Forensic Care Education:Lessons Learned from International ExperiencesArlene Kent-WilkinsonRN, CPMHN(C) BSN, MN, PhDAssociate ProfessorPresentation at 2nd Federal Conferenceon Forensic Care EducationJuly 14, 2015

Arlene Kent-Wilkinson RN, CPMHN(C) BSN, MN, PhD Associate Professor, College of Nursing, University of Saskatchewan Saskatoon, Saskatchewan, Canada A RN for 44 years 1971 graduated from 3 year hospital program 1990 baccalaureate degree; 1993 masters; 2008 PhD Dissertation on forensic nursing education in North America 30 years of clinical experience in emergency, addictions, correctional and forensicpsychiatric nursing. 1997 developed and taught first online courses in forensic nursing globally Recognized provincially, nationally and internationally for forensic nursing education 2012, PI on province-wide needs assessment of programs and services for mentallydisordered offenders in Saskatchewan 2013, PI on International Study Abroad Survey of nursing students See url for Recent Publications ails kent-wilkinson a

Forensic Care Education:Lessons Learned from International ExperiencesNursing Career in Canada1971 Nursing: Low Image/Wages/Education2015 Nursing: High Image/Wages/EducationPatterns in Nursing Development Globally Similarities and differences in the developed/emerging countries Historical, social, economic, and political influencesNursing in Germany Major recent growth in Nursing Education Forensic Psychiatric Nursing is a leading specialty of nursing

Forensic Care Education:Lessons Learned from International ExperiencesOverview of Presentation History of Forensic specialties Subspecialties of Forensic Nursing Forensic Psychiatric/Correctional Nursing Need for a Medico-legal Role Forensic Nursing Education Influences of Social Movements Forensic Nursing different from General Nursing Forensic Nursing different from other Forensic Disciplines Nursing Education in Canada Inequities of Nursing Globally (Wages & Education) Future of Forensic Psychiatric Nursing

Saskatoon, Canada35.16 million-30 to 30

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Forensic Discipline Specialties forensic medical examinersforensic nursingforensic occupational therapistsforensic psychiatryforensic psychologyforensic social workforensic toxicologistsforensic recreational therapists* evolved with the need for a medico legal role

Forensic Nursing:Relevance to Nursing PracticeForensic nursing is:Nursing practice at the intersectionof law and health care (dual roles)Forensic nursing cares for or servesthe populations of victims andperpetrators, living and deceased,and the families of both.

Forensic Disciplines1100’slate 1800s1700-1800Forensic Nursing HistoryMid 1970s1950sNurse DeathInvestigatorsSexual AssaultNurse examinersCorrectionalNurseslate nalViolence Nurses

GermanyGermany - Forensic Psychiatry – HISTORICAL Timeline1797 Ernst Platner, a physician in Leipzig, Germany “Amentia occulta” a disease characterized by a defect of feeling Impelled the sufferer to commit acts of violence/crime Allowed physicians to presume authority in courts of justice (Miller, 1998).Late 1700s Immanuel Kant (1724-1804) For the question of knowing whether the accused at the time of the crimewas in possession of his natural understanding and capable of judgment, liesentirely in the domain of psychology" (Miller, 1998). The concept of evil had been challenged now not only in disease and insanitybut also in criminal intent”

United Kingdom1800 The Trial of Hadfield set a legal precedent for the “insanitydefence” Public reaction to the results of high profile cases shaped the law.After Hadfield was acquitted on grounds of insanity of attempting toassassinate King George III, provision was made to detain suchpersons at the pleasure of His Majesty Hadfield definition of insanity; that any act committed as a result of adelusion was by definition an act of insanity.

Forensic Nursing Sub-Specialties Forensic Nurse Death InvestigatorsSexual Assault Nurse Examiners (SANEs)Interpersonal Violence Nurse CliniciansForensic Clinical ER Nurse SpecialistsCorrectional or Prison NursesForensic Psychiatric NursesForensic Community NursesForensic Pediatric NursesForensic Geriatric NursesForensic/Legal Nurse Consultants

Factors Influencing Developmentof Forensic Specialty Need for a Medico-legal RoleHuman Rights movements (1960s)Legislation/Policy ChangesSpecialization evolvement (1980s)Social Awareness of ViolenceScience & Technology AdvancesMedia Influence/Social Trends/Globalization

Factors Influencing Developmentof Forensic Nursing Specialty Need in Society/Medico-legal roleSocial Movements (1960s)Public Inquiries/Inmate LawsuitsSpecialization evolvement in Nursing Education (1980s)Sanctioned Role of the PhysicianHealth Care Reform

Forensic Nursing Roles in Canada1960’s - forensic correctional nursing1969-721970sSeparation of services for prison health physical and mentalForensic psychiatric services established federally and provincially1970’s - forensic psychiatric nursing1976’s - forensic nurse investigators (death)1977 - forensic sexual assault nurse examiners (USA)1989 - forensic sexual assault nurse examiners (CAN)1980’s - forensic legal nurse consulting- forensic nurse researchers1990’s - clinical forensic nursing(Emergency forensic nursing)(Interpersonal violence)1990s - forensic nurse educators

