Stress is a universal phenomenon affecting the physical, mental, and psychosocial wellbeing of humans [1,2]. Being multifactorial, its burden increases when the environmental stressors increase. Among these stressors on a nation level are poverty, politically-driven economic instability, lack of direction, absence or unenforced human rights laws, double standards, corruption, and lack of a system in place, to name a few [3-11].
The Lebanese people have sustained, and to some extent got engaged in a 15 years of civil war (1975-1990). Although the war stopped, yet the economy and political hardships remain. The stress disorders associated with the war and these hardships have been noted in the attitude and behavior of the residents of the country, whereby many have been exhibiting signs and symptoms of anxiety and mood disorders . Consequently, there has been a significant increase in violence, harassment, abuse, road rage and related deaths and disabilities, development of an indifferent attitude, divorce rate resulting in fragmented families and single parents, financial inability to get married and start a family, and social isolation, to name a few [12-17]. Although psychological counseling is available, it remains out of reach for most of the Lebanese people due to the high cost, being uninsured, or the insurance does not cover the fees . This leaves 9 out of 10 of individuals requiring counseling/treatment without such a service or paying for it out-of-pocket .
The country also suffers from a significant shortage in forensic and mental health professionals . Forensic inpatient facilities do not have beds for individuals with stress-related disorders, and the absence of proper forensic units makes the data on users and length of stay not available . As such, establishing Forensic Nursing education, and integrating Forensic Nursing into the practice of the profession could be two important strategies that the government could use to alleviate the shortage, especially in relation to early identification of signs and symptoms of violence, abuse, harassment, and other physical and psychosocial injuries inflicted on victims (children, adults, elderlies, and women).
Forensic Nursing is defined as the practice of nursing universally, whereby the legal systems and health intersect. Death investigation, intimate partner violence, legal/criminal justice, and administrative, correctional and psychiatric-mental health all represent various specialties in Forensic Nursing. We aim in this study at surveying the current status of Forensic Nursing in Lebanon in relation to education and practice.
Materials and Methods
We conducted two separate comprehensive PubMed and Medline searches using MeSH terms “Forensic Nursing education” AND “Lebanon”, and “Forensic Nursing practice” AND “Lebanon”. We selected “All Fields” in both searches to ensure that if such MeSH terms were included in the title, abstract, key words, or any other components of the journal articles searched, then such articles will automatically appear in our search. We did not use any of the filters available in the PubMed and Medline search engines, such as article types, text availability, publication dates, ages, search fields, languages, sex, subjects, and journal categories, in order to avoid accidental exclusion of any article that matches the MeSH terms we used.
In parallel, we reviewed the catalogues and the related description of courses of the nursing programs currently offered by the various universities, colleges, technical institutions, and hospitals in Lebanon in relation to Forensic Nursing education. Access to such catalogues and description of courses was obtained through screening the related degree programs posted on the websites of these universities, colleges, technical institutions, and hospitals. These websites were located through Erasmus Plus Lebanon, and through visiting 132 individual website links obtained through Google search for “nursing degree in Lebanon”  (Figure 1).
Finally, we reviewed the Lebanese law for the existence of legislations in relation to the practice of Forensic Nursing in Lebanon, and the current regulations governing the practice of forensics in the country [19-21].
Our literature search revealed a total lack of publications about Forensic Nursing education, and Forensic Nursing practice in Lebanon (Figures 2 and 3).
There are currently 50 certified higher education institutions in Lebanon . The total number of these institutions currently offering a bachelor degree in nursing is 18. The total number of credits required to graduate nurses with a bachelor degree from these institutions ranges from 99 to 188 credits. The average duration of the degree is 3 years, excluding the freshman year. The language taught is either English or French, with very few institutions exceptionally offering the degree in both English and French. Some of the institutions offer a bridging nursing program allowing the students with a Baccalaureate Technique (BT) or Technique Superieure (TS) degrees in nursing to enroll in the bachelor degree (Table 1).
Our analysis of the bachelor in nursing degree programs offered by the 18 institutions revealed a total absence of a Forensic Nursing course. We then reviewed the course description of the individual courses pertaining to these programs aiming at assessing whether Forensic Nursing has even been covered as a topic in these courses. Our findings turned out to be negative.
