Journal of forensic nursing最新文献

Background: Sexual assault medical forensic exam-ready facilities with access to sexual assault nurse examiners (SANEs) are concentrated in urban areas. Telehealth SANE (TeleSANE) is a strategy to increase access to care in rural areas.

Aim: To assess nurses' positive attitudes, confidence, and intention to share information about and encourage use of the Texas Teleforensic Remote Assistance Center (Tex-TRAC) services.

Methods: Seventy-four nurses participated in Tex-TRAC trainings, where pretests and posttests examined changes in attitudes, confidence, and intention to share information/encourage use of the Tex-TRAC telehealth platform. Paired preassessments/postassessments and logistic regression to predict odds of nurses' intent to share/encourage use of Tex-TRAC were analyzed.

Results: Improvement in pretest to posttest mean scores of nurses' positive attitudes toward the Tex-TRAC telehealth platform (3.62-3.83), Tex-TRAC technology (4.72- 5.81), confidence (2.32-7.41), and likelihood to share information/encourage use of Tex-TRAC program (1.84-1.96) were seen (all ps <.001).

Discussion: The findings suggest that targeted training on the SANE telehealth platform increases positive attitudes toward its use, which is critical to sustaining access.

Background: Rural sexual assault survivors face barriers to accessing trauma-informed care (TIC), including shortages of sexual assault nurse examiners (SANEs) and limited resources, leading to retraumatization and poorer outcomes.

Aim: To improve TIC knowledge among SANE-competent nurses in a rural Midwestern emergency department and assess effects on advocacy service use.

Methods: A quasi-experimental, mixed-methods design that included 12 SANE-competent nurses who completed the Attitudes Related to Trauma-Informed Care-10 Scale (ARTIC-10) pre/post and a 16-minute TIC and advocacy video.

Results: ARTIC-10 scores increased significantly, indicating improvement in TIC attitudes and competencies. Qualitative findings showed greater empathy, empowerment, and communication. Advocacy center calls doubled post-intervention.

Discussion: Brief, targeted TIC training show promise to improve competencies and advocacy utilization. A concise microlearning module can strengthen TIC and advocacy collaboration among rural SANE-competent nurses, offering a scalable model for underserved communities.

Aim: To assess jurisdictional policies specifying: (a) which health care professionals are authorized to perform postsexual assault medical forensic exams (MFE); (b) whether specialty training is required; (c) restrictions on patient transfer when lacking sexual assault nurse examiner (SANE) or specialized response; and (d) whether telehealth to increase access is addressed.

Methods: Reviewers conducted a systematic search of regulatory language related to MFEs across all U.S. jurisdictions between August 2023 and October 2024.

Results: Nearly half (45%) of U.S. jurisdictions do not legislate or regulate the type of provider who may perform a MFE. Of those that do, only eight (14%) identify SANE among authorized providers.

Conclusions: This policy review reveals inconsistencies across U.S. jurisdictions regarding provider authorization, training requirements, and access to MFEs. Without regulation, survivors face inequitable access to care nationwide, underscoring the need for strengthened state-level policies that standardize access and establish funding for consistent care standards.

Background: Despite the widespread adoption of established and emerging forensic training and education modalities, there is limited evidence supporting effective ways in which to systematically evaluate their adoption into forensic nursing practice. To address this, our team developed the Sexual Assault Nurse Examiner (SANE) Practice Integrated Competency Evaluation (SPICE) as an innovative tool to support self-reflection, goal setting, and an evaluation of role development.

Aim: To establish expert consensus on the content and capacity of SPICE to evaluate role development across essential forensic nurse competencies, responsibilities, and clinical practice expectations.

Method: We utilized a modified Delphi method to establish expert consensus.

Results: We engaged forensic experts in multiple rounds of review. A deductive, rapid thematic analysis synthesized qualitative discussion. Survey-based results were summarized descriptively.

Discussion: The expert consensus approach we describe here highlights the potential and promising utility of SPICE to evaluate, guide, and enhance SANE role performance and ongoing professional development.

Background: Sexual assault (SA) nurse examiners conduct SA medical forensic examinations (SAMFEs), addressing pain assessment, documentation, and treatment. Limited research exists on patients' pain and related nursing interventions during SAMFEs.

