Preservation of Forensic Evidence by Nurses in a Prehospital Emergency Care Service in Brazil.

Violence is a growing public health problem worldwide. Nurses increasingly must perform forensic procedures with the responsibility to collect, document, preserve, and store evidence that may be used in the investigation of a violent crime. However, few nurses receive education in forensic evidence collection as part of their training. This study aimed to evaluate the relationship between nurses' knowledge and performance of forensic evidence procedures. This is a descriptive survey study of nurses working in a prehospital emergency care service in Aracaju, Brazil. A 32-question survey related to forensic evidence knowledge and procedures was completed by 128 nurses. Descriptive statistics and Kendall's Tau-b were used to describe the sample and evaluate correlations. Results revealed an overall linear relationship between knowledge and performance of forensic evidence procedures (r = .69). The strongest correlation was between knowledge and documentation (r = .71). Weaker correlations were demonstrated between knowledge and evidence collection (r = .47), evidence preservation (r = .47), and overall evidence procedure execution (r = .53). Forensic nursing knowledge is related to forensic evidence procedure performance. Although the study showed that nurses agreed forensic evidence procedures are important for criminal investigations, most reported they were unprepared to carry out these procedures. The need for additional training and adherence to established institutional protocols are identified as contributing factors.

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.

Opportunities to preserve forensic evidence in emergency departments.

Victims of violence often seek assistance from emergency departments, so emergency nurses are ideally placed to identify them, and other 'forensic' patients, and protect the evidence that could support any ensuing legal process. Emergency nurses who are trained to identify, collect and preserve forensic evidence can support the identification, elimination and prosecution of suspects. This article gives an overview of forensic evidence, and explains how emergency nurses can preserve and collect samples effectively.

Standards of evidence for emergency nurses.

Many people who attend emergency departments and urgent care centres are vulnerable adults or children, or may have been involved in road traffic incidents. In these cases, emergency nurses must safeguard evidence that could prove useful in the elimination, identification and prosecution of suspects. They must ensure that such evidence is retained, transferred and stored so that it does not deteriorate.

Can a workbook work? Examining whether a practitioner evaluation toolkit can promote instrumental use.

In large-scale, multi-site contexts, developing and disseminating practitioner-oriented evaluation toolkits are an increasingly common strategy for building evaluation capacity. Toolkits explain the evaluation process, present evaluation design choices, and offer step-by-step guidance to practitioners. To date, there has been limited research on whether such resources truly foster the successful design, implementation, and use of evaluation findings. In this paper, we describe a multi-site project in which we developed a practitioner evaluation toolkit and then studied the extent to which the toolkit and accompanying technical assistance was effective in promoting successful completion of local-level evaluations and fostering instrumental use of the findings (i.e., whether programs directly used their findings to improve practice, see Patton, 2008). Forensic nurse practitioners from six geographically dispersed service programs completed methodologically rigorous evaluations; furthermore, all six programs used the findings to create programmatic and community-level changes to improve local practice. Implications for evaluation capacity building are discussed.

Interdisciplinary team communication among forensic nurses and rape victim advocates.

Victim advocates and forensic nurses provide integrated care to address the complex legal, medical, and mental health needs of rape survivors. Research suggests that conflict exists between nurses and advocates, but it remains unknown how their communication patterns contribute to or resolve these conflicts. Utilizing a qualitative case study approach, the current study interviewed 24 nurses and advocates from a Midwest organization to better understand team communication patterns when addressing conflicts. The findings suggest that most nurses communicate concerns directly while advocates avoid direct communication. Factors that influenced direct and indirect communication and their implications for practice will be discussed.

Forensic analysts' perspectives: sexual assault kits under the microscope.

Properly collected evidence from a sexual assault examination can assist in the prosecution of the suspected perpetrator or in the exoneration of the wrongfully accused. Previous studies have documented the increased quality of evidence collected by sexual assault nurse examiners (SANEs) versus non-SANE trained providers (Ledray & Simmelink, 1997; Sievers, Murphy, & Miller, 2003) as well as the effectiveness of SANE programs (Campbell, Patterson, & Lichty, 2005; National Institute of Justice, 1999). SANE nurses attempt to collect appropriate specimens through the correct means and in sufficient quantities for forensic analysis with every examination. Samples of good analytical quality offer the best chance of obtaining deoxyribonucleic acid (Burg, Kahn, & Welch, 2011). As one method of quality improvement, SANE nurses can learn to increase the consistency of quality evidence collection by eliciting feedback from the analysts who receive and process the specimens. A national survey of crime laboratories that analyze sexual assault kits was conducted. This paper will present forensic analysts' perspectives about the quality of data collection, feedback for improvement, and resources for further education.

