Journal of forensic nursing最新文献

Background: Child maltreatment is a significant global health concern with significant morbidity and mortality. Sexual assault forensic examiners (SAFEs) provide a valuable skill set and may be utilized in child maltreatment evaluations.

Aim: The purpose of the study was to describe patient characteristics and trends after implementation of a hospital-wide standardized child maltreatment protocol including forensic examiners in child maltreatment cases.

Methods: Data from January 2017 through December 2022 were retrospectively collected and reviewed on all children under 18 years old who had a child maltreatment evaluation after initiation of a standardized child maltreatment screening process and protocol incorporating SAFE forensic evaluations at a tertiary care Level 1 trauma center.

Results: From January 2017 through December 2022, there were 764 child maltreatment evaluations of 742 total patients completed, with 763 (99.9%) evaluations completed by a trained SAFE. There were 378 examinations (49%) completed in children under 2 years old, 281 (37%) in children 2 years old until the 10th birthday, and the remaining 105 (14%) in children 10 years and older. The overall number of cases increased since the initiation of standardized screening and protocol from 68 cases in 2017 to 158 cases in 2022, with peak of 167 cases in 2020.

Conclusion: SAFE-trained providers can be successfully incorporated in the multidisciplinary evaluation of child maltreatment patients and can add invaluable education, forensic documentation, and standardization of practice in the care of this vulnerable population.

Background: Implementation of trauma-informed care (TIC) into forensic clinical practice may contribute to positive outcomes for both patients and staff.

Aim: The current study aimed to describe forensic mental health nurses' perceptions and experiences of using TIC within a high-secure forensic hospital.

Method: Twenty-seven forensic mental health nurses were interviewed regarding their experiences of using TIC within a high-secure hospital.

Results: Participants recognized the importance of understanding the past traumatic experiences of patients in their care but described a number of barriers to the implementation of TIC. A lack of organizational support, the negative impact of patient psychopathology on nurse well-being, and environmental factors were all perceived to negatively impact the successful delivery of TIC. Participants also discussed a widespread lack of knowledge and confidence in the application of TIC but expressed great desire for training to improve service delivery.

Implications for clinical forensic nursing practice: The application of TIC into daily clinical practice appears to be suboptimal. To support nurse and patient well-being and contribute to a highly skilled trauma-informed workforce, further training in this area is vital.

Conclusion: Training in TIC may contribute to enhanced patient outcomes and promote nurse well-being and should be supported organizationally with sufficient resources.

Background: Emergency department (ED) encounters are often the only healthcare provider encounter for patients seeking care after a reported sexual assault (SA), making the encounter a crucial opportunity to connect patients to support services in the community. An opportunity existed at an urban Level II trauma center to standardize SA discharge planning.

Aims: This quality improvement project aimed to improve access to SA support services.

Methods: The Model for Improvement guided two plan-do-study-act (PDSA) cycles. Implementation included (a) creation of a QR-code-accessible SA resource website, (b) ED standardized patient print and electronic medical record after-visit summaries with follow-up guidelines and the QR code, (c) ED staff education, and (d) a community stakeholder survey to assess facilitators and barriers to support services.

Results: During the first PDSA cycle, 19 reported SA survivors were seen in the ED (18 adult, one pediatric) and 14 SA resource website visits. During the second PDSA cycle, 13 reported SA survivors (10 adult, three pediatric) were seen in the ED and 29 website visits. Stakeholder survey data revealed barriers to support services were transportation, overloaded support services, and survivor knowledge of existing services.

Conclusion: The QR code intervention model is a discrete method of improving access to resources and is applicable to other vulnerable populations. The multiagency SA response team will utilize partner survey data to improve access to community resources such as housing and transportation.

Background: Compared with the general population, prison inmates show a higher prevalence of mental disorders, particularly among those with childhood traumas. Despite childhood traumas being robust indicators of poor mental health, there is limited research on their relationship with prisoners' attitudes toward seeking psychological help. This study investigates the impact of childhood traumas on prisoners' attitudes toward help-seeking and self-stigmatization.

Methods: This cross-sectional, explanatory study was conducted with 250 persons in prison. Data were collected using a sociodemographic information form, the Childhood Trauma Questionnaire, the Attitudes Toward Seeking Psychological Help Scale, and the Self-Stigma of Seeking Help Scale. Statistical analysis was performed using Spearman correlation test and multiple linear regression analysis with SPSS Version 28.

Results: A significant link was found between childhood traumas and self-stigmatization in seeking psychological help. Positive attitudes toward help-seeking were significantly associated with increased self-stigmatization. Childhood traumas were significantly related to single-parent families, conflicted intrafamilial relationships, entering prison at the age of 19 years or older, mental health issues, and behavioral disorders. Moreover, a meaningful association was observed between self-stigmatization in help-seeking and being from a single-parent family with a low socioeconomic status.

Conclusion: In conclusion, imprisoned persons with childhood traumas exhibit higher levels of self-stigmatization in seeking psychological help, contributing to negative attitudes. Recommendations for adequate access to mental health services in prisons include fostering a culture of psychological help, enhancing mental health literacy, providing trauma-informed care, and developing comprehensive strategies. In addition, the suggestion is made for the development of societal reintegration programs.

Introduction: Sexual assault nurse examiners (SANEs) provide specialized medical forensic care to survivors of sexual assault, often working in stressful conditions, with routine exposure to the traumatic experiences of their patients. SANEs experience high levels of both vicarious trauma and burnout.

Purpose: The purpose of this article was to describe the development of a SANE support application, accessible to all SANEs, that utilizes self-care and positive coping strategies to enhance SANE resilience and thereby reduce burnout.

Methods: The conceptual framework for the SANE support application was psychological first aid, an evidence-informed, manualized intervention to assist individuals in the immediate aftermath of exposure to potentially traumatic events. Focus groups with SANEs informed the content of the application named "SANE Well."

Result: SANE Well delivers these helpful coping elements within an easy-to-use, mobile platform, at no cost. User testing during two SANE clinical skills laboratory trainings revealed the app had smooth and efficient functionality and meets its intended goals without unnecessary complexities.

Conclusion: There is an urgent need for SANEs to protect their well-being while they care for individuals who have experienced sexual assault. The SANE Well application offers a novel way to provide and encourage positive coping strategies for nurses to reduce burnout.

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.