Understanding PTSD: The Role of Forensic Nurses

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A forensic nurse reaches out her hand to comfort a patient.

Forensic nurses work closely with victims of violent crimes, providing compassionate medical care while collecting medical evidence to bring perpetrators to justice. Within the scope of their work, forensic nurses must be prepared to identify signs of post-traumatic stress disorder (PTSD) and help victims as they navigate the difficulties that come with the diagnosis.

PTSD is a condition that affects eight million people nationally, according to the U.S. Department of Veterans Affairs (VA) — and that makes it one of the country’s most prevalent mental health issues. Its symptoms include distressing and unwanted memories, mood changes, sleep disruptions and angry outbursts.

It’s normal for people to experience troubling memories, anxious feelings or difficulty sleeping after a traumatic experience. For people with PTSD, these challenges make going through life’s daily routines difficult for months or more.

Understanding PTSD can help forensic nurses as they treat crime victims. Because PTSD can start days, weeks or years after an individual experiences or witnesses a traumatic event, nurses should look to identify signs of PTSD as a result of both recent and past events.

In helping crime victims, forensic nurses — including those who work as sexual assault nurse examiners (SANEs) — need an education that connects the compassion of nursing with an understanding of PTSD care. Through online master’s in nursing degree programs, aspiring forensic nurses learn the essential elements to help people living with PTSD.

Different Types of Trauma

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders first recognized PTSD in 1980. Before then, the disorder was thought to be exclusive to combat veterans who were overwhelmed by the trauma of war.

Researchers now know the disorder can impact anyone who experiences, witnesses and, in some cases, is involved in traumatic events. Different types of trauma include the following.

Direct trauma

When a victim experiences or witnesses a traumatic event firsthand, the victim is subjected to direct trauma. Examples include being the victim of an assault or being injured during a disaster.

Indirect trauma

Also known as vicarious trauma, indirect trauma occurs as a result of secondary trauma exposure. Healthcare workers, including nurses, can be victims of vicarious trauma as a result of working closely with crime victims.

Acute trauma

Acute trauma occurs after exposure to a single event. Experiencing a car crash, natural disaster or an act of violence can lead to acute trauma.

Complex trauma

Complex trauma results from being exposed to multiple traumatic events. Examples of complex trauma include ongoing child abuse, domestic violence or combat-zone situations.

Repetitive trauma

Repetitive trauma occurs when an individual is subjected to the same traumatizing event repeatedly. Recurring abuse or ongoing treatment for an illness can cause repetitive trauma, for example.

Developmental trauma

Developmental trauma concentrates on the impact of child abuse throughout a lifetime. Physical abuse and neglect are among the causes of developmental trauma.

Intergenerational trauma

Also called transgenerational trauma, intergenerational trauma impacts cultural groups or generations of families. Examples of intergenerational trauma include racism and genocide.

Understanding PTSD’s various causes can help nurses pinpoint which types of interventions to pursue. Some more common types of traumatic experiences include:

  • Military combat
  • Car accidents
  • Death of a loved one
  • Natural disaster
  • Serious injury or illness
  • Terrorism
  • Sexual abuse
  • Physical abuse
  • Community violence
  • Early childhood (through age 6) trauma
  • Sexual abuse or assault
  • Witnessing violence

Research shows that exposure to trauma, particularly trauma that occurs in childhood, is associated with ongoing behavioral and physical conditions. Trauma is linked to substance abuse (cigarette smoking and recreational or acute drug use), mental health problems (ongoing depression and thoughts of suicide) and risky behaviors (unsafe sexual encounters and self-injury).

The Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the U.S. Department of Health and Human Services, says anyone could experience trauma that triggers PTSD. While some people can move on from traumatic experiences without lasting impacts, others suffer from ongoing problems.

The behaviors associated with PTSD can affect relationships, careers and other facets of life, so healthcare professionals should understand the causes and impact of trauma — and explore ways to address them.

How Do Forensic Nurses Help People With PTSD?

