CFN cheat sheet

Forensic nursing is the application of nursing science to public or legal proceedings; the forensic nurse integrates clinical practice with the legal and judicial system, caring for victims, offenders, and communities.

Core roles include sexual assault nurse examiner (SANE), death investigator, legal nurse consultant, correctional nurse, and violence/abuse examiner; each carries distinct scope and competency standards.

The forensic nursing process adds evidence preservation, chain of custody, and documentation for legal use to the standard nursing process of assessment, diagnosis, planning, implementation, and evaluation.

Scope of practice is governed by state nurse practice acts plus institutional policy; a nurse may never testify or perform examinations beyond licensure, certification, and training.

Chain of custody is the chronological documentation of every transfer of evidence; a break in the chain can render evidence inadmissible or reduce its evidentiary weight.

Forensic nurses distinguish clinical findings from investigative conclusions: they document objective observations and defer cause-and-effect opinions to qualified experts.

Specialized certification (e.g., SANE-A, SANE-P, Advanced Forensic Nurse) requires documented education, supervised clinical hours, and examination; certification is not a license to practice.

Standard of care in forensic contexts is measured against what a reasonably prudent nurse with similar training would do under similar circumstances, often established through expert testimony.

Medical forensic examination includes history, head-to-toe assessment, injury documentation, evidence collection, and aftercare planning; consent for each step is obtained separately and may be withdrawn at any time.

Documentation uses direct quotations for patient statements, objective descriptors for injuries (size, color, shape, location), and body diagrams or photographs with a scale and patient identifier.

Injury descriptions should avoid conclusory terms such as "defensive wounds" unless supported; describe the wound and note the patient's account separately.

Evidence collection kits (e.g., sexual assault kits) follow manufacturer or jurisdiction protocols; collect before the patient showers, changes clothes, or eats/drinks if oral contact is alleged, when feasible.

Trace evidence includes hair, fibers, glass, soil, and debris; package each item separately in paper (not plastic) to prevent moisture and degradation of biological material.

Biological evidence (blood, saliva, semen, epithelial cells) must dry at room temperature before packaging; wet packaging promotes bacterial growth and DNA degradation.

Chain-of-custody form records item description, collector, date/time, storage location, and every transfer with signatures; copies accompany the evidence and the medical record.

Photography should be consistent, include a scale, and be documented in a log with date, time, photographer, and body location; images are part of the medical record and subject to legal discovery.

Trauma-informed care rests on safety, trustworthiness, peer support, collaboration, empowerment/choice, and cultural humility; it assumes widespread trauma exposure and avoids re-traumatization.

Trauma responses include hyperarousal, re-experiencing, avoidance, and negative cognitions; the nurse assesses for these rather than interpreting them as noncompliance.

Universal precautions for trauma include explaining each step, asking permission before touch, offering choices, and providing a private, quiet environment.

Screening tools (e.g., brief IPV screen, PHQ-9 for depression, PCL-5 for PTSD symptoms) are used to detect need and guide referral, not to diagnose in isolation.

Acute stress reactions and posttraumatic stress disorder differ by duration and functional impact; PTSD requires symptoms lasting more than one month with clinically significant distress or impairment.

Empowerment means the survivor controls decisions about reporting, examination, and evidence collection; the nurse provides information and supports choice without coercion.

Mandatory reporting obligations vary by jurisdiction and by patient age, disability, and injury type; the nurse must know local statutes and inform the patient of limits of confidentiality.

Cultural humility and interpreter services are essential; use trained medical interpreters, not family members, and document language and accommodation.

Sexual assault includes any nonconsensual sexual act; consent requires capacity, freedom from coercion, and may be withdrawn; intoxication or incapacitation negates consent.

The medical forensic exam is offered regardless of whether the patient reports to law enforcement; treatment and evidence collection are separate from the decision to prosecute.

Emergency contraception, STI prophylaxis, HIV post-exposure prophylaxis (when indicated), and injury treatment are offered per protocol; document what was offered and accepted or declined.

Intimate partner violence indicators include patterned injuries, delayed care-seeking, partner controlling the interview, inconsistent explanations, and injuries inconsistent with the stated mechanism.

Strangulation is a high-risk marker for future lethality; assess for voice change, difficulty swallowing, breathing difficulty, and neck pain, and document findings even when external marks are absent.

Elder and dependent adult abuse includes physical, sexual, emotional, financial, and neglect; assess for unexplained injuries, dehydration, poor hygiene, and financial exploitation.

Child abuse assessment considers developmental stage, injury pattern, and consistency of history; sentinel injuries and injuries in non-mobile infants raise concern and require reporting per law.

