Towards a more integrated and gender-sensitive care delivery for victims of sexual assault: key findings and recommendations from the Belgian sexual assault care centre feasibility study.

BACKGROUND: Sexual assault remains a major threat to public health, affecting every gender, gender identity and sexual orientation. Following the Belgian ratification of the Istanbul Convention in 2016, the feasibility of a Belgian sexual assault centre model was investigated, aiming to provide more integrated and patient-centred health and judiciary services to victims of sexual assault. By actively involving health professionals, police and judiciary system representatives, as well as victims themselves, this feasibility study eventually fed into the Belgian Sexual Assault Care Centre model. In this process, this paper assessed current Belgian health services and the degree to which the implementation of this model could contribute to both a more integrated and gender-sensitive care delivery. Findings from this study and the subsequent recommendations aim to contribute to similar reforms in other countries that have already taken or are about to take steps towards an integrated, multi-agency support framework for victims of sexual assault. METHODS: A qualitative, descriptive analysis of the survey response of 60 key health professionals (N = 60) representing 15 major Belgian hospitals was first conducted. Comparing their approach with the international guidelines and standards, a Strengths Weaknesses Opportunities and Threats analysis of the current sexual assault health services and their potential transition to the Sexual Assault Care Centre model was then executed. RESULTS: Despite adequate equipment, the clear fragmentation of health services and limited follow-up hamper an integrated care delivery in most hospitals. Only three hospitals differentiated their sexual assault care protocol based on the victim's gender, gender identity and sexual orientation. A striking unawareness among health professionals of sexual assault in male victims, as well as in gender and sexual minorities further hampers a gender-sensitive care delivery. CONCLUSIONS: The Sexual Assault Care Centre model aims to counter most of the current sexual assault health services' weaknesses and threats hampering an integrated care for victims of sexual assault. Further research and training of health professionals are however required in order to tune this integrated form of care to sexuality and gender-based differences in victims' already multi-faceted healthcare needs.

Transforming Care for Victims of Violence.

In this month's Magnet® Perspectives column, Anne Boatright, MSN, RN, SANE, describes her efforts to develop a comprehensive forensic nursing program at Methodist Hospital in Omaha. Ms Boatright transformed a sexual assault nurse examiner (SANE) program into one that provides 24/7 coverage at Methodist's 2 SANE locations and cares not only for victims of sexual assault but also for the victims domestic violence, sex trafficking, strangulation, elder abuse, and neglect. Her work extends beyond the walls of Methodist to the community, where she serves as a core member of the Nebraska Human Trafficking Task Force. She works collaboratively with the Federal Bureau of Investigation and helped Nebraska state senators draft legislation to create a sexual assault payment program. In recognition of her determination to make a difference for victims of violence, she received the 2016 National Magnet Nurse of the Year Award for Transformational Leadership.

Assistance to victims of violence in Emergency services from the Forensic Nursing perspective.

OBJECTIVE: to analyze nurses' role in collecting, identifying and preserving traces in Emergency care for victims of violence, from the perspective of these professionals. METHOD: a qualitative study with an exploratory and descriptive approach. It was developed through semi-structured interviews with 21 nurses from hospitals that are part of the intersectoral flow to assist victims of violence from two reference hospitals in this type of care, in a capital city from southern Brazil. Nurses that are members of the multiprofessional team working in the Emergency areas at the respective hospitals were included; in turn, the exclusion criteria corresponded to professionals relocated in Emergency areas during the pandemic. Data analysis was performed according to Thematic Content Analysis. RESULTS: the data were discussed in five categories: 1) Professional qualification; 2) Institutional protocol and materials; 3) The professionals' perceptions; 4) The professionals' actions; and 5) Team structure. CONCLUSION: Nursing professionals' skills in collecting, identifying and preserving traces in Emergency assistance provided to victims of violence need to be better organized, structured and standardized. The presence of Nursing professionals in the care of victims of violence in Emergency services is undeniable, but their importance is still underestimated and their potential contribution to the forensic approach is underused.

Implementing and maintaining nurse-led healthy living programs in forensic inpatient settings: an illustrative case study.

