Availability of Certified Sexual Assault Nurse Examiners in Appalachian States.

INTRODUCTION: Sexual assault nurse examiners are crucial care providers in cases of sexual assault. However, it is not clear whether sexual assault nurse examiner availability differs throughout the 13 states that comprise the Appalachian region of the United States. Therefore, this cross-sectional analysis identified sexual assault nurse examiner availability in 13 states and determined differences in availability by both county-level Appalachian status and county-level rurality status. METHODS: Data were downloaded from 2 public sexual assault nurse examiner registries for the included 13 states. Descriptive statistics of sexual assault nurse examiner certification type and availability by state were calculated. In addition, bivariate analyses of sexual assault nurse examiner availability by rurality and by Appalachian status were performed using 2-sample z-tests for equality of proportions. RESULTS: State-level sexual assault nurse examiner availability ranged from 0.34 to 0.86 sexual assault nurse examiners per 100,000 residents. Sexual assault nurse examiner availability in these 13 states did not differ by Appalachian status. However, rural areas had significantly lower sexual assault nurse examiner availability than urban areas in these 13 states. DISCUSSION: These data support previous literature on the need for stronger sexual assault nurse examiner programs in rural areas in the United States. Future research should take sexual assault prevalence into account to determine whether local sexual assault nurse examiner access needs, as well as appropriate support for sexual assault nurse examiners, are being met throughout Appalachian states.

Multicenter evaluation to determine the deficiencies of emergency nurses in forensic case management.

INTRODUCTION: Emergency services are the first places where victims and/or perpetrators of different types of violence are brought for medical treatment. Emergency service nurses are the first health workers who first encounter with the forensic case, first communicate and are in an important position in the rapid and accurate continuation of the forensic process. In this study, it was aimed to determine the level of knowledge of emergency department nurses regarding the management of forensic cases. METHODS: The study was a cross-sectional, descriptive. Ninety-eight emergency nurses working in the emergency departments of three different public hospitals in the same province participated in the study. Study data were collected with the "Nurse Personal Information Form" and the "Knowledge Levels of Nurses related to the Approaches to Forensic Cases Questionnaire". RESULTS: 70.4 % of the nurses participating in the study were women, their mean age was (X ± SD = 27.36 ± 5.21). It is seen that 87.8 % of the nurses have a total working time in the emergency unit between 1 and 5 years and 11.2 % have received training on forensic nursing. "Total Knowledge Score" of undergraduate graduate nurses The mean score was higher and there was a significant difference between the groups (p > 0.05). The nurses who received in-service training and forensically evaluated all cases admitted to the emergency department had a higher mean score in the "Knowledge Score Regarding the Duties of Nurses Regarding Forensic Cases" mean was higher and there was a significant difference between the groups (p > 0.05). CONCLUSION: We recommend the use of institutional guides/protocols together with in-service training for emergency nurses to provide medically and legally correct forensic care and to have sufficient knowledge.

Professional Quality of Life and Turnover Intention in Forensic Nurse Program Coordinators: Implications to Forensic Nurse Workforce Development.

BACKGROUND: Significant barriers to forensic nurse workforce development exist, affecting patient care access. Retention of forensic nurses is a persistent problem, and turnover of forensic nurses can be attributed to many factors related to professional quality of life, including compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS). PURPOSE: The aim of this study was to identify the effect of an educational session on the topic of professional quality of life and strategies for mitigating the impact of stressors within the forensic nurse role on Professional Quality of Life Scale-5 and Turnover Intention Scale-6. METHODS: A convenience sample of forensic nurse program coordinators was surveyed using a pretest-posttest quasi-experimental survey design. Correlation between professional quality of life indicators and turnover intention was explored. RESULTS: Cohort ( n = 38) preintervention CS levels were average to high (mean = 41.42), BO levels were average to low (mean = 22.53), and STS levels were average to low (mean = 22.89). Statistically significant positive correlations were noted between each Professional Quality of Life Scale indicator and turnover intention (CS: r = 0.59, p < 0.0001; BO: r = 0.98, p < 0.0000; STS: r = 0.67, p < 0.0000). A statistically significant decrease in BO level (α = 0.05, p = 0.0454) was noted postintervention. IMPLICATIONS: BO and STS had a strong positive correlation to turnover intention. BO levels decreased to a significant degree when reassessed 3 months after the educational intervention. Increased awareness of the impact of CS, BO, and STS could decrease BO in forensic nurses with potential reduction in turnover.

