Care, Heal, Preserve: Forensic nurses fill many needs in emergency room

April 28--TERRE HAUTE -- Candice Carroll has gotten used to encountering some people on the worst day or the worst night of their life.

She is a forensic nurse, and has worked many shifts in a hospital emergency room -- where illness, mayhem and tragedy present life-threatening situations on a regular basis.

Among the most challenging cases that any nurse handles are those involving victims of sexual assault, child molestation, domestic violence and physical neglect. Those patients need more than a bandage on an obvious wound -- especially if the person responsible for the injury is to be held responsible by a court of law.

Meticulous care

Forensic nursing involves caring for crime victims while collecting evidence on the circumstances surrounding the incident that has brought them to the hospital.

Carroll and a team of nine other nurses at Terre Haute Regional Hospital have been certified to provide forensic nursing on a 24-hours-a-day, 7-days-a-week basis. Each nurse can not only provide the needed medical care, but also is trained to collect and preserve evidence material, and to put the patient in touch with appropriate assistance agencies.

"There's no schedule for when violence occurs," Carroll said during a recent interview. "It occurs day or night, weekends and holidays, and it usually occurs when there are stressers."

When an abuse case is presented, a forensic nurse will be assigned to the patient, and that is the only case that the nurse will handle.

"The role of a forensic nurse," she explained, "is to interview the patient to get as much detail as we can, doing a head-to-toe assessment, collecting evidence material such as leaves, dirt, hair, clothing, DNA and body fluids found on the patient, all packaged by the forensic nurse to be forwarded to the crime lab by local law enforcement."

That is the type of evidence that can make or break a case in court. And whether they realize it or not, the victims benefit from the attention to detail by the nurse.

Career evolves

Carroll came to Regional Hospital in 2010 as chief nursing officer, with the task of directing a staff of hundreds of highly skilled medical professionals.

She had previously worked in her native Virginia, where she first earned an associate's degree in criminal justice. She was working as an emergency dispatcher while in college when she realized she had a keen interest in the medical calls, often following up on patients and their outcomes.

"Through that, I learned that I needed to switch gears, and so I went into the nursing side of it," Carroll said. She earned a bachelor's degree in nursing and became a registered nurse in 1996. She later earned a master's degree in business as she administratively advanced.

It was an emergency room director who realized that Carroll's ongoing interest in criminal justice made her a good candidate for a forensics training class. What then started as a small forensics nursing program -- handling six cases in its first year -- at one Virginia hospital in a four-hospital market grew a forensics program covering three of those area hospitals, handling 800 victims per year.

Her expertise grew as she became certified to teach classes on treating sexual assault victims; she precepted -- or taught through experience -- more than 25 nurses to go onto their forensic exams. Carroll also has given expert testimony in countless court cases, and has served as an expert witness for the FBI and the Navy's investigative agency, NCIS.

Prior to Carroll leaving Virginia in 2010 for her move to the Wabash Valley, she received the Golden Halo award for her work with child victims of abuse.

DEFINITE NEED

When Carroll interviewed for the nursing director position at Regional Hospital, she met with Dr. Roland Kohr -- a forensic pathologist who works closely with investigators on cases when criminal activity is suspected. For Kohr, it was exciting to have a nursing director interested in setting up the forensic team.

"She has been valuable over the years," he said, "especially when you need a feminine touch with a patient."

Not only in the abuse cases, he noted, but for example, in one case where a wife wanted to see her husband's body, which was rather decomposed. After the woman rejected Kohr's advice not to be in the room with her husband in his body's condition, Carroll was able to talk to the wife and come to a compromise where the woman viewed only images of his body. That type of intervention saved the woman needless emotional trauma, but satisfied her insistence to see her husband one last time.

Kohr said it is also a benefit for other agencies in the community -- such as Child Protective Services -- to have a forensic nursing team that knows how to document abuse and neglect for legal purposes.

"It's a great asset for the community. I know law enforcement has to appreciate it," he said. "They've seen the need. It's not been something offered before. It's kind of like going from having a layperson coroner to having a forensic coroner on site."