Aim: To evaluate patients' reported pain levels, locations, treatments, and implications for forensic nursing practice.

Methods: Retrospective chart review (2017-2022) of 5,052 SAMFEs from five Mountain West sites included patients aged 14+, with unrestricted SA kit collection. Descriptive and logistic regression analyses identified predictors of pain reports and treatments.

Results: Pain was reported by 63.1% of patients (mean score: 6/10). Common pain locations were anogenital (41%), abdomen/pelvis (28%), and head (26%). Age, gender, race, injuries, and assailant actions predicted pain reports. Despite documented pain (>4/10), 55.4% received no treatment. Predictors of treatment included age, injury severity, and SAMFE site.

Discussion: SA nurse examiners should conduct thorough pain assessment, documentation, treatment, and reevaluation to improve patient outcomes.

Background: Sexual misconduct by health care clinicians is a type of sexual abuse with significant consequences for patients, although there is limited literature examining the experience of male survivors.

Aim: To examine the effects of sexual misconduct experienced by male patients during young adulthood by the same healthcare clinician.

Methods: Using BERTopic modeling, a machine learning-based topic modeling method, we analyzed the narratives from records in a class-action lawsuit involving men aged 18-22 at the time of the abuse, who provided narratives years later that included reflections on their experiences over time.

Results: Three themes were described by the men: "Violation of Trust in Clinical Settings," "Breaking Silence Through Public Disclosure," and "Long-term Psychological and Relational Consequences."

Conclusion: There is an enduring psychological impact of clinician sexual misconduct on male survivors, and a subsequent need for trauma-informed, gender-sensitive forensic nursing care in every patient encounter.

Background: There is a nationwide shortage of sexual assault nurse examiners (SANEs), particularly in rural areas, which is exacerbated by a lack of infrastructure to support newly trained SANEs in gaining practice experience.

Aim: To explore the experiences of newly trained SANEs attempting to complete practice hours.

Methods: Semi-structured interviews were conducted with 29 nurses who had completed an HRSA-funded education program in a Midwestern state.

Findings: SANEs identified difficulties fitting practice hours into their personal lives and navigating the logistics of coordinating practice experiences. Facilitators for practice experience were employer support, nonclinical activities, and post-training mentorship. Some participants benefited from a toolkit resource; however, the resource was less helpful for SANEs from rural areas.

Conclusions: SANE education programs that elicit support from nurses' employers and create an infrastructure for sustained, personalized post-training mentorship may yield greater successes in supporting these nurses through certification and improving access to forensic nursing care.

Background: Exposure to stories of sexual violence can lead to secondary traumatic stress (STS) or the occurrence of posttraumatic stress symptoms in forensic nurses and other professionals.

Aims: To investigate the prevalence of STS among Dutch nurses and other professionals involved in the treatment of individuals convicted of sex offenses, and the predictive impact of coping styles and social support on STS levels.

Method: Using a cross-sectional survey design, we collected data from 37 nurses and 66 other practitioners.

Results: Our findings indicate a low prevalence of STS symptoms among the participants. Avoidant and active coping were associated with STS, but social support was not.

Conclusion: The relationship between social support and STS may be more complex than previously thought and warrants further research. Targeted interventions are needed to support the development of effective coping mechanisms that have the potential to mitigate the impact of STS.

Background: Adolescent violence in emergency departments (EDs) is a serious problem.

Aim: To examine outcomes of a violence reduction intervention among adolescents seen in EDs.

Methods: Aggressive Behavior Risk Assessment Tool for Emergency Departments was used to identify patients at high risk. Following a baseline period, a Phase 1 intervention of signage posting and a Phase 2 intervention of additional behavioral emergency response team huddles were implemented. A subset analysis of adolescents aged 10-18 years was performed.

Results: Among 8,658 adolescents, 156 had ≥1 violent event (1.80%). The violence rate during Phase 1 showed a 34% reduction compared with the baseline (p=0.035); no significant reduction was observed in Phase 2 compared with Phase 1.

Conclusion: Signage posting appears to be an effective strategy contributing to reducing violent events among adolescents visiting EDs. The use of a validated screening tool to identify high-risk adolescents facilitated targeted preventive intervention efforts.