Healthcare Personnel's Knowledge and Management of Frequently Encountered Forensic Cases in Emergency Departments in Turkey.

BACKGROUND: Emergency department (ED) personnel frequently encounter incidents related to crime, violence, and suspicious injuries. The aim of this descriptive study was to determine the knowledge levels of ED healthcare personnel in their handling of frequently encountered forensic cases. METHODS: A cross-sectional descriptive study composed of ED healthcare personnel at all state, education and research, and university hospitals with EDs, located in Ankara, Turkey, was completed. Participants at the 15 hospitals in question were interviewed via a questionnaire developed by the researchers. RESULTS: Three hundred fifty healthcare personnel who worked agreed to participate in the study. The results show that ED healthcare personnel have less knowledge than expected of the right way to handle frequently encountered forensic cases. Very few of the healthcare professionals who participated in the study had received any training or education in the field of forensic nursing. Among participants, postgraduates, health professionals educated in forensic nursing, and healthcare staff who used additional resources to understand forensic cases, and those who had evaluated cases that presented to the ED as forensic cases, had significantly higher levels of knowledge. IMPLICATIONS: This study supports the need for professional development in forensic nursing, such as in-service training, and curriculum development for a certificate in forensic nursing to enhance the practical training of healthcare professionals who work in EDs.

'We try' - how nurses work with patient participation in forensic psychiatric care.

RATIONALE: Patients in secure forensic psychiatric care have reduced autonomy because of the constraints imposed on them by compulsion laws. Thus, it is vital that nurses enable patient participation whenever possible. Patient participation, and it's clinical use in forensic psychiatric care, is an understudied field. AIM: To describe nurses' experiences of their work with patient participation in forensic psychiatric care. METHODS: Managers at different secure forensic psychiatric institutions in the south of Sweden approved the study, and oral consent was retrieved from informants. Interviews guided by a semi-structured interview guide were conducted with nine nurses from five different forensic psychiatric institutions and analysed with content analysis. FINDINGS: Nurses describe diverse understandings and abilities in an inflexible setting. This indicates that what participation is, and how to achieve it, is not the same for nurses as for patients. Moreover, patients have different abilities to participate, and the secure setting in itself is perceived as hindering participatory work. Still, participation is described as a crucial part of work that requires a caring relationship. Furthermore, nurses pronounce potentially excluding attitudes and strategies that may obstruct patient participation for all, and at the same time, they have a belief that improvement is possible. CONCLUSION: Compulsory forensic psychiatric care is a complex care context that requires constant efforts from nurses to balance patients' rights and needs with mandatory care. The very nature of this caring context appears to be a major obstacle when promoting patient participation. Nevertheless, nurses express that they do aim for patient participation, 'they try'. From a patient's perspective, trying is not sufficient and a need for improvement is evident. The results can be of clinical interest in similar secure forensic psychiatric nursing settings, and a point of departure in future development of care striving for increased patient participation for all.

Legal mobilization in medicine: Nurses, rape kits, and the emergence of forensic nursing in the United States since the 1970s.

Routine administration of the sexual assault medical forensic exam (commonly known as the "rape kit") is one of the most significant healthcare reforms advanced by the U.S. anti-rape movement since the 1970s. To promote reform, nurses acted as practitioner-activists in emergency medicine and created the new specialty of forensic nursing to administer the medical forensic exam independent of physicians. Their efforts suggest a new way of conceptualizing the interface of law and medicine: the proactive invocation of criminal law in clinical medicine for the purpose of institutional reform in healthcare organizations, or what I term legal mobilization in medicine. Using the framework of legal mobilization in medicine, I ask: (1) how did nurses mobilize criminal law and rights to health in emergency medicine to facilitate reform? and (2) what were the effects on clinical practice and knowledge production? To chart this history, I draw on a review of published writings by early forensic nurses, interviews with leaders in the field, and ethnographic observation at the 20th anniversary International Association of Forensic Nurses conference in 2012, commemorating the founders and origins of this new specialty. Bringing together scholarship on law and social movements in socio-legal studies and scholarship on health and social movements in science, technology, and medicine studies, I argue that nurses forged a porous boundary between the overlapping institutional spheres of medicine and law in order to align the objectives of medical care and criminal investigation and, thereby, seek rights to healthcare and rights to justice for patient-victims through the enactment of new medical routines. I demonstrate the historical emergence of a novel, hybrid form of professional jurisdiction and medical practice, and I explore its benefits as well as its unintended consequences. I conclude by discussing the ethical implications of this case for the use of medical evidence to corroborate rape.

