Journal of Forensic Nursing最新文献

Background: Transgender and non-binary (trans*) individuals face disproportionately high rates of sexual violence yet experience discrimination at rape crisis centers (RCCs). Sexual assault nurse examiners (SANEs) who receive targeted education are better equipped to care for the trans* community.

Aims: This quality improvement project aimed to increase SANEs' self-perceived competence in caring for trans* assault survivors. The secondary purpose was to promote a trans*-inclusive environment at an RCC based on an environmental assessment.

Methods: The project involved creating and implementing a virtual continuing education course on providing gender-affirming and trans*-specific care for sexual assault survivors and an environmental evaluation at an RCC. A questionnaire measured SANEs' perceived competency pretraining and posttraining, and paired t tests were conducted to examine the change in competencies. A modified assessment tool was used to evaluate the RCC's capacity for addressing trans* survivors needs.

Results: The training increased self-perceived competency in all four components measured (p < 0.005). More than one third of participants (36.4%, n = 22) indicated having no expertise, and 63.7% reported having some expertise in caring for trans* clients. Two thirds (66.7%) had prior trans*-specific training; however, only 18.2% received trans*-specific content in their SANE training. Most strongly agreed (68.2%) they would benefit from additional training. The organizational assessment identified key areas for improvement.

Conclusions: Trans*-specific training can significantly impact SANEs' self-perceived competency in caring for trans* assault survivors and is feasible and acceptable. This training could have a global impact on SANEs if disseminated more widely, particularly with inclusion in SANE curriculum guidelines.

Abstract: Patients presenting to the emergency department after strangulation are in need of specialized care and treatment. Patient presentations after nonfatal strangulations vary dramatically; however, regardless of variation, no assumptions should be made about the seriousness of the injury. The clinician's goal should be a thorough assessment and evaluation, followed by treatment in accordance with individual patient needs. One way to ensure this comprehensive care is through the implementation of forensic nursing care and a detailed nonfatal strangulation assessment. In this case report, three different cases of women who reported to the emergency department after strangulation by their intimate partners are presented. Although all three patients presented differently, it is imperative to remember that not all patients present in the same manner, and therefore, bias associated with lack of injury, or presentation with injury, should not deter the treatment provided.

Abstract: In an effort to prevent inpatient violence on forensic psychiatric units, it is necessary to have a feasible and effective measure for nursing to screen for risk of short-term verbal and physical aggression. The Imminent Risk Rating Scale (IRRS; Starzomski & Wilson, 2015) showed promise in an initial validation study. This study aimed to further examine the predictive validity of the IRRS by utilizing clinical pilot data collected from a forensic inpatient unit. Nursing staff scored the IRRS for adults who were hospitalized for at least 1 week ( n = 109), as well as outcomes related to verbal and physical aggression as measured by the Modified Overt Aggression Scale. The results from the clinical pilot data provided additional support for the potential use of the IRRS for predicting physical and verbal aggression in a forensic inpatient setting, although further rigorous empirical research is needed. The findings are important for nursing staff in the prediction and prevention of inpatient violence.

Abstract: National prevalence data indicate that college students are at a high risk for sexual assault, but most institutions of higher education do not provide postassault medical forensic examinations as part of student-facing healthcare services. College sexual assault patients might have access to sexual assault nurse examiners (SANEs) in local hospitals, if they are available where they are attending school, but unfortunately, many student victims do not have options for postassault health services. Creating campus-based SANE programs could address this gap in services and increase access to healthcare. In this article, we describe how we created a free-standing, campus-based SANE program at Michigan State University. We worked with a multidisciplinary community advisory board to identify core guiding principles to inform stakeholder engagement, program location decisions, program policies, training protocols, staffing plans, and collaborative partnerships with other disciplines (e.g., advocacy, law enforcement, prosecution, forensic sciences). We discuss how we navigated opening the program in the midst of the global COVID-19 pandemic and share lessons learned for creating campus-based SANE programs.

Background: Sexual assault is a pervasive problem associated with negative long- and short-term consequences related to mental health consequences, educational function, physical health, and sexual and relationship functioning. People with mental illness, particularly those with psychotic disorders, have a significantly higher risk of becoming victims of violence compared with the general population.

