Advancing Health Equity Through Graduate Forensic Nursing Education.

ABSTRACT: Social justice is a core value of nursing and is deeply rooted within forensic nursing. Forensic nurses are uniquely positioned to examine and address social determinants of health that contribute to victimization, lack of access to forensic nursing services, and inability to utilize resources and services aimed at restoring health after an injury or illness related to trauma or violence. To achieve this, forensic nursing capacity and expertise must be strengthened through robust education. A graduate, forensic nursing, program sought to address this educational need by integrating content related to social justice, health equity, health disparity, and social determinants of health throughout its specialty curriculum.

A Needs Assessment and Educational Intervention Addressing the Care of Sexual Assault Patients in the Emergency Department.

Emergency department (ED) providers serve as the primary point-of-contact for many survivors of sexual assault but are often ill-prepared to address their unique treatment needs. Sexual assault nurse examiners (SANEs) are therefore an important resource for training other ED providers. The objective of this project was to create a SANE-led educational intervention addressing this training gap. We achieved this objective by (a) conducting a needs assessment of ED providers' self-reported knowledge of, and comfort with, sexual assault patient care at an urban academic adult ED and, (b) using these results to create and implement a SANE-led educational intervention to improve emergency medicine residents' ability to provide sexual assault patient care. From the needs assessment survey, ED providers reported confidence in medical management but not in providing trauma-informed care, conducting forensic examinations, or understanding hospital policies or state laws. Less than half of the respondents felt confident in their ability to avoid retraumatizing sexual assault patients, and only 29% felt comfortable conducting a forensic examination. On the basis of these results, a SANE-led educational intervention was developed for emergency medicine residents, consisting of a didactic lecture, two standardized patient cases, and a forensic pelvic examination simulation. Preintervention and postintervention surveys showed an increase in respondents' self-perceived ability to avoid retraumatizing patients, comfort with conducting forensic examinations, and understanding of laws and policies. These results show the value of an interprofessional collaboration between physicians and SANEs to train ED providers on sexual assault patient care.

Development of forensic medicine in post reform Indonesia.

Forensic medicine practice in Indonesia was introduced through the Dutch colonial criminal justice system in the early twentieth century. After more than 70 years of national independence, the development of forensic medicine still faces fundamental challenges, including confusion in the distribution of responsibility with law enforcement agencies, difficulties in managing conflicts of interest, and impediments in scientific practice and professional development. Despite of the golden opportunity from the Indonesian Reform movement in the late 1990s, the impact on forensic medicine development has been less than expected. It is thus important to identify the scope of the problems plaguing the development of forensic medicine, as well as its causes. We conducted a qualitative study to explain the problems and propose solutions. The results show that the standards of practice have developed more slowly than those in many other branches of medicine, despite its increasing popularity from its role in counterterrorism and disaster victim identification. A strong thriving spirit exists in forensic science, although growth in forensic research activities should be facilitated more. The 2009 Health Law has included forensic medicine practice in the health system to cover the role of forensic medicine for health and medical education purposes. It also potentially provides a way to support the justice system without exposing forensic practitioners to possible conflicts of interest, for instance, by utilizing a tiered referral system. To this aim, an alternative is proposed: to place forensic medicine practice within the context of the health system.

Increasing the Accessibility of Sexual Assault Forensic Examinations: Evaluation of Texas Law SB 1191.

INTRODUCTION: Texas SB 1191 was enacted in 2013 with the intent of increasing access to medical forensic examinations for sexual assault victims by requiring every hospital with an emergency department to be prepared to provide a medical forensic examination if requested by a sexual assault victim. To realize that goal, the law also required basic forensic training for medical professionals before conducting a medical forensic examination as well as a requirement that hospitals develop a "plan to train personnel on sexual assault forensic evidence collection." METHODS: Interviews were conducted in 18 healthcare facilities (five with sexual assault nurse examiner [SANE] programs and 13 without SANE programs) in Dallas, Lubbock, and Austin to determine their awareness and compliance with SB 1191. RESULTS: The data suggest that the law had a little effect on actual practice, and sexual assault survivors still sought a SANE program for a medical forensic examination. DISCUSSION: Although SB 1191 is an important state level effort to make forensic examinations more readily available, it did not fully account for the challenges faced by smaller hospitals that do not see enough sexual assault victims to justify training staff to SANE standards and did not adequately address the training required by medical professionals to feel prepared to conduct a medical forensic examination.

Valoración preoperatoria: función anestésica / Preoperative assessment: anesthetic function

Resumen:La valoración preoperatoria en nuestro país se ha convertido en la obtención de un visto bueno para una cirugía.La preparación de un paciente para cirugía requiere la comprensión del estado del paciente, la cirugía y los riesgos y alteraciones fisiológicas de cada técnica anestésica. Los pacientes sin valoración preoperatoria por un anestesiólogo tienen hasta siete veces mayor mortalidad, es por lo tanto pertinente que la valoración preoperatoria sea realizada por especialistas en esta área con conocimiento sobre las metas de la optimización perioperatoria de las comorbilidades y la disminución del riesgo quirúrgico.