Qualitative Analysis of Prosecutors' Perspectives on Sexual Assault Nurse Examiners and the Criminal Justice Response to Sexual Assault.

OBJECTIVE: The aim of this study was to understand prosecutors' perspectives on the contribution of Sexual Assault Nurse Examiners (SANEs) to evidence collection and trials in sexual assault cases. BACKGROUND: Several studies have suggested that a sexual assault case is more likely to progress in the criminal justice system when a SANE conducts the forensic medical examination. However, little is known about how prosecutors perceive SANEs and what they value about SANEs versus other medical professionals. METHOD: Semistructured interviews, conducted in one jurisdiction with eight assistant district attorneys who prosecute sexual assault cases, included questions about the value of SANEs in evidence collection and trials. Interview transcripts were analyzed to identify common themes and variability among prosecutors. RESULTS: Most prosecutors identified advantages for SANEs in evidence collection, trial preparation, and testimony. Specific advantages cited by one or more prosecutors included superior documentation, thoroughness of the physical examination, better identification of injuries, quality of relationships with patients, professionalism, skill in trial preparation and testifying, and credibility with jurors. DISCUSSION: These findings help validate SANEs' contribution to the criminal justice response to sexual assault, despite the study's limitations in sample size and inclusion of only one jurisdiction. The study also suggests the value of further education about SANEs for prosecutors who may not have the opportunity to learn about the range of skills SANEs possess.

Now We Know: Assessing Sexual Assault Criminal Justice Case Processing in an Urban Community Using the Sexual Assault Nurse Practitioner Evaluation Toolkit.

Campbell and colleagues developed an evaluation Toolkit for use by sexual assault nurse examiners (SANEs) to assess criminal case outcomes in adult sexual assault cases seen by SANE programs (Campbell, Townsend, Shaw, Karim, & Markowitz, 2014; Campbell, Bybee, et al., 2014). The Toolkit provides step-by-step directions and an easy-to-use statistical program. This study describes implementation of the Toolkit in Salt Lake County, the first site outside the pilot sites to utilize the program. The Toolkit revealed that, in Salt Lake County from 2003 to 2011, only 6% of adult sexual assault cases were successfully prosecuted. These findings prompted multiple community discussions, media attention, and a call to action to improve the investigation and prosecution of adult sexual assault cases. The primary purpose of this case report is to encourage other SANE teams and communities to use the Toolkit by sharing the successful experience of Salt Lake County in implementing the Toolkit.Video Abstract available for additional insights from Dr. Valentine (see Supplemental Digital Content 1, http://links.lww.com/JFN/A19).

Forensic nursing - Global scenario and Indian perspective.

Sexual violence is a significant cause of physical and psychological harm and suffering for women and children. Although sexual violence mostly affects women and girls, boys are also subject to child sexual abuse. Nurse is the person who attends the victim first. In order to meet the rigid and ever-changing demands of providing care to the victim and complying with our confusing system of laws, the nursing should has been forced to expand into a Forensic nursing, specialty of its own. Nursing roles in the criminal justice service known by many names worldwide-Custody nursing, Prison/Correctional nursing, Immigration centre nursing, Sexual Assault Nurse Examiner (SANE) or Sexual Assault Forensic Examiner (SAFE), SARTs (Sexual assault response team), SARCs (Sexual assault referral centre) and FNDIs (Forensic nurse death investigator). In India the premier institutes like AIIMS New Delhi and The PGI Chandigarh, do not have forensic content in their nursing curriculum manuals. The WHO and IAFN have urged inclusion of forensic content in both undergraduate and postgraduate nursing programs. Forensic Nurse Specialist can provide direct services to individual clients, consultation services to nursing, medical and law-related agencies, as well as providing expert court testimony in areas dealing with trauma and/or questioned death investigative processes, adequacy of services delivered, and specialized diagnoses of specific medical conditions. Research Findings on the Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs suggests various improvements in each and every step in care of victim of sexual assault.