Improving forensic mental health care to Indigenous Australians: theorizing the intercultural space.

This paper uses the 'intercultural space' as an educational strategy to prepare nurses to work respectfully with Indigenous patients in a forensic mental health context; offers an educational approach that introduces nurses to Indigenous knowledge, beliefs and values, examines power relations in colonized countries between the dominant white cultural group and the Indigenous population and encourages nurses to critically reflect on their health care practice; and explores the intercultural space as a shared space between cultures fostering open and robust inquiry where neither culture dominates and new positions, representations and understandings can emerge. Given the disproportionately high number of Indigenous people imprisoned in colonized countries, this paper responds to research from Western Australia on the need to prepare forensic mental health nurses to deliver care to Indigenous patients with mental health disorders. The paper highlights the nexus between theory, research and education that can inform the design and implementation of programmes to help nurses navigate the complex, layered and contested 'intercultural space' and deliver culturally safe care to Indigenous patients. Nurses are encouraged to critically reflect on how beliefs and values underpinning their cultural positioning impact on health care to Indigenous patients. The paper draws on intercultural theory to offer a pedagogical framework that acknowledges the negative impacts of colonization on Indigenous health and well-being, repositions and revalues Indigenous cultures and knowledges and fosters open and robust inquiry. This approach is seen as a step towards working more effectively in the intercultural space where ultimately binary oppositions that privilege one culture over another and inhibit robust inquiry are avoided, paving the way for new, more inclusive positions, representations and understandings to emerge. While the intercultural space can be a place of struggle, tension and ambiguity, it also offers deep potential for change.

Standards of practice for forensic mental health nurses--identifying contemporary practice.

Forensic mental health nursing is a recognized field of nursing in most countries. Despite a growing body of literature describing aspects of practice, no publication has been found that captures the core knowledge, skills, and attitudes of forensic mental health nurses. One group of nurses in Australia have pooled their knowledge of relevant literature and their own clinical experience and have written standards of practice for forensic mental health nursing. This paper identifies the need for standards, provides a summary of the standards of practice for forensic mental health nurses, and concludes with how these standards can be used and can articulate to others the desired and achievable level of performance in the specialty area.

Hodges' Health Career Model and its role and potential application in forensic mental health nursing.

Forensic mental health nursing is increasingly recognized as a speciality of mental health nursing. Despite this, there are limited examples of theoretical models to underpin this specialism. This paper describes a conceptual framework known as the Hodges' Health Career - Care Domains - Model, hereafter referred to as the Health Career Model (HCM). Readers will learn of the model's origins, development, structure and content together with its application in forensic mental health nursing. Created in the 1980s, the model was developed in the North West of England by Brian E. Hodges. Overall, the purpose of the paper is to demonstrate the model's potential in forensic mental health nursing, its flexibility, adaptability and its increasing relevance to the problems of 21st century health, social care and well-being. Forensic nursing is discussed and the rationale for a nursing model is made. Hodges' model is introduced by explaining its original purposes, structure, its four knowledge (care) domains, its current status, publications and resources. The model's relevance and application in forensic nursing is explored, in particular the demands and unique constraints of this care environment as exercised upon service users, the multidisciplinary team, families, carers and other stakeholders. Future implications for research and recovery-orientated practice are discussed.

Nonoccupational postexposure prophylaxis following sexual assault in industrialized low-HIV-prevalence countries: a review.

Although available for over a decade, use of nonoccupational postexposure prophylaxis (nPEP) remains controversial in the United States. There are concerns over sexual assault survivors' adherence, or lack thereof, leading to increased costs without an appreciable decrease in human immunodeficiency virus (HIV) transmission. This review examines and synthesizes the available literature from the past 10 years to determine the true rates of provision and adherence to nPEP regimens in sexual assault survivors in low HIV prevalence, industrialized nations. Findings suggest that further prospective research is necessary to better understand the process of post-assault nPEP evaluation and subsequent follow-up and adherence.

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.

Evaluation of image quality of digital photo documentation of female genital injuries following sexual assault.