And for the patients who are going through a traumatic experience, it can be comforting to have a person who is a natural caregiver, rather than police officer, compile with sensitivity the facts of the case.

GROWING CASELOAD

Carroll said that having the oversight of a forensic pathologist on staff was exciting, because that expertise is crucial for training others on staff.

"Pretty early on, I recognized this [forensics] is a need for the local cases," Carroll said of her early days at Regional. "I have been called in many times to do forensic nursing, but I realized we needed a team here."

Late last year, the nurses for the forensics team were selected and the training began. It includes multiple hours of oversight for each nurse before he or she can handle a case solo from start to finish. The training can be a long process, with standards set by the International Association of Forensic Nurses.

To pass the forensics standards for pediatric cases, a nurse must handle 50 cases, Carroll said. Realistically, no one looks forward to handling 50 cases of child abuse, neglect or sexual assault.

"It's really hard to hear a 6-year-old child tell you about how her father groomed her for sex," Carroll said. "That takes a toll on you mentally."

So the team also has resources through a psychologist, who can talk to both the victims and do stress debriefing for the medical team.

The weekly caseload for the forensics team varies. At this time, Carroll said, the team gets a call at least weekly, and sometimes daily. The team is also receiving calls from hospitals outside the area to consult on abuse cases because word is spreading about the specialty training.

"We are also getting called to inpatient cases when a doctor recognizes elder abuse or neglect," she said. "They want us to talk to them, to see if there is any way to help them in their situation."

COALITION RECOGNITION

Information about the forensics team at Regional Hospital has spread across the state, and into Illinois.

Carroll was recently honored as the Outstanding Professional in Medical by the Indiana Coalition Against Sexual Assault for her creation of the first forensics nursing team at a Terre Haute hospital.

Nurse Andrea Helman, a member of the forensics team, nominated Carroll for the award. Carroll said it was an unexpected compliment by someone she has trained, and it is affirmation that those in the medical community value the forensics approach as another tool to help patients.

Vigo County Prosecutor Terry Modesitt agreed that the forensic nursing program is a benefit to the prosecution of abuse, violence and neglect cases.

"It's important because there are protocols that get followed every time," he said. "There's evidence that gets protected. Consistency is everything in preserving evidence."

Dr. Kohr agrees, noting that while all emergency room nurses are trained to perform a rape evidence collection kit when needed, some nurses do it so infrequently that the same or current procedures may not be followed each time.

END THE SILENCE

Unfortunately in American society, sexual violence is an uncomfortable topic that people often do not want to discuss.

April is Sexual Assault Awareness Month in Indiana, and with that in mind, state officials are trying to educate the public about sexual violence prevention. This year's theme is "It's time...to talk about it."

"Even one person impacted by sexual violence is too many," said State Health Commissioner Dr. William VanNess. "Sexual violence is a public health issue and as such there are evidence-based interventions that can be applied to help prevent it. It's going to take the collaborative effort of the entire community, including the State and local health departments, schools, faith-based organizations and community groups to move the dial in the right direction."

In Indiana, one in five women will be victims of sexual violence, according to the Centers for Disease Control and Prevention. Nearly 3 in 10 women and 1 in 10 men will be victims of rape, physical violence or stalking by an intimate partner. Youth also feel the impact as nearly 15 percent of young women and 5 percent of young men have been physically forced to have sexual intercourse in their lifetime.

HELP IN COMMUNITY

Carroll said the Wabash Valley has good community resources available to assist victims of violence and abuse.

She has volunteered in the past with CODA -- the Council on Domestic Violence -- and she is now involved in the citizen's police academy being taught by the Terre Haute Police Department.

It is important for area residents to realize that if they, a friend or a loved one have been a victim of abuse or neglect, there are resources available to assist them, she said.

Regional Hospital is located at 3901 S. Seventh St.

For more information about CODA, call 800-566-2632 or go online to www.codaterrehaute.org.

Reporter Lisa Trigg can be reached at 812-231-4254 or lisa.trigg@tribstar.com. Follow her on Twitter @TribStarLisa.

Copyright 2013 - The Tribune-Star, Terre Haute, Ind.