Clinical Decision Making in Forensic Nursing: A Cross-Sectional Study From an Emergency Nursing Perspective.

BACKGROUND: Appropriate clinical decision making (CDM) is very important for emergency nurses when working with forensic patients with violence-related injuries and can improve patient outcomes. Therefore, it is essential for emergency nurses to have the basic skills to make the right clinical decisions when working with forensic patients. AIM: The aim of this study was to evaluate the CDM of emergency nurses when caring for forensic patients. METHODS: This study was conducted using a cross-sectional design. Nurses working in the seven emergency departments of Rasht hospitals, Guilan Province, Iran, were recruited to take part in the study. Data collection was performed via census sampling from September to November 2019. Data were collected via a two-part questionnaire developed by the researcher(s) that addressed (a) demographic characteristics and (b) simulated scenarios that assessed their CDM in caring for forensic patients. FINDINGS: One hundred ninety-two emergency nurses participated in this study. The mean score of CDM in forensic nursing was moderate (56.46; 95% CI [54.49, 58.43]). Of the participants, 60.42% of the emergency nurses had moderate CDM knowledge related to forensic nursing, whereas only 2.8% had desirable knowledge of CDM. There was a statistically significant relationship between CDM in forensic nursing and the history of encountering forensic patients ( p = 0.008). CONCLUSION: CDM scores regarding emergency nurses' knowledge of forensic nursing were moderate. Knowledge of and CDM in forensic nursing is very important and provides high-quality safe care for forensic patients. IMPLICATIONS FOR CLINICAL FORENSIC NURSING PRACTICE: This study highlights the importance of additional education and professional development in forensic nursing, for emergency nurses, and should be considered further by nursing administrators and nursing educators.

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.

Innovative Pedagogical Approaches to Teaching Advanced Forensic Nursing.

Forensic nursing is a specialty in nursing with unique knowledge and skills, founded on a theoretic framework identifying three pillars of knowledge--legal principles, forensic science, and forensic nursing with concepts, context, and content unique to the specialty. To care for patients with trauma backgrounds, who are or have intersected with the legal system, forensic nursing education and subsequent certification today requires educational technology. Transforming learning takes demonstrative activities, changing them into interactive dynamic opportunities that teach metacognitive activities to provide complex trauma-informed care in the aftermath of violence, to forensic nurses.

Forensic professional's thoughts on New Zealand emergency nurse's forensic science knowledge and practice.

INTRODUCTION: The clinical forensic nursing role in emergency departments is a recognised nursing speciality globally but there is no designated clinical forensic role in New Zealand nor is their adequate tertiary education despite New Zealand emergency nurses being expected to be able to complete these duties if required. The study sought to find out the perceptions of forensic professionals about 1) how well if at all forensic protocols and practices are adhered to by emergency nurses in New Zealand, 2) what areas of forensic practice if any do ED nurses need tertiary training in to effectively care for patients with health conditions related to violence, and, 3) what relationship exists between emergency nurses and forensic professionals. METHODS: Health professionals in forensic nursing roles were invited to complete an anonymous, online survey consisting of Likert scale questions and free text commentary. A descriptive, content analysis of the data was undertaken. RESULTS: Content analysis described, incorrect evidence collection, erroneous chain of custody errors, limited relationship between emergency nurses and forensic professionals and clear support for a postgraduate clinical forensic nursing programme. DISCUSSION: This study identified that forensic science knowledge and practices by emergency nurses are inadequate for the work they are required to undertake, suggesting that additional professional development is warranted in order to maintain best practice standards for forensic emergency care.

The paradigm of forensic nursing for nursing aspirants in India: Promises, caveats & future directions.