With the patient's consent, physical injuries sustained in a sexual assault are evaluated and treated by the sexual assault nurse examiner (SANE) and documented on preprinted traumagrams and with photographs. Digital imaging is now available to the SANE for documentation of sexual assault injuries, but studies of the image quality of forensic digital imaging of female genital injuries after sexual assault were not found in the literature. The Photo Documentation Image Quality Scoring System (PDIQSS) was developed to rate the image quality of digital photo documentation of female genital injuries after sexual assault. Three expert observers performed evaluations on 30 separate images at two points in time. An image quality score, the sum of eight integral technical and anatomical attributes on the PDIQSS, was obtained for each image. Individual image quality ratings, defined by rating image quality for each of the data, were also determined. The results demonstrated a high level of image quality and agreement when measured in all dimensions. For the SANE in clinical practice, the results of this study indicate that a high degree of agreement exists between expert observers when using the PDIQSS to rate image quality of individual digital photographs of female genital injuries after sexual assault.

Interrelationship between core interventions and core competencies of forensic psychiatric nursing in Finland.

The importance of core competencies (CC) and their relationship to core interventions in clinical practice guidelines on schizophrenia (CPGS), and the abilities to master these competencies were studied among registered nurses (RN) and practical mental nurses (PMN) in a forensic psychiatric setting. Data were collected from RNs, PMNs, and managers of all five forensic psychiatric facilities in Finland. The research material was obtained by using a 360-degree feedback method. The response rate was 68% (N = 428). The differences between the nurse groups were statistically significant (p ≤ 0.05) regarding the importance of and ability to master the following CCs: (1) pharmacotherapy, (2) knowledge in forensic psychiatry and violent behavior, (3) the treatment of violent patients, (4) processing patient's and own emotion, and (5) need-adapted treatment of the patient. Overall, RNs exceeded PMNs in mastering the CCs, however the principles of the CPGS were not achieved within the current resources in Finland. In summary, RNs, rather than PMNs, should be recruited for work in forensic psychiatric nursing, although a considerable amount of specific training would still be required to achieve competence. Implications of our research indicate that all nurses working in this area need to receive further education in forensic psychiatry and in forensic psychiatric nursing.

Forensic learning disability nursing skills and competencies: a study of forensic and non-forensic nurses.

This paper reports on an investigation into the skills and competencies of forensic learning disability nurses in the United Kingdom. The two sample populations were forensic learning disability nurses from the high, medium, and low secure psychiatric services and non-forensic learning disability nurses from generic services. An information gathering schedule was used to collect the data; of 1200 schedules, 643 were returned for a response rate of 53.5%. The data identified the "top ten" problems that forensic learning disability nurses may encounter, the skills and competencies necessary to overcome them, and the areas that need to be developed in the future. The results indicated that the forensic learning disability nurses tended to focus on the physical aspects to the role whilst the non-forensic learning disability nurses tended to perceive the forensic role in relational terms. This has implications for practice, policy, and procedures.

Enhancing effectiveness in assessing forensic nursing staff competency.

Assessing the competency of forensic nurses is an evolving area of management practice. This article presents a performance-based model for the assessment process. Examples of competency assessment activities that can measure psychomotor skills, critical thinking, and interpersonal skills are discussed, along with a sample competency for a selected skill. Evaluation strategies and their effectiveness are also analyzed.

The emergency department and victims of sexual violence: an assessment of preparedness to help.

The Emergency Department (ED) is a key source of care for victims of sexual violence but there is little information available about the extent to which EDs are prepared to provide this care. This study examines the structural and process factors that the ED has in place to assist victims. A survey of all 82 publicly accessible EDs in the Commonwealth of Virginia was conducted (RR 76%). In general, the EDs provide the recommended medical care to victims. However, at least half do not have the needed resources in place to effectively assist victims and most (80%) do not provide regular training to their medical staff about sexual violence. Further, almost one-quarter do not have a relationship with a local rape crisis center. It is recommended that each ED partner with local rape crisis centers to provide training to their staff and to ensure continuity of support for victims. It is also suggested that the state government explore ways in which a forensic (SANE) nurse be made available to every victim of sexual violence that presents to the ED for medical assistance. Ideally, each ED would become part of a community-wide Sexual Assault Response Team (SART) in order to provide comprehensive care to victims and thorough evidence collection and information to law enforcement.