[The closure of forensic hospitals and the implications for nursing care]. / La chiusura degli ospedali psichiatrici e le implicazioni per l'assistenza.

SUMMARY: The closure of forensic hospitals and the implications for nursing care. The closure of forensic hospitals led to the opening of new wards to admit psychiatric patients who committed a crime and by Italian law, cannot be imprisoned. Over 826 residents of forensic hospitals, around 350 cannot be discharged because considered dangerous for the society. The new wards where these patients will be admitted raise some legal and ethical problems as health professionals (doctors and nurses) will be responsible not only of the patients health but also of their legal custody. The professional and ethical implications need a debate among professionals.

The relationship between the forensic nurse in the emergency department and law enforcement officials.

This article describes the need for a collaborative relationship between the advanced practice forensic nurse in the emergency department and critical care settings with law enforcement officials. The relationship is necessary when working with victims and/or perpetrators in the context of the 27 categories of forensic patients.

Evaluating the legal impact of Sexual Assault Nurse Examiner programs: an empirically validated toolkit for practitioners.

There has been sustained interest in the academic literature and in policy circles regarding how Sexual Assault Nurse Examiner (SANE) programs may bolster sexual assault prosecution rates in their communities, in addition to the health care they provide to their patients. To build evaluation capacity among forensic nurses so that they can evaluate their own programs, a practitioner-oriented, step-by-step evaluation toolkit (the SANE Practitioner Evaluation Toolkit) that can be used by SANE-A and SANE-P programs, and their community partners, to examine sexual assault prosecution rates in their local jurisdictions was created and validated. This article describes the process of creating and empirically validating the toolkit and presents the toolkit itself and accompanying resources that are available to practitioners. This article also provides recommendations regarding program readiness to engage in evaluation activities, without compromising program sustainability and patient care.

Original research: Giving sexual assault survivors time to decide: an exploration of the use and effects of the nonreport option.

BACKGROUND: Forensic nurses, sexual assault nurse examiners (SANEs), and victim advocates have long recognized the trauma of sexual assault crimes and the significance of survivors' decisions around reporting these crimes to law enforcement agencies. Until recently, survivors who didn't report the crime were not entitled to a free medical forensic examination. In a significant policy shift, the Violence Against Women and Department of Justice Reauthorization Act of 2005 provided an additional decision option with regard to the medical examination for survivors of sexual assault. This provision, referred to here as the nonreport option, was established to offer survivors a full range of reporting options and to ensure exemplary health care, with evidence collection as an important secondary goal. OBJECTIVES: This study sought to examine the implementation of the nonreport option in Texas; explore its impact on SANEs, survivors, and the criminal justice system; and identify strengths and challenges of the nonreport process. METHODS: A mixed-method approach was used that included qualitative interviews with 79 professionals who regularly respond to sexual assault crimes, a Web-based survey questionnaire of such professionals that yielded 131 completed surveys, and a review of existing data. RESULTS: The step-by-step process involved in a nonreport case was described, and findings in three descriptive areas emerged: confidentiality processes, storage and shipment of evidence, and the use of the nonreport option. Beneficial effects of the nonreport option were identified in five areas: the role of SANEs, the impact on survivors, collaborative relationships, collateral crimes, and anonymous reporting strategies. Seven areas of remaining dilemmas were also identified. CONCLUSIONS: Findings indicate that the nonreport option has had a considerable positive impact on SANEs, survivors of sexual assault, and the criminal justice system. But challenges remain if this option is to be fully utilized in the future; further research is warranted. The authors also present recommendations to improve health care delivery.