Forensic nursing is an emerging sub-specialty in India holding the potential to rejuvenate the medico-legal system of the country. Also, in India, with its rampant increase in crime rates, the greatest promise of forensic nursing is the emergence of a new holistic approach to legal issues surrounding patient care in the hospital and community setting. The Indian Nursing Council has introduced forensic nursing as a subject in the graduate nursing program in the year 2021. The inclusion of forensic nursing as a subject in the nursing curricula introduces the students to a wider role in contemporary nursing practice that contributes to our own and to public health safety. The implementation of graduate and postgraduate programs in forensic nursing further reduces the gap between health care systems and judiciary systems. The knowledge and practice-related realms of forensic nursing are still in the infancy stage among nursing aspirants of India. The integration of forensic nursing in the existing forensic medical science might be more gainful to improve professionalism. Though forensic nursing has a broad scope, there are certain issues related to the feasibility, ethical and legal implications regarding the mode of service delivery of forensic nursing practice in the Indian setting which needs central attention. The article highlights and discusses the evolution, scope, promises, caveats, and future directions of forensic nursing in the Indian setting.

Providing trans-affirming care for sexual assault survivors: An evaluation of a novel curriculum for forensic nurses.

BACKGROUND: Transgender (trans) persons experience high rates of sexual victimization, often face discrimination by healthcare providers, and may have unique and diverse needs post-victimization. However, there remains a lack of comprehensive trans-specific training among healthcare professionals, including nurses. OBJECTIVES: Our primary objective was to develop and evaluate a novel curriculum for its efficacy in improving the competence of forensic nurses in providing sensitive, informed, and appropriate healthcare services for trans survivors of sexual assault. METHODS: The curriculum was evaluated among forensic nurses working in sexual assault treatment centres across Ontario, Canada. Forty-seven nurses participated in this study, all of whom were selected by their respective programs to receive in-depth formal Sexual Assault Nurse Examiner training. Changes in participants' perceived expertise and competence in providing trans-affirming care were assessed on a 5-point Likert scale (5 being the highest level) using pre- and post-training questionnaires. Participants were asked to indicate their level of agreement with 31 competency-based statements, which were organized thematically into four domains: Initial Assessment, Medical Care, Forensic Examination, and Discharge and Referral. A clinical vignette assessed participants' demonstrated competence in providing care across four questions. RESULTS: Participants level of expertise improved significantly from pre- to post-training (Mean [M] = 1.89, Standard Deviation [SD] = 0.84 vs. M = 3.47, SD = 0.62, p< 001), as well as their competence across all content domains: initial assessment (M = 3.79, SD = 0.63 vs. M = 4.70, SD = 0.31, p < .001), medical care (M = 3.33, SD = 0.73 vs. M = 4.69, SD = 0.33, p < .001), forensic examination (M = 3.40, SD = 0.75 vs. M = 4.72, SD = 0.35, p < .001), and discharge and referral (M = 3.62, SD = 0.80 vs. M = 4.59, SD = 0.40, p < .001). There were also significant improvements in competence associated with the clinical vignette pre- to post- training (M score = 2.13, SD = 1.06 vs. M score = 3.23, SD = 0.87, p < .001). CONCLUSIONS: The success of this curriculum may have relevance to the more than 5000 members of the International Association of Forensic Nurses who practice and support forensic nursing across the globe, as well as to other healthcare professionals.

Factors Associated With Knowledge Retention 3 Months After a Sexual Assault Forensic Examiner Blended Learning Course.

INTRODUCTION: A blended learning continuing education course may appeal to busy healthcare professionals because the primary content can be learned online while an in-person component can hone clinical skills. The current study assessed knowledge retention in a sample of healthcare professionals who participated in a nationwide sexual assault forensic examiner blended learning course (12-week online course and 2-day in-person patient simulation). METHODS: Participants' characteristics, motivation, and external barriers were collected through a precourse web-based survey. Participants' knowledge was assessed through pretests and posttests for 12 modules and a 3-month postcourse examination. Utilizing repeated measures analysis of variance, the study examined whether participants retained their knowledge at the 3-month follow-up point. Multiple linear regression was utilized to explore the factors associated with knowledge retention. RESULTS: The results found a knowledge score from 77.92% to 68.83% correct. The findings indicate that participants who were interested in the blended learning course because of the 2-day patient simulation were more likely to retain knowledge. Learners with more years of experience also had slightly higher knowledge retention. Conversely, participants who were interested in becoming a sexual assault forensic examiner because of a sexual assault experience had lower knowledge retention. Participation in a past online course also was associated with a reduction in knowledge retention. DISCUSSION: The findings indicate a modest knowledge loss 3 months after the blended learning course. Still, some participants experienced less knowledge retention than others. Postcourse activities such as a brief refresher course may be useful to help these participants maintain their knowledge gains.