The Purpose, Process, and Advancement of Forensic Nursing Standards.

BACKGROUND: To strengthen the nation's use of forensic science and advance professional practice, forensic practitioners and scientists in the Organization of Scientific Area Committees (OSAC) develop standards in forensic science. The Forensic Nursing Subcommittee was created by OSAC in 2021 to develop standards that improve patient outcomes through delivery of consistent practice guidelines, evidence-based techniques for preservation of evidence, and accurate representation of practice and examination findings. PURPOSE: The purpose of this article is to relate the history of forensic science standard development in the United States, discuss the rationale for forensic nursing standards, and describe the standards development process. In this article, we provide an overview of OSAC and the OSAC Forensic Nursing Subcommittee. We discuss how forensic nurses can be involved in the development and advancement of standards that define minimum requirements, best practices, and evidence-based protocols to ensure reliable and reproducible outcomes. IMPLICATIONS FOR FORENSIC NURSES: The development of forensic nursing standards is an important step in advancing the profession. It is critical that forensic nurses are actively involved in the standards development process, which includes volunteering to serve on the OSAC Forensic Nursing Subcommittee or a forensic nursing standards development organization, providing input into standards drafts during the public comment period, and implementing approved standards into practice.

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.

Trauma- and Violence-Informed Empowering Care for Sexual Assault Survivors.

BACKGROUND: Forensic nurse examiners, including sexual assault nurse examiners, provide care for survivors holistically through healthcare, emotional support, connection to follow-up care, safety planning, and, if desired, evidence collection to aid in the prosecution of sexual assault. There is increasing recognition that trauma-informed care must also include an understanding of the impacts of structural violence on minoritized patients to ensure health equity. AIM: To help address this guidance gap, we expanded Campbell and colleagues' empowering care model using a trauma- and violence-informed care (TVIC) lens. METHODS: We used an iterative discussion-based process that included five joint meetings between a seven-member transdisciplinary research team and a five-member nurse advisory board. RESULTS: In a TVIC-informed empowering care model, we propose behavioral examples for forensic nurses for each of Campbell et al.'s five key domains of empowering care for forensic nurse examinations (i.e., build rapport and establish trust, show compassion, provide patient-directed care, convey professionalism, and provide resource referral and follow-up). CONCLUSIONS: These behavioral examples for nurses can help guide forensic nurse training and practice to reduce disparities in treatment and follow-up support. Structures and systems are needed that enable forensic nurses to provide trauma- and violence-informed empowering care to survivors of sexual assault and, over time, increase the accessibility of forensic nurse examinations and improve patient outcomes.

Enacting an "Empowerment Approach" After Sexual Assault: The Views and Beliefs of Forensic Nurse Examiners and Crisis Support Workers.

BACKGROUND: Sexual violence is a profoundly disempowering experience. It is essential that survivors are offered access to comprehensive medical care, psychological support, and follow-up in a way that offers them a high level of choice and control. AIMS: There has been little research into how practitioners working in the context of immediate postassault understand empowerment and reflect this in their care delivery. This study sought to explore how crisis support workers and forensic nurse examiners conceive how they enact an "empowerment approach" in a sexual assault referral center (SARC) in the United Kingdom. METHODS: A phenomenological approach was taken, and data were gathered through focus groups and interviews. FINDINGS: Themes were identified under the headings of "indicators of empowerment," "empowerment as a process," and "the empowerment approach." CONCLUSION: As part of providing person-centered care that enacts an empowering approach within the SARC setting, professionals need the skills and resources to be able to respond flexibly to their clients. They have a role in addressing victim blaming of those subjected to sexual violence and in promoting the accessibility of SARC services.

Problematic Sexualized Behavior in Children: Essentials for the Pediatric Forensic Nurse.

ABSTRACT: Problematic sexual behavior (PSB) in children and adolescents is a significant public health problem. PSB is defined as harmful or developmentally inappropriate behaviors involving sexual organs or regions of the body exhibited by children or adolescents. PSB may be harmful to self or others or be abusive toward another child, adolescent, or adult. Adolescents, typically defined as children 12 years old or older, engaging in PSB can be vulnerable to formal court adjudication as their behaviors may be considered a sexual offense. PSB can result in significant negative consequences for all children and adolescents involved as well as their families. This article will describe sexual behavior in children, normative and problematic, and explore implications for forensic nursing practice.

