When a Child Is Found Dead: The Role of the Forensic Nurse Death Investigator and Psychosocial Impact for Parents.

The traumatic death of a child is an immediately life-changing event. In all cases, a parent who finds that their child has died suddenly and violently is no longer the same person. Early in the chaotic aftermath of this journey, they will likely be disoriented and affectively numb because their sense of an otherwise predicted life trajectory has been destroyed in an instant. Subsequently, early in the arrival of the forensic nurse death investigator, there will be multidimensional challenges to be strategically navigated during scene investigation while simultaneously ensuring awareness of psychosocial issues that will have an enduring impact on an adaptive trajectory of bereavement for a surviving parent.

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.

Using Telehealth for Pediatric, Adolescent, and Adult Sexual Assault Forensic Medical Examinations: An Integrative Review.

OBJECTIVE: Improved access to qualified nurse examiners to perform sexual assault forensic examinations is needed. This integrative review examines the current research literature on synchronous "real-time or live" telehealth support and guidance during pediatric, adolescent, and adult sexual abuse/assault forensic examinations. METHODS: Informational databases (CINAHL, Health Source: Nursing/Academic Edition, Medline, PsychInfo, and Violence & Abuse Abstracts) were searched, and research articles including live telehealth for sexual assault survivors were reviewed (n = 98). RESULTS: Review of the articles resulted in the inclusion of seven studies that utilized live video telehealth during the sexual assault forensic examination. CONCLUSION: The current research literature supports the premise that synchronous telehealth is a promising modality for this patient population. However, the lack of large comprehensive studies warrants additional research to understand outcomes and develop best practices. Additional research studies are needed to evaluate the effectiveness, cost, and criminal justice impact of this intervention.

Child Labor Trafficking Essentials for Forensic Nurses.

Human trafficking is a form of modern-day slavery and is a significant pediatric healthcare problem in the United States. The term "human trafficking" encompasses both sex and labor trafficking. Sex trafficking, especially child sex trafficking, has received significant lay and professional attention. However, few efforts have focused on learning more about youth experiencing labor trafficking in the United States. Pediatric healthcare providers, including forensic nurses, are likely to encounter victims of child labor trafficking in their practice. A basic understanding of child labor trafficking will assist forensic nurses in timely identification of and appropriate intervention for victims. In this article child labor trafficking is discussed in terms of definition, epidemiology, history, risk factors, consequences, identification, and implications for practice.

Nurse-Led Forensic Services for Foreign-Born Torture or Abuse Survivors Seeking Legal Immigration Relief: Results of a Feasibility and Acceptability Study.

BACKGROUND: In 2017, a team of forensic nurses in Maryland launched the first known nurse-led and managed service delivery program designed to meet the unique medicoforensic needs of immigrant survivors, including asylum seekers, in their community. The expanded suite of services involved conducting forensic physical evaluations, which included medicolegal history-taking, head-to-toe forensic physical assessment, photodocumentation, and presentation of related findings in the form of written affidavits for use in applications for legal reliefs in immigration court (e.g., asylum, T or U visas, Convention Against Torture). METHODS: Case-based data for patients served as part of the program (n = 8), and semistructured interview data were collected from key service delivery stakeholders (n = 5) to assess the feasibility and acceptability of this pilot program. RESULTS: Eight asylum-seeking patients received medicoforensic nursing services between May 2017 and December 2018. Key benefits of services to clients included accessibility to timely, trauma-informed care by a professional nurse at no cost and with flexible scheduling. Furthermore, the skill sets required to conduct forensic physical evaluations were found to align with sexual assault and forensic nursing scope of practice. CONCLUSION: Forensic nurses are well positioned to fill current service delivery gaps to meet the medicolegal needs of this vulnerable population in civil court proceedings. Recommendations of this study may be used by other forensic nurse teams to inform the design and implementation of initiatives to expand the core services of a forensic nursing program to include asylum and immigration-specific medicolegal care.

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.

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.

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.

'We try' - how nurses work with patient participation in forensic psychiatric care.

RATIONALE: Patients in secure forensic psychiatric care have reduced autonomy because of the constraints imposed on them by compulsion laws. Thus, it is vital that nurses enable patient participation whenever possible. Patient participation, and it's clinical use in forensic psychiatric care, is an understudied field. AIM: To describe nurses' experiences of their work with patient participation in forensic psychiatric care. METHODS: Managers at different secure forensic psychiatric institutions in the south of Sweden approved the study, and oral consent was retrieved from informants. Interviews guided by a semi-structured interview guide were conducted with nine nurses from five different forensic psychiatric institutions and analysed with content analysis. FINDINGS: Nurses describe diverse understandings and abilities in an inflexible setting. This indicates that what participation is, and how to achieve it, is not the same for nurses as for patients. Moreover, patients have different abilities to participate, and the secure setting in itself is perceived as hindering participatory work. Still, participation is described as a crucial part of work that requires a caring relationship. Furthermore, nurses pronounce potentially excluding attitudes and strategies that may obstruct patient participation for all, and at the same time, they have a belief that improvement is possible. CONCLUSION: Compulsory forensic psychiatric care is a complex care context that requires constant efforts from nurses to balance patients' rights and needs with mandatory care. The very nature of this caring context appears to be a major obstacle when promoting patient participation. Nevertheless, nurses express that they do aim for patient participation, 'they try'. From a patient's perspective, trying is not sufficient and a need for improvement is evident. The results can be of clinical interest in similar secure forensic psychiatric nursing settings, and a point of departure in future development of care striving for increased patient participation for all.

