Abstract
Forensic science has been classically associated with investigations of suspicious or wrongful deaths. However, in the past decade, a new discipline, living forensics, has emerged, focusing on trauma survivors and the perpetrators of violent acts. This new forensic arena is germane to healthcare personnel in any setting, and bridges the gaps that have traditionally distanced them from law enforcement and the judicial systems. The requirement to educate nurses in the fundamentals of forensic science was firmly established in 1997 when the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) published its revised standards for patient assessment. The guidelines require that all staff members be educated to identify victims of abuse, violence and neglect, and be able to collect and safeguard physical evidence associated with a known or potential criminal act. The purpose of this proposal is to develop an asynchronous, interactive learning program for the World Wide Web, which will enable nurses and other healthcare personnel to identify forensic cases and to properly document and manage evidentiary materials. Total project expenses are $21,700; $9,700 to be contributed by Indiana University School of Nursing, and $12,000 requested from the Course Development Grant Program.
Narrative
Need to be addressed and learners to be served.
The administrative staffs of Indiana's 128 hospitals are scrambling to interpret and comply with the several provisions of JCAHO's and other agency guidelines. There are no hospitals in Indiana which currently have a forensic nurse specialist, there are no healthcare-specific forensic texts, and a dearth of any useful resources to aid in personnel education and training required for regulatory compliance. There are only 14 individuals, among Indiana's nearly 60,000 registered nurses, with known affiliations with the forensic nursing specialty and 11 of these are practicing as sexual assault examiners. The need for an education and training program which could reach each of the vast number who still require essential indoctrination in the forensic sciences relevant to nursing is obvious.
The futility which citizens perceive when perpetrators of violent acts are not identified, or set free when authorities lack appropriate evidence for prosecution has been recently highlighted in conspicuous forensic cases. Insiders know that breaches often can be traced to hospital personnel who fail to identify and collect evidentiary materials, or who do not follow appropriate procedures in the documentation and safeguarding of evidence. The expenditure for legal proceedings aborted by lack of pertinent evidence is a significant financial burden to taxpayers. Furthermore, perpetrators may be set free to engage in further acts of violence when evidence is insufficient for a conviction. It is important to note that the principles of living forensics also serve those wrongfully accused since flawless evidence can prove innocence as well as guilt.
In 1989, C. Everett Koop (then Surgeon General of the U.S.) emphasized that healthcare personnel must become active participants in stemming the tide of escalating violence. He proclaimed that they must actively identify cases and report them to appropriate authorities in order to assure the protection of our society. "As a major public health problem (violence), it has become the responsibility of the health professionals, including nurses to assume a greater role and go beyond mere treatment and symptoms. It is also the responsibility of educational institutions and educators to provide resources through innovative and creative educational programs in order to begin to resolve an identified problem that can be described as beyond crisis" (Koop, 1989).
The proposed course will be structured to fulfill the needs of nurses who work in a setting where potential living forensic cases may present for treatment. These include hospitals, clinics, schools, occupational health centers, correctional custody facilities, nursing homes, rehabilitation centers, senior citizen habitats, free-standing emergency units and the community. The course will be offered by the Indiana University School of Nursing (IUSON) Center for Teaching / Life Long Learning as a continuing education program offered on the Internet targeting all licensed professional (RN) and technical nurses (LPN). Continuing Education Units will be awarded for nurses, and will be obtained for non-nursing participants from appropriate CE-granting agencies. The course is designed to fulfill the staff education mandated by JCAHO's 1997 accreditation guidelines related to identifying victims of physical assault, rape, or other sexual molestation; domestic abuse; and abuse or neglect of older adults and children. It will serve as an informational tool to assist hospitals and other healthcare institutions in their development of special procedures for the collection, retention, and safeguarding of physical evidence.
Rationale for Course and Technologies
The proposed course in forensic sciences, tailored to the needs of healthcare personnel, will ensure that forensic cases are promptly recognized, and that evidentiary materials are properly detected, collected, preserved and transmitted to appropriate authorities within law enforcement or the criminal justice system. The Internet technology will permit individuals or groups of individuals to access the on-line program at various times, accommodating shift personnel, orientation and in-service schedules, and other personal or institutional requirements. The course is designed to present core content first, and to follow with specific applications relevant to unique problems, types of patients or specialized settings. In order to demonstrate relevancy of content to the learner, clinical scenarios will be used to illustrate the roles and responsibilities of healthcare personnel in assessments and forensic evidence handling. The consequences of proper and poor techniques will be contrasted using outcomes from the files of judicial proceedings that relied upon forensic evidence collected within the hospital setting. Essentials for composing written and creating photo-documentation will be presented and critical standards emphasized via interactive case studies. A working glossary of relevant terms will be constructed as participants proceed through the offering. The times for course offerings will be flexible to meet specific needs of the learner or groups of learners. The course management software (WebCT) will permit many options for learning activities including, discussion, case studies, guest lectures, on-line testing, access to forensic experts, multiple data bases and libraries worldwide via the WWW.
Institution's Capacity and Commitment
There is a solid commitment to distributed education within the university, the campus and School of Nursing. This proposal is consistent with the Indiana University Information Technology Strategic Plan (http://www.indiana.edu/~ovpit/strategic) and IUPUI Campus initiatives to support distributed learning.