Methods: Three case studies of women with preexisting mental health problems who were sexually assaulted and requested a sexual assault examination are presented. These cases illustrate common mental health problems, how mental health problems can be associated with an increased risk for sexual assault, and things the sexual assault nurse examiner (SANE) should consider in the care and treatment of these patients.

Results: These cases illustrate important ideas regarding the care of people who have been sexually assaulted: prioritizing safety, ethical issues related to consent, the importance of empathetic communication, and the need for SANEs to expand their knowledge to improve care of patients with mental health disorders.

Discussion: Being sexually assaulted can contribute to destabilization, prolongation, and exacerbation of existing mental illness, placing patients at an increased risk for sexual assault, beginning a vicious cycle of mental illness and violence. Working effectively with the interdisciplinary team, the SANE can help break this devastating cycle of violence.

Abstract: Child sexual abuse (CSA) is a pediatric health problem of epidemic proportions. CSA can result in significant lifelong physical and mental health consequences. A disclosure of CSA affects not only the child but also everyone close to the child. Nonoffending caregiver support after a disclosure of CSA is key to optimal victim functioning. Forensic nurses play an integral role in the care of CSA victims and are uniquely positioned to ensure best outcomes for both child victims and their nonoffending caregivers. In this article the concept of nonoffending caregiver support is explored, and = implications for forensic nursing practice delineated.

Abstract: The aim of the study was to explore women's experience of Icelandic prisons and of the interconnectedness of trauma, substance use, and prison. Nine incarcerated women, 20-45 years old, participated in this phenomenological study. One or two in-depth interviews were conducted with each participant, in all 16 interviews. The interconnectedness of trauma, substance use, and prison was evident in the participants' accounts. The participants had experienced severe traumas, in childhood and/or in adult life, most of it caused by recurrent experience of violence, bullying, neglect, and beatings and later violent relationships. For the participants, substance use was an unhelpful coping strategy intended to numb severe emotional distress. Most of the participants used substances intravenously that had progressed incredibly fast from initial drug use. They had tried most of the addiction treatments available to them, none of which were trauma based. Participants struggled with complex physical and mental health problems related to substance use and previous traumas but often felt prejudged when they sought healthcare services. They experienced being in prison as depersonalizing and dehumanizing. Most of them were mothers and had lost custody of their children because of substance use causing some of them deep grief. Participants called for more active substance treatment programs in prisons and complained about idleness that they felt increased their addiction. As a conclusion, we call for a trauma-informed care approach in prisons for women to prevent revictimization as well as to assist with mental health issues and substance use.

Introduction: Emergency department (ED) nurses play a critical role in caring for sexual assault patients, but many have not received training on how to conduct a proper sexual assault forensic medical examination. Live or real-time sexual assault nurse examiner (SANE) consultation provided via telemedicine (known as "teleSANE") during sexual assault examinations is a promising new practice to address this issue.

Purpose: The purpose of this study was to assess ED nurses' perceptions of influences on telemedicine use, as well as the utility and feasibility of teleSANE, and identify potential influences on teleSANE implementation in EDs.

Methods: Guided by the Consolidated Framework for Implementation Research, this developmental evaluation involved semistructured qualitative interviews with 15 ED nurses from 13 EDs.

Results: Interviews revealed facilitators and barriers to current telemedicine use across Consolidated Framework for Implementation Research levels. Facilitators included state-level grant funding and technical assistance. Barriers included clinician discomfort being on video and access to ongoing training. Participants believed teleSANE consultation would improve patient care and forensic evidence collection but had concerns for patient privacy and acceptability. Most participants worked in EDs that have the information technology support and telemedicine equipment needed to support teleSANE implementation, although many requested ongoing education and trainings on teleSANE and sexual assault care to improve clinician confidence and account for high staff turnover.

Discussion: Findings highlight the unique needs of sexual assault survivors receiving telemedicine services in EDs, particularly those in rural communities with heightened privacy concerns and limited access to specialty care.