Journal of forensic nursing最新文献

Background: Feelings of shame after interpersonal assault directly impact survivor well-being. Although the concept of trauma-related shame has been well defined and applied in psychology, the direct application to nursing care for victims of sexual assault is unclear.

Objective: The aim of this study was to perform an interdisciplinary concept analysis to clarify and synthesize the concept of trauma-related shame as it relates to interpersonal assault.

Method: A multidisciplinary literature search was conducted using the term "trauma-related shame." Article titles and abstracts were reviewed for significance to interpersonal assault. Rodgers' evolutionary method of concept analysis was used to identify attributes and related concepts and also clarify the contextual basis of trauma-related shame.

Results: The search resulted in 150 articles, 15 of which met the specified inclusion criteria. Fourteen of the selected articles were research studies, and one was a systematic review. A thematic analysis was used, and two attributes were identified: self-devaluation and self-isolation. An experience of trauma, fear, multivictimization, preexisting shame, low self-esteem, stigmatized events, and negative reactions from others were identified as antecedents. Finally, when reviewing for consequences, anxiety, depression, posttraumatic stress disorder, acute stress disorder, distress, poor health outcomes, social withdrawal, and suicidal tendencies were identified as common themes.

Conclusion: This concept analysis is a first step in the further development and implementation of trauma-related shame in nursing. It will be vital to the provision of holistic care for the profession to conduct research and publish literature related to shame for survivors of interpersonal traumatic events.

Background: The implementation of the recovery model into forensic mental health care promotes hope and has important implications for inpatients' community reintegration.

Aim: This study aimed to describe forensic mental health nurses' perceptions and experiences of providing care using the recovery model within a high-secure forensic hospital in Queensland, Australia.

Methods: Twenty-seven forensic mental health nurses were interviewed regarding their perceptions and experiences of providing recovery-oriented care within a high-secure forensic hospital.

Results: The participants described an individualized approach to recovery, both in the goals developed and in the level of support they required. There was an overarching shared goal across the participant group, which was focused on supporting patients to reintegrate back into the community. Inadequate resources (both internal and external), the severity of patient psychopathology, legal constraints, and the nursing role within the broader treating team were all perceived to present challenges to utilizing the recovery model within a high-secure forensic hospital.

Implications for clinical forensic nursing practice: To fully realize the potential of the recovery model, a system-wide reconceptualization is necessary.

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: Although hotly disputed, coercive measures are widely used in mental health services globally. In Denmark, to ensure the rights of patients, special psychiatric legislation that emphasizes the imperative to always use the least intrusive intervention has been implemented. This raises the question of which coercive measures are perceived as being less intrusive than others.

Aim: The aim of this study was to investigate the perceptions of Danish mental health professionals regarding the intrusiveness of various coercive measures used in mental health settings.

Methods: We conducted a web-based survey among 132 mental health professionals (response rate: 22%). The participants rated the intrusiveness of different coercive measures using the visual analog scale (VAS).

Results: Mental health professionals perceived mechanical restraint as being the most intrusive coercive intervention (belt and strap fixation received a VAS rating of 92 out of 100). Conversely, body searches and observation were perceived as being among the least intrusive measures, with VAS ratings of 35 and 50, respectively. Participants with different professional backgrounds, including general and forensic mental health workers, tended to perceive the coercive measures included in this study as being equally intrusive.

Conclusion: The participating mental health professionals generally perceived belt fixation as a highly intrusive measure, whereas seclusion, which is currently illegal under Danish law, was considered less intrusive. Because of the small sample size in this study, caution should be exercised when drawing conclusions based on the findings. Nevertheless, the study may add to how the principle of using the least intrusive measure is interpreted.

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: 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.

Background: Much of the research on sexual assault nurse examiners (SANEs) focuses on program outcomes rather than the individual experiences of SANEs. The present research therefore sought to examine the individual experiences of SANEs regarding trauma, support, training needs, and challenges.

Methods: A national sample of SANEs participated in an online survey. In addition to a series of questions on work-related challenges and training needs, participants also completed the Secondary Traumatic Stress Scale (Bride et al., 2004) and the Professional Quality of Life Scale Stamm, 2009). Written survey responses were analyzed for themes regarding support services and training needs.

Results: One hundred twelve SANEs from 24 U.S. states participated in our survey. Of these, 74 SANEs completed the Secondary Traumatic Stress Scale, and 69 SANEs completed the Professional Quality of Life Scale. Overall, SANEs reported little secondary trauma or burnout. Furthermore, SANEs identified key areas in which additional training would be beneficial, including trial preparation, photography, and hands-on training.

Discussion: Self-reported trauma and burnout findings are discussed in light of the high use of support services such as therapy, decompressing with other SANEs, and leisure activities. Our findings provide valuable information for supervisors and training providers of SANEs and have important implications for future SANE research.

Objective: This scoping review aimed to summarize the published literature on patient involvement in violence risk assessment. Two research questions reviewed the extent of patient involvement and what evidence exists.

Inclusion criteria: English-language peer-reviewed published articles of any methodology related to violence risk assessment toward others were included. Articles were related to forensic and mental health practice and involve patients directly in the process.

Methods: Five electronic databases were comprehensively searched, as well as the reference lists of included articles. Both authors reviewed articles for inclusion and extracted data from included articles.

Results: Fifteen articles met the inclusion criteria. Articles reported on three approaches to patient engagement in structured violence risk assessment: how patients were involved or experienced the process, using rating scales, and using questions related to patient self-perceived risk. In relation to what evidence existed, four main themes emerged: patient views about risk and their involvement in risk assessment, comparing the predictive accuracy of patient self-rated tools with clinician-rated tools, predictive accuracy of a patient self-rated tool, and comparing risk ratings between patients and clinicians.

Conclusions: There is a dearth of research published about involving patients in their own risk assessment. Patients report both positive and negative experiences of the process. From cohort-type studies, results have shown that patient self-risk assessment can have a similar predictive ability to the clinician ratings related to adverse violence outcomes. Findings from studies can pave the way for future clinical research around the tools that have been developed thus far.

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.