Knowledge of Forensic Nursing Practices: Efficacy of an Intervention for Nursing Students.

BACKGROUND: Forensic science has become increasingly relevant to health professionals' roles in preserving trace evidence when crimes have been committed. OBJECTIVE: The aim of the study was to assess the efficacy of a structured intervention to improve nursing students' knowledge of forensic nursing practices. METHODS: A pretest/posttest quasi-experimental study, without a control group, was conducted. A nonprobabilistic sample of students from the third and fourth years of a nursing degree program took part in the study. The General Questionnaire on Forensic Nursing and the Questionnaire on Knowledge of Forensic Nursing Practices were administered before and after a structured intervention. RESULTS: Eighty-seven students (mean age of 22.8 ± 3.9 years) took part in the study. Of the participants, 85.7% were female, 98.8% claimed they had not received training in forensic nursing during their degree, and 97.6% reported that they did not have contact with situations that involved the collection and preservation of forensic evidence during their internships. As for their knowledge of forensic practices, out of a total of 74 questions, the number of right answers after the course (69.15 ± 3.05) was higher than the result obtained previously (62.95 ± 4.47). The difference was statistically significant (p < 0.01), leading to the conclusion that the structured intervention was effective in improving knowledge of forensic nursing practices. CONCLUSION: The results demonstrated the importance of specific training in forensic nursing and support the conclusion that a curricular unit in this area should be developed for inclusion in nursing degree curricula.

Healthcare in Secure Environments: Leading a Collaborative for Forensic Nursing Education.

Atlantic Canada hosts six federal and 18 provincial correctional facilities distributed across the four provinces. All employ nurses and offer significant career opportunities, yet minimal content related to forensic nursing is provided in nursing curricula. Furthermore, there is a paucity of continuing educational offerings for Canadian forensic nurses. This article describes the series of events that brought the practice of forensic nursing to the forefront of provincial news media. Actions taken by nurses in academia and practice addressed the lack of educational opportunities for forensic nurses in Atlantic Canada. One of these actions, a Knowledge Forum, was held to nurture partnerships between nurse leaders responsible for healthcare in correctional services in New Brunswick and nurse educators. The idea was to connect nurse leaders responsible for healthcare in federal and provincial jurisdictions, community liaison nurses and nurse managers working in hospital-based forensic mental health assessment units, and nurse educators, to explore nursing practice within secure environments and the current educational needs of forensic nurses.

Evaluation of Fundamental Forensic Knowledge and Perceived Ability in Emergency Nurse Practitioner Education via Forensic Simulation.

INTRODUCTION: The need for trauma care and forensic services is among the top five reasons for seeking healthcare in the United States. Critical aspects of caring for a forensic patient include early recognition of the need for implementing forensic approaches to care: assessment, evidence collection and preservation, and forensic documentation. The intent of this study was to examine fundamental forensic knowledge and perceived ability of graduate-level emergency nurse practitioner students. METHODS: The study was designed to assess fundamental forensic knowledge of graduate-level emergency nurse practitioners using a pretest-and-posttest prospective design utilizing simulation. RESULTS: Students showed an increase in their knowledge of forensic nursing concepts from pretest to posttest (t(39) = 9.63, p < 0.001). In addition, there was an increase in students' perceived ability (confidence) to recognize the forensic aspects of patient care. Two unexpected findings were revealed during debriefing. Although the students were interested in gaining forensic knowledge, they felt it was more important to know when to refer a patient rather than to gain the requisite knowledge to perform forensic functions on their own. Furthermore, students developed an awareness of how their previous clinical experiences influenced their care. CONCLUSION: Findings from this study will inform further development of graduate-level nursing education to include forensic and multidisciplinary simulation exercises.

Healthcare Personnel's Knowledge and Management of Frequently Encountered Forensic Cases in Emergency Departments in Turkey.