Abstract:In our country the pre-surgery evaluation has become limited to an approval to perform it. Preparing a patient for surgery requires the understanding of its medical condition, surgery's risks, and the physiological alterations of each anesthetics procedure. Patients without a pre-surgery evaluation by an anesthesiologist have seven times higher risk of death; it is pertinent that this evaluation be performed by specialists with knowledge on the perioperative optimization goals, on comorbidities, and decrease of the surgical risks.

Assessment of knowledge about, attitudes toward, and awareness of a forensic medicine course among medical students at the University of Dammam.

AIM: This study assesses the knowledge about, awareness of, and attitudes toward forensic medicine and the forensic medicine undergraduate course among medical students at the University of Dammam in Dammam, Saudi Arabia. METHOD: We conducted a cross-sectional study of 143 fourth-year students. We used a structured, self-administered questionnaire containing 10 items relating to forensic medicine to assess the knowledge about, awareness of, and attitudes toward forensic medicine and the forensic medicine undergraduate course. RESULTS: The results showed inadequate knowledge about, poor attitudes toward, and limited awareness of the importance of the forensic medicine course among medical students. Media had an effect on the students as they are a major source of forensic science information among medical students. CONCLUSION: The forensic medicine undergraduate course is important for medical students. We recommended that it be taught at the undergraduate level because it is the only academic source for forensic medicine that physicians may encounter in their careers. Teaching how to conduct an autopsy is important and has a positive role in medical education, and the forensic medicine curriculum must include instruction on autopsies, both from theoretical and practical perspectives. Medical institutes must take responsibility to increase awareness about the effect of media on medical education.

[The teaching and guiding forensic medical commission: its significance role in the educational process].

The activities of the Educational and Methodological Association (EMA) for pharmaceutical teaching in the Russian higher education institutions were renewed and updated. The Educational and Methodological Commission (EMC) on forensic medicine is an integral part of EMA. EMC was set up with an object of further developing the system of continuous professional education, implementing the federal state educational standard of the third generation, preserving and maintaing the uniform educational environment. The work of EMC in the field of forensic medicine is of primary importance for the optimization of academic activities in medical higher education institutions and research institutes training personnel for forensic medical facilities.

[Reform of forensic autopsy in the German Code of Criminal Procedure]. / Die dritte Anfrage: Zur Reform der gerichtlichen Leichenöffnung in der Strafprozessordnung.

The Federal Ministry of Justice has presented another proposal to rephrase the wording of Section 87 of the German Code of Criminal Procedure (StPO). The new version of Section 87 StPO is to be rejected as it would lead to a loss of institutional and professional standards. The bill is clearly influenced by a tendency towards privatisation for the benefit of a small group of specialists in forensic medicine mostly organised in limited liability companies and thus at the expense of institutes of legal medicine affiliated to universities or physicians working in the forensic service of regional courts. In the long run, this reform would not only jeopardize medicolegal research and teaching but also medical education and specialist medical training. For future severe negative consequences would have to be expected on the rule of law and legal certainty.

Is knowledge power? The effects of a victimology course on victim blaming.

The current study examines the impact of a victimology course on students' perceptions of the blameworthiness of crime victims and knowledge of victimization issues. Victim-blaming attitudes among college students enrolled in a victimology course were compared with students enrolled in other courses. Results from a pretest and posttest suggest that the victimology students were significantly less likely to blame victims and these students also gained significantly more knowledge over time compared with the students who did not enroll in the course. Results from the multivariate analysis indicate that less knowledge over time and a higher propensity to blame victims at the beginning of the semester predicted more victim-blaming attitudes on the posttest. Overall, the findings suggest that knowledge of victimology significantly affects students' propensity to blame victims of crime.

[Rape and transgression. Forensic medicine and sexual morality in Spain in the 19th century]. / Violación y transgresión. Medicina forense y moral sexual en la España del siglo XIX.

The purpose of this paper is to analyse the importance of the contribution of the Spanish forensic medical discourse in the 19th century, and its application in cases of sexual harassment, to legitimize the sexual moral value of the time. For that reason we will analyse the main forensic medicine treaties edited in Spain during this century.

[External and internal post mortem examination according to the german code of criminal procedure (StPO)--review of section 87 StPO with special emphasis on the forensic autopsy]. / Die äussere und innere Leichenschau nach der deutschen Strafprozessordnung--Analyse des 87 StPO unter besonderer Berücksichtigung der gerichtlichen Leichenöffnung.

