Evidence Management of Self-Collected Items
Written by P. M. Speck, R. A. Ekroos, D. K. Faugno, J. A. Johnson, V. Sievers & S. A. Mitchell   

THE CRIMINAL JUSTICE SYSTEM relies on functioning teams of professionals and an evidence management system with high standards to guide identification, collection, packaging, storage and security of evidence, guaranteeing no contamination or degradation while being transported. Figure 1 identifies evidence for multiple variables that influence the quality and amount of DNA evidence. Although health-care providers obtain knowledge about influencing health variables during their basic education, this does not include evidence identification or management. Therefore, there is a recommendation for appropriate training in the collection, preservation, and packaging of items holding potential probative value. Integral to the evidence process is chain of custody, which tracks all of the handlers.

Note: To read the full article with references, please view it in our Digital Edition.

“In order for qualified forensic science experts to testify competently about forensic evidence, they must first find the evidence in a usable state and properly preserve it.” —National Academies of Sciences Engineering and Medicine, 2009

 

Figure 1. Influences in DNA Recovery. Figure by PM Speck (2007).

Victims of sexual crimes are often first in the chain of custody, maintaining evidence through recommended behaviors (e.g., “do not shower,” “do not drink,” “avoid eating”). The sexual assault victim often showers and saves items for authorities to take when reporting. Most medical forensic health-care providers or law enforcement professionals do not decline items collected by patients/victims or, in the case of child victims, their guardians. Most professionals accept the items and document date, time, identify what the collected items are, and initial or sign, but frequently they do not distinguish who brought the item. They follow best practice standards that properly preserve and transfer the items in the course of their respective roles, demonstrated in Figure 2.

Figure 2. Evidence movement among sexual assault response team (SART) members.

Background

The history of post-sexual assault care has been prejudicial in the promotion of stereotypical views and false notions about victims. These views hindered the effective investigation and prosecution of these crimes, resulting in a backlog of untested sexual assault kits. The forensic nursing movement in a variety of organizations and educational institutions, when championed by emergency nurses and team-based approaches, increasingly improved post-sexual assault criminal justice outcomes.

Recognizing the link between stress and health, patient-centered, trauma-informed, and motivational approaches assist the patient/victim who experienced forced submission during the sexual assault, which affects the person’s self-concept of shame during a disclosure. Trauma-informed care principles of safety and transparency, voice and choice, along with peer support, enhance participation in the reporting process. This was the thinking behind the emergence of a self-collection kit. One company responded to poor reporting statistics and defended its motives as an effort to provide victims of sexual assault options in the safety of their homes. This company marketed the kit to colleges where sexual assault remains poorly reported or understood among the enrolled students.

The firestorm that followed cited patient safety, cost, proof of chain of custody, and untested use in court resulting in the absence of case law to support or refute the practice. Others cited that victims would suffer immeasurably in a society that persists in victim-blaming. Michigan Attorney General Dana Nessel issued an “immediately cease and desist” letter, citing authority to “bring injunctive actions to protect the interests of consumers” under the Michigan Consumer Protection Act, MCL 445.901 et seq. The concern included failure to provide cost to consumers and information about free sexual assault medical forensic examination within 120 hours of the assault. Several correctable conditions were listed with opportunity for compliance while not selling to Michigan consumers.

Medical forensic health-care providers’ opinions fall on both sides. The health care equity following a sexual assault is a long-time concern among health-care providers, and evidence supports that access is dependent on geography, racial disparities, age, and medical concerns. Some cautioned victims about potential negative outcomes that “may” materialize, e.g., the evidence or the patient is not trust-worthy and without a chain of custody. Others cite lack of documentation of injuries or post-assault medication access whereas others have highlighted ethical considerations, the time-sensitive nature of collection, and the need for appropriate consumer education materials. The rapid dissention from many professionals, including Sexual Assault Nurse Examiners (SANE) organizations and state attorney generals, was swift. The attorney general’s concerns were nested in “consumer safety,” citing state commerce legislation. However, some responses were based on fears rather than science.

