CFN in context: an interview with Dr. Dianne Ditmer.
Article Type: Interview
Subject: Nurses
Forensic scientists
Pub Date: 09/22/2009
Publication: Name: The Forensic Examiner Publisher: American College of Forensic Examiners Audience: Professional Format: Magazine/Journal Subject: Health; Law; Science and technology Copyright: COPYRIGHT 2009 American College of Forensic Examiners ISSN: 1084-5569
Issue: Date: Fall, 2009 Source Volume: 18 Source Issue: 3
Product: Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners
Persons: Named Person: Ditmer, Dianne
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 205905776

Dianne Ditmer, RN, PhD, CFN, DABFN, CMI-III, CHS-III. SANE, FACFEI, is a certified forensic nurse and clinical educator at Kettering Medical Center in Dayton, Ohio. with a background in emergency nursing, risk and management, medical error investigation. Dr. Ditmer is committed to improving the quality of care provided to vulnerable populations and victims of violence through education of multi-disciplinary professionals. Dr. Ditmer was appointed to the Governor's Taskforce on Child Abuse and Childhood Trauma. She collaborates with educators, law enforcement, and legislative members to develop evidence-based educational programs for school systems, healthcare providers, and foster families. In addition to her role as an educator, Dr. Ditmer provides direct care for living victims of abuse, neglect, and sexual assault.

With 30 years of experience as an RN, Dr. Ditmer has worked as a Nurse Resident in a Trauma Center for one year and has also been an Emergency Department Nurse manager for 7 years and a Sexual Assualt Nurse Examiner for 8 years. As a credentialed Fellow of the American College of Forensic Examiners Institute (ACFEI) and Diplomate of the American Board of Forensic Nursing (DABFN), she serves as chairman of the American Board of Forensic Nursing and board member of the Ohio Healthcare Taskforce on Family Violence. As a member of the Montgomery County Sexual Assault Response Team and contributing author of the Montgomery County Sexual Assault Protocol Manual. Dr. Ditmer collaborates with members of law enforcement, coroner's office, and the prosecutor's office. She has been an integral part of the forensic nursing program as author of ACFEI's Intro to Forensic Nursing course, and has seen the benefits of the certification firsthand.


What is the importance of forensic nursing and how did you first become involved with the this program?

Six thousand acts of violence are committed every day across the United States. Victims of rape, abuse, neglect, and trauma occupy beds in our medical centers, clinics, and private practices. Victims are much more than faceless numbers; they are our patients. They come to us with acute injuries exacerbated by chronic illness and social issues. They are physically fragile, emotionally devastated, and experience extreme humiliation and denial. Nurses, by training and a commitment to excellence, apply the foundations of physical, biological, psychosocial, and spiritual aspects of man to the evidence-based investigation and treatment of vulnerable populations. Forensic nurses are in a unique position to make a difference in the lives of our patients through prevention, community and family education, and early identification and universal screenings. Multidisciplinary collaboration and intervention through comprehensive utilization of community resources are foundational to the health of our patients and the safety of our society.

Awareness of the prevalence of violence and the opportunity to care for victims launched my personal interest in developing focused curriculum that would provide a broad-based introduction to forensic nursing. Developing a program that allows nurses to investigate the application of forensic principles and standards of care while integrating this contemporary science into the nursing process will result in better patient care and evidence-based practice.

How does forensic nursing as a specialty fit into the medical world today?

Forensic nursing is the application of the nursing process to medical and legal investigations. Nurses apply forensic aspects of healthcare to the scientific investigation of trauma, abuse, violence, death, and criminal activities related to medical-legal issues.

We care for vulnerable populations, both living and deceased, and apply the foundations of physical, biological, psychosocial, and spiritual aspects of academic training to the scientific investigation and treatment of physical or emotional injuries. Based on the nursing process, forensic nurses perform a thorough assessment, identify injuries or wounds, and document our findings. The forensic nurse's unique ability to obtain and document information ensures that evidence is secured for further forensic analysis.

As advocates for our patients and advocates for the truth, forensic nurses are healthcare's response to violence based on specialized knowledge and clinical training to do the following:

* examine and care for individuals through the lifespan, including victims and perpetrators.

* collaborate with multidisciplinary colleagues.