Finally, our thorough review of the Lebanese laws revealed a total lack of listing of Forensic nursing, and, accordingly, total absence of legislations concerning the practice of Forensic Nursing [19-22]. This indeed was not surprising, given the fact that neither Forensic Nursing education nor Forensic Nursing practice exist in Lebanon. Nevertheless, we thought to examine the status of forensic regulations in Lebanon, hoping to build a framework for the practice of forensics in the country. Our results are summarized in Table 2 [19,21].
Discussion and Conclusion
Nursing education in Lebanon has been well established for over 100 years in the capital city Beirut, but to a much lesser extent in the rural sides of the country [23,24]. However, neither Forensic Nursing education nor Forensic Nursing practice do exist in Lebanon. Given the fact that the country is in need of forensic health services, which happen to be limited and expensive, and that the number of qualified forensic doctors does not exceed 81 for a population of 6,229,794 (based on the 2017 statistics), the establishment of Forensic Nursing in Lebanon seems to be a necessity [12,25,26].
Forensic Nursing is defined as the practice of nursing universally, whereby the legal systems and health intersect. Death investigation, intimate partner violence, legal/criminal justice, and administrative, correctional and psychiatric-mental health all represent various specialties in Forensic Nursing [27,28]. The practice of Forensic Nursing has soundly developed through the integration of modern forensic knowledge and technology into nursing care. The aim is to enhance the healthcare services offered to patients who experienced injury and brutality, and to act as early identifiers and preventers of such injury and brutality. The malicious impacts, the propagation of brutality over the life expectancy, and the requirement for injury-oriented methodologies to assessment and care constitute the fundamental hypotheses to Forensic Nursing practice.
A Registered Nurse (RN) could specialize in Forensic Nursing through formal, well-structured, and clinically-oriented university degree programs in the field. Their practice venues include hospitals, psychiatric institutions, anti-violence programs, coroners’ and medical examiners’ offices, communities (after natural disasters), and correctional facilities [29-33]. He/she then becomes a Forensic Nurse Examiner (FNE) whose roles include, but not limited to, the following [29-33]:
1 Providing comprehensive nursing care to forensic patients in healthcare and community settings.
2 Early identification of victims, and prevention of assaults.
3 Clinical forensic assessment.
4 Clinical forensic investigation.
5 Clinical forensic examination.
6 Clinical forensic analysis.
These entail victims, suspects, or perpetrators of unintentional or intentional psychological and/or physical trauma or violence. Abuse of children and elderlies, intimate partner violence, sexual harassment and assault, death, and/or natural disasters are among the domains incorporated in the field [29-33]. Accordingly, Forensic Nurses must be detail-oriented, skilled in collecting and preserving evidence that is admissible in court, organized, and committed to vigilant and precise documentation. Because nurses are skilled in effective documentation, assessment, and communication, Forensic Nurses are then capable of the following [29-33]:
1 Providing sympathetic and empathetic care to victims of violent crime, abuse, or neglect, while assembling evidence to maintain law enforcement.
2 Helping their communities by working abreast with coroners and pathologists to detect accurate causes of death and ensure exact recording of vital statistics and epidemiology inclinations.
3 Consulting with legal authorities and providing expert testimony that can be used in court.
4 Addressing violent crimes, such as homicide and attempted homicide, non-negligent manslaughter, robbery, aggravated assault, adult sexual assault or rape, child neglect, molestation or rape, and elder neglect or abuse.
5 Treating physical injuries.
6 Gathering and preserving evidence that is admissible in court (e.g., crime tools like bullets, knives, etc., victim’s clothing and hair, as well as other physical evidence).
In conclusion, stress-related disorders could range from simple anxiety to anger, rage, violence, assault, homicide, and suicide. In a country like Lebanon where most of the Lebanese people suffer from stress-related disorders, where psychological and psychiatric counseling are financially out of reach, and where there is a severe shortage in psychiatrists, mental health nurses, and medical forensic practitioners, there is an urgent need to introduce Forensic Nursing education, followed by establishing Forensic Nursing practice. Graduates from such a degree will assume roles in clinical forensics, teaching, legal nurse consulting, research, forensic psychiatric nursing (evaluation of alleged perpetrators of violent crime), violence prevention programs, and other roles that require collaboration with the criminal justice system [29-33].
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Saleh F, College of Public Health, Phoenicia University, Lebanon, E-mail: email@example.com
Saleh F and Ismail N. Forensic nursing education and practice in Lebanon: Current status and future perspectives (2018) Nursing and Health Care 3: 80-83