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AFN Impact: Expanding Forensic Nursing in Puerto Rico

Welcome to the first edition of AFN Impact. This column profiles members who have interesting stories, career trajectories, or a body of work that is deemed a best practice, new or evolving sub-specialty, or emerging program that we believe other members might be interested in learning more about. Dr. Rose Marie Méndez-Avilés is our featured member for September.

– Dr. Kathleen Thimsen, AFN Treasurer

Our first story came about through conversations about a new forensic nursing education program in Puerto Rico.

Rose Marie Méndez-Avilés began her nursing career by achieving her undergraduate and then a master’s degree in nursing from the University of Puerto Rico. She then attended Rutgers University in New Jersey in 2002 and attained her SANE-A education. She became certified in sexual assault nursing through the International Association of Forensic Nursing. Méndez-Avilés then completed her doctorate of nursing practice at the University of Virginia with a DNP scholarly project that she executed by developing an evidence-based protocol with sexual assault victims in the adolescent and adult populations. Her current primary position is professor of nursing with the University of Puerto Rico - Mayaguez Campus.

Méndez-Avilés became involved with the Academy of Forensic Nursing earlier this year as she was working on developing a program of education at the University of Puerto Rico School of Nursing. In Puerto Rico, the prevalence of forensic nurses is limited. The country has a total of two forensic nurses: Méndez-Avilés, plus one other nurse on the west side of the island. Puerto Rico, an officially adopted territory of the United States, has a population of 3.3 million.

Given the population base, the country’s crime rates do not seem extraordinarily high. However, the crime statistics are limited to reported crimes. The driving forces of crimes in Puerto Rico are centered around poverty, drugs, and gang activity. In 2016, the FBI’s Uniform Crime Reporting Program reported 7,643 cases of violent crime in Puerto Rico. Rape cases that same year numbered 169, with aggravated assault reported at 3,594 cases. Property crimes, burglary, auto thefts, and larceny cases round out the leading causes of crimes on the island.

The importance of the crime statistics and emphasis on the “reported” crimes is essential in understanding that the socio-political climate is known for its corruption. Fear of reporting and lack of confidence in the justice of reporting are two major reasons that case rates are so low for the stated population size.

Méndez-Avilés is in the process of developing a forensic nursing education program that would serve the island’s communities by increasing the number of competent and skilled forensic nurses – with the goal of improving access, quality of care, and victim response and recovery outcomes.

Puerto Rico has the same regulatory body for nursing practice. APRNs can practice under the supervision of a medical provider. In the veteran’s hospital, there is greater leeway for APRN practice authority. A general hospital in Puerto Rico can also give privileges to a forensic nurse examiner to practice without physician oversight. This practice does still embrace collaboration between all members of the interprofessional healthcare team.

Méndez-Avilés has created a curriculum with 180 hours of didactic, and a clinical component of 180 hours for practice. In addition, the use of clinical simulation is an integral part of the training to advance skills development and competency in a safe setting. Simulation also affords the acquisition of skills that may not be experienced in a clinical setting, but which are critical to learn and validate so that nurses can be practice-ready upon completion of the program.

Méndez-Avilés has a robust goal for every emergency department in Puerto Rico to have a forensic nurse on staff and available 24/7 by the end of 2024. To achieve the goal, she has a strategic, 18-month plan. The expansion of forensic nursing is a necessity, not a cost. It is an investment in creating capacity for change for the people of Puerto Rico.

"The impact of forensic nursing interventions for the greatest of pandemics (violence) can change the outcome of the human spirit – that is, the prevention of negative consequences of being and in giving hope." – Dr. Rose Méndez-Avilés

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