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Forensic Nursing Defined 103 University of Bradford eThesis This thesis is hosted in Bradford Scholars – The University of Bradford Open Access repository. Visit the repository for full metadata or to contact the repository team © University of Bradford. This work is licenced for reuse under a Creative Commons Licence. SPECIMEN LAYOUT FOR THE TITLE PAGE THE MEANING OF BEING AS A NURSE INVOLVED IN THE WORK OF DEATH INVESTIGATION A North American view and its implications to practice in England Jane Elizabeth RUTTY submitted for the degree of Doctor of Philosophy The School of Health Studies University of Bradford 2010 ABSTRACT Jane Elizabeth Rutty The meaning of Being as a nurse involved in the work of death investigation. Keywords: Being, hermeneutics, Heidegger, nurse, forensic, death investigation, coroner, North America, England. This research study explored the meaning of “Being” (i.e. Heidegger’s four philosophical concepts of Being-in the-world, fore-structures, time and space) as a nurse involved in the work of death investigation in the USA. The objectives were to: reveal the hidden meaning of Being; transfer the findings into an English context by examining what nurses could offer beyond their current role boundaries in an area not currently practised to the extent that nurses make to other medical specialities; and finally put forward developments that would need to take place to ensure such proposals were successful in making an effective difference to health care. In the USA there are two systems of death investigation, the Coronial and Medical Examiner system. The Coroner is an elected county or state position with varied educational and professional requirements. Some Coroner positions have been filled by registered nurses as they have put themselves forward successfully for election. In contrast, the Medical Examiner is an appointed county or state position who must be a licensed physician and a qualified pathologist or forensic pathologist in most cases. Within the Medical Examiner systems death investigators may also be appointed of which some have been filled by registered nurses. It was under the interpretive paradigm that a Heideggerian hermeneutic study was undertaken. Snowball sampling was instigated to reach a hidden population and collect qualitative data by means of unstructured interviews, non-participant observations, interrogation of historical records and the keeping of a personal reflective diary. The seven phase analysis process underpinned by the hermeneutic circle was developed to enable a synopsis of the shared meaning of Being to be revealed through the presentation of paradigm cases that encompass stories and themes. 1 Of the 22 nurses found to be working as either death investigators or Coroners in the USA who fulfilled the inclusion criteria, 17 nurses from 11 States in the USA consented to take part. Fore-structures concerning age (average 37), gender (82% were women) and professional experience (majority came from an adult nursing background with emergency department or critical care experience) are discussed. Overall participants were interviewed for a total of 78 hours in 11 States, five of which were also observed in practice for a total of 142 hours in 3 States, giving a total of 220 hours of interview and observational data. The interpretive analysis revealed the three major paradigms of: the authentic and inauthentic reality of Being (the death investigator nurse in action); the everydayness and averageness of Being (community outreach) and the publicness of Being (mass fatality care). This study reveals knowledge concerning the meaning of Being as a nurse involved in the work of death investigation in the USA. Aspects of this illuminated landscape have propositioned for the advancement of nursing clinical practice to replace and further develop the current coroner’s officer and soon to be implemented medical examiner officer role in England and Wales. Hence recommendations are made for practice development and further research in England. Warning: This study contains images of the dead, with images of both the external surface of the body and internal organs. If having read this warning, you choose to read the rest of this study you do so at your own free and informed choice. 