Forensic Correctional TeamForensic Specialty in each DISCIPLINE Prison Medical Officer Correctional Nurse Institutional Psychologist Correctional Officer Parole Officer Probation Officer Police

Forensic Psychiatric TeamForensic Specialty in each DI SCI P LI NE Forensic Psychiatrist Forensic Psychiatric Nurse Forensic Psychologist Forensic Psychometrist Forensic Social Worker Forensic OT/RT Court/Judge/Police

Correctional/Prison Nurses:Roles Care/custody role balanceAdmission Cursory MedicalsAssessments: physical & mental status, suicide & addictionMedication managementReferral, resource, educator, advocateInfection control (education, prevention, reporting)Crisis intervention (seizures, suicide attempts, cardiac arrest,choking, diabetic reaction/coma)24 hour health care assessment/interventionMedical Records (documentation, health care transfers)(Kent-Wilkinson, 2000)

Correctional/Prison Nurses:Responsibilities To provide for each offender a standard of health carecomparable to that in the community. To provide health care services to incarcerated individuals. To assist the offender to achieve and maintain that level ofphysical and mental well being regarded as essential for theindividual concerned To implement the nursing care process for most healthproblems (everything from A to Z) (Kent-Wilkinson, 2000)

Forensic Psychiatric Nurses:Role & Responsibilities 24hr care (Care and Custody) Counseling/therapeutic skills Case Worker Crisis Intervention Stress Debriefing Milieu Management Medication Management Mental health focus as a correctional/prison nurse Assessment/intervention skills in psychiatricsymptomatology Member of the multidisciplinary team(Kent-Wilkinson, 2000)

Forensic Nursing Education1970’s Historically schools of nursing have been less than responsiveto the health needs of inmate population in their education ofnurses1980’s Literature began to cite the use of correctional institutions forclinical learning experience in Canada and US.1980’s Research studies on need for forensic nursing education.

Forensic Nursing Education1980s Specializations in Nursing Nursing specialties (geriatrics, critical care, OR)1995 Forensic Nursing (Classroom Course) 1 in Canada, 2 in US1995 First Web-based course in California (Bates & Poole, 2003)1997 First Online Courses Forensic nursing educators, supported by progressive administrators, usedthe technology to offer the first online forensic course in January of 19972001 By 2000-2001, there were a few classroom and online courses in thedeveloped countries2010 Forensic nursing education in at least 14 countries

Implications for Interprofessional Education With the trend to interprofessional education, specialties that crossdisciplinary borders like forensic nursing are well suited (Kent-Wilkinson,2009). It is important that the different roles and focuses of the different disciplinesbe demarcated, and it is vital that nurses can articulate how we are different. Specialty areas that intersect many disciplines may more clearly distinguishthe specific knowledge that is similar and different to each specialty anddiscipline (Kent-Wilkinson, 2009 ).

FORENSIC NURSING EDUCATION: RESEARCH2008 Forensic Nursing Education StudyWhat Forensic Nursing Is. and Is Not Forensic nursing IS NOT a nursing specialty in forensics Forensic nursing IS a forensic specialty in nursingDefinition Forensic nursing is a recognized global specialty of nursing, integrating theapplication of nursing art and science at the clinical/legal interface servingthe human health experience as a response to violence in society (KentWilkinson, 2008).

Research In Forensic Nursing EducationForensic nursing is different from nursing in general inthat forensic nurses are: more likely to be caring for patients who are victims or offenderson a continual basis; therefore, our practice has ahigh likelihood of interfacing with one of the justice systems;more likely to rely on the knowledge from law and forensicscience;more likely that the case and the documentation will end up incourt.(Kent-Wilkinson, 2008, 2010).

Research In Forensic Nursing EducationForensic nursing is different from other forensicdisciplines in that forensic nursing is:more likely to have knowledge applied at the clinical/legal interface; more likely to provide care and services to both victims and offenders, livingand deceased; and more likely to be responsible for medication administration, supervision, andevaluation of the impact of medication.Different from other forensic disciplines that also lay claim to a caringparadigm, forensic nursing is: more likely to include not only therapeutic aspects of caring, but also a holisticand objective approach; more likely to have a social sense of responsibility for the continuous24/7/365 care across the life span, where care and contact is maintained withthe client, and care is extended to the family and to the community. (Kent-Wilkinson, 2008, 2010).

