Journal of forensic nursing最新文献

Background: Commercial sexual exploitation of children (CSEC) is a critical public safety and health concern in the United States. While evidence exists on the healthcare needs of exploited youth, less is known about the barriers they face accessing care. Discrimination in health care is one barrier reported by exploited youth and can include the perception of being treated differently based on perceived intelligence, engagement in commercial sex, or not feeling heard by nurses or doctors.

Aims: To explore asa experienced or are at high risk of CSEC.

Methods: Survey data from a sample of 534 young people aged 13-24 years who experienced or are at risk of CSEC were collected via agency partnership and social media. Ordinary least squares and logistic regression models examined the associations among victimization histories and different perceived discrimination events in healthcare settings. CSEC disclosure is highly associated with discriminatory events in medical settings.

Results: Among evaluated victimization histories, CSEC experiences were the most highly associated with an increase in the odds of each discriminatory event in the present measure, compared to other victimization histories that yielded lower associations of discrimination in medical settings. Experiences of discrimination in health care are an underexamined barrier to CSEC victims seeking and engaging with health care.

Implications: By fostering a supportive, nonjudgmental environment, healthcare providers can improve healthcare experiences for CSEC survivors. Recommendations include enhancing training for healthcare professionals and creating more accessible and supportive healthcare services tailored to the unique needs of these young people.

Aims: This study investigates the risk factors and prevalence of nonfatal strangulation (NFS) within the contexts of intimate partner violence and sexual assault, with a particular focus on the demographic and relational dynamics that influence its occurrence.

Design/methods: A comprehensive literature review was undertaken, encompassing both quantitative and qualitative data from existing research on NFS.

Results: The Extremely High Risk Category Conceptual Model for NFS emerged as an innovative, investigator-developed framework that synthesizes the current literature on factors associated with NFS risk.

Conclusion: Frameworks that integrate current evidence on NFS risk factors, such as the Extremely High Risk Category model, have the potential to inform the practices of healthcare, social services, and law enforcement professionals. By identifying higher risk individuals, these professionals can implement targeted safety planning and support services. There is an urgent need for focused research and intervention strategies to address the complexities of NFS within intimate partner violence and sexual assault contexts. Expanding research to include diverse populations across genders and ages is crucial for the development of comprehensive prevention and support measures.

Abstract: The Runaway Intervention Program (RIP) is a strengths-based, nurse-led home visitation and case management model for runaway youth at risk of sexual exploitation, violence, and mental health challenges. RIP aims to promote healthy development, reduce trauma responses, and lower risk behaviors. This study evaluates the effectiveness of three optional psychological interventions-individual therapy, group therapy, and combined therapy-administered by licensed mental health practitioners. Using archival data from 128 RIP participants enrolled between 2015 and 2019, the study assessed pretreatment and posttreatment posttraumatic stress disorder (PTSD) symptoms using the University of California Post t raumatic Stress Disorder Index.Statistical analysis suggested a reduction in PTSD symptoms from pretreatment ( M = 35.33, SD = 15.29) to posttreatment ( M = 22.91, SD = 16.31), regardless of treatment type. There was no significant difference in symptom reduction between the three treatment modalities, indicating comparable effectiveness across modalities. Across all treatment modalities, clinically significant change analysis showed that 41% of participants recovered, 51% showed no change, 2% improved, and 6% deteriorated. These findings suggest that although RIP interventions effectively reduce PTSD symptoms, no single modality outperformed the others. The results underscore the value of flexible therapeutic options to address the diverse needs of runaway youth.

Introduction: Healthcare professionals play a vital role in the identification and assistance of individuals affected by trafficking who are seen in the healthcare setting. The objective of this project was to analyze a screening tool with newly added questions specifically geared at human trafficking and determine its efficacy in identifying trafficked persons who were seen in the emergency department or who were inpatients.

Methods: This retrospective cohort study occurred at a large Level 1 trauma center located in the Midwest. Nursing staff administered a mandatory Abuse Risk + Human Trafficking tool. A retrospective chart review was conducted. Data from the abuse screen were reviewed from April 1, 2021, to February 28, 2023.