Like many issues today, emotions drive initial responses, shutting down a robust discussion about the strengths and barriers in self-collection following sexual assault or rape. There is no research to support nor deny support for self-collection following sexual assault. The authors plan to analyze each of the issues associated with self-collection to explore the aims below.

Aims of Analysis

The aims of the analysis are to

1. Identify the actual practice of securing evidence by medical forensic health care professionals;

2. Identify gaps in medical forensic practices and data collection related to evidence collection;

3. Determine the health care delivery impact of medical forensic providers; and

4. Provide a path forward for researchers, administrators, educators, and funders alike.

There are four sections for analysis, including

1. The victim and their activities following a crime;

2. The health-care provider dual role in a health care system where the patient is assessed for injury, treated, and referred;

3. The health-care provider as a collector of evidence, whether an RN at the bedside or advanced practice forensic nurse or physician in sexual assault or other forensic patient’s care; and

4. The system’s response in determining patient medical management or management of evidence and its usefulness (probative value) after collection.

The Victim/Patient/Survivor*

*Note: In this paper, the patient, victim, and survivor terms are used interchangeably. As nurse authors, patient is the preferred term, as the person seeking care is receiving care under a license governed by the state boards of nursing or other governmental agency designated to license providers. The purpose is to guarantee minimum education, scope and practice standards, and safety of the population served.

Most survivors do not seek health care following sexual assault. When they do, victims experience scrutiny about motives for reporting by criminal justice (CJ) representatives, and many do not report, or they delay reports. Particularly at risk are patients unable to report due to lack of equity and access—military deployed, incarcerated, confined, in care homes, remote rural locations, and others. Predictable in delayed or no reporting is: age, gender, relationship to assailant, shame, rape myth acceptance, and geographical location. Supporting the reasons for the lack of reporting following sexual assault is evidence that 70% of sexually assaulted women wash their genitals following an assault and before contact with healthcare providers or law enforcement. In this case, self-collection availability helps capture the maximum DNA before washing, time, or activity diminish DNA detection. Some argue that rapid collection provides evidence if the victim chooses to intersect with the criminal justice system where safety, design, and storage methods mitigate and explain contamination and degradation.

Not generally known, post-coital injury is common with consensual sexual activity, and when it occurs, heals rapidly. There was expressed a fear that patients might hurt themselves during self-collection. Patients don’t typically hurt themselves with self-administered procedures where self-insertion is common practice with the genitourinary system, e.g., sample collection for sexually transmitted infection testing, intravaginal and rectal medication application, self-catheterization, tampon or insertional birth control, or vaginal condom use, among others. The growing home testing market for socially sensitive tests includes viral PAPs, HIV, and STIs. When studied, evidence research supports increased access to health care for underserved populations at risk for serious health sequelae. While not specifically referring to patients who experienced a sexual assault, increasing the utilization of specially trained medical forensic providers is a desired goal.

The Health-Care Provider

Medical forensic health care has little to do with the law enforcement investigative process, and prosecution is outside medical forensic health-care provider expertise. While the evidence is an important tool in adjudication, findings of usefulness of a particular piece of evidence are mixed, especially when findings remain unclear early in an investigation when patients are typically taken to the medical forensic health-care provider.

There is a lack of medical forensic health care services, and patients outside the urban areas use routine clinical settings, such as public health clinics, if they choose follow-up for STI and pregnancy risks. Most communities/regions have available emergency contraception services through federally funded clinics.

There is no evidence that forensic nursing improves recovery or mitigates adverse health outcomes. However, research supports “adversarial growth”** even without treatment after trauma. They identify elements necessary for recovery from all trauma such as cognitive behavioral therapy, social support, and a healthy lifestyle. Therefore, continuous contact with a skilled health-care provider is a strategy supported by research and promotes patient mastery of feelings about sexual violence and other traumas, as well as anxiety reduction exercises and structured reflection—all contributing to the patient’s recovery.