BACKGROUND: Emergency department (ED) personnel frequently encounter incidents related to crime, violence, and suspicious injuries. The aim of this descriptive study was to determine the knowledge levels of ED healthcare personnel in their handling of frequently encountered forensic cases. METHODS: A cross-sectional descriptive study composed of ED healthcare personnel at all state, education and research, and university hospitals with EDs, located in Ankara, Turkey, was completed. Participants at the 15 hospitals in question were interviewed via a questionnaire developed by the researchers. RESULTS: Three hundred fifty healthcare personnel who worked agreed to participate in the study. The results show that ED healthcare personnel have less knowledge than expected of the right way to handle frequently encountered forensic cases. Very few of the healthcare professionals who participated in the study had received any training or education in the field of forensic nursing. Among participants, postgraduates, health professionals educated in forensic nursing, and healthcare staff who used additional resources to understand forensic cases, and those who had evaluated cases that presented to the ED as forensic cases, had significantly higher levels of knowledge. IMPLICATIONS: This study supports the need for professional development in forensic nursing, such as in-service training, and curriculum development for a certificate in forensic nursing to enhance the practical training of healthcare professionals who work in EDs.

The impact of forensic nursing course on students' knowledge level on forensic evidence.

The study is designed as quasi experimental including pre-test and post-test. The sample of the study is consisted of 98 students who are taking the Forensic Nursing course in the second year of the School of Nursing at a university. The mean score obtained from the test on the knowledge of forensic evidence before the training was 23.63 ±â€¯5.24 while the mean score after the training was 33.32 ±â€¯4.54. A statistically significant difference was found when the average scores of the students were compared before and after the course of forensic nursing. It was revealed that the course of forensic nursing taken by the students has a positive effect on the knowledge of forensic evidence of students and increases their knowledge level. The results suggest to add a course of forensic nursing as an elective or mandatory course to the curriculum of nursing programs and disseminate the postgraduate education on forensic nursing.

Forensic Nursing Education and Practice in the Netherlands: Where Are We at?

BACKGROUND: Forensic nursing is a new discipline to the Netherlands. Since 2013, a program has been in place to train experienced nurses in several aspects of forensic nursing, including injury assessment and wound documentation, sexual assault examination, assessment of child abuse, death investigation, and primary care for detainees of the police. OBJECTIVE: The purpose of the study was to provide information on the working environment, self-rated competencies, and practice experiences of forensic nurses after having completed the program. METHODS: In 2017, an online questionnaire was developed by the researchers and distributed among the 114 Dutch forensic nurses who had completed the program. RESULTS: Eighty-three nurses responded to the questionnaire, resulting in a 73% response rate. Nurses who practiced in the emergency and ambulance sector or as pediatric nurses continued to work in these roles after having finished the program. Upon completion of the program, more nurses were employed at sexual assault centers. Overall, respondents indicated that they felt competent with performing forensic nursing tasks. Respondents had a positive outlook of their work as forensic nurses, with a large majority seeing possibilities for further expansion of their roles (87%). Forty-eight percent reported that, at times, they experienced resistance to their involvement with forensic matters from other professionals in their work environments. DISCUSSION: Forensic nursing in the Netherlands is an emerging profession. Although its foundation has been established, further developments will only be achieved through collaboration with the wider medical field.

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.

The Priority of Administering HIV Postexposure Prophylaxis in Cases of Sexual Assault in an Emergency Department.

INTRODUCTION: Contracting the human immunodeficiency virus (HIV) is a genuine concern for sexually assaulted patients. Emergency departments are a place where sexually assaulted patients seek care, including treatment to prevent HIV. Prompt administration of nonoccupational postexposure prophylaxis is essential because of the time-sensitive nature of the medications. Quality improvement measures at an urban hospital revealed delays in administration of postexposure prophylaxis to these patients. METHODS: A forensic simulation course and checklist was developed for emergency departments to improve care for sexually assaulted patients. Data used for analysis included time of administration of nonoccupational postexposure medication and length of stay before and after intervention with the simulation course and checklist. Points of measurement included student t-test to assess any significant differences and regression analysis to determine associations. RESULTS: When comparing differences between time of nonoccupational postexposure before and after intervention, there was a trend toward improving the time of administration, but it was not found to be significant. Before intervention, an association was found with sexually assaulted patients' lengths of stay and the time that nonoccupational postexposure medication was administered, with a regression equation of R2, 0.76. After intervention, this association was absent, with an R2 of 0.017. DISCUSSION: Implementing a simulation course and checklist for emergency nurses in caring for sexually assaulted patients helps to improve the timeliness of administration of nonoccupational postexposure medications and resolve the association between the length of stay and time of administration of medication.

