Journal of Forensic Nursing最新文献

Abstract: Background: As with many areas of the nation, Texas lacks a robust sexual assault nurse examiner (SANE) workforce. A program in Texas offers courses to educate and expand SANE skills to better provide trauma-informed care to vulnerable populations. Methods: A survey to stakeholders of a SANE educational program, as part of a planned program evaluation, elicited not only barriers to providing care but also specific program needs to better expand access to sexual assault and domestic violence medical forensic examinations in Texas. Results: In January 2022, a total of 40 stakeholders, all registered nurses in the state of Texas, provided vital information on their current program. Analysis of written survey responses provided themes regarding barriers to providing SANE care and suggestions for expanded education. Discussion: The survey provided valuable feedback and comments on the perceptions of the current SANE program. Written responses offered direction for additional learning desires of SANEs associated with the program as well as areas for the program to expand to meet the needs of the learners. This stakeholder guidance has implications beyond this one SANE education program to enhance and expand other programs based on learner needs.

Background: There is a steady increase in the number of people dying within the walls of forensic institutions across the world. This escalation is, to a large extent, because of an aging population. There is a need to explore how palliative care can be delivered in these settings where, historically, security has been the main focus.

Objective: The aims of this study were to explore staff experiences of providing palliative care in a forensic mental health unit and to establish the subjective significance of those experiences.

Method: A qualitative, descriptive, case study approach was used. This study examined staff perspectives of provision of palliative care to a long-term service user who had been diagnosed with a life-limiting illness and who subsequently died. Interviews were analyzed using codebook thematic analysis.

Results: There were nine in-depth interviews with staff who were involved in the service user's care. Analysis resulted in five main themes: intrinsic dignity, "It was out of our depth," "It's just the way these places are," "Hospital was the practical place," and specialist services.

Conclusion: If equitable access to palliative care is a human right, then it is essential that individuals in secure care with mental illness are able to access palliative care services that are responsive to their needs. Forensic mental health services need to be proactively prepared for the inevitability that people will die in their care.

Background: Despite the prevalence and risks for hepatitis A virus (HAV) and hepatitis B virus (HBV) infection and the availability of safe and effective vaccines, HAV/HBV vaccinations are disproportionately low in jails. This quality improvement project evaluated the effectiveness of clinical decision support systems: electronic standing orders to nurses, clinical alerts to nurses and healthcare providers, and secondarily staff education in enhancing HAV and HBV vaccination and knowledge of hepatitis infection.

Methods: We distributed a validated self-report hepatitis knowledge questionnaire (α = 0.7-0.8) before and after an educational presentation to nurses, nurse practitioners, and physicians ( N = 26) at a Northeastern state jail and then embedded electronic clinical alerts and standing orders in the electronic medical record. The questionnaire assessed pre- and posteducation knowledge scores. The number of vaccine status screenings and vaccinations was retrieved from the electronic medical record 3 months pre- and post-implementation. Descriptive statistics and the Wilcoxon signed-ranks test were used for data analysis.

Results: Twenty-one participants completed the pretest, 18 attended the educational intervention, and 15 completed the posttest. Vaccine status screening increased by 97.5%, and HAV and HBV vaccinations increased by 8.7%. Knowledge scores improved significantly post-intervention ( p = 0.04), with an effect size of r = 0.67).

Discussion/conclusion: Using the Donabedian quality of care model, we showed that quality initiatives are feasible in a jail setting. Implementing a clinical decision support system and education improved the vaccination rate, which may decrease HAV/HBV incidence in the jail and prevent community spread.

Introduction: Research has shown the viability of telehealth consultations to provide medical forensic services, particularly in areas with a dearth of medical examiners. This study examined Illinois hospital administrators' willingness to utilize telehealth to meet new requirements under Illinois Public Act 100-0775, which intends to increase timely access to quality forensic examiners. Consequently, as of March 2021, roughly half of Illinois hospitals unable to meet these requirements have opted not to treat some or all patients presenting for medical forensic services of sexual assault.

Methods: We surveyed and conducted in-depth interviews (between October 2020 and April 2021) with 65 hospital administrators responsible for implementing Illinois Public Act 100-0775. Descriptive statistical analysis was used to analyze survey results.

Results: Our study found limited staffing resources and difficulties educating and training new forensic medical examiners were the major barriers to providing acute medical forensic services. The overwhelming majority of respondents (95%) saw opportunities to use telehealth across all aspects of the medical forsenic evaluation. Barriers to implementing telehealth included perceived patient discomfort with telehealth technology and current legislative restrictions.

Discussion: Legislative efforts to mandate timely access to qualified medical forensic examiners can unintentionally exacerbate disparities in access to care. Illinois hospital administrators are receptive to utilizing telehealth to improve access to forensic examiners, particularly in lower-resourced hospitals.

Conclusion: One method for responding to staffing shortages and improving equitable access to forensic sexual assault services may include implementing networks of qualified forensic examiners that support on-site clinicians in lower-resourced areas via telehealth.

Background: There are persistent gaps in access to sexual assault nurse examiners (SANEs) in rural and underserved areas, yielding health and legal disparities for survivors. These inequities prompted federal investment in novel telehealth programs to improve SANE access.

Purpose: The aim of this study was to examine program case studies from two sexual abuse/assault (SA) telehealth centers, illuminating successes, challenges, and lessons learned.

Methods: Two state SA telehealth program directors used a collective instrumental case study approach to understand telehealth SANE (teleSANE) program challenges/lessons learned, outcomes, and recommendations for the field. Cross-program commonalities and differences were examined, pooling experiences to derive recommendations to sustain telehealth to increase SA health equity.

Results: Collectively, the two programs have served 18 remote sites and provided 335 consultations. Both programs provide access to 24/7 teleSANE consultation, quality assurance, and mentoring. Unique to each program were engagement of hospital leadership in advisory boards, use of telehealth technology, training programs, and fiscal sustainability. Both programs identified flexibility, offering a tailored implementation approach, regular site support and communication, and teleSANE mentoring aligned with the Quality Caring Model as essential to success. Critical needs identified to sustain programs included (a) multilevel community and hospital buy-in, (b) sustainable funding specific to local institution needs, and (c) robust processes to oversee clinical and technology support.

Conclusions: Cross-program similarities and differences show the impact telehealth can have on equitable SA care. Program evaluation showed common challenges, lessons learned, and recommendations to advance equitable SA care access in underresourced communities.