Attitudes of adult/adolescent sexual assault nurse examiners and caring for younger patients.

INTRODUCTION: Sexual Assault Nurse Examiners (SANEs) are specialized nurses who provide sexual assault (SA) examinations and forensic evidence collection. Currently, Adult/Adolescent (A/A) SANEs in Massachusetts are trained and certified to care only for patients 12 years and older who present acutely to EDs. The purpose of this study was to describe the attitudes of SANEs regarding the possibility of cross-training to care for younger patients (<12 years). METHODS: This qualitative, descriptive study included a sample of 45 A/A SANEs who participated in a series of 6 focus groups. The focus groups were audiotape-recorded and transcribed verbatim. Content analysis was used to analyze the raw data. Units of in vivo coding assisted in the identification of initial broad categories that were winnowed to represent final themes that described the participants' attitudes. RESULTS: Although the majority of SANEs enthusiastically endorsed the option of pediatric cross-training, a smaller portion of participants expressed strong opposition to the proposal. The SANEs' concerns included the emotional toll of caring for children who have been sexually assaulted, and the need for an adequate infrastructure within the SANE Program to educate, train, and support the cross-training effort. DISCUSSION: This research fills a gap in the forensic and ED nursing literature by providing insights into the attitudes and concerns of SANEs who care for some of the most vulnerable patients. The findings of this study can inform the acute care and evidence collection practices that are used when caring for pediatric patients who have experienced SA.

Mock juror perception of sexual assault nurse examiner testimony.

The perception of a sexual assault nurse examiner's (SANE) testimony in a criminal rape trial was investigated. Men and women undergraduates (N = 138) read a fictional criminal trial summary of a rape case in which medical testimony from a SANE or a registered nurse (RN) was presented, or no medical testimony was presented. Results indicated that mock jurors were more likely to render guilty verdicts when a SANE testified than when an RN testified, and this relationship was fully mediated by perceived credibility of the nurse as well as provictim perceptions. Results are discussed in terms of the impact of SANE involvement in legal proceedings.

The forensic nursing in sexual assaults: the immunochemical diagnosis and prevention of its adverse effects.

Sexual assault was a ubiquitous and serious problem in our society. The world's care centers and forensic associations, which were at the forefront of scientific research in sexual assaults, discussed the role of the Forensic Nursing in their early diagnosis and their prevention, but little has been written in literature regarding their appropriate management. This article focuses on the immunochemical laboratory investigation in diagnosis and prevention of its adverse effects in sexual assaults and the role of the Forensic Nursing played in this task. After a careful reading of all the material received from many of the care centers and the associations contacted, a Forensic Nursing Examination Program, with specific immunochemical address, is identified.

Developing a policy for sexual assault examinations on incapacitated patients and patients unable to consent.

Sexual assault examinations consist of a medical evaluation and forensic evidence collection. Usually the patient signs a consent form allowing the examination to occur. Occasionally circumstances exist that render a patient unable to give consent for this examination. Such circumstances include young age, mental health disease, cognitive delay, or drug/alcohol ingestion. This article provides suggestions for developing a policy allowing a sexual assault examination to be conducted without patient consent. A sample of such a policy is provided.

Nobility in objectivity: A prosecutor's case for neutrality in forensic nursing.

This article describes the three primary functions that Sexual Assault Nurse Examiners (SANEs) provide to the judicial process from a prosecutor's perspective. These three functions include comfort and care of patients complaining of sexual assault, competent and consistent evidence collection, and expert testimony on anatomy and tissue. The article makes the argument that all three of these functions are conducted more effectively when the SANE maintains her objectivity and neutrality as a medical and scientific professional. Finally, a recent Supreme Court ruling, Crawford v. Washington, might greatly affect a SANE's ability to repeat hearsay statements made to her by patients who become unavailable to testify. The article will discuss the impact of this case, as it relates to the SANE's function as an expert witness and the issue of hearsay admissibility.