BACKGROUND: Healthy living programs (HLPs) within the context of mental health units are an applied response to the concerns of metabolic syndrome and the associated physical illnesses to which people with serious mental illness are susceptible. OBJECTIVE: To illustrate how nurses, with other health professionals and service users, have established and maintained HLPs in two locked forensic mental health units in New Zealand. DESIGN: This illustrative case study adopts a multimodal approach to data collection and analysis. Across two programs, interviews were undertaken with service users (n = 15) and staff (n = 17), minutes of meetings were analyzed for major decision points, and clinical notes were reviewed to identify which service-user health status measures (body mass index, glucose tolerance test results, blood pressure, and medication use) were recorded. RESULTS: Similarities were identified in the way the HLPs were implemented and maintained by champions who advocated for change, challenged staff attitudes, secured funding, and established new systems and protocols. Successful implementation depended on involvement of the multidisciplinary team. Each program operated within a different physical environment and adopted its own philosophical approach that shaped the style of the program. The HLPs had an impact on nurses, other staff, and on the culture of the institutions. The programs raised dilemmas about restrictions and risk versus autonomy and self-management. CONCLUSION: Understanding the effects of the clinical and philosophical contexts in which HLPs are established and the way challenges and benefits are affected by context has practical significance for the future development of health programs in forensic settings, prisons, and general mental health units.

Forensic psychiatric/mental health nursing: responsive to social need.

Forensic nursing is an emerging global nursing specialty, with subspecialties that focus on nursing practice at the clinical-legal interface of tending to victims and offenders, living and deceased. An integrated review of the literature provides an overview of the role development of forensic nursing subspecialties. The subspecialties of forensic nursing that deal with the mental health care of victims and offenders are the focus of this paper. Forensic nursing, like all forensic specialties, developed from a need in society for a medico-legal role. This paper discusses the global role of forensic nursing and argues that role development has been both proactive and responsive to vital needs of victims and offenders in society. Advanced practice forensic nurses have taken leadership roles in the role development of this nursing specialty. A future challenge for forensic psychiatric/mental health nurses with advanced education is to take leadership roles in all areas of psychiatric assessment, intervention, and evaluation of clients.

Perceptions of diagnostic labels in forensic psychiatric practice: a survey of differences between nurses and other disciplines.

This paper reports on a study of nurses' and non-nurses' perceptions of labels of mental illness and personality disorder in forensic services in the UK. The objectives of the study were to establish if differences in perceptions existed within, and between, the two groups of professionals. The research method was a survey design with 1,200 questionnaires distributed to nurses and 300 to other professionals in disciplines on forensic units in the UK, with response rates of 34.6% and 43%, respectively. The target population included clinical health care staff who had patient contact, including nurses, psychiatrists, psychologists, social workers, and occupational therapists. The results indicate that there are statistically significant differences within both nursing and non-nursing groups and also between the groups in relation to a "management" perspective for individuals labelled with a personality disorder and a "clinical" focus for individuals who are labelled as mentally ill. This paper adds research into the arena of forensic mental health in relation to the diagnostic labels of mental illness and personality disorders. It also adds evidence of a clinical response or a management response to such diagnostic labels which may impact on the practice of forensic psychiatry.

Forensic mental health nursing and evidence-based practice: a quantitative study.

Background: Little is known about the personal, professional and workplace factors that influence evidence-based practice for forensic mental health nurses. Aim: This study describes the sources of practice knowledge for forensic mental health nurses, and the factors that influence the implementation of evidence-based practice. Design: This research study utilised a cross sectional survey design. Methods: All nurses (n = 244) working in one forensic mental health in-patient facility were sent an electronic invitation to complete the Developing Evidence Based Practice Questionnaire. Data was analysed to calculate descriptive statistics. Findings: Fifty-three respondents completed the survey. Respondents reported using experiential knowledge and locally derived sources of information more frequently than research-based evidence to inform their practice. Respondents reported being least skilled at finding, reviewing and using research evidence to change practice. The most frequently rated barriers to evidence-based practice were having insufficient time and resources to both finding and reviewing information and to implement changes in practice. Conclusions: Forensic mental health nurses tend to express a bias towards valuing social or qualitative sources of information to inform practice. Exploring the relationships between individual and organisational factors in the context of forensic mental health is recommended in order to gain further insights into the translation of evidence into practice for forensic mental health nurses. Impact statement: Unique contextual aspects of the forensic mental health environment may influence the implementation of evidence-based practice. Our study highlights that further support, resources and training is required to promote the use of research-based evidence in forensic mental health nursing.

A description of the forensic nursing role in emergency departments in Durban, South Africa.

