A Systematic Review of Evidence-Based Treatments for Adolescent and Adult Sexual Assault Victims.

BACKGROUND: Sexual assault (SA) is a serious crime that is a prevalent mental and public health problem. AIMS: Addressing the needs of SA victims and providing appropriate treatment are essential to reduce potential adverse short- and long-term outcomes. METHODS: Our team undertook an extensive systematic literature review (published between January 2006 and July 2021) to provide evidence-based mental health intervention recommendations for adolescent and adult victims of SA. Where SA-specific research was limited, the literature and clinical practice guidelines on treatments for trauma-induced post-traumatic stress disorder (PTSD) were reviewed to provide additional information to formulate recommendations. RESULTS: Findings strongly support several primary psychotherapy treatments: cognitive behavioral therapy, cognitive processing therapy, eye movement desensitization and reprocessing, narrative exposure therapy, and prolonged exposure therapy. Complementary (aerobic exercise, art, drama, and music therapy) and pharmacological treatments were explored. CONCLUSIONS: Mental health nurses who provide services for victims of SA can utilize this overview to guide recommendations for treatment of SA trauma and related PTSD symptoms to mitigate the short- and long-term negative impacts after a traumatic event. When victims of SA receive optimal mental health treatments, our communities benefit as victims heal and recover.

Dating App Facilitated Sexual Assault: A Retrospective Review of Sexual Assault Medical Forensic Examination Charts.

Dating app facilitated sexual assault (DAppSA) is a concerning phenomenon with minimal published research. This retrospective study explored if DAppSAs were different than other sexual assaults (SAs) committed by acquaintances through a review of 3,413 sexual assault medical forensic examination (SAMFE) charts from 2017 to 2020 in a Mountain West state in the United States. Routine Activities Theory and Confluence Model of sexual aggression provided the theoretical framework for the study. Inclusion criteria for DAppSA cases included (1) victim was 14 years of age or older; (2) victim indicated meeting the perpetrator on a dating app; (3) SA occurred at initial in-person meeting; and (4) victim had a SAMFE with SA kit evidence collection. DAppSAs (n = 274) represented 8.02% of overall cases and 13.92% of acquaintance SAs (n = 1,968). DAppSA victims had unique characteristics including a higher percentage of male victims (7.5%), college students (22.2%), and victims with self-reported mental illness (MI) (59.6%). Victims were less likely to fight back during the assault with lower percentages of kicking (5.8%) and hitting (9%). DAppSA victims and perpetrators were less likely to use drugs or alcohol before or during the assault. DAppSAs were found to be more violent SAs with increased strangulation (32.4%); assaultive/penetrative acts; and victim injuries, especially anogenital and breast injuries. Unique and troubling differences were found in DAppSA cases than other SAs committed by acquaintances. Due to the increased violent nature of DAppSAs, the researchers propose that sexual predators use dating apps as hunting grounds for vulnerable victims. Recommendations to address dating app safety concerns, influence dating app usage policies, and improve care to survivors are discussed through systems-based and trauma-informed approaches.

Forensic Nurses' Understanding of Emergency Contraception Mechanisms: Implications for Access to Emergency Contraception.

BACKGROUND: An estimated 25,000 pregnancies result from sexual assault in the United States annually. Numerous professional healthcare organizations endorse offering emergency contraception (EC) as an integrated aspect of post-sexual-assault care. Lack of knowledge surrounding EC's mechanism of action, including misinterpreting ECs as abortifacients, might restrict patient access to this important healthcare option. PURPOSE: We evaluated sexual assault nurse examiners' understanding of the mechanism of action of oral ECs levonorgestrel (LNG) and ulipristal acetate (UPA). METHODS: A cross-sectional survey of practicing sexual assault nurse examiners was conducted through the International Association of Forensic Nurses. RESULTS: Among 173 respondents, 96.53% reported they prescribed/dispensed EC at the time of medical forensic examinations. LNG was prescribed more frequently than UPA (57.80% vs. 38.2%, respectively). When asked if they agreed or disagreed if LNG and UPA can disrupt an established pregnancy, 83.2% selected disagree/strongly disagree for LNG versus 78.6% for UPA, which were not significantly different. When asked whether the Supreme Court ruling overturning Roe v. Wade would change their EC prescribing, 79.77% reported it will have no change, 6.94% said it would increase, and 12.72% reported they were unsure. Several commented they were concerned whether state laws would prohibit EC and at least one program stopped prescribing EC because of their state laws. IMPLICATIONS: Addressing misinformation regarding EC's mechanism of action and increasing access to oral EC options after sexual assault have the potential to reduce the incidence of rape-related pregnancy.

