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This book explores sexual assault forensic interventions and how they are mediated by the relationship between law and medicine in formal emergency room-based programs. Drawing on four years of participatory research in a Baltimore emergency room between January 2002 and December 2006, the book looks at the complex of care that emerges from the interpenetration of legal and therapeutic practices. It also examines the events and processes that must take place as a precondition to prosecution, and how institutional interventions sometimes preclude the consideration of sexual violence within a broader social framework. The book paints a picture of forensic nursing as a newly emergent professional field, and each chapter highlights a different aspect of the proficiencies and capabilities comprising the skill set of forensic nurse examiners. It argues that the ethical consequences of sexual assault interventions are borne almost solely by sexual assault victims, and outlines ways in which different stakeholders in the intervention might challenge the institutional structure to reduce or eliminate such burdens.

This chapter examines the methods by which forensic nurse examiners (FNEs) are trained and accrue experience in what might be characterized as emotional labor. Drawing on scholarship around emotional labor, disgust, and training, it argues that FNEs rely on criteria abiding within institutional structures and drawing on legal frameworks, and that these modes of reasoning and evaluating evidence are particularly marked when nurses are challenged by emotional distress. It shows that sexual assault forensic examinations are intimate and challenging encounters and highlights the importance of managing emotional distress in sexual assault interventions. The chapter discusses three areas of ethnographic research that highlight forensic nurses' strategies and the moments in which their motivations become ambiguous to sexual assault victims: observations of nurses conducting forensic examinations; interviews with nurses about their personal intervention style; and observations of forensic nurse training programs.

This chapter focuses on a particular legal–medical artifact: the photos of wounds and injuries collected by forensic nurses who work with sexual assault victims. The use of medical expertise in legal procedures lends medicine's authority to law without necessarily appropriating the therapeutic concerns of medical practice. Forensic medicine is practiced under the sign of justice while producing its own practices of caregiving. This chapter first considers the emergence of caregiving in the forensic encounter before explaining how the medical and legal are materially linked through forensic photographs. It shows that forensic photography is not a simple combination of obstetric and criminological photographic traditions, but rather unique in that it seeks to break the photographic plane with the victim's gaze. The intersection of forensic gazes during sexual assault forensic examinations allows the victim to communicate her pain to the forensic nurse, who relies on visual documentation to carry out the therapeutic aspects of sexual assault care while carrying out a juridical intervention.

This chapter analyses the labor performed by Sexual Assault Nurse Examiners (SANEs), demonstrating how they represent their clinical interactions with victims while testifying during the trial. SANEs often sanitized sexual assault testimony while deploying medicolegal knowledge infused with cultural norms and heteronormative frameworks to testify about the resilience of the female body and the fragility of forensic evidence. The authors reveal the process of credentialing the forensic nurse on the stand and the objectification and cultural mores attached to the female body in order to explain the absence of evidence. The chapter considers the primacy of the nurse as a white narrator whose description of the bodies of women of color is considered more authoritative than their own subjective testimony.

This book has explored the particular form of forensic care that emerges from the interaction of legal and therapeutic practices and how it imposes violence on sexual assault victims. It argues that this violence is born not from the intentions of individual forensic nurses, but rather from the institutional, professional, and historical location of sexual assault interventions. By highlighting various forensic nursing techniques characterized by the routine violences that found and re-found a particular political and administrative order, this book shows that victims are left to figure out the institutional mode with which their suffering is received. The care of the forensic intervention and its foundational violence produce a structure in which the victim bears all of the costs of sexual assault. How forensic nurses articulate their role in this foundational violence and gestures toward the displacement of the victim may be summed up by the sentiment: “We're not there for the victim.”

