Journal of forensic nursing最新文献

Background: In 2019, over 459,000 persons in the United States survived sexual assault, and 21%-26% sought medical treatment. Ideally, trained medical professionals who understand the unique physical and mental health needs of this patient population, such as forensic nurses, would provide care. Yet, the care that forensic nurses and other healthcare providers can offer to sexual violence/abuse survivors is hindered by the lack of understanding of the demographics of those who seek care. With the delineation of highly affected demographic groups, barriers to care can be addressed.

Purpose: This study compared rates, demographic characteristics, acuity, and codes for sexual violence/abuse encounters experienced by those patients residing in rural versus urban counties of Kentucky (KY). This included encounters before and after SARS-CoV-2.

Methods: Deidentified claims data were extracted for patient encounters billed with the International Classification of Diseases, 10th Revision, Clinical Modification for sexual violence/abuse seen at a university healthcare center serving the Northeastern, Southeastern, and Central regions of KY from October 2015 to February 2021. Analysis comprised descriptive statistics, independent samples t tests, and chi-square tests of association.

Results: Significant demographic differences were identified between the two groups. The mean age of those residing in rural areas was significantly younger than those living in urban areas. Similarly, the percentage of male survivors was significantly higher in the rural population. The racial composition also differed, with higher percentages of survivors being Black and Hispanic in the urban population, relative to rural dwellers.

Conclusion: Findings suggest that rural youth (especially boys aged 10 years and younger) and urban minorities are at a higher risk for sexual violence/abuse in KY when compared with their counterparts (i.e., urban youth and rural minorities).

Background: The United States makes up 4.4% of the world's population but nearly a quarter of the world's incarcerated population. Despite caring for nearly 2 million incarcerated persons and managing their unique needs, little is known about how this work spills over and affects the nurses who work in correctional settings.

Study objective: This descriptive study aimed to (a) examine write-in answers regarding correctional nurse perceptions of how their work impacts their health and their home lives and (b) explore correctional nurse responses for how to improve the work environment to better support their well-being.

Method: The researchers compiled and analyzed qualitative data from a cross-sectional study where U.S. correctional nurses ( N = 270) completed an online survey. Manifest content analysis was used to analyze optional write-in data.

Results: Approximately 41% ( n = 111) of participants answered qualitative questions. Participants were primarily White (77.3%) and non-Hispanic or Latino (88.7%), working in prisons (65.8%), and employed by the state (63.8%) as registered nurses (70%). Three major themes emerged: (a) "personal impact": increased stress and burnout, overwhelming work hours, and emotional and physical effects; (b) "social relationships and family impacts": withdrawn, strained homelife, and uncertainty; and (c) "need for change": improved staffing, reduced mandatory overtime, and better support from management.

Conclusions: Correctional organizations may consider ways to support the well-being of their nurses through adequate staffing, flexible scheduling, decreased mandatory overtime, and hiring effective nurse managers as key members of the correctional team.

Abstract: When trafficked patients are identified in the healthcare setting, clinical forensic examiners, including sexual assault nurse examiners (SANEs), may be consulted to provide medical care and to collect forensic evidence. However, using a standard sexual assault protocol and documentation form may not completely identify or address the unique needs of these patients. Our SANE program sought to improve the healthcare approach to trafficked patients by developing a trafficking-specific documentation flowsheet. The goal of this quality improvement project was to guide a clinical forensic examiner through a comprehensive examination while addressing specific patient needs and optimizing trauma-informed service delivery. We gathered several local multidisciplinary human trafficking specialists together to provide expert recommendations and feedback during the creation process. Both paper and electronic forms of the flowsheet were designed. SANEs completed the flowsheet on 22 patient encounters and filled out a utilization review survey describing their experience. Feedback data collected through the utilization review process guided further modifications to the flowsheet, which were then implemented into clinical practice guidelines. We found that engaging multidisciplinary specialists and community partners both enhanced the effectiveness of the flowsheet and supported the learning needs of our SANEs. We recommend that clinical forensic programs that wish to develop a similar flowsheet collaborate with local professional agencies to meet the unique needs of the populations within their catchment area and use examiner feedback to maximize the usefulness of the flowsheet.

Background: Sexual violence by an intimate partner or by a stranger remains highly prevalent in the United States. Yet, the use of post-sexual-assault health care is still underutilized. Persons in vulnerable populations such as immigrants, LGBTQIA+, and Black women may experience additional barriers to care.

Objective: We sought to determine the extant research in this area, the methodologies used, and whether specific barriers exist for seeking sexual assault services. We sought to understand if barriers differed for vulnerable populations.

Inclusion criteria: Peer-reviewed literature published before September 2023, written in English, conducted in the United States, and that included survivors of sexual violence and explored barriers to seeking care postassault (i.e., sexual assault nurse examiners) were included in the review.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews protocols were followed. PubMed, Scopus, CINAHL, PsycINFO, and PTSDpubs databases were used to identify literature that met the inclusion criteria, from which we selected 14 publications.

Results: Much of the literature employed qualitative or mixed methods designs. Several studies focused on underserved minority groups, including immigrant women, Black women, and homeless youth. Common barriers existed on the intrapersonal, interpersonal, organizational, community, and societal levels.