Mental Illness as a Vulnerability for Sexual Assault: A Retrospective Study of 7,455 Sexual Assault Forensic Medical Examinations.

BACKGROUND: Persons with severe mental illness (MI) are at a high risk of becoming victims of sexual assault (SA). Vulnerability for SA with any type of MI is unknown. This study aimed to identify the prevalence of preexisting MI and other significant factors in patients reporting preexisting MI at the time of their SA medical forensic examinations (SAMFEs). METHOD: A retrospective SAMFE chart review of patients ( N = 7,455) from 2010 to 2020 was conducted. Sexual assault nurse examiners completed SAMFEs. Inclusion criteria included (a) aged 14 years and older, (b) completed SAMFE with SA kit evidence collection, and (c) reported to law enforcement (restricted cases not included). Descriptive statistics and chi-square analyses were completed. FINDINGS: It was found that 46.7% of study participants reported preexisting MI and/or current use of psychotropic medications, more than double the MI prevalence rates in the general population. MI in patients seen for SAMFE was associated with prior history of SA, medical health problems, and physical or mental impairment. In addition, patients with MI reported more violent SAs with increased anogenital and nonanogenital injuries. DISCUSSION: The high prevalence rate of any MI in patients seen for SAMFE indicates MI in varying severity is a significant vulnerability for SA. The association of preexisting MI with a history of SA, health problems, and physical or mental impairment expands understanding of associated MI factors. These findings support the development of interventions by healthcare providers and stakeholders to address SA vulnerabilities in individuals with MI.

Ability to consent to a sexual assault medical forensic examination in adult patients with serious mental illness.

When a patient reporting a sexual assault (SA) presents with signs and symptoms of serious mental illness (MI), medical providers or forensic examiners may have concerns regarding the ability to legally consent to a sexual assault medical forensic examination (SAMFE). Numerous encounters have occurred where a SAMFE was not offered to a cooperative adult patient because the patient exhibited signs and symptoms of MI. Medical providers and examiners may be motivated by beneficence (believing that treating the patient's MI must take priority over the SAMFE) and/or non-maleficence (a concern that the in-depth SAMFE may worsen the patient's psychological state). Situations where a patient has received psychiatric medications or is under involuntary psychiatric detention also raise capacity to consent to SAMFE concerns. This review explored these concerns and provides recommendations for conducting SAMFEs in adult patients with MI. In instances where a patient has the capacity and is cooperative, the decision to undergo, postpone, or decline a SAMFE ought to be ultimately made by the patient, rather than on their behalf by the provider, SANE or forensic examiner.

Evidence Collection and Analysis for Touch Deoxyribonucleic Acid in Groping and Sexual Assault Cases.

ABSTRACT: Historically, evidence collection in sexual assault cases focused on obtaining foreign contributor bodily fluids through swab collection. With improvements in deoxyribonucleic acid (DNA) analysis methods, DNA profiles can be developed from touch DNA and applied to sexual assault cases. Following a literature review on factors affecting touch DNA transfer, a groping case study with innovative evidence collection is presented to support the expansion of touch DNA evidence collection in sexual assault cases. The groping case led to the development of a statewide sexual assault touch DNA form to guide evidence collection. DNA findings from additional groping sexual assault cases are reported to further show and justify the importance of evidence collection in groping cases. Implications on multidisciplinary practices are summarized to promote evidence collection and analysis in groping sexual assault cases. As forensic nurses are educated to accurately collect DNA evidence and provide trauma-informed, patient-centered care, they are best suited to provide nursing care for patients who have experienced groping sexual assaults. Optimal DNA findings in groping and sexual assault cases are best achieved through development of strong multidisciplinary, collaborative relationships between forensic nurses and forensic scientists.

Forensic Nursing Research: The Basics Explained.