**Note: Adversarial growth is a term that describes the process of recovery and acceptance of traumatic events in one’s life, identifying strengths and lessons learned. Research is clear that most recover from traumas, where recovery is more difficult with adverse childhood experiences.

The Evidence

Chain of custody. A concern related to self-collection is that packaging, storage, and transfer (chain of custody) “won’t stand up in court”. There is little evidence to support the cautionary warnings about chain of custody, trust-worthiness of the collector/victim, or lack of documentation. According to the Biological Evidence Preservation Handbook, “Chain-of-custody documentation identifies all persons who have had custody of evidence and the places where that evidence has been kept in chronological order from collection to destruction.” Chain of custody is a possession document designed to help victims and accused alike.

The chain of custody begins with the victim, who gives evidence to a health-care provider or law enforcement officer, who then continues the chain of custody. The courts use the chain linkages to ensure the integrity of evidence during adjudication and after adjudication. In health care settings, the patient is the first possessor of evidence in the chain of custody. An underlying assumption in health care settings is that the patient will tell the truth because the health-care provider relies on the patient’s history of events to create a treatment plan. There is also a presumption that the patient would not alter or destroy evidence if adequately instructed on the maintenance of the evidence, an aspect not explicitly addressed by the first self-collection kits. In cases without proper instruction on the collection and maintenance of collected items, the evidence may be compromised, where adulteration may occur without intent in an uncontrolled environment and with aging of the evidence. Clear instructions about the evidence and maintenance mitigate degradation when packaging and environment is controlled.

Accuracy. Evidence collection by SANEs is more accurate than collection from non-SANE collectors. Accuracy in this study was measured with ordinal descriptions of documentation and not the probative value of evidence (e.g., completed chain of custody, properly sealed and labeled envelopes, collected blood and swabs, and included crime laboratory report). However, statistical significance was not measured. The concern of contamination was not addressed, which is always a risk, even with medical forensic providers who have responsibility for infection control and sterile environments. Regardless, medical forensic providers may or may not follow recommended guidelines to avoid contamination, e.g., barrier clothing and frequent glove changes, which may be a function of capacity and cost. With highly sensitive DNA testing, it is not uncommon to find aberrant DNA from persons not in the sphere of the victim, e.g., investigators or health care professionals. Defense challenges of such can always occur during adjudication.

Parallel science of self-collection. Conflicting data in parallel science exists supporting self-collection of very sensitive tests. A thorough analysis of the self-collection issue is difficult when there is no reliable research to support or refute self-collection following sexual assault. There is anecdotal evidence from forensic nursing self-reports in practice, where medical forensic health-care providers and law enforcement accept self-collected evidence routinely from patients.*** Many times, the victim is the first in the chain of custody, giving the evidence to a health-care provider or law enforcement officer, and from there, the evidence proceeds throughout the established evidence management processes (Figure 1). Keep in mind that the probative value of any item of evidence is initially unknown.

***Note: At a recent meeting of forensic nurses, the following question was asked of random attendees: “Have you declined to take items that were collected by the victim and brought to the medical forensic examination?” The resounding answer was “No,” and many reported taking tampons, washcloths, toilet paper, and other odds and ends brought by the patient to the medical forensic evaluation.

The self-collection movement and research exist to support in-home self-collection for at-risk, vulnerable patients. Advocacy groups support and advise consumers about utilizing sensitive tests such as those for sexually transmitted infections. Consequently, today consumers can self-test for DNA and all the available tests around heredity, offered by the home-testing market, like Ancestry.com or 23andme.com. The companies offering sensitive sexually transmitted disease testing encourage “tak[ing] control of your intimate health” and sending the samples to CLIA-approved organizations and cite FDA approval for self-collection devices.