Ethical Expert Witness Testimony.

Forensic nurses are routinely called upon to provide expert consultation and witness testimony. Nearly half of the enumerated standards in the Forensic Nursing Scope and Standards of Practice reference competencies directly related or complementary to ethical testimony. Requests from the field, coupled with the increasing opportunities for forensic nurses to serve as expert witnesses, necessitate the development of clear parameters for ethical expert witness testimony.

Intervenções de enfermagem na prevenção da violência em contexto Forense: uma Scoping Review / Nursing interventions to prevent violence in forensic settings: a scoping review

Introdução: Atualmente, a violência, por ser um fenómeno complexo e dinâmico, exige, dos enfermeiros em geral e em particular daqueles que trabalham em serviços de psiquiatria forense, uma compreensão multidimensional e intervenções sistémicas e resilientes. Objetivo: Mapear as intervenções implementadas pelos enfermeiros, para prevenção da violência por parte das pessoas internadas, em serviços de psiquiatria forense. Metodologia: Protocolo de Scoping Review com base nos princípios preconizados pelo Joanna Briggs Institute, considerando os materiais bibliográficos publicados de janeiro de 2018 a julho de 2023, nas bases de dados CINAHL e MEDLINE e selecionados com recurso à plataforma Rayyan. Esta revisão considerou a inclusão de estudos, independentemente da área geográfica ou do desenho, nos idiomas português, inglês e espanhol, disponíveis sem custos para os revisores. Esta pesquisa procura responder à questão norteadora, fundamentada pela estratégia PopulaçãoConceito-Contexto (PCC): Que intervenções são implementadas pelos enfermeiros, para prevenção da violência por parte das pessoas internadas, em contexto de psiquiatria forense? Resultados: Foram incluídos quatro artigos na revisão e identificadas intervenções e programas de treino para a prevenção/redução da violência, pelos enfermeiros, em serviços de psiquiatria forense. Espera-se que os resultados possam contribuir para melhorar a prática de cuidados à pessoa com doença mental nestes contextos. Conclusão: Esta pesquisa identificou intervenções e programas de treino sustentados, dois deles baseados na Terapia Cognitivo-Comportamental, para prevenção da violência por parte das pessoas internadas, em serviços de psiquiatria forense. Mais estudos devem ser realizados para identificar intervenções inovadoras com foco na prevenção/redução do comportamento violento das pessoas internadas em serviços de psiquiatria forense.

The Development and Implementation of a Forensic Education Module for Nebraska Critical Access Providers: A Pilot Study.

BACKGROUND: Sexual assault, intimate partner violence, and human trafficking are traumatic events for individuals and communities. As healthcare shortages increase, critical access hospitals must manage resources to ensure comprehensive forensic care effectively. Current literature indicates a lack of forensic healthcare education for providers within critical access hospitals. This forensic education module for critical access healthcare providers aimed to (a) increase forensic examination competencies, (b) improve forensic interviewing skills, (c) increase provider self-efficacy, and (d) show knowledge retention. METHODS: This mixed-methods pilot study utilized a convenience sample of 45 healthcare providers in Nebraska critical access hospitals who presented for the forensic education module training. Repeated measures analysis of variance and paired t tests assessed the aims of this study. Structured surveys gathered qualitative data on three themes. RESULTS: Implementation of the forensic education module showed a statistically significant increase in forensic interviewing skills, nonstatistically significant changes in general self-efficacy, and sustainability of knowledge and self-efficacy over 6 weeks. Analysis also showed a clinically significant increase in provider self-efficacy over 6 weeks. Structured questionnaire responses showed participants valued the content to address their perceived barriers to providing care. CONCLUSIONS: This study validates the need for increased education in Nebraska's rural and medically underserved areas to ensure access to forensic care and provision of services. This pilot study shows the potential for forensic education interventions to increase provider competencies and improve provider self-efficacy, with evidence of retention of knowledge and skills.

Do Concerns About Police Reporting Vary by Assault Characteristics? Understanding the Nonreporting Decisions of Sexual Assault Victims Who Utilize Alternative Reporting Options.

