TMC PULSE

t m c » p u l s e | a u g u s t 2 0 1 4 27 t m c » p u l s e | a u g u s t 2 0 1 4 while we mostly see victims of violent crime, we see perpetrators and suspects, too. our role is objective—we're not on anybody's side, we're just here to gather information. the story tells itself. — khArA BrEEdEn, M.s., Bsn Forensic nurse examiner for Harris Health System work closely with the Houston Police Department, as well as other jurisdic- tions within Harris County, Breeden and her colleagues are careful to distinguish themselves from law enforcement. "It's a common miscon- ception, and I don't want a patient to think that we're playing a different role," she said. "While we mostly see victims of violent crime, we see perpetrators and suspects, too. Our role is objec- tive—we're not on anybody's side, we're just here to gather information. The story tells itself." The information and treatment that they provide is nonetheless a huge asset to law enforcement agen- cies. "Harris Health's forensic nurses help the Houston Police Department with our follow up investigations involving victims of sexual violence and domestic abuse," said Shamara Garner, lieutenant of the Adult Sex Crimes Unit, Special Victims Division at the Houston Police Department. "The trauma informed services that they render help the complainant be at ease with the medical and emotional aspect, which filters its way up to the investigation by furthering their recov- ery and making it easier for us to come alongside and take care of the criminal investigation. Their specialty helps strengthen our case, and their scope of involvement extends from the victim to the community at large by helping us possibly identifying perpetrators." Harris Health's forensic nurses are also expected to testify in court, both as a fact and expert witness, when called upon. "We're able to provide an opinion about those injuries and what they mean in the overall scheme of the case," said Mitchell. "We're bound by the same rules as anyone else who tes- tifies in court, even though we're often qualified as experts, and don't testify outside of our scope of practice." Maintaining objectivity and reserving judgment are both prerequi- sites for this unique nursing specialty, although they both pose their own set of challenges. "As nurses, we are patient advocates, but as patient advocates within this context we have to adopt a different perspective, because we're also an advocate for the process itself," reflected Mitchell. "We want to ensure that all of the procedures are followed so that the patient can have justice. At times, it can be challenging to sustain that objectivity, but it's something that, consciously, a forensic nurse has to ensure that they do—it's essential." For Breeden, the necessity of keeping emotional distance was a skill that she had to learn to cultivate. "You really have to learn to put it somewhere else," she said. "My first few months, I didn't think I was going to be able to do it because it was too hard; you see too many things that make you question how people can do this to each other. After a particular patient interaction, I realized I was doing the right thing. Once you know that, you're able to put it in a different box. I just do the best I can and treat everyone with kindness." As the field of forensic nursing continues to expand, so does the necessity of community engagement and education. Harris Health's forensic nursing program provides community education to both law enforcement officials and victim advocates like the Rape Crisis Center and Child Protective Services. According to Mitchell, the medical component can be complicated in terms of the significance of their findings. "Educating community part- ners can help make their jobs easier," she said. "Our nurses are also required to take two classes, totaling over 80 hours of classroom time, to learn about the types of patients that they'll be seeing and how to collect and preserve evidence, as well as provide proper documentation." With four full time nurses on-site at Ben Taub Hospital's emergency center and five nurses who take calls, and respond to cases at Lyndon B. Johnson Hospital and any other community health centers within the Harris Health System, Mitchell and her team are expecting even more consults in the next year. As the only program in Houston to focus on all victims of crime, violence, abuse and neglect, rather than just sexual assault patients, Harris Health's forensic nursing pro- gram is uniquely positioned to benefit their community. "The biggest value that we provide is that we're here for the citizens of Harris County," concluded Mitchell. "Having these services is so import- ant. An emergency room nurse is thinking about all of the lifesaving treatments that need to be done. We're thinking about that, but also address- ing the other areas, from legal needs to resources, that need to be encom- passed. We're here for our patients." harris health forensic nurses work alongside law enforcement officials to coordinate patient exams and retain crucial evidence for possible legal action against assailants. (Credit: harris health system)

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