Determining the effectiveness of an Elder Abuse Nurse Examiner Curriculum: A pilot study.

OBJECTIVES: To pilot and evaluate a novel Elder Abuse Nurse Examiner Curriculum and its associated training materials for their efficacy in improving Sexual Assault Nurse Examiner (SANE)s' knowledge of elder abuse and competence in delivering care to abused older adults. METHODS: Pilot training was held with 18 SANEs from across Ontario, Canada. A 52-item pre- and post-training questionnaire was administered that assessed participants' self-reported knowledge and perceived skills-based competence related to elder abuse care. A curriculum training evaluation survey was also delivered following the training. Qualitative non-participant observational data were collected throughout the training. RESULTS: There were statistically significant improvements in self-reported knowledge and perceived skills-based competence from pre-training to post-training for all content domains of the curriculum: older adults and abuse (p<0.0001), documentation, legislative, and legal issues (p<0.0001); interview with the older adult, caregiver, and other relevant contacts (p<0.0001); assessment (p=0.0018); medical and forensic examination (p<0.0001); case summary, discharge plan, and follow-up care (p<0.0001). The post-training evaluation survey demonstrated satisfaction among participants across all components of the curriculum and its delivery, particularly with reference to the comprehensiveness of the curriculum, and the clarity and appropriateness of the training materials. CONCLUSIONS: The Elder Abuse Nurse Examiner Curriculum and associated training materials were efficacious in improving SANEs' self-reported knowledge of and perceived competence in delivering elder abuse care. Future steps will further evaluate these materials as a component of a pilot of a larger comprehensive Elder Abuse Intervention at multiple sites across Ontario.

SANE-A-PALOOZA: Logistical Development and Implementation of a Clinical Immersion Course for Sexual Assault Nurse Examiners.

SANE-A-PALOOZA, a continuing education program that utilizes hands-on practice with standardized patients and human simulators, was developed to fulfill a portion of the required supervised clinical experience for certification as a sexual assault nurse examiner. The program is designed to provide concentrated clinical skill practice application, eliminate the time gap between gaining and applying clinical knowledge, and decrease discontinuity among multiple preceptors. This article provides an overview of SANE-A-PALOOZA logistics, with the goal of aiding other organizations in developing skill-building experiences for new or less-experienced sexual assault nurse examiners.

Forensic nursing - Global scenario and Indian perspective.

Sexual violence is a significant cause of physical and psychological harm and suffering for women and children. Although sexual violence mostly affects women and girls, boys are also subject to child sexual abuse. Nurse is the person who attends the victim first. In order to meet the rigid and ever-changing demands of providing care to the victim and complying with our confusing system of laws, the nursing should has been forced to expand into a Forensic nursing, specialty of its own. Nursing roles in the criminal justice service known by many names worldwide-Custody nursing, Prison/Correctional nursing, Immigration centre nursing, Sexual Assault Nurse Examiner (SANE) or Sexual Assault Forensic Examiner (SAFE), SARTs (Sexual assault response team), SARCs (Sexual assault referral centre) and FNDIs (Forensic nurse death investigator). In India the premier institutes like AIIMS New Delhi and The PGI Chandigarh, do not have forensic content in their nursing curriculum manuals. The WHO and IAFN have urged inclusion of forensic content in both undergraduate and postgraduate nursing programs. Forensic Nurse Specialist can provide direct services to individual clients, consultation services to nursing, medical and law-related agencies, as well as providing expert court testimony in areas dealing with trauma and/or questioned death investigative processes, adequacy of services delivered, and specialized diagnoses of specific medical conditions. Research Findings on the Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs suggests various improvements in each and every step in care of victim of sexual assault.