Lethality risk assessment tools (e.g., danger assessment) help identify elevated risk; safety planning is done collaboratively and includes emergency contacts, documents, and exit options.

The medicolegal death investigation determines cause (the disease or injury producing death), mechanism (the physiologic derangement), and manner (natural, accident, homicide, suicide, undetermined).

Jurisdiction over death investigation varies: medical examiner systems use appointed physicians, while coroner systems may use elected lay officials with medical consultants.

Deaths reportable to the medical examiner/coroner include suspected homicide, suicide, accident, unexplained or unattended deaths, and deaths in custody or under suspicious circumstances.

Postmortem changes used to estimate time since death include livor mortis, rigor mortis, algor mortis, and decomposition; each is affected by environment and body habitus.

Forensic nurses may assist with death scene documentation, evidence preservation, and family notification; they do not determine cause or manner of death.

Organ and tissue donation, autopsy consent, and release of the body follow jurisdiction-specific law and medical examiner authority; the nurse clarifies processes with the family.

Documentation at death includes last known alive time, circumstances, medical interventions, and chain of custody for personal effects and evidence.

Grief and bereavement support for survivors is part of forensic nursing; sudden, violent, or unexplained deaths carry elevated risk for complicated grief.

Confidentiality is limited by mandatory reporting laws, court orders, and duty to warn/protect where recognized; the nurse informs patients of these limits.

HIPAA permits disclosure for treatment, payment, and operations and for certain legal processes; disclosures to law enforcement require patient authorization or a legal exception.

Informed consent requires capacity, disclosure of risks/benefits/alternatives, voluntariness, and comprehension; consent for minors follows state law and may involve guardians.

The nurse-patient relationship creates legal duties including competence, confidentiality, and documentation; breach can support negligence claims.

Evidence handling is an ethical and legal duty; tampering, loss, or contamination can constitute spoliation and harm both patient and case.

Expert witnesses must be qualified and may testify to opinions within their expertise; fact witnesses testify to observations.

Ethical principles include autonomy, beneficence, nonmaleficence, justice, and veracity; conflicts arise when patient choice conflicts with legal mandate, and must be resolved transparently.

Regulatory bodies (state boards of nursing) enforce practice standards; institutional policy, accreditation standards, and statutes together define the legal environment.

Behavioral crisis assessment includes risk of harm to self or others, substance intoxication/withdrawal, medical causes of agitation, and access to lethal means.

Suicide risk screening uses validated tools and direct inquiry; ask about ideation, plan, intent, means, and prior attempts; do not rely on no-harm contracts as a substitute for assessment.

Agitation may be medical (hypoglycemia, hypoxia, head injury, sepsis, delirium) and must be ruled out before attributing behavior to psychiatric illness.

De-escalation is first-line for behavioral crisis: reduce stimulation, maintain distance and safety, use calm communication, and offer choices; restraints require legal authority and monitoring.

Vulnerable populations include persons with disabilities, older adults, children, LGBTQ+ individuals, immigrants, and those with mental illness or substance use disorder; they face elevated violence risk.

Trauma-informed mental health care avoids coercive practices, respects autonomy, and recognizes that crisis behavior may reflect prior trauma.

Confidentiality in mental health is subject to duty-to-warn/protect laws and mandatory reporting; document risk assessments and actions taken.

Referral pathways include crisis lines, mobile crisis teams, psychiatric emergency services, and community mental health; coordination reduces repeat crisis presentations.

Interprofessional teams in forensic contexts include law enforcement, prosecutors, victim advocates, medical examiners, social workers, and mental health clinicians; roles and boundaries must be explicit.

Role clarity prevents duplication and gaps; the nurse documents what was done and refers matters outside scope to the appropriate professional.

Multidisciplinary team (MDT) and child advocacy center models coordinate child abuse investigations; information sharing follows confidentiality and consent rules.

Testimony preparation includes reviewing the medical record, understanding the legal question, and distinguishing facts from opinions; the nurse should not guess or speculate.

Lay versus expert testimony differs: lay witnesses testify to observations, expert witnesses may offer opinions based on specialized knowledge and reliable methods.

Courtroom conduct includes answering only the question asked, avoiding jargon, being truthful, and acknowledging limits of knowledge; demeanor should be professional and neutral.

Documentation is the foundation of testimony; contemporaneous, objective, and complete records are more credible and withstand cross-examination.

Subpoenas and court orders must be honored; the nurse should confirm scope, notify legal counsel or risk management, and prepare records for production.