Section 87 subs. 2 of the German Code of Criminal Procedure stipulates that a forensic or court-ordered autopsy shall be performed by two physicians. One of them must be a "forensic medical officer" (in German "Gerichtsarzt") or the head of a public forensic or pathology institute or a physician of such an institute entrusted with this task and having specialist knowledge of forensic medicine. Recently, it has been suggested to amend Section 87 subs. 2 StPO to the effect that self-employed specialists in forensic medicine can also be entrusted with court-ordered autopsies. The authors object to such privatization of forensic autopsies for legal and factual reasons and recommend to keep the present regulation according to which one of the physicians conducting the autopsy is not only required to have the necessary professional qualification, but must also hold a public position as defined in the law.

A new system for forensic physicians in Taiwan.

Forensic physicians play an important role in legal justice. Taiwan has a population of 23 million. It has had a serious shortage of forensic physicians for more than half a century. This has resulted in poor quality of forensic medical practice. In order to increase the number of forensic physicians, new education and training system have been proposed. Legislation of Forensic Physicians Law was enacted in 2005. It is expected that the quality of forensic practice will be improved when the new forensic physicians join this profession.

Legal medicine and the medical establishment.

Formal medical discipline-based regulation and professional support for legal medicine practitioners have been a long time coming. While informal associations and societies of like-minded doctors and dentists have existed for some time, they have not had the sort of "establishment credibility" that is required to influence policy-makers and drive formal processes for professional training and regulation in this area. The recent creation of formal medical College status for medico-legal specialists within the medical establishment is described and the advantages discussed. The creation of formal career pathways, organised training structures and policy advisory systems in legal medicine for government has the potential to support recruitment to this difficult and challenging area of medical practice. This can only be of benefit to the legal profession who rely on these medical practitioners in so many areas. The standards setting, recertification, revalidation and accreditation activities of a formal Royal Medical College are likely to have significant influence on the work of health and legal policy regulators at a time of considerable change.

Responding to sexual violence: critical issues for healthcare providers.

Sexual violence is a monumental problem in Kentucky and elsewhere, and healthcare providers play a critical role in its identification, treatment, and prevention. This article provides essential information for physicians treating survivors of sexual violence, including treatment options, protocol for medical-forensic examinations, tips for documentation, and information about community resources that can facilitate treatment outcomes and proide follow-up services.

The role of nurses in telemedicine and child abuse.

Telemedicine allowed for imaging and videoconferencing between staff at a medical center hub and registered nurses who performed child abuse examinations at community hospitals. By means of electronic communication and information technology, a network was designed to facilitate the examination of children at distant locations when abuse was suspected. Telemedicine provided for expert consultation, rapid evaluation, response to community needs, and an expanded role for nurses. This anecdotal evaluation explored the experience from the view of the registered nurses and an advanced registered nurse practitioner who participated in the telemedicine network. Findings indicated that nurses went through phases of adjustments while becoming familiar with the information technology, cameras, and setup while focusing on the needs of the children and their own responses. Telemedicine nurses were able to draw upon their clinical backgrounds in caring for children and apply their knowledge and skills when assessing victims of abuse. On the basis of interviews and observation, it was concluded that telecommunication did not interfere with the nurse-patient relationship.

The role of Victorian emergency nurses in the collection and preservation of forensic evidence: a review of the literature.

Emergency Departments (ED) are providing care for increasing numbers of patients who present as a result of criminal or interpersonal violence and patients may be victims, suspects or perpetrators. As a result, the role of emergency nurses in the recognition, collection and preservation of forensic evidence is increasing. There is little published literature about the role and responsibilities of emergency nurses regarding the collection and preservation of evidence in the state of Victoria and this is complicated by a lack of department and organisation policy and the need for more specific educational preparation of emergency nurses in this area. While it is well accepted that the primary focus of nursing care will always be the physical and emotional care of the patient, the increasing importance of the role of emergency nurses in the recognition and collection of forensic evidence in Victoria is now being recognized and the need for education of emergency nurses in this area understood. This paper reviews the literature related to the recognition, collection and preservation, of forensic materials in EDs by emergency nurses in the state of Victoria and discusses the role of emergency nurses in Victoria in caring for patients who present as victims of violence and in whom the collection and preservation of forensic evidence is required.

Specific training in clinical forensic medicine is useful to ACEM trainees.

OBJECTIVE: To assess the effectiveness of a 6-month rotation in forensic medicine in developing medicolegal and forensic skills for doctors training for a fellowship with the Australasian College for Emergency Medicine (ACEM). METHODS: Over a period of 6 years 12 trainees undertook a 6-month rotation with the Victorian Institute of Forensic Medicine (VIFM) as a clinical forensic registrar. These 12 trainees were surveyed and asked structured questions regarding their perception of the usefulness of the training and the impact of the rotation on their professional development. RESULTS: Twelve replies were received (100% response rate). All respondents felt that the term had a major positive influence on their ability to examine victims of physical and sexual assault, obtain forensic specimens and prepare a medicolegal report. CONCLUSIONS: A 6-month rotation in clinical forensic medicine improves ACEM trainees perceived ability to perform a number of medicolegal tasks without interfering with other areas of professional development.