INTRODUCTION: Forensic nurses routinely provide services to sexual assault victims who are uncertain about reporting their assault to police. The purpose of this study was to determine whether assault characteristics are related to the concerns about police reporting expressed by sexual assault victims who have forensic evidence collected but do not report their assault to police at that time. METHODS: We analyzed medical records of patients who received services at a hospital-based forensic nursing program between 2010 and 2021. Records were included if a sexual assault evidence kit was collected, the patient declined to report the assault to police, and the patient completed a nonreport sexual assault evidence kit supplement form that included a question asking why they chose not to report the assault ( N = 296). We qualitatively analyzed patients' reasons for not reporting the assault and then used two-variable case-ordered matrices and chi-square analyses to explore relationships between reasons for not reporting and assault characteristics. RESULTS: Identified reasons for not reporting included lacking information about the assault, fear of harm/retaliation, and self-blame/minimization. Physical force, drug/alcohol consumption, and victim-offender relationship were related to patients referencing lacking information and fearing harm/retaliation as reasons for not reporting, but not related to the frequency of patients referencing self-blame/minimization. IMPLICATIONS: Results indicate that assault characteristics are related to reasons for not reporting at the time of the medical forensic examination. Being aware of these relationships may help forensic nurses provide patient-centered services and anticipatory guidance.

Assistance to victims of violence in Emergency services from the Forensic Nursing perspective / Atención a víctimas de violencia en el servicio de urgencias desde la perspectiva de la enfermería forense / Atendimento às vítimas de violência no serviço de emergência na perspectiva da enfermagem forense

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.

Objetivo: analizar el papel del enfermero en la recolección, identificación y preservación de rastros en la atención de emergencia a las víctimas de violencia, desde la perspectiva de estos profesionales. Método: estudio cualitativo, con enfoque descriptivo exploratorio. Desarrollado a través de entrevistas semiestructuradas a 21 enfermeros de hospitales que forman parte del flujo intersectorial de atención a víctimas de violencia en dos hospitales de referencia de este servicio, en una capital del sur de Brasil. Se incluyeron enfermeros que forman parte del equipo multidisciplinario que trabaja en el servicio de urgencias de sus respectivos hospitales, y el criterio de exclusión fue profesionales reasignados al servicio de urgencias durante la pandemia. El análisis de los datos se realizó según análisis de contenido temático. Resultados: de los datos surgieron cinco categorías: 1) Calificación Profesional; 2) Protocolo Institucional y Materiales; 3) Percepción de los profesionales; 4) Acciones de los profesionales y 5) Estructura del equipo. Conclusión: es necesario organizar, estructurar y estandarizar mejora las competencias de los profesionales de enfermería para recolectar, identificar y preservar rastros en la atención de emergencia a las víctimas de violencia. La presencia de los enfermeros en la atención a las víctimas de violencia en los servicios de emergencia es innegable, pero aún se subestima su importancia y se subutiliza su contribución potencial en el abordaje pericial.

Objetivo: analisar a atuação dos enfermeiros no recolhimento, identificação e preservação de vestígios no atendimento de emergência à vítima de violência, na perspectiva desses profissionais. Método: estudo qualitativo, com abordagem descritiva exploratória. Desenvolvido por meio de entrevista semiestruturada com 21 enfermeiros de hospitais que integram o fluxo intersetorial para atendimentos às vítimas de violência de dois hospitais de referência neste atendimento, em uma capital do sul do Brasil. Foram incluídos enfermeiros membros da equipe multiprofissional que atuam na emergência nos respectivos hospitais, e o critério de exclusão foi profissionais realocados na emergência durante a pandemia. A análise de dados foi realizada conforme análise de conteúdo temático. Resultados: os dados foram discutidos em cinco categorias: 1) Qualificação Profissional; 2) Protocolo Institucional e Materiais; 3) Percepções dos profissionais; 4) Ações dos profissionais e 5) Estrutura da equipe. Conclusão: as competências dos profissionais de enfermagem no recolhimento, identificação e preservação de vestígios no atendimento de emergência à vítima de violência precisam ser melhor organizadas, estruturadas e padronizadas. É incontestável a presença de profissionais enfermeiros nos atendimentos às vítimas de violência nos serviços de emergência, mas sua importância ainda é subestimada e sua potencial contribuição para a abordagem pericial é subutilizada.

Forensic Nursing.

These nurses practice where the health and legal systems intersect.