Module 5 Discussion: Initial Post
The Nurse at the Death Scene: What Nursing Adds to Medicolegal Death Investigation
When an older woman is found dead in her apartment with no obvious injury, someone must decide whether her death was natural, accidental, self-inflicted or the result of violence, and whether an autopsy is needed. In the United States, that decision belongs to a medical examiner or coroner and the death investigators who work for them. Hanzlick (2014), reviewing the national system, noted that most of the officials who lead death investigation systems are coroners, many of them elected, while most of the population lives in areas served by medical examiner systems, and that the country needs more trained and certified medicolegal death investigators. That workforce gap is where nurses fit.
Nurses bring three things that make death investigation more accurate. The first is clinical interpretation at the scene. A nurse investigator looking at the woman's medications can count remaining tablets against the fill date, recognize that an opioid patch and a sedative were prescribed by different clinicians, and notice a glucose meter with no recent readings. Those details can distinguish a natural death from an accidental overdose before the autopsy. The second is medical record review: nurses read hospital and clinic records quickly and know what a normal course looks like, which helps a forensic pathologist focus. Romano (2011) describes the forensic nurse death investigator as combining nursing's knowledge of disease, medications and treatment with the investigative duties of the role.
The Human Side of the Role
The third contribution is communication with families. Death investigators notify next of kin, gather history from grieving relatives and explain why an autopsy is or is not being done. Nurses are trained to deliver bad news, assess family members' reactions and connect them with support, and they do so while collecting the history an investigation needs. That combination of compassion and precision is the same balance the forensic nursing standards describe for all forensic practice (American Nurses Association & International Association of Forensic Nurses, 2017).
The role also has limits that nurses must respect. A death investigator does not determine the cause or manner of death, which is the responsibility of the medical examiner or coroner, and must document observations objectively rather than reach conclusions at the scene. Nurses moving into the role also need specific training in scene investigation, evidence handling and the law of their jurisdiction, and many pursue certification through the national board for medicolegal death investigators.
My Question for Classmates
Our county uses an elected coroner who is not a physician and relies on two part-time investigators, neither of them nurses. Would adding a nurse death investigator be the best first improvement in a system like ours, or would the money be better spent on access to forensic pathologists? I would be interested to hear how death investigation is organized where you live.
References
American Nurses Association & International Association of Forensic Nurses. (2017). Forensic nursing: Scope and standards of practice (2nd ed.). American Nurses Association.
Hanzlick, R. L. (2014). A perspective on medicolegal death investigation in the United States: 2013. Academic Forensic Pathology, 4(1), 2-9. https://doi.org/10.23907/2014.001
Romano, C. (2011). Examining the role of the forensic nurse death investigator. American Journal of Nursing, 111(1), 20-21. https://doi.org/10.1097/01.NAJ.0000392855.52189.ce
How this N 560 Module 5 example is structured
Aspen does not publish N560 module prompts, so check your classroom for the exact discussion question. This example opens with a death scene, describes the U.S. death investigation system from a national review, names three nursing contributions with examples, states what the role does not include and closes with a question about local systems.
N560 Module 5 questions, answered
What does N560 Module 5 usually ask for?
Aspen's N560 description covers forensic roles in health care and nontraditional settings, and a discussion of one role outside the hospital, such as death investigation, is a typical shape. Check your classroom for the exact question and reply requirements.
Does a nurse death investigator determine the cause of death?
No. The cause and manner of death are determined by the medical examiner or coroner. The investigator gathers and documents information at the scene, from records and from family to support that determination.
What is the difference between a coroner and a medical examiner?
A coroner is often an elected official who may not be a physician, while a medical examiner is usually an appointed physician, often a forensic pathologist. States and counties use either system or a mix.
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