INTRODUCTION: South Africa has unenviable rates of violent crime and low rates of conviction and prosecution. Contributing to this is the poor collection of medical evidence by health workers. METHODS: A quantitative exploratory descriptive survey using a questionnaire was carried out with nurses, either registered or enrolled with the South African Nursing Council, who had a minimum of 6 months experience in the Emergency Department. The Emergency Departments of two provincial (state) and two private hospitals, as well as two comprehensive care clinics (state) were used. RESULTS: The findings revealed that most of the forensic tasks to be performed by the Emergency Department nurses were rated as never or seldom done and this was due to a lack of training and knowledge in the field of forensic nursing. The respondents did however indicate that forensic nursing was very important to their daily activities in the Emergency Departments. DISCUSSION: Emergency nurses in South Africa are facing new challenges in acquiring the skills to effectively care for crime victims. It is becoming extremely important for these nurses to correctly manage the forensic evidence, as failure to do so can have far reaching legal consequences.

Laying the Foundation for the National TeleNursing Center: Integration of the Quality-Caring Model Into TeleSANE Practice.

In 2012, the Massachusetts Department of Public Health Sexual Assault Nurse Examiner (SANE) Program was awarded a grant from the Department of Justice, Office for Victims of Crime, to pilot the use of telemedicine technology to extend the reach of SANE expertise to six diverse communities across the United States. To meet the goals of this project, the National TeleNursing Center (NTC) developed a three-phase professional practice model integrating the Quality-Caring Model (QCM) to support the delivery of NTC teleSANE services. Using the QCM as a foundation for teleSANE practice ensures that patients experiencing a recent sexual assault who participate in teleSANE encounters receive quality forensic nursing care. In this article, we briefly review elements of the QCM, describe the application of the model to the NTC Professional Practice Model, and detail how teleSANEs integrate the QCM Caring Behaviors into all three phases of its model. The NTC Professional Practice Model provides a quality-based teleSANE model that may be translatable to other areas of telenursing practice.

Correctional nursing and transformational leadership.

Transformational leadership (TL) is a highly discussed approach in the literature for many professions. Likewise, the TL approach continues to be explored in a myriad of nursing contexts to demonstrate its advantages for practice and client health. The tension between custody and care is particular to correctional nursing practice, such as the correctional priorities of safety and security that often override caring-focused nursing practice. Presented herein, is information relating to correctional nursing leadership as found in the minimal, available literature; and hypothetical examples of how correctional nursing leaders can use TL are provided. Measuring the influence of TL on practice and offender health can assist in determining if this approach is an appropriate "fit" for the correctional nursing context. The dearth of literature regarding correctional nursing leadership must be addressed to advance this subspecialty of nursing and promote offender health. The intent is not to argue that TL is the only applicable leadership approach for this subspecialty of nursing. Rather, introductory insight is offered regarding the suitability of TL in correctional nursing practice.

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.

Forensic nursing implications for organ and tissue transplantation.

Most critical care nurses are aware of the clinical protocols that relate to organ and tissue recovery and transplantation. However, few understand the forensic or legal implications. The shortage of transplantable organs and tissue has prompted the development of a national network for recovering and allocating of suitable organs. Rigorous federal and state laws address the myriad of issues about medicolegal or forensic issues associated with the processes involved in retrieval and use of human organs and tissues. This article describes unique contributions of the forensic nurse in ensuring that medical and legal requirements are appropriately addressed.

Integrating forensic nursing into the undergraduate nursing curriculum: a solution for a disconnect.

Violence occurring in the home and community, and its resultant negative effects on public health, is of critical concern to health care professionals. The aim of this article is to underscore the importance of the role of nurse educators in preventing and reducing the consequences of domestic violence and abuse. A viable solution for the disconnect that exists between violence reduction strategies and their effective implementation is proposed, including an integration of forensic nursing concepts and skills into the undergraduate nursing curriculum. Doing so will enable nurse educators to prepare practitioners who can help break the cycle of violence and close the gap that exists in health care delivery for individuals affected by violence. Related issues and challenges are presented, including the need to prepare culturally competent health care professionals, to examine and revise overloaded curricula on the basis of empirical research and societal trends, and to address faculty competence.

Sexual assault nurse examiners' application of statutory rape reporting laws.