Barriers for Forensic Nursing Education Disciplinary BoundariesLevel of EducationResources/Technology/FundingUnsupportive AdministrationLack of role models or champions

Facilitators for Forensic Nursing Education Fluid disciplinary boundariesInterprofessional collaborationAdvanced education or Equal to other ProfessionalDisciplinesChampions/ Pioneers/Role models

Nursing Education in Canada1900s Hospital nursing educational programs1970s Nursing education in Colleges and Universities1980s Specialty Nursing Education1990s First PhD nursing doctoral program Canada in 19922000s Degree as entry to nursing practice2010 46 undergraduate degree nursing programs 13 doctoral programs

Nursing Globally Inequality of wagesInequality of educationFacilitators to Nursing Advancement Social movements of the 1960sGender rights, human rights, civil rights, offender rightsProfessional Associations/Standards/RegulationUnions/Worklife Issues/Job satisfaction/Strikes/Higher Wages

Highest Paying Undergraduate Degree in CanadaProfessional Undergraduate Degree Engineering Computer Sciences Commerce Nursing Architecture Occupational or Physical Therapist Pharmacist Education/TeacherEarnings Premium117%86%74%71%65%60%58%53%

International – Lessons LearnedGermany (developed country) Status of Nursing in Germany Status of Nursing Education in Germany Inline with/ Leader of the European Union Developed country/high techBrazil (emerging country) 2011- Forensic nursing recognized specialty High rates of violence Need for Sexual Assault Nurse ExaminersThe Philippines (emerging country) Status of Nursing in the Philippines Psych/mental health nursing in the Philippines No forensic sexual assault nursing 24-26 Nursing programs in Manila alone

Global Society - Forensic mental health Mental health is a challenge for our global society with consequences forhealth internationally.New policies are needed for interventions and health services.Health care professionals, with advanced education can contribute.Global Issues Treatment and/or Warehousing Care and/or Custody Restraint and/or Seclusion

Future Directions for the 21 Century Violence/Mental illness is a problem of global order, the improvement ineducating skilled professionals to perform in this situation is essential andurgent. Forensic nursing education initiatives could create a new path Nurse Practitioners (NP) advanced practice nurses could provide forensicpsychiatric assessment/evaluations/ interventions and in inpatient andoutpatient services where there are limited forensic psychiatrists.

Questions?Forensic Nursing

Arlene Kent-Wilkinson RN, BSN, MN, PhDAssociate Professor College of NursingUniversity of SaskatchewanEmail: [email protected]: (w) (306) 966-6897

Selected ReferencesKent-Wilkinson, A. (2006). Forensic nursing education: Developments, theoreticalconceptualizations and practical applications for curriculum. In R. M. Hammer, B.Moynihan, & E. R. Pagliaro (Eds.), Forensic nursing: Concepts and challenges (pp.781-820). Sudbury, MA: Jones & Bartlett.Kent-Wilkinson, A. (2008, August 19). Forensic nursing education in NorthAmerica: An exploratory study [doctorial dissertation]. Department ofEducational Administration, University of Saskatchewan, Saskatoon, SK.Available from 2008- 171000/Kent-Wilkinson, A. (2009a). Forensic nursing education in North America:Constructed definitions of forensic nursing. Journal of Forensic Nursing, 5(4),201-211. doi: 10.1111/j.1939-3938.2009.01055.x

Selected References (cont.)Kent-Wilkinson, A. (2009b). Forensic nursing education in North America: Socialfactors influencing educational development. Journal of Forensic Nursing,5(2), 76–88. doi: 10.1111/j.1939-3938.2009.01038.x.Kent-Wilkinson, A. (2009c). The unique knowledge of forensic nursing:Implications for interprofessional education. International Journal ofInterdisciplinary Social Science, 4(7). Retrieved nson, A. (2010). Psychiatric mental health forensic nursing:Responding to social need. Issues in Mental Health Nursing, 31, 425-431.doi: 10.3109/01612840903506444

Selected References (cont.)Kent-Wilkinson, A. (2011). Forensic nursing educational development: Anintegrated review of the literature. Journal of Psychiatric and Mental HealthNursing, 18(3), 236–246. doi: n, A. (2011). Forensic nursing education. In V. Lynch with J. Barber(Eds.). Forensic nursing science (2nd ed., Chapter 3, 20-31) St. Louis, MO:Elsevier, Mosby.Kent-Wilkinson, A., Starr, L., Dumanski, S., Fleck, J., Lefebvre, A., & Child, A.(2010). International Nursing student exchange: Rural and remote clinicalexperiences in Australia. Journal of Agromedicine, 15(1), 58-65. doi:10.1080/10599240903389672. Retrievedfrom

Selected References (cont.)Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (Eds.). (2002).World report on violence and health. Geneva, Switzerland: World HealthOrganization. Retrieved 1545615 eng.pdfMiller, R. (1998). History of forensic psychiatry. Retrieved ry.htm.World Health Organization. (2002a). Report on violence and health. Geneva:WHO. Retrieved 1545615 eng.pdf.

Germany. Germany-Forensic Psychiatry - HISTORICAL Timeline. 1797 Ernst Platner, a physician in Leipzig, Germany "Amentia occulta" a disease characterized by a defect of feeling Impelled the sufferer to commit acts of violence/crime Allowed physicians to presume authority in courts of justice (Miller, 1998). Late 1700s Immanuel Kant (1724-1804)