* offer consultative services to physicians and law enforcement agencies.

* identify, collect, and preserve evidence.

* interface with the Judicial System by providing expert testimony.

How would you describe the role of the forensic nurse in the major types of medical/legal forensic cases and engagements?

Forensic nursing combines the traditional nursing process with the principles of forensic science and criminal justice when caring for the most vulnerable--victims of violence; investigating legal matters; evaluating product tampering and liability; leading death investigations; and investigating child and elder abuse, custody matters, and domestic violence and trauma.

There are many sub-specialities within forensic nursing, which allow for a multi-disciplinary approach and collaborative practice in which knowledge and responsibility are shared in order to reach common goals.

Specialities include:

Sexual Assault Nurse Examiner (SANE)

Domestic Violence Forensic Nurse

Forensic Pediatric Nurse

Forensic Nurse Examiner

Nurse Death Investigator

Forensic Psychiatric Nurse

Forensic Clinical Nurse Specialist

Forensic Nurse Educator/Researcher

Nurse Attorney

Police Nurse

Forensic Geriatric Nurse

Legal Nurse Consultant

Nurse Coroner

Forensic Nurse Consultant

Correctional Nurse

Disaster Response

The common thread for all forensic nursing sub-specialities includes specialized education and experience, conducting research in their area of expertise to substantiate evidence-based care, testifying in legal matters, identifying and evaluating injuries for all types of crimes and all patient populations, and taking care of legal and healthcare needs.

Forensic nurses, based on expertise and specialized knowledge, benefit the patient populations they serve in the following ways:

* recognizing and caring for vulnerable populations, including those who are incarcerated or mentally ill, abused or neglected children, the elderly, or victims of intimate partner violence

* providing specialized nursing care for living and deceased.

* determining unsafe conditions and products resulting in injuries or death.

* investigating product tampering or toy-related injuries and deaths.

* dealing with hazards in the workplace including equipment, toxins, and violence.

Supporting the community is also an essential role of forensic nurses. They educate other healthcare professionals based on identified community health needs, risks, or crime data. Forensic nurses also benefit the legal community by serving as liaison between healthcare and the justice system. They bridge the gap between nursing and law enforcement with their ability to collect and preserve evidence in the following ways:

* gather critical information and evidence based on clinical assessment.

* identify injuries from weapons or human abuse.

* interview patients to evaluate method and mode of injury.

* determine whether injury or death can have forensic implications.

* testify to the medical findings and evidence collected.

What are some of the focal points of the Introduction to Forensic Nursing course?

Introduction to Forensic Nursing allows nurses to investigate the application of forensic principles and standards of care while integrating this contemporary science into traditional healthcare. Meeting the healthcare and legal needs of vulnerable populations and victims of violence through the lifespan is explored with prevention and intervention as the focus. Topics include assessment and interview strategies with consideration of physical and cognitive limitations, age specific needs, gender-related concerns, and ethnic- and cultural-specific risk factors. Red flags and warning signs of school violence as well as individual and community strategies to prevent youth violence are evaluated. Physical, emotional, and psycho-social implications of children witnessing acts of domestic violence are explored. Wound and injury identification is included to provide an in-depth comparative focus on traumatic wounds indicative of abuse, self-inflicted injuries, and anticipated, age-specific injuries. Cause, manner, and mechanism of death are examined in relationship to working with the coroner's office. Documentation skills and evidence collection techniques are enhanced while learning about individualized examination techniques, forensic terminology, body maps, and photographic techniques that are the best practice. This course evaluates the role of the forensically trained nurse in the courtroom and with law enforcement as supported by ethical, legal, and moral principles that guide daily practice and lifelong commitment to our patients, the victims of violence.

What is the significance of a CFN designation and how will earning this designation set someone apart from other nursing professionals?

The Certified Forensic Nurse certification credential is an important indicator to patients, employers, the public, and other professional colleagues that the certified nurse is qualified, competent, and current in this nursing specialty. Certified Forensic Nurses have met rigorous requirements to achieve this expert credential.

To become a Certified Forensic Nurse, CFN[R], a candidate must meet all eligibility criteria as established by the ABFN and ACFEI. CFN candidates must submit the completed CFN application form and payments, then successfully pass the certification examination. For more information, call us at (800) 423-9737 or check out
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