ABSTRACT: As a growing profession, forensic nursing requires research to establish best practice guidelines leading to evidence-based practice. In addition, forensic nursing quality improvement projects are necessary to evaluate and improve practices and policies. The purpose of this article is to provide step-by-step guidelines on research and quality improvement projects to encourage all forensic nurses to actively contribute to and utilize research in practice. Research will expand our forensic nursing science and knowledge base. Ultimately, forensic nursing research will benefit our patients and communities by establishing enhanced, evidence-based care.

Evolution of Forensic Nursing Theory--Introduction of the Constructed Theory of Forensic Nursing Care: A Middle-Range Theory.

The constructed theory of forensic nursing care is a middle-range nursing theory developed from the integrated practice model for forensic nursing science, a conceptual framework. Theory evolution was achieved following a critique of the conceptual framework and through inductive and deductive reasoning. A review of nursing theory growth and significance of middle-range theories is presented as background information in understanding the importance of this emerging forensic nursing middle-range theory. The philosophical and theoretical foundations of forensic nursing are bolstered with the addition of three nursing theories, two healthcare models and one social theory. Links are made between theory components and the current state of forensic nursing. Assumptions and concepts are clearly defined. The middle-range theory provides three testable propositions to frame forensic nursing practice, education, and research. Research conducted on the propositions will expand the forensic nursing scientific base leading to enhanced evidence-based practice. A pictorial model illustrates the propositions as relational statements. The constructed theory of forensic nursing care affirms the focus of forensic nursing care is on the nurse-patient relationship and improved health outcomes. Additional results of forensic nursing care are improved forensic science and criminal justice system outcomes.

Justice Denied: Low Submission Rates of Sexual Assault Kits and the Predicting Variables.

Following sexual assaults, victims are advised to seek health care services with forensic evidence collected and packaged in sexual assault kits (SAKs). This large (N = 1,874), retrospective study examined rates of SAK submissions by law enforcement to the state crime laboratory for analysis from 2010 to 2013 at four sites in a Western state in the United States with established sexual assault nurse examiner (SANE) programs. Variables of legal and extralegal characteristics in sexual assault cases were explored through generalized estimating equations (GEE) modeling to determine what factors statistically predicted SAK submissions. For submitted SAKs, the length of time between the dates of assault and dates of submission was categorized, and bivariate and multivariate analyses were calculated to discover legal and extralegal characteristics affecting time of submission. The study sites represented 40% of the state's law enforcement agencies and 65% of the state's population. Out of the 1,874 SAKs in the study, only 38.2% were submitted by law enforcement to the state crime laboratory for analysis. When SAK submissions were examined based on time between assaults and submission dates, 22.8% were submitted within a year of the assault and 15.4% were submitted more than a year after the assault following media and community pressure for law enforcement agencies to submit SAKs in storage. Significant variability of SAK submission rates and the time submitted from the assault dates were found between the sites. Site location was found to be the main determinant of whether or not SAKs were submitted. The lack of SAK submissions for analysis results in justice denied for victims and raises public safety concerns. The finding that the location in which the sexual assault occurred was the primary factor on SAK submissions represents an inequity of justice.

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.

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).

Why we do what we do: a theoretical evaluation of the integrated practice model for forensic nursing science.

An evaluation of the Integrated Practice Model for Forensic Nursing Science () is presented utilizing methods outlined by . A brief review of nursing theory basics and evaluation methods by Meleis is provided to enhance understanding of the ensuing theoretical evaluation and critique. The Integrated Practice Model for Forensic Nursing Science, created by forensic nursing pioneer Virginia Lynch, captures the theories, assumptions, concepts, and propositions inherent in forensic nursing practice and science. The historical background of the theory is explored as Lynch's model launched the role development of forensic nursing practice as both a nursing and forensic science specialty. It is derived from a combination of nursing, sociological, and philosophical theories to reflect the grounding of forensic nursing in the nursing, legal, psychological, and scientific communities. As Lynch's model is the first inception of forensic nursing theory, it is representative of a conceptual framework although the title implies a practice theory. The clarity and consistency displayed in the theory's structural components of assumptions, concepts, and propositions are analyzed. The model is described and evaluated. A summary of the strengths and limitations of the model is compiled followed by application to practice, education, and research with suggestions for ongoing theory development.