Results: Of all positive screens on the Abuse Risk + Human Trafficking tool, 33% were positive for at least one human trafficking question. Among those with a positive screen on the human trafficking questions, 25 screenings (20 adults, five minors) were associated with patients who had documentation highly concerning for trafficking. There were also 11 screenings with documentation highly concerning for trafficking that did not screen positive on any human trafficking questions and were positive for the non-human-trafficking questions only.

Discussion: The addition of three human trafficking questions to create the Abuse Risk + Human Trafficking tool resulted in an increase in the identification of individuals exploited by human trafficking in this hospital setting when compared with the existing Abuse Risk tool that did not have the additional human trafficking questions.

Abstract: In the southeastern United States, sexual assault nurse examiners, registered nurses, and advanced practice registered nurses partnered with local, state, and federal law enforcement to provide comprehensive medical services to recovered persons of human trafficking. Medical services were provided in conjunction with Homeland Security Investigation's human trafficking recovery operations. Over five operations, 31 trafficked women were recovered and provided trauma-informed, holistic medical care. Medical services provided included pelvic exams, sexually transmitted infection testing and treatment, cancer screenings, pregnancy testing, and contraception. Supportive services such as nourishment, comfort items, and initial counseling sessions were also offered.

Abstract: Commercial sexual exploitation of children (CSEC) is a global public health crisis. CSEC is defined as the use of a child under the age of 18 years in a range of crimes and activities involving the sexual abuse or exploitation of the child for the financial benefit of any person or in exchange for anything of value given or received by any person. CSEC is a problem of epidemic proportions throughout the world including the United States. It is difficult to determine the true number of CSEC victims in the United States. However, the National Center for Missing & Exploited Children states that, in 2021, more than 17,200 reports of child sex trafficking were received from all 50 U.S. states and estimates that of the 25,000 children reported missing, one in six were likely victims of sex trafficking. CSEC can result in significant physical and mental health consequences for victims, even death. Studies indicate that CSEC victims are consumers of healthcare. Up to this point, the focus of healthcare related to CSEC has primarily been upon recognizing red flags that should raise CSEC concerns and the identification of victims. Although victim identification is critical, it is time for forensic nurses to understand their role in the prevention of CSEC. This narrative review will discuss the prevention of CSEC using a multitiered healthcare approach.

Background: Recruiting, preparing, and retaining sexual assault nurse examiners (SANEs), particularly in rural and isolated areas, is increasingly difficult because of widespread emotional exhaustion and burnout among nurses. We describe our academic-clinical partnered development and initial outcomes from the ReImagine Clinical Residency. The residency is part of the larger Re LAB workforce program to support competency development and confidence building among current and future SANEs with limited experience.

Methods: SANEs were screened and enrolled in the residency for 1-2 weeks, participating in patient encounters at hospitals in the Minneapolis-St. Paul metropolitan area. Preresidency and postresidency surveys were completed, including our SANE Practice Innovation Configuration Evaluation tool. Descriptive statistical and thematic analyses were conducted.

Results: Eleven SANEs completed the ReImagine Clinical Residency; most were early-career nurses working in healthcare provider shortage areas in the United States. Statistically significant pre-post improvements were observed in five of the six SANE Practice Innovation Configuration Evaluation components. Residents described valuing the hands-on experience, diverse clinical environments, and preceptor support.

Conclusion: Residency programs are essential for addressing the specific professional development needs of novice SANEs and those with limited patient encounters in their current practice settings. By providing structured, precepted experiences, these residencies can contribute to workforce retention and ultimately strengthen patient care for victim-survivors of sexual violence.

