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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Toward the establishment of a forensic nursing specialty in Brazil: an integrative literature review.

BACKGROUND: Over the past two decades, Brazil has made progress in bringing political and community attention to issues related to violence. The recognition of links between violence and health has intensified calls to accelerate the development of a forensic nursing specialty in Brazil. AIM: The aim of this study was to systematically examine and synthesize the literature on the development of the forensic nursing specialty around the globe and to extract important lessons for the establishment of a forensic nursing specialty in Brazil. METHOD: An integrative review was conducted according to the method described by Whittmore and Knafl (2005). Electronic searches of the following databases were conducted between December 2012 and March 2013: CINAHL Plus with Full Text, Criminal Justice, Index to Legal periodicals, MEDLINE, Soc Index with Full Text, Social Work Abstracts, SCOPUS, and PsycINFO. The search terms used were: [(TI nurs* or SU nurs*) and [TI (forensic* or penal or prison*) or SU (forensic* or penal or prison*)] and (sexual assault nurse examiner*). Preestablished inclusion/exclusion criteria were used to select published articles for review. RESULTS: Twenty-three articles met inclusion criteria and were included in the full review. Important lessons for Brazil are discussed in terms of education and curricular issues and forensic psychiatric nursing. CONCLUSIONS: In Brazil, there is a window of opportunity to contribute the theoretical foundations of forensic nursing science and to advance nursing specialty practice in the areas of Sexual Assault Nurse Examiners and forensic psychiatric nurses.

The emergence of forensic nursing and advanced nursing practice in Switzerland: an innovative case study consultation.

BACKGROUND AND METHODS: The objectives of this article were to systematically describe and examine the novel roles and responsibilities assumed by nurses in a forensic consultation for victims of violence at a University Hospital in French-speaking Switzerland. Utilizing a case study methodology, information was collected from two main sources: (a) discussion groups with nurses and forensic pathologists and (b) a review of procedures and protocols. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined by Hamric, Spross, and Hanson (2009). RESULTS: Advanced nursing practice competencies noted in the analysis included "direct clinical practice," "coaching and guidance," and "collaboration." The role of the nurse in terms of "consultation," "leadership," "ethics," and "research" was less evident in the analysis. DISCUSSION AND CONCLUSION: New forms of nursing are indeed practiced in the forensic clinical setting, and our findings suggest that nursing practice in this domain is following the footprints of an advanced nursing practice model. Further reflections are required to determine whether the role of the forensic nurse in Switzerland should be developed as a clinical nurse specialist or that of a nurse practitioner.

Client satisfaction with nursing-led sexual assault and domestic violence services in Ontario.

INTRODUCTION: There is still little known about survivors' experiences of and satisfaction with comprehensive nursing-led hospital-based sexual assault and domestic violence treatment programs. METHOD: To address this gap, we surveyed and collected information from clients/guardians presenting to 30 of 35 of Ontario's Sexual Assault/Domestic Violence Treatment Centres across seven domains: presentation characteristics, client characteristics, assailant characteristics, assault characteristics, health consequences, service use, and satisfaction with services. RESULTS: One thousand four hundred eighty-four clients participated in the study, 96% of whom were women/girls. Most were White (75.3%), 12-44 years old (87.8%), and living with family (69.6%); 97.9% of clients used at least one service. The most commonly used service was assessment and/or documentation of injury (84.8%), followed by on-site follow-up care (73.6%). Almost all clients/guardians reported that they received the care needed (98.6%), rated the overall care as excellent or good (98.8%), and stated that the care had been provided in a sensitive manner (95.4%). Concerns and recommendations to improve care expressed by a small proportion of clients/guardians focused on long wait times, negative emergency department staff attitudes, issues of privacy and confidentiality, and difficulty with accessing services. DISCUSSION: The high uptake and positive evaluation of services provided by Ontario's Sexual Assault/Domestic Violence Treatment Centre programs confirms the value of nursing-led, hospital-based care in the aftermath of sexual assault and domestic violence. Ongoing evaluation of such services will ensure the best care possible for this patient population.

The role of the Sexual Assault Nurse Examiner in England: nurse experiences and perspectives.

Sexual Assault Nurse Examiners (SANEs) were introduced in the United Kingdom in 2001, but there is a lack of knowledge about their role and the services they provide. The aim of this study was to explore the role of SANEs currently working in England. Qualitative semistructured interviews explored the training experiences, roles, and working practices of five SANEs in a variety of settings. The findings identified three categories: training and qualifications, SANE care, and working within multidisciplinary teams (MDT). SANEs have complex roles that involve patient care as well as collection of forensic evidence. There was variation in service provision and training of SANEs interviewed and differences in how they felt their role was regarded by members of the MDT. The findings suggest that SANE services need further evaluation to determine a model of practice that can be consistently implemented to provide both optimal patient care and reliable forensic evidence.

Provision of clinical forensic medical services in Australia: a qualitative survey 2011/12.

The provision of clinical forensic medicine services is dependent on jurisdiction and relevant legal instruments. A needs analysis was performed to understand the current service provision within NSW and compare and contrast the service with other jurisdictions in Australia. The aim of this study was therefore to identify the roles, functions and clinical forensic medical services currently provided in the different Australian jurisdictions.