Evidence timing. Although the timing for evidence collection is widening and methods for DNA detection improve annually with rigorous analysis of the backlog, all agree that rapid collection increases the probative value of evidence of sexual assault. Self-collection is an option for reducing the time interval between the act and the collection of evidence. With proper and safe instructions for collection, packaging, and preservation, the research indicated that patients seek care more often from health-care providers.

Evidence acceptance or collection? Often patients bring items to the medical forensic examination, and the medical forensic health-care provider does not reject any items. The gap identified by this analysis is that the evidence collected and delivered by the patient and the evidence collected from the body of the patient by the health-care provider are not always differentiated in the documentation by the medical forensic provider. More research is needed to discern the value of items collected by the patient and brought to the health-care provider versus collected from the body by the health-care provider. There is opportunity to discern the probative value of both through research.

The System

The evidence for the effectiveness of forensic nurses in courtrooms is challenging to study. Trends demonstrate improved psychological care of victims, fewer errors in evidence collection, documentation, and chain of custody, and better adjudication outcomes. Adjudication outcomes are not a nursing science outcome, but rather reflect the totality of a case in a criminal justice system, including investigation, gathering evidence of a crime, charging decisions, and attorney strategies for prosecution or defense—all outside the scope of the forensic nurse’s practice. There is one area identified that is influenced by forensic nurses: the victim participation in court processes. One study recognized “strong patient care practice had positive indirect effects on victims’ participation in the criminal justice system”. There is no evidence to demonstrate that victim participation in adjudication processes is good or bad for the victims’ emotional, mental, or physical health.

All evidence, whether brought to the nurse or collected by the nurse should be accurately recorded. The court views the role of the forensic nurse as unbiased with three functions. They are: “comfort and care of patients complaining of sexual assault, competent and consistent evidence collection, and expert testimony on anatomy and tissue.” Other benefits of forensic nurse witnesses include their availability, cooperativeness with the court, and understanding their role is to describe nurse-initiated activities under the institution’s protocols (e.g., physical evaluation, evidence collection, and management), reasons for referrals for medical diagnoses, documentation of injury, and, if deemed an expert (based on education and experience), to provide an evidence-based opinion about their findings to the court.

Courts deem registered nurses as experts when they meet the court’s definition of an expert. Expertise in nursing is a licensed designation, not afforded to the registered nurse without additional credentials (e.g., SANE, wound care, emergency care) and practice history. For advanced-practice nurses in forensic nursing settings, advanced education and additional credentialing (e.g., nurse practitioners and clinical nurse specialists) are required, in addition to their entry into practice credentials. The advanced practice nurse role with independent practice authority includes creation of a differential diagnosis for the cause and manner of the findings (e.g., co-morbid disease influence or blunt trauma) as well as prescriptive treatment plans (e.g., psychological interventions and medication prescriptions). Regardless of the nurse’s practice authority, evidence presentation and the determination of its probative value is a criminal justice process, outside the scope of all nursing practices.

Limitations

The authors realize that there are other concerns not addressed in this analysis, such as delving into the ethical considerations of self-collection, explicit or implicit bias, and current collection and management processes. As best as possible, supporting data and research about the identified issues were brought forward, including publications that may be considered outside of the dates typically useful in establishing an evidence base. However, some of the cited publications are seminal and provided the foundation for thinking about forensic nursing practices that permeates today. For the most part, the assertions about forensic nursing practice outcomes and concerns are without evidence in this analysis to support widely disseminated assertions about forensic nursing practices or self-collection by victims of sexual assault.

Discussion

The analysis contained herein was to identify the actual practice of securing evidence by medical forensic health care professionals and identify gaps in medical forensic practices and data collection related to evidence collection, as well as the health care delivery impact. The authors hope to provide a path forward for researchers, educators, administrators, and funders alike in the areas of patient/victim/survivor care, forensic medical health-care provider education and practices (whether RN or advanced practice), evidence management in health care settings, and legal systems’ use of professional practice roles and the evidentiary outcomes. The following summary follows the evidence for each stakeholder.