This chapter discusses the role of DNA in sexual assault forensic examinations, the popular imagination, and as an element of the narratives of victimization that sexual assault victims describe in the reporting of sexual assault. It explores the social, material, and representational practices that contribute to the contingent configuration of the bodies and subjectivities of sexual assault victims and perpetrators within forensic interventions. In particular, it considers the relationship between forensic nursing protocols and victim experiences of forensic examination, including those protocols and experiences associated with the pursuit and recovery of DNA. It also examines how sexual assault victims, forensic nurses, and even perpetrators imagine DNA as a legitimizing feature of victim narratives as well as material validation of the experience of sexual victimization. Finally, it explains how nurses reinforce the primacy of DNA evidence in the intense scrutiny and time allocated to the process of collecting DNA in the course of the forensic examination.

This chapter focuses on documents used to record the findings of sexual assault forensic examinations and how they might preserve and proliferate many problematic and damaging attitudes about sexual assault and sexual assault victims. It examines the ways that forensic nurses complete documents, the fields that are available for entering data, the instances in which audit mechanisms “trigger” an exception, the subsequent debates that arise from auditing paperwork, and the reading practices by which personnel interact with various documents. It also considers how technologies of forensic documentation sustain particular gendered imaginations of rape victim and perpetrator. It shows that the paperwork used by nurses tend to cast women in the role of victim and men in the role of perpetrator.

This chapter examines patient compliance as part of forensic intervention. It considers how forensic nurses rely on their nursing practice in their work with sexual assault victims, especially when mobilizing ideas about patient compliance. It shows how patient compliance creates uncertainty in forensic interventions and suggests that nurses are skeptical of victims who show signs of drug use or an HIV-positive status in the course of the medico-legal intervention. The combination of HIV-positive status and drug use is often interpreted as indicators of participation in “risky behavior.” In this case, patient-victims who present with either one or both of these conditions are more likely to be cast as non-compliant and therefore less likely to have their cases end in prosecution, while at the same time experiencing more judgment and diminished access to care and compassion during their hospital stay.

This chapter examines how time is worked during forensic interventions and how institutional temporality differs from the ways in which sexual assault victims narrate their experiences in time. More specifically, it considers the ways in which time saturates sexual assault interventions. The problem of documenting medico-legal evidence is typically a problem of time; by the time a case goes to trial, the victim's wounds, psychological and physical, may have healed. During examination, forensic nurses capture these wounds through technological intervention, fixing them in time. This chapter considers the series of forensic interviews that the sexual assault victim goes through and presents cases to illustrate how the biographical, forensic, and criminal modalities of time introduced by forensic nurses reframe victims' suffering and its emplotment along particular trajectories that lead to specific destinations—legal, medical, and therapeutic.

This chapter examines how forensic medicine configures the home as both harmful and healing for sexual assault victims. Forensic interventions not only reshape the image of the sexual assault victim and her wounded body in the forensic photograph or documentation, but also rework the victim's sense of her home and her family. Sexual violence most often involves a victim and a perpetrator who know one another, often through the same kinship network. In sexual assault forensic examinations, forensic nurses micro-localize the crime scene to the victim's body rather than locate the crime at a set of geographic coordinates. This chapter explores the complicated family negotiations that emerge among members of a victim's kinship network as the forensic intervention unfolds. It shows that the family is aware of itself as a potential source of comfort and healing, but also betrayal and harming.

This chapter examines how reproduction figures within sexual assault interventions. It begins with the case of emergency contraception to elucidate the relationship between sexual violence and reproductive violence. In particular, it considers the role of emergency contraception in the production of credibility and the corroboration of non-consent, as well as the production of children born from the violent encounter of rape. It then stresses the need for forensic nurse examiners (FNEs) to manage sexual assault victims' reproductive potentials and possibilities in order to bring the victim into being as a legal subject. It shows how the FNEs' orientation to victims' future possibilities and potentialities is framed by legal criteria, while sexual assault victims draw on very complicated relationships and histories of sexual violence. It argues that sexual violence and subsequent interventions into sexual violence may disrupt kinship relations as well as access to livelihood, leading victims to consider the possibility of re-knitting or stabilizing already delicate social relations when deciding whether to participate in or withdraw from the legal process.