This course will be offered through the Center for Teaching/Lifelong Learning at the School of Nursing. The School's strategic plan, "Becoming a School of Nursing without Walls," calls for the development of academic and continuing education courses and provides the necessary support services from the School's instructional support team (learning resource coordinator, multimedia developer, database manager, video conferencing coordinator, instructional designer, webmaster, and LAN manager) as well as campus team members from the IUPUI Library and Center for Teaching and Learning. This team will support the development and deployment of this proposed course. The SON has a four-semester experience of offering web-based courses using the course development team approach described above.
Additionally, participant support services are also well developed for offering this course. For example, the user's guide for the course management software has been developed and posted on-line; there is a student database for gathering evaluation data; the campus bookstore has capability for mailing course material; the library can offer full text on-line resources and electronic resources; and participants can register on-line through the SON CE Department. (See letter of support from the University Dean.)
Instructional Design Plan
The instructional design plan involves planning, peer review, usability testing, implementation and evaluation. The course content plan will explore the fields of forensic science as they relate to social, ethical and legal issues that arise in a healthcare setting. Among these are domestic violence, sexual assault, child and elder abuse or neglect, emotional terrorism, self-inflicted trauma, vehicular and firearm trauma, environmental pollution, drug or medical device mishaps, organ and tissue procurement, and deaths. Specific skills required to perform victim and perpetrator examinations and to assist these individuals in coping with the injuries and other consequences of wrongful acts will be emphasized. Human rights and legal processes will be explored as they relate to the management and rehabilitation of those victims within healthcare institutions, correctional custody facilities, or other settings. Nursing responsibilities for reporting and documenting incidents and planning for follow-up care with social agencies will also be addressed. The program concludes with the role of the nurse in serving as a witness or providing courtroom testimony.
The course management software WebCT will be used to structure the course for discussion, testing, and access to resources. The course will be offered on the Internet, so participants can access it any time, any place. Participants will also be afforded the opportunity to participate in discussions, use clinical case scenarios, and access digital images of victims who illustrate injuries of inflicted trauma or the manifestations of human abuse and neglect.
Course Evaluation Plan
The evaluation plan includes evaluation of learning outcomes, as well as course and faculty effectiveness. Nurses from the target audience will be invited to review the draft of the course materials and test the on-line functionality in order to determine appropriate contact hours and technical effectiveness of the course. Learning outcomes will be assessed by post-test and clinical case scenarios that emphasize application to practice. Course and faculty evaluations will be conducted using SON instruments developed for use in the on-line learning community. Summative evaluation will draw on data obtained from participants, instructional support team and lead faculty and used to revise the course.
Plans for Peer Review and Interinstitutional Acceptance
The course will be marketed to institutions within IPSE, all healthcare agencies in Indiana, professional organizations with members requiring this content to comply with JCAHO certification, and to interested participants worldwide. Marketing capabilities exist within the SON and will include posting course information on the SON Web site and using course announcement brochures. Other strategies to gain interinstitutional acceptance include presentation at national meetings where potential participants would be recruited. Finally, the course will be marketed to JCAHO accredited institutions world- wide to be considered for offering as a part of healthcare agencies' workforce development plans.
Project Timeline
January, 1999 Complete course design; develop learning activities; select on-line resources; prepare course guide; conduct technical team meetings.
February-June, 1999Begin to market course to target audience.
February-March, 1999 Technical specifications developed; course created in WebCT (course management software); course linked to the SON home page.
April-May, 1999 Technical usability testing by technical team, nurses, peer reviewers; develop and refine evaluation instruments, assign CE contact hours.
August, 1999 Offer course on ongoing basis.
September, 1999 Summative evaluation by participants, technical team, project course development personnel.
Key Course Development Personnel
Janet M. Barber Duval, MSN, RN, CEN, Distinguished Fellow, International Association of Forensic Nurses and Principal Editor of the Core Curriculum, International Association of Forensic Nurses. Mrs. Duval will develop and teach the course.
Michael Vaughn, MA, Director of Information Technology and Multimedia Developer, will design user interfaces, develop tutorials and clinical case scenarios that integrate the digital files of forensic evidence.
Appendix A
Summary of Lead Faculty's Experiences
Biosketch: Janet Barber Duval, MSN, RN, CEN will be the lead faculty for the course. She is former Associate Professor of Nursing at the SON and has recently served as Forensic Course Coordinator for the University of Texas at Austin's SON Forensic Nursing Series. Mrs. Duval has more than 30 years of experience in clinical nursing and education. She is a recipient of Purdue University's Award for Outstanding Service to Continuing Education. Her curriculum vitae include more than 200 sites for continuing nursing education programs throughout the United States. Throughout her career, she has attained a national reputation for her publications in emergency, trauma and critical care nursing. Mrs. Duval is currently Editor of Critical Care Nursing Quarterly and Publications Advisor for the International Association of Forensic Nurses. She is a member of the American Academy of Forensic Sciences and presented papers at its last five scientific assemblies. In 1997 the title of Distinguished Fellow was bestowed by the International Association of Forensic Nurses for her pioneering work in the new specialty. In 1998 Mrs. Duval was selected to serve as Editor for the Core Curriculum of the International Association of Forensic Nurses. She is contributing author and Editor for the first comprehensive textbook for forensic nursing, to be published in 1999.
Appendix B
References:
Koop, C. Everett: Proceedings of Surgeon General's National Conference on Violence, Washington, D.C., 1989.
Joint Commission on Accreditation of Healthcare Organizations. Comprehensive Accreditation Manual for Hospitals; The Official Handbook. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 1997.