The Patient

• Self-collection of samples/specimens is a safe, widely accepted practice in medical communities, particularly for populations at risk. Without access to care, self-collection promotes engagement with health-care providers.

• Self-injury concern is unfounded, as there is no evidence supporting that patients will self-injure any more than other patients who seek a medical forensic health-care provider or law enforcement intervention with a report of rape or sexual assault.

• The concern about patients not receiving comprehensive care is a valid concern, supported by the persistent evidence that few victims report (<1:4) and most wash or bathe before reporting (8 of 10 reporters). There are no recommendations, other than to encourage reporting of sexual assault and care in a medical forensic setting, if available.

• For those in rural and remote locations, there is a federal push to train providers that has not yet materialized to all geographic locations. Telemedicine is growing to assist providers. In the future, this may provide an outlet for direct care of the victim.

• There is no evidence to address the outcomes from self-collection as there is no data. However, self-collection offers the military-deployed, remote, or rural victims a choice about when and if to report with strong evidence that reduces the timing from event to collection. For those unsure about reporting, educational literature that emphasizes seeking specialized care post-assault may capture a population of never-served by the medical forensic health-care provider community.

• Self-collection in medical procedures is receiving wide acceptance, particularly in vulnerable populations where manufacturers adhere to regulations for safe use of their products.

• Nursing ethics supports the autonomy of the patient by providing options for individuals without resources to participate in alternate methods for seeking services. One of the options in the case of sexual assault is self-collection.

• Companies providing self-collection options must meet legislative and regulatory guidelines for the protection of the public, with evidence-based instructions for the collection process and safety of the product, and strong recommendations to seek formal care from medical forensic providers.

The Medical Forensic Health-Care Provider

• Self-collection, a trauma-informed and patient-centered approach, meets the ethical obligation for nurses supporting patient autonomy and self-actualization.

• The sparse evidence is clear that quality of evidence collected by a medical forensic provider is more accurate than a non-trained provider, but the notion that quality evidence diminishes without a medical forensic provider is conjecture. There is no data with which to compare the two. There is a need in health-care communities serving victim-patients to distinguish between “evidence collected by the patient/victim/survivor and given to the provider” from “items directly collected by the medical forensic provider.” The patient-provider encounter should reflect this distinction in the documentation about items of evidence.

• The research evidence indicates a dearth of providers to care for victims outside urban areas. However, there are community health-care centers and public health departments that could provide contraceptive and medical care recommended to patients after a sexual assault.

• All evidence collected by the medical forensic health-care provider holds potential probative value because the items are collected as directed by the patient’s history of the event. Licensed registered nurses are skilled providers trained to recognize potential health sequelae as a risk to recognize and mitigate. Licensed advanced-practice registered nurses have the RN skills and, like physicians, can also diagnose and treat post-assault risk and illness. In the best circumstances, the patient/survivor has access to the advanced forensic nurse provider for future health-care needs.

• There is no evidence that medical forensic health-care providers improve recovery or mitigate adverse health outcomes for patients/victims. However, nurses motivated by ethical principles in patient-centered and trauma-informed care encourage patients to exercise autonomy through follow-up with mental health and medical services that improve opportunities for post-trauma growth.

• Large scale studies are recommended to follow victims through their survivor experiences into a place where growth improves thriving with an overall positive and healthy outlook on life.

The Evidence

• Questions about the victim’s motive to bring in the evidence to a medical forensic provider destabilizes the victim’s belief of safety when seeking care. The question about source or motive undermines the decision of the victim to self-collect any evidence and questions the victim’s desire to enhance their case or improve the quality of evidence with rapid collection, particularly if there is a psychological urge to bathe, shower, or clean orifices “contaminated” by an assailant.