2 CONTENTS Page No Abstract 1 Contents 3 Acknowledgements 12 Dedication 15 Glossary of terms 16 Author declaration 25 1.0 CHAPTER ONE: INTRODUCTION 26 1.1 Introduction 27 1.2 Personal reflection 27 1.3 My credibility as a researcher 31 1.4 Research question 34 1.4.1 Concept clarification 34 1.5 Research aims 35 1.6 Significance of the research question 36 1.7 Importance of the research question 37 1.8 Focus 39 1.9 Framework 39 1.10 Outline of the study 41 1.11 Chapter summary 43 2.0 CHAPTER TWO: LITERATURE REVIEW 45 2.1 Introduction 46 3 Page No 2.2 The role of the nurse in health care historically 47 2.3 The role of the nurse in health care today 49 2.4 Expanding and advancing nursing practice 58 2.5 Implications and effects on nursing in expanding their roles 63 2.5.1 Nursing practice is unique and free of medicine 64 2.5.2 Nursing is ultimately associated to and subservient to 66 medical practice 2.5.3 Caring and curing are not incompatible notions, merely 68 parts of the same continuum 2.6 Expanding nursing roles and the way forward 70 2.7 Current expanding and advancing developments in nursing 75 2.8 The historical development of HM Coroner in England and Wales 79 2.9 The purpose of HM Coroner in England and Wales 82 2.9.1 The autopsy 85 2.9.2 The Coroner’s inquest 86 2.10 Death investigation framework in Scotland 90 2.11 Death investigation framework in Northern Ireland 93 2.12 The coroner service: A relic in need of reform 94 2.13 Other death investigation frameworks from around the world 97 2.13.1 The generic criminal investigation and judicial system 97 2.13.2 The medical examiner system 99 2.13.3 The coronial system outside the UK 100 2.14 Forensic nursing defined 103 2.15 Death investigation and forensic nursing in the UK 106 4 Page No 2.16 The emerging forensic nurse in England and Wales 108 2.16.1 Nursing roles that contribute covertly to the coroner’s 108 enquiry 2.16.2 Nursing roles that contribute directly to the coroner’s 111 enquiry 2.16.3 Future nursing roles that could contribute to the coroner’s 116 enquiry 2.17 Death investigation and forensic nursing in the USA 118 2.18 A future nursing workforce need outside the boundaries of 122 traditional health care 2.19 Chapter summary 123 3.0 CHAPTER THREE: STUDY DESIGN - THE JUSTIFICATION 125 3.1 Introduction 126 3.2 Philosophy 127 3.3 Habermas’ three major sciences 128 3.3.1 Positivist paradigm 129 3.3.2 Interpretive paradigm 132 3.3.3 Critical theory paradigm 134 3.3.4 Justification for choosing the interpretive paradigm 135 3.4 The interpretive paradigm and methodology 137 3.4.1 The rejection of ethnography justified 140 3.4.2 The rejection of grounded theory justified 141 3.4.3 The rejection of phenomenology justified 142 5 Page No 3.4.4 The justification for hermeneutics 147 3.5 Hermeneutics and western world history 148 3.5.1 Hermeneutics in Ancient Greece and Rome 148 3.5.2 Early Biblical and Medieval hermeneutics 149 3.5.3 Hermeneutics during the Renaissance and 149 Enlightenment periods 3.5.4 Modern hermeneutics 150 3.5.5 Contemporary hermeneutics 153 3.5.6 The justification for Heidegger’s hermeneutics 154 3.6 Heidegger’s hermeneutic philosophy 156 3.6.1 Being-in-the-world 158 3.6.2 Fore-structures 159 3.6.3 Time 161 3.6.4 Space 163 3.7 Chapter summary 165 4.0 CHAPTER FOUR: STUDY DESIGN - APPLIED TO METHODS 167 4.1 Introduction 168 4.2 Heidegger’s hermeneutic philosophy applied to methods 168 4.3 The hermeneutic circle 172 4.4 Sampling 178 4.5 Instrumentation 181 4.5.1 Unstructured non-participant observation and field notes 182 4.5.2 Unstructured interview 184 6 Page No 4.5.3 Historical documents 186 4.5.4 Reflective diary 187 4.6 Protection of participants 188 4.6.1 Gaining approval for the study 188 4.6.2 Informed consent and gaining access 189 4.6.3 Confidentiality and anonymity 191 4.6.4 Secrets 192 4.7 Methods of analysis 192 4.7.1 Phase 1 – Entering the hermeneutic circle 194 4.7.2 Phase 2 – Data collection and initial interpretation 195 4.7.3 Phase 3 – Validation of transcriptions 195 4.7.4 Phase 4 – Global thematic analysis 195 4.7.5 Phase 5 – The capturing of stories 196 4.7.6 Phase 6 – The search for paradigm cases 197 4.7.7 Phase 7 – The search for shared meanings of Being 197 4.8 Trustworthiness 198 4.8.1 Credibility 199 4.8.2 Transferability 201 4.8.3 Dependability 202 4.8.4 Confirmability 202 4.9 Reporting the findings 203 4.10 Chapter summary 203 7 5.0 CHAPTER FIVE: RESEARCH FINDINGS AND DISCUSSION 205 5.1 Introduction 206 5.2 Changing personal horizon 206 5.2.1 Formulating the research question 207 5.2.2 Research design 210 5.2.3 Data collection and analysis 212 5.2.4 Summary 214 5.3 The study sample 215 5.4 Interpretive findings and discussion 219 5.4.1 Paradigm A – The authentic and inauthentic reality of 226 Being: The death investigation nurse in action 5.4.1.1 Theme A1 – The real world 227 i.
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