INTRODUCTION: The objective of this study was to compile a list of current state laws that mandate medical providers' reporting of statutory rape and assess the subjective interpretation of such laws by sexual assault nurse examiners (SANEs) throughout the country. METHODS: We contacted an SANE representative from each state by use of the International Association of Forensic Nurses' Web site to obtain information on his or her interpretation of the respective state's statutory rape reporting laws. We compared current state laws and SANE interpretation of such laws with legal interpretation of state laws 5 years previously. RESULTS: According to practitioners, the number of states that legislate mandatory reporting has increased over the past 5 years. State law routinely mandates reporting in 26 states and does not mandate reporting in 10 states. In 3 of those 10, the law prohibits reporting. The law requires reporting only under certain conditions in 14 states. DISCUSSION: Practitioner interpretation of state laws regarding definitions and mandatory reporting of statutory rape varies widely from state to state, and these laws have changed significantly in many states over the past 5 years. Practitioners wishing to comply with state reporting laws require updated legislation information.

Stress and burnout in forensic mental health nursing: a literature review.

Forensic mental health nurses who work with patients who have severe and enduring mental health needs have been identified as at risk of suffering from occupational stress, and even developing burnout syndrome. Therefore, this article reviews the available literature on stress and burnout in inpatient forensic mental health nursing to identify the stressors and to highlight recommendations. From the review, the main stressors placed on forensic nurses are identified as interprofessional conflicts, workload, and lack of involvement in decision-making. Recommendations to reduce stress and burnout for nurses within this specialty are highlighted. These are identified as follows: staff should have easy access to support systems including clinical supervision; managers should foster an open and honest culture to enable staff members to express their feelings openly or in confidence and learn how to deal with their frustrations; and staff should be encouraged to rotate wards to increase personal and professional development and reduce boredom and apathy. Furthermore, staff should be provided with, and encouraged to undertake, continuing professional development which may include psychosocial interventions training.

Supporting role.

Our nursing expertise series ends with a look at a nurse consultant in forensic mental health care.

Looking closer: forensic nursing.

With a keen eye, you can foster comprehensive care to victims; protect your organization from allegations of abuse, negligence, and malpractice; and offer a care environment that recognizes the complexities of our current society.

Forensic Nursing State of the Science: Research and Practice Opportunities.

INTRODUCTION: The International Association of Forensic Nurses (IAFN) is the only nursing organization advancing the forensic nursing specialty. The organization seeks to advance the profession, and one mechanism for doing so is development of a research agenda. METHODS: The purpose of this action-based research study was to aid in the development of a forensic nursing research agenda. The study was carried out in two integral stages: (a) focus groups with IAFN members attending the annual conference and (b) reviewing posted IAFN member listserv material. RESULTS: The findings of this study identified similar gaps of other nursing specialties experiencing "growing pains," including role confusion and variation in educational preparation. CONCLUSION: Findings from this study will inform development of the IAFN 5-year research agenda to advance forensic nursing science and evidence-based practice.

Mental health nurses: de facto police.

This paper examines the consequences for nursing staff and patients when police bring to hospital a person they assess to have a mental illness who exhibits violent or criminal behaviour. In particular, the impact on the nurse-patient relationship and the occupational health and safety of patients and staff is explored. Tensions between the conflicting roles for nurses of controlling the behaviour of this small minority of patients, while providing care and therapy, are examined within the context of health policy, bed shortages, and staffing problems. Recent Australian government and non-government reports are examined to assess the capacity of current health services in the State of New South Wales, to adequately and safely control behaviour while also provide therapeutic care for patients who are seeking help for their mental illness and emotional distress.

Nurses' Time Use in Forensic Psychiatry: Core Interventions Outlined in the Finnish Clinical Practice Guideline on Schizophrenia.

Forensic psychiatric nurses are key in implementing the core interventions outlined in the clinical practice guideline on schizophrenia. This study endeavors to ascertain how these were implemented in routine practice in forensic psychiatry by measuring how nurses use their time. Data were collected from registered nurses and practical mental nurses in all forensic psychiatric facilities in Finland using self-report diary forms for 1 week. In total, nurses used 20% of their weekly working hours on core interventions. The differences between the nurse groups were statistically significant (p ≤ 0.05) regarding the following core interventions: (a) care planning with physicians, (b) pharmacotherapy, and (c) basic clinical care. Nurses' qualifications, types of facilities and units, working experience, gender, and staffing levels explained the time used on core interventions. In summary, forensic psychiatric inpatients received insufficient appropriate nursing services according to the relevant guideline regarding schizophrenia. Furthermore, managerial recommendations need to restructure nurses' time use to increase the proportion of productive working hours spent with patients.