• Victims/survivors have traumatic treatment experiences in systems and are often subjected to court proceedings that question motives for reporting, where their words or behaviors are twisted, and often the victim regrets agreeing to the court processes.

• The parallel science of self-collection is robust and used throughout medicine for a variety of sensitive testing (e.g., STIs) and routine testing (cardiac arrhythmia and diabetes monitoring), and the probative value of any self-collection, as in medicine, is unknown until translated by the licensed health-care provider or laboratory scientist, whether clinical or forensic.

• The research supports a narrow interval between the event and collection of samples, a goal of the self-collection movement. Once consumer safety needs are met, instructions to seek care from medical forensic providers is important to the adjudication process.

• A gap occurs due to a lack of evidence supporting the assertion that self-collection of evidence, a common practice noted anecdotally by forensic nurses, results in problems with the chain of custody.

• There is no evidence that the “chain of custody” is vulnerable to defense charges, any more than it already is. Data is needed to support or refute this claim.

• Evidence collected from the patient who brings evidence and consents to release the evidence to a forensic nurse or law enforcement professional should follow standard operating procedures (found at https://www.safeta.org/page/ExamProcessEviden3).

• The probative value of self-collected evidence has no support in the literature as it is not yet studied. The literature, however, does support the need for accuracy in labeling and packaging, and management of evidentiary items, including sexual assault kits and other items, collected following sexual assault.

• Contamination is also not studied, whether by providers, law enforcement professionals, or victims, but is omnipresent in standards requiring increasing barrier protections for the current highly sensitive DNA tests.

• The concern about an interrupted chain of custody is not supported by published studies or current evidence management practices.

• Additional research is needed to differentiate the evidentiary value of items, regardless of the collection procedures or acceptance into the chain of custody.

The System

• The courts find useful the practices of medical forensic health-care providers, where they document activities of care, interventions to mitigate trauma reactions, collect evidence, document injuries, and testify about their activities.

• Medical forensic health-care providers advocate and influence victim participation in the criminal justice system through fewer errors in evidence collection, treatment, and psychological care of victims, resulting in better adjudication.

• However, it is unknown if the victim benefits from participation in the adjudication process, and the link to nursing is not measurable.

• Also unavailable are data systems that answer many of the questions about court participation and impact, except in anecdotal experiences of the professionals in the courts. The lack of collaborative data collection drives many of the lack of answers to the questions in this analysis.

• The evidence presentation by officers of the court, acceptance by the court, and determination of the probative value of evidence in the adjudication process, is outside the scope of all nursing practices.

Conclusions

This analysis identifies many gaps in the literature and an absence of data to answer questions posed in this analysis. However, this is not an exhaustive list of the research gaps in medical forensic health-provider practices or patient outcomes outside the health-care system. For example, research is necessary to answer the following:

• What is the impact of nursing practice on patient health outcomes following trauma (rape)?

• What methods are used to establish the safety and efficacy of self-collection after sexual assault or rape?

• What impact does self-cleaning have on DNA retrieval over time?

• What defines victim self-collection and medical forensic provider collection?

• What evidence tracking occurs from the collection of items in a sexual-assault kit through the disposition of the kit or items in the kit?

• What are the ethical tenets to be considered and addressed regarding self-collection following a sexual assault?

• What are the minimal recommended contents of a sexual-assault kit, whether used by a medical forensic health-care provider, law enforcement officer, or the survivor of a sexual assault?

In order to establish a robust data-retrieval system, instructions in self-collection should include access to educational materials, location of nearest health-care services, and detailed instructions about safe self-collection where the consumer can read, or listen, or visually see the website, with language options and visual/auditory support. There should be tracking of the self-collection kits from development through collection to destruction, with time limits for use. For example, an activation coding system, use of a cell phone to photograph documentation of date and time for steps, and access to a system to document their history in a journal, allowing the sexual-assault survivor to record their memory as it returns.

