May 01, 2015
By Leah Geller

Forensic nursing’s game changer

Sheila Early has been a tireless advocate for this unique nursing specialty and its importance in patient care

Teckles Photography Inc.“There are so many ways forensic nurses can make a difference in the care of those who have undergone violence or trauma.”

In 1992, Sheila Early was the nurse clinician in the emergency department at the Surrey Memorial Hospital in Surrey, B.C. One day, she was asked to investigate a complaint about the length of time a sexual assault victim had waited for care. As Early proceeded, she was surprised to discover that the sexual assault investigation process had remained virtually unchanged since the 1970s. “There was little recognition that violence and trauma are health-care issues.”

Early and her colleagues on the ED management team set out to explore ways to provide timely and appropriate care for sexual assault patients. “At first, we considered the option of training physicians or training nurses to assist them in sexual assault examinations,” she explains. “But we knew that it’s almost always nurses who have first contact with the person and that the trauma patients experience is emotional as well as physical.”

The team received funding to develop a sexual assault nurse examiner (SANE) program at the hospital, the first of its kind in the province and only the second in Canada. The objective of the program, launched in 1993, was to train nurses to gather legal forensic evidence while providing supportive, confidential care following a sexual assault.

“I was so excited about designing the program, and I knew I wanted to continue to be a part of it,” Early says. “Sexual assault examination puts all nursing skills to use — communication, care and analytical abilities.” Over the next 13 years, Early taught in and then became coordinator of the SANE program, which has expanded to include responses to human trafficking, child abuse and other forms of interpersonal violence.

This work in sexual assault certainly set the stage for Early’s career in forensic nursing, but it was a specific case in 1995 that was the turning point for her. A young homicide victim was brought in to the ED. Early, recognizing the importance of collecting forensic evidence, persuaded the physician to adapt the examination so samples could be collected and stored properly. As a result of this intervention, the perpetrator of the crime was eventually identified.

Forensic nursing in Canada was in its infancy, she says. “We didn’t even hear that term here until about 1995.” She began taking courses and attending conferences, increasingly convinced of the importance of forensics in patient care. “Those trained in forensics don’t make assumptions,” she explains. “They can identify signs of abuse and assess the potential for investigation. They understand the mechanisms of an injury — was it caused by a blunt or a sharp object? They know not to cut through clothing or throw anything away.”

When she started instructing at the British Columbia Institute of Technology (BCIT), Early developed Canada’s first classroom-delivered specialty certificate program in forensic health sciences. A decade later, she remains the coordinator and an instructor. Her knowledge and expertise are clearly in demand. She has provided forensic nursing consulting services to various organizations and to the criminal justice system and is a co-founder of the Forensic Nurses’ Society of Canada.

Early attributes the increased interest of the public in forensics to the popularity of the CSI TV shows. She is pleased that young nurses are showing interest in becoming coroners or working with specific forensic populations. Experienced nurses, too, are signing up for forensic training, she says, “because they have been involved in situations where it would have been useful to know how to collect forensic evidence.”

However, she adds, there is neither sufficient supply of, nor demand for, properly trained forensic nurses, and awareness of the value of these skills continues to be low. She hopes to see forensically trained individuals in every ED in Canada one day, but she acknowledges she will have to be patient.

In recent years, Early has served as president-elect and president of the International Association of Forensic Nurses, with membership of about 3,200. She proudly points out that she is the first non-American to be elected president. She believes the association has an essential role in raising awareness, and she travels extensively herself to promote this specialty.

Early describes her career in forensics as “rewarding, demanding and difficult.” The case of the young homicide victim that motivated her to follow this path affected her profoundly; she suffered vicarious trauma afterward and was unable to even talk about the case for several years.

What has sustained her, Early says, is that she has been able to change the course of many lives after these individuals experience violence and trauma, whether through her own practice or as a result of educating other health-care providers. “That has been so gratifying, and it has reinforced everything I do as a nurse.”

What is one word you would use to describe yourself?

What are you most proud of having accomplished?
Raising two daughters, who are everything a parent could wish for, with my husband of almost 50 years

What is one thing about you that people would be surprised to learn?
I was married while I was nursing student

“If I had more free time, I would...”
Be out reading in our garden. I have a stockpile of books

Where did you go on your last vacation?
Our cabin at Emma Lake, Sask.

Name one place in the world you’d most like to visit.
Kyiv, Ukraine, the birthplace of my mother’s parents

Who inspired you to become a nurse?
When I was six, I suffered internal injuries in an accident. I was cared for after surgery by a kind nursing student. I met her later on, and she became my mentor

What was the best piece of career advice you’ve received?
Care for your patients as you would want to be cared for

What do you like most about being a nurse?
Being able to combine a career and family life

What do you like least about being a nurse?
Lack of recognition of how powerful we could be if we united to change the course of health care

Leah Geller is a freelance health and science writer in Ottawa.
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