Conclusion: The literature provided substantive context for the multilevel barriers, all contributing to survivors remaining silent rather than seeking much-needed help. Although there is a need for additional research on barriers to sexual assault services specifically, the extant research supports strengthening multilevel, alternative approaches to deliver much-needed services.

Purpose: This study aimed to identify the factors influencing the personal recovery of inpatients of a forensic psychiatric hospital.

Methods: A descriptive study design was assigned. The participants were 136 inpatients in a forensic psychiatric hospital in South Korea. The data were analyzed using SPSS Statistics Version 26.0 with descriptive statistics, independent t test, analysis of variance, Pearson correlation coefficient, and multiple regression.

Results: Perceived physical health status (β = 0.16, p = 0.034), perceived mental health status (β = 0.20, p = 0.023), perceived family support (β = 0.17, p = 0.013), duration of hospitalization (β = 0.25, p < 0.001), and recovery attitudes (β = 0.36, p < 0.001) were the significant factors explaining 42.6% of the variance in the personal recovery of participants.

Conclusion: The findings of this study indicate that recovery attitudes, health status, and personal support affect forensic mental health personal recovery. Personal recovery can be strengthened through nursing intervention and support to strengthen recovery attitudes and health status. It is necessary to get used to personal recovery through long-term and systematic education, and organizations and nurses need to make efforts to provide services centered on personal recovery.

Background: Sexual violence is a profoundly disempowering experience. It is essential that survivors are offered access to comprehensive medical care, psychological support, and follow-up in a way that offers them a high level of choice and control.

Aims: There has been little research into how practitioners working in the context of immediate postassault understand empowerment and reflect this in their care delivery. This study sought to explore how crisis support workers and forensic nurse examiners conceive how they enact an "empowerment approach" in a sexual assault referral center (SARC) in the United Kingdom.

Methods: A phenomenological approach was taken, and data were gathered through focus groups and interviews.

Findings: Themes were identified under the headings of "indicators of empowerment," "empowerment as a process," and "the empowerment approach."

Conclusion: As part of providing person-centered care that enacts an empowering approach within the SARC setting, professionals need the skills and resources to be able to respond flexibly to their clients. They have a role in addressing victim blaming of those subjected to sexual violence and in promoting the accessibility of SARC services.

Background: The dual task for forensic mental health care is community protection and treatment of mental disorders. The Short-Term Assessment of Risk and Treatability (START) has become an established tool for risk assessment and care planning in forensic psychiatry. When using the START, items judged as critical factors are chosen to be addressed in the care plan. However, it is not known which critical factors that are of special interest need to be addressed to reduce the risk for future violence.

Aims: The main aim of this study was to explore how staff's choice of critical factors in the care planning influences risk for future violence.

Methods: The study is based on 787 START assessments from 285 convicted and involuntary admitted inpatients at the Forensic Psychiatric Clinic of Stockholm County, Sweden. The influence on risk for future violence by selecting a certain item as a critical factor in the care plan was measured by comparing patients' sum of vulnerabilities at the time this certain critical factor was selected with this sum at the next assessment.

Results: The results show that a patient's overall risk for future violence decreases significantly when the items "insight," "attitudes," "mental state," "coping," and "drug use" were addressed as critical factors in the care planning. The importance of specified critical factors differs between diagnostic groups and time after admission.

Conclusions: When staff select certain specified items as critical factors in the care planning, the patients' risk of relapse into acts of violence was significantly reduced.

Background: Individuals experiencing pain while incarcerated depend on nurses, security structures, processes, and regulations for relief.

Purpose: The intent of this research was to understand men's experience of pain during incarceration to inform correctional nursing practice.

Method: Interpretive description, co-positioned with relational ethics, guided this study. Twelve incarcerated men participated in a single 1-hour interview that was audio-recorded and transcribed. The resultant text was analyzed for themes.

Findings: The two main themes were dependence on staff and institutional processes and dependence on oneself and others who were incarcerated. Participants reported a substantial loss in their ability to access pain-relieving medications, products, and services. Unresponsive or delayed pain-relieving interventions from nurses contributed to their sense of indignity, disrespect, and injustice. The participants employed whatever was available, mainly exercise equipment and social support, to manage their pain.

Discussion: Nurses must engage with incarcerated patients meaningfully to understand and respond to contextual factors that influence their pain experiences. Participants identified loss of autonomy and dependence on nurses as barriers to their pain relief.

Conclusion: Nurse engagement and responsiveness are crucial to altering incarcerated men's perceptions of injustice or helplessness while improving their pain experiences. Nurses must also foster autonomous pain-management approaches that men can use without limitations within correctional settings.

Abstract: Problematic sexual behavior (PSB) in children and adolescents is a significant public health problem. PSB is defined as harmful or developmentally inappropriate behaviors involving sexual organs or regions of the body exhibited by children or adolescents. PSB may be harmful to self or others or be abusive toward another child, adolescent, or adult. Adolescents, typically defined as children 12 years old or older, engaging in PSB can be vulnerable to formal court adjudication as their behaviors may be considered a sexual offense. PSB can result in significant negative consequences for all children and adolescents involved as well as their families. This article will describe sexual behavior in children, normative and problematic, and explore implications for forensic nursing practice.