The medical forensic health-care provider should add data points to the medical forensic chart that distinguish who brings evidence to the encounter (first in the chain of custody), and who collects evidence after arrival in the system. In self-collection, the medical forensic health-care provider avoids challenging victim decisions and encourages patients/victims to be confident in their motives and actions, accepting all items and history of the patient’s experience, supporting trauma-informed principles, beginning with their autonomy, voice and choice to report, and any subsequent choices, aligning with nursing ethics81. Additionally, advanced-practice and physicians take opportunities to support the survivor throughout post-trauma emotional growth and are present to help overcome triggering that occurs for some throughout the lived experience. Nurses also provide additional instructions and opportunities to return for all health concerns.

For the courts, all evidence—regardless of source—requires effective recording to maintain the chain of custody. Sharing data as much as possible will answer some of the most difficult questions. The role of the nurse is broad, but for the court, the expectation is to take care of the patient first. Then the court expects consistent evidence collection, based on the current science. Last, the court expects testimony about nursing education and experience, and, in the case of sexual assault, caring for the biopsychosocial and spiritual impact and outcome—which is nursing. The medical forensic nurse provider should understand that factual witnessing about the patient encounter and their nursing activities is providing documented and verbal evidence. Unknown to the medical forensic health-care provider and unstudied is the comprehensive criminal justice or civil investigation and other probative evidence gathered by the professionals charged with the investigation of the crime and court outcomes. Nurses must know their scope of practice and the limits of their role in the adjudication processes, whether RN or APRN. The decisions about what is evidence and the determination of its probative value to an adjudication process is outside the scope of all nursing practices.

About the Authors

Patricia M. Speck (DNSc, APRN, FNP-BC, DF-IAFN, FAAFS, DF-AFN, FAAN) is a professor and coordinator of the Advanced Forensic Nursing Department of Family Community & Health Systems at the University of Alabama at Birmingham School of Nursing. She has a doctoral preparation in public health nursing with a focus on SANE Programs and epidemiology.

Rachell A. Ekroos (PhD, APRN, FNP-BC, AFN-BC, DF-IAFN, FAAN) is an assistant professor at the University of Nevada, Las Vegas School of Nursing, and a clinical forensic expert and consultant for the Center for Forensic Nursing Excellence International.

Diana K. Faugno (MSN, RN, CPN, SANE-A, SANE-P, FAAFS, DF-IAFN, DF-AFN) is a Founding Board Director for End Violence Against Women International (EVAWI), is the current president of the Academy of Forensic Nurses, as well as a retired-fellow in the American Academy of Forensic Science and a Distinguished Fellow in the Academy of Forensic Nursing. She now works for Life Safe as a forensic nurse in Marietta, Georgia.

Jennifer A. Johnson (DNP, APRN, AFN-BC, SANE-A, SANE-P, DF-AFN) is a board-certified women’s health nurse practitioner, board-certified advanced forensic nurse, and sexual assault nurse examiner with more than 20 years’ experience in practice. She developed and manages a comprehensive forensics program for AdventHealth in the Midwest and is the president and owner of Johnson Legal Nurse Consulting, LLC.

Valerie Sievers (MSN, RN, CNS, SANE-A, SANE-P, DF-AFN) is a Forensic Clinical Nurse Specialist with more than 35 years of health care experience as a registered nurse, advanced-practice nurse, educator, and consultant. She is currently owner of MedLaw Consultants, LLC, editor of Forensic Nursing Exchange, and serves as a board member of the Academy of Forensic Nursing.

Stacey A. Mitchell (DNP, MBA, RN, SANE-A, SANE-P, DF-AFN, FAAN) is a clinical associate professor at the Texas A&M College of Nursing.

 
< Prev   Next >






Interview with an Expert

One of the more specialized areas of crime-scene investigation has to do with searching for evidence of arson. To get some background in this area, we spoke with an individual who has had more than 46 years in fire service, 24 of which have focused specifically on fire/arson investigation.

Read more...