Introduction: The relationship between sexual violence victimization (SVV) and suicidal thoughts and behaviors (STBs) has been established. However, when applied to LGBTQ+ (i.e., lesbian, gay, bisexual, transgender, and queer) populations, the impact of SVV on the severity of STBs experienced requires further exploration. Suicide is a major public health problem, with youth aged 10-24 years accounting for 14% of all suicides seen in the United States. The association between SVV, STBs, and other psychopathologies, such as anxiety and depression, is stronger in sexual minorities (LGBQT+) than in the heterosexual population. A cross-sectional secondary analysis of the 2021 Youth Risk Behavior Survey (YRBS) was completed to investigate the association between SVV and STBs in LGBTQ+ youth populations when compared with their heterosexual peers and to determine if sexual orientation is a potential moderator in this relationship.

Methods: Sexual orientation, questions related to STBs, and sexual assault/rape and intimate partner violence experiences were extracted from the 2021 YRBS. Binary logistic regression considering the complex sample survey design of the YRBS was utilized to assess associations of SVV with STBs while controlling for sexual orientation.

Results: Sexual minority youth exhibit higher odds of both experiencing SVV and exhibiting STBs compared with their heterosexual peers. Some aspects of STBs in the presence of SVV are moderated by sexual orientation.

Conclusion: Further investigation is needed into this association in LGBTQ+ youth populations who have experienced sexual violence to better understand this relationship.

Background: Human trafficking and sexual exploitation are pervasive issues in society. Forensic nurse examiners are skilled at identifying and assisting victims of trafficking and exploitation, who frequently seek healthcare. However, forensic nurse examiners often lack specialized training for trafficking cases, unlike their training for sexual assault, and may hold biases regarding a trafficking victim's appearance, complicating their response.

Aim: To bridge this knowledge gap, a Human Trafficking/Sexual Exploitation (HT/SE) Skills Lab was created and piloted by a multistate forensic nurse education program in a Midwest metropolitan area.

Methods: A survivor-centered approach was employed by collaborating with a human trafficking advocacy agency and a youth survivor panel to design curriculum, review scenarios, and co-instruct the lab. The lab used a combination of didactic and hands-on training to address gaps in both knowledge and skill.

Results: Nearly all participants reported an increase in knowledge, and over half showed skill improvement. Self-assessments showed 25% of learners progressed from "advanced beginner" to "competent" in handling trafficking cases. Facilitators rated learners' competence, with most participants showing advancement.

Conclusions: The pilot lab's success indicates that this HT/SE Clinical Skills Lab can be replicated across healthcare disciplines, potentially improving responses to HT/SE survivors beyond sexual assault contexts, but more practice is needed to reach true competence.

Background: Interpersonal violence (IV) is a global pandemic. Geographic borders represent unique spaces that are often shaped by cultural clashes, economic inequality, and jurisdictional complexities. Given the intricate social dynamics along the U.S.-Mexico border, this region provides a compelling yet understudied setting to advance research on the geographic dimensions of IV. However, communities situated alongside the U.S.-Mexico border are noticeably absent from this body of research, which is problematic as these regions often face unique social and structural challenges.

Method: This retrospective study examined the spatial distribution of a subset of zip code data that represented IV incidences between 2017 and 2022 in the El Paso, Texas region. The source of the IV data was medical records of patients that were seen by sexual assault nurse examiners for IV-related injuries at a Level 1 trauma center.

Results: The retrospective study included 384 IV incidents. In terms of IV survivors' characteristics, the mean age of trauma survivors was 26 years (SD = 14 years), with the majority in the 25- to 59-year age range (39.4%). Most of the survivors were identified as Hispanic, Latino, or Spanish (78.2%). The findings illustrate the uneven spatial distribution of IV incidence rates in El Paso, emphasizing the presence of high-risk zones within the inner city.

Conclusion: This study examined the spatial distribution and characteristics of IV incidents in the El Paso region. The combination of spatial analysis, hotspot identification, and establishment overlay mapping offers a holistic perspective on the spatial dynamics of IV. The identification of hotspots and exploration of regions with high IV occurrence contribute to actionable insights for the development and implementation of targeted interventions. By understanding IV occurrence within the community, forensic nurses can target trauma survivor prevention efforts and integrate education and resources for nurses caring for survivors in emergency situations. In addition, forensic nurses become proactive agents of change, tackling IV at its source with targeted recognition, response, and safety protocols.