Stronger than when they came in

Forensic nurses answer the call for patients who have been affected by crime, violence, and other traumatic injuries. Like everyone else, COVID-19 has affected us in many ways. Initially, the pandemic felt dire, layering problems on top of illness and general strain. Times have been trying for everyone—lockdowns, constant testing, vaccinating, and quarantining along the way have all taken their toll. Not to mention supply chain disruptions, economic strain, and burnout. But some populations have been affected more than others due to a lack of equity within our social system. With less access to resources, individuals suffering from interpersonal violence, such as family violence, sexual assault, child maltreatment, and neglect, have largely suffered in silence. 

As forensic nurses, we are trained to provide comprehensive, trauma-informed care to individuals impacted by crime. We serve as an intersection between the medical world and the criminal justice system for many of our patients. We provide resources to our patients to make sure they are safe and healthy and have access to the support they need to move forward from their encounter with us and that they’re stronger than when they came in. 

Providing forensic nursing services during the pandemic has proven to be a challenge. The pandemic has caused an increase in unemployment, social isolation, and financial strain. There has also been an uptick in mental health issues and substance use. These factors created the perfect storm for an increase in interpersonal violence and child maltreatment. You would think this would make forensic nurses busier than ever, but this is not necessarily true. Some forensic nursing programs and emergency departments have seen an increase in people seeking care for interpersonal violence during quarantine; however, other healthcare facilities have seen the opposite. These variations may be related to a patient’s ability to access resources or may align with waves of COVID-19 restrictions. 

Caring for patients during the pandemic has been challenging, particularly when those patients suffer from traumatic injuries or have been a victim of violent crime. Resources are now scarce and difficult to obtain. For example, shelter capacities have been lowered to maintain social distancing, and a negative COVID test is required to enter many of them to keep their residents safe. A positive COVID test often further restricts access to many resources for patients. 

With people increasingly working from home or becoming unemployed, they may not have someone to notice a difference in their behavior or notice new injuries from violence. In the case of child maltreatment, there has been a decrease in the department of child services receiving reports due to fewer people having eyes on these children outside the home. Children largely depend on someone (usually a teacher, nurse, or other caregiver) speaking up for them when something is not right. While some assumptions are that family violence and child abuse have decreased, the reality of this is highly unlikely. It is more likely, due to social factors, that there has actually been an increase in child maltreatment, and fewer people are reporting it due to limited social interaction. This lack of intervention may pose long-term health and emotional consequences. It is possible that since these children are unable to receive the care they need for acute abuse, they may be suffering chronic or complex trauma leading to further medical and mental health issues in the future.  

Victim advocates are an integral part of providing patients with wrap-around services. They help patients with safety planning and next steps with the criminal justice system. Many of these services are now limited due to visitor restrictions in hospitals. While some advocacy organizations offered teleservices to interact with patients, many survivors of trauma would decline, noting they would prefer a face-to-face interaction. The criminal justice system is backlogged, too, delaying closure for survivors. 

Despite the bumpy start to caring for patients during the beginning of the pandemic, we have risen to the call, and we are coming out stronger on the other side. Many places have increased their service options by expanding to include telehealth services and catering to follow-up requests by texting patients instead of calling or sending emails, per patient’s requests. We are constantly seeking innovative solutions to improve the way we care for our patients because we have begun to perfect our skills in modifying our care to fit a situation through necessity. 

As nurses, we are called into a life of service. With every patient encounter, we can learn and gain new skills to the benefit of our future patients. Since access to forensic nurses is extremely limited, we rely on all healthcare providers to help identify patients with medical forensic needs. When serving those who may be affected by violence or trauma, please keep in mind that the most important thing we can do is start by believing them. The Start by Believing campaign is a global movement to change the way we respond to survivors. When we start by believing, we empower survivors and help them begin their journey to healing. As a nurse, you can help these survivors simply by knowing where your resources are, like where your nearest forensic provider is. Understanding the needs of the population you are supporting is essential to helping them start their journey to healing.

The further we go along, the better we will become.