Using Telehealth for Sexual Assault Forensic Examinations: A Process Evaluation of a National Pilot Project.

INTRODUCTION: This project describes the first time live sexual assault nurse examiner (SANE) services were provided via telehealth to support site clinicians conducting sexual assault forensic medical examinations for adult and adolescent patients. It involved six sites in three states, including rural, tribal, military, and community hospitals. The purpose of this process evaluation was to determine the extent to which patients consent to telehealth technology, examine how the technology worked, and explore the types of assistance. METHODS: We reviewed information for sexual assault patients who presented at emergency departments (N = 215) and conducted telephone and online surveys with 178 clinicians who provided or received telehealth services. RESULTS: Between May 1, 2015, and March 31, 2018, 129 patients and site clinicians received services via telehealth and an additional 86 site clinicians received consultation advice via telehealth. Most patients consented and accepted SANE services via telehealth (86% overall and 97% in non-U.S. Navy sites). No significant technology problems were experienced for most interactions (92%). The assistance provided remotely by SANEs to site clinicians included guiding clinicians through history taking and documentation, forensic examination and evidence collection techniques, identifying and documenting injuries, and guiding clinical practice. Site clinicians reported, on average, a positive impact of the assistance on their confidence in providing an effective examination, their ability to provide their patient with the best care, and their sense of feeling supported. IMPLICATION: Results of this pilot suggest that using live telehealth services for sexual assault forensic examinations is a promising 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.

Lessons Learned From iCare: A Postexamination Text-Messaging-Based Program With Sexual Assault Patients.

BACKGROUND: Although beneficial, few sexual assault patients seek follow-up healthcare or counseling after a medical forensic examination. Mobile technology interventions may help patients engage in postcare, but there is a dearth of research on patients' utilization of these interventions. The current study examines patients' engagement with a 4-week postassault text message program (iCare), which assessed patients' safety and well-being, if they needed assistance with accessing nonoccupational postexposure prophylaxis, or scheduling appointments for follow-up pregnancy and sexually transmitted infection testing, and their experience with the criminal justice system. METHODS: This pilot study collected data from 40 adult patient records and texting communications between the nurse and patients. We utilized descriptive statistics to examine patient utilization of the program. RESULTS: Sixty-five percent of the patients responded at least once during the program, but only two responded to every text. Nearly a quarter of the patients (22.5%) requested the texts to stop before the end of the program. A larger portion of the patients (42.5%) did not opt out but stopped replying by the third message. The program appeared to be helpful for increasing the amount of communication between the nurse and the patient, but patients rarely utilized the nurse's offers of assistance (e.g., counseling, advocacy). DISCUSSION: Text interventions appear to be effective for relaying information but may be limited for increasing postexamination service utilization for sexual assault patients. Future research should examine areas of patient needs in the weeks and months postexamination that can be addressed in text interventions.

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.

Forensic Nursing Provides Closure in Workplace Fatality.

The Workers' Compensation Board of British Columbia in Canada is the provincial agency mandated to investigate workplace injuries and fatalities. In 2012, the Fatal and Serious Injuries Investigation section of this organization initiated the integration of forensic nursing expertise into the investigation of workplace incidents. The goals were to improve investigative outcomes and aid in prevention initiatives by achieving a more accurate understanding of incident causation through the application of forensic nursing science. An unexpected outcome of the use of forensic nursing expertise was providing closure for families through a deeper understanding of their loved one's tragic workplace incident.

Defining the role of a forensic hospital registered nurse using the Delphi method.

AIM: A Delphi survey was undertaken to refine the position description of a registered nurse working in a forensic hospital, in New South Wales, Australia. BACKGROUND: Prior to commencing operation in 2008, position descriptions were developed from a review of legislation, as well as policies and procedures used by existing forensic mental health services in Australia. With an established workforce and an evolving model of care, a review of the initial registered nurse position description was required. METHOD: An online Delphi survey was undertaken. Eight executive (88.9%) and 12 (58.3%) senior nursing staff participated in the first survey round. A total of four survey rounds were completed. RESULTS: At the final round, there was consensus (70%) that the revised position description was either very or somewhat suitable. There were a total of nine statements, from 31 originally produced in round 1, that did not reach consensus. CONCLUSIONS: The Delphi survey enabled a process for refining the Forensic Hospital registered nurse position description. IMPLICATIONS FOR NURSING MANAGEMENT: Methods that facilitate executive and senior nursing staff consensus in the development and review of position descriptions should be considered in nursing management.

Now We Know: Assessing Sexual Assault Criminal Justice Case Processing in an Urban Community Using the Sexual Assault Nurse Practitioner Evaluation Toolkit.

Campbell and colleagues developed an evaluation Toolkit for use by sexual assault nurse examiners (SANEs) to assess criminal case outcomes in adult sexual assault cases seen by SANE programs (Campbell, Townsend, Shaw, Karim, & Markowitz, 2014; Campbell, Bybee, et al., 2014). The Toolkit provides step-by-step directions and an easy-to-use statistical program. This study describes implementation of the Toolkit in Salt Lake County, the first site outside the pilot sites to utilize the program. The Toolkit revealed that, in Salt Lake County from 2003 to 2011, only 6% of adult sexual assault cases were successfully prosecuted. These findings prompted multiple community discussions, media attention, and a call to action to improve the investigation and prosecution of adult sexual assault cases. The primary purpose of this case report is to encourage other SANE teams and communities to use the Toolkit by sharing the successful experience of Salt Lake County in implementing the Toolkit.Video Abstract available for additional insights from Dr. Valentine (see Supplemental Digital Content 1, http://links.lww.com/JFN/A19).