When a forensic nurse works with a crime victim, the nurse delivers compassionate, holistic care while also focusing on collecting evidence for use in criminal proceedings and helping victims cope with the trauma of the events.

Forensic nurses help victims navigate the emotions that come with trauma early on by providing a safe and comfortable environment and asking victims for permission to provide care. While the many types of trauma may elicit different responses in different people, forensic nurses can identify the behaviors generally associated with PTSD to determine how to address the issue. Overall, patients who have PTSD typically experience symptoms in four different stages.

Stages of PTSD

Forensic nurses can assist PTSD patients through each of the stages of PTSD, starting with identifying the signs of the first stage of the condition. In many cases, forensic nurses are the first providers to hear the victim’s description of the events. During this early process of remembering and mourning, the victim may also express vulnerability. Forensic nurses help victims by acting as a supportive witness to their story, which aids in the healing process.

Psychiatric professionals have identified the following four stages of PTSD.

Emergency Stage

The first stage of PTSD reflects the preliminary shock of a traumatic event. The length of time this stage lasts often depends on the severity of the trauma. The emergency stage can include emotions and behaviors such as feeling surprise, shock, doom and fear; avoiding family, friends and responsibilities; suffering from survivor guilt; and being anxious, nervous and hyperalert.

Rescue Stage

In the second stage, individuals begin to accept what they’ve experienced or witnessed. Remembering or talking about traumatic experiences can lead those suffering from PTSD to enter this stage which often includes nightmares, flashbacks, sadness and anger, and feelings of apathy.

Midway Stage

The third stage occurs when the person accepts that a traumatic experience has affected the individual’s life. Patients in this stage can work to return to everyday responsibilities such as working and managing family and home commitments.

Long-Term Repair Stage

The fourth stage includes living with the symptoms of PTSD on a long-term basis. Nurses assisting PTSD patients at this stage should help them understand that managing emotions can help PTSD patients overcome any feelings that may return from earlier stages of PTSD.

Overall, forensic nurses help crime victims from the very moments after an assault; playing an integral role in each individual’s survival and healing. For registered nurses (RNs) who want to help crime victims, working as a forensic nurse provides a bridge between healthcare and the criminal justice system.

Explore Forensic Nursing’s Role in Treating PTSD

If you’re an RN who holds a bachelor’s in nursing degree, an excellent choice is to explore an advanced degree in forensic nursing through the Duquesne University online Master of Science in Nursing in Forensic Nursing program. Duquesne also offers an online post-master’s certificate in forensic nursing for RNs who already have an MSN degree.

As an enrolled student, you will learn how to provide trauma-informed care through a program that has garnered national attention for its dedication to melding nursing and criminal justice. The program operates in partnership with the university’s Cyril H. Wecht Institute of Forensic Science and Law while also offering the convenience and flexibility of online learning.

RNs who graduate from Duquesne University’s MSN in Forensic Nursing online program work as sexual assault nurse examiners (SANEs), forensic nurse investigators, nurse death investigators and expert witnesses. The program also provides opportunities for students to add a concentration in nursing education or transcultural nursing.

Discover how Duquesne’s online Master of Science in Nursing in Forensic Nursing program can help you achieve your professional goals.

Recommended Readings

Ethical Practice in Forensic Nursing

Helping LGBTQ Patients in the Forensic Setting

Top Websites for Forensic Nursing


American Nurse, “Forensic Nurses Make Strides Toward Social Justice”

Mayo Clinic, Post-Traumatic Stress Disorder (PTSD)

National Child Traumatic Stress Network, Trauma Types

National Institute of Mental Health, Post-Traumatic Stress Disorder

Nurse Advisor, “PTSD: How You Can Raise Awareness”

SeniorLiving.org, “A Close Look at PTSD Among Aging Adults”

Southcoast Psychiatric Services, “Understanding the Impact of Trauma: The Four Stages of PTSD”

Substance Abuse and Mental Health Services Administration, Trauma and Violence

U.S. Department of Veterans Affairs, PTSD: National Center for PTSD

Your Experiences Matter, Types of Trauma