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.

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.

Abstract: The commercial sexual exploitation (CSE) of children occurs when individuals under the age of 18 years exchange sex/sexual acts for goods, services, drugs, or money. Current research suggests that many survivors of CSE had contact with a variety of professionals during their victimization experiences; however, many child CSE survivors are wary of those working with them in professional roles, including those seeking to engage them in regular care. The current study used qualitative interviews with professionals working with children who have experienced CSE to explore their strategies for facilitating trust. Qualitative data were collected from 80 diverse professionals from 11 different cities across the United States. Grounded theory analysis revealed three main themes regarding the facilitation of trust building: (a) clear communication, (b) humanization of experience, and (c) boundaries/limits. Findings from the current study offer practical implications for professionals, such as nurses, who are interested in facilitating rapport with children who have experienced CSE victimization in the interest of primary and tertiary prevention. Future research should focus on survivor perspectives to explore how professional's approaches are experienced by the populations they purport to serve.

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: Changes to New Zealand's Oranga Tamariki Act in 2019, saw 17-year-olds moved from adult to youth jurisdiction. This study described mental distress experienced by 17-year-olds appearing in Youth Court compared to their high school peers.

Methods: Seventeen-year-olds in the youth justice (YJ) system between 2019 and 2021 were compared to 17-year-olds in the Youth19 survey (Y19) by demographic characteristics, types, and prevalence of mental distress.

Results: YJ 17-year-olds experienced greater exposure to family violence, parental separation, and child protection compared to their Y19 peers. Depressive symptoms (OR 10.5, p < 0.0001), suicidality (OR 7.8, p < 0.0001), and cannabis use (OR 3.2, p < 0.001) were significantly more common when compared to Y19, with Māori males disproportionately affected.

Conclusions: Seventeen-year-olds in YJ experience elevated levels of poverty, trauma, and mental health distress. Criminalizing trauma and mental distress is preventable. Forensic clinicians must facilitate evidence-based culturally safe mental health and addiction rehabilitation as part of a crime prevention strategy.

Aims: To synthesize healthcare experiences of victims of sex trafficking, identify common challenges, and inform improvements for healthcare.

Methods: Using Arksey and O'Malley's framework and the PRISMA-ScR checklist, we reviewed CINAHL, Embase, and PubMed databases for studies published between 2010 and 2024 involving interviews with trafficked individuals and were categorized for thematic synthesis.

Results: Of 155 articles, 16 met inclusion criteria, and involved 669 people who had experienced trafficking. Participants across studies identified reasons for and barriers to seeking healthcare, and their perceptions and recommendations about clinicians' attitudes, law enforcement, and recognizing trafficking. Participants emphasized the need for better clinician training, stronger policies, greater patient autonomy, and a more supportive clinical environment.

Conclusions: Gaps persist in healthcare for trafficked individuals. Collaboration among healthcare workers, especially forensic nurses, is essential, along with enhancing trauma-informed interventions and closing gaps in quality care.

Background: Nurse care coordination for children and adolescents experiencing acute sexual assault is rarely done but could yield positive outcomes. Demonstrating the value of forensic nurse care coordination (RNCC) is challenging: No benchmarks or metrics existed to measure the impact of RNCC on patient care or outcomes. Hours could be tracked, contact attempts could be tallied, but evaluating the value and outcomes of a forensic RNCC was lacking.

Methods: Using quality improvement (QI) methodology, we identified measures to quantify the impact of care coordination by a forensic nurse for pediatric and adolescent patients who had experienced acute sexual assault. Measures included attending follow-up clinic, obtaining follow-up labs at 6 weeks and 3 months post-assault, and patient concordance with an established clinical care follow-up pathway. We implemented the forensic RNCC between October 2022 and June 2023, with pre- and post-QI intervention chart review to establish baseline and post-QI outcome measures.

Results: The forensic RNCC role was successfully implemented. All measures demonstrated improvement from pre- to post-intervention. Clinic follow-up increased from 70% to 98% of patients. Patients obtaining screening labs 6 weeks post-assault increased from 53% pre-intervention to 92% post-intervention. The pathway recommends patients obtain labs 3 months post-assault as well, and we saw an increase from 67% to 89% of the post-intervention group obtaining labs at 3 months. Overall concordance to the system's evidence-based clinical care pathway increased from 45% to 83% of the post-intervention group.

Conclusions: This QI initiative achieved measurable improvement in patient care and outcomes by leveraging the expertise of a forensic RNCC.

Introduction: Hypermasculine prison culture produces hierarchies based on individuals' ability to assert dominance through strength and violence. Pain can impact physical strength, thereby limiting the ability to elevate or maintain social status within such hierarchies.

Aim: The aim of the study was to explore the pain experiences of incarcerated men who were embedded into hypermasculine prison culture.

Methods: Interpretive description co-positioned with relational ethics informed the study design. Twelve males participated in 1-hour interviews, which were transcribed verbatim and analyzed inductively to identify themes. The data analysis occurred in three phases: sorting and organizing, making sense of patterns, and transforming patterns into findings.

Results: We found that correctional settings were characterized by a social culture of toxic hypermasculinity that influenced the pain experiences of people who were incarcerated. Individuals who experienced pain were more vulnerable to self-isolation in situations in which pain threatened their ability to defend themselves and their previously established social status within the prison hierarchy. Yet, those who felt secure in subordinate hierarchical positions and had effective peer relationships perceived greater safety in communal settings, which proved to be a distraction from pain.

Conclusion: In the context of incarceration, positive peer relationships and perceptions of safety positively influenced individuals' experience of pain.