicting interests. They encounter ethical dilemmas that may create moral distress and have extremely limited resources for guidance. Forensic nursing is a specialty practice that encounters situations involving sexual assault, child abuse, homicide, torture, and other tragedies that are emotionally charged and involve medico-legal implications. The outcomes associated with these events may have life-long negative effects for the patient, their families and loved ones, their community as well as for the accused, suspects and perpetrators of the violence and his/her family and loved ones.
Issues related to clinical, professional, and organizational ethics within forensic nursing practice span the realms of clinical practice, research, education, administration, and policy. Forensic nurses find themselves at the intersection of healthcare and the law, yet there remains an absence of forensic nursing research on topics such as dual loyalty to the patient and society; to nursing and the criminal justice system), professional values (e.g., value development, response to conflicting values), and ethical decision making processes. There is also a lack of published articles addressing conflicts of interest and conflicting interests, and where the two concepts overlap, in clinical forensic nursing practice2 Interestingly, within the Scopes and Standards of Forensic Nursing Practice (2009), there are several references to the ethical paradigms of forensic nursing practice although a literature search for such a paradigm or their application to practice was unsuccessful within the forensic nursing literature and textbooks. Discourse surrounding forensic medical services for unconscious patients serves as an exemplar of the concerns described above3
OBJECTIVES OF THE STUDY
LEGAL ASPECTS:
FORMS OF SEXUAL VIOLENCE INCLUDE:
Section 164A CrPC lays out following legal obligations of the health care workers in cases of sexual violence:
CLAA 2013, 357C CrPC:
ROLE OF DOCTOR UNDER POCSO ACT:
DISCUSSION
During discussions of potential ethical conflicts, many forensic nurses become focused solely on the pelvic exam, specifically, the insertion of a speculum into the vagina of an unconscious female patient. Considerations are not given to other related invasive procedures (e.g., sample collection from anal or oral cavities), equivalent concerns for male or transgender patients, nor grounds for suspicion of assault itself.
Individual decisions and even program policies have been based on what the forensic nurse would want if s/he were the patient or based on an assumed fear on the part of the forensic nurse of risking his/her professional nursing license(s). These decision processes are not consistently evidence-based nor patient cantered and represent a weak ethical decision making process
Much of the formal and informal discourse appeared to be anecdotal at best and similar to the exemplar shared above. These conversations tended to focus primarily on female patients and their genitalia. Yet there was a lack of evidence-based or research-informed literature related to the use of digital imaging for photo documentation among forensic nurses. The same held true for forensic nurses concerns.
CONCLUSION
A second exemplar, and the impetus behind the data generating section of my doctoral studies, involves the practice and policy surrounding photo documentation, particularly digital photo documentation. Concerns around the use of digital imaging technology for photo documentation emerged through formal and informal discussions during an International Association of Forensic Nurses symposium on photo documentation, posts on general and sub-specialty discussion boards, articles exploring the use and purpose of digital imaging technology, and questions posed during forensic nurse training and presentations.
involving the practice of photo documentation and use of digital imaging technology. This gap in the literature included both extra-genital and ano -genital photo documentation practices. To develop best practices, policy statements or guidelines, and to address ethical concerns surrounding the use of digital imaging technology in clinical forensic nursing practice, it is critical to move beyond anecdotal accounts.
CONFLICTS OF INTEREST: No conflicts of interest.
AUTHORS FUNDING: Self.
CONCLUSION
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REFERENCES
Karthikeswari, A Review Article on Exploring Forensic Mental Health Nursing Ethics and Practice - Roles, Loyalties and Photo documentation Practices, Int. J. of Pharm. Sci., 2024, Vol 2, Issue 11, 1312-1315. https://doi.org/10.5281/zenodo.14220579
10.5281/zenodo.14220579
