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Trauma-Related Shame

ABSTRACT Background Feelings of shame after interpersonal assault directly impact survivor well-being. Although the concept of trauma-related shame has been well defined and applied in psychology, the direct application to nursing care for victims of sexual assault is unclear. Objective The aim of this study was to perform an interdisciplinary concept analysis to clarify and synthesize the concept of trauma-related shame as it relates to interpersonal assault. Method A multidisciplinary literature search was conducted using the term “trauma-related shame.” Article titles and abstracts were reviewed for significance to interpersonal assault. Rodgers' evolutionary method of concept analysis was used to identify attributes and related concepts and also clarify the contextual basis of trauma-related shame. Results The search resulted in 150 articles, 15 of which met the specified inclusion criteria. Fourteen of the selected articles were research studies, and one was a systematic review. A thematic analysis was used, and two attributes were identified: self-devaluation and self-isolation. An experience of trauma, fear, multivictimization, preexisting shame, low self-esteem, stigmatized events, and negative reactions from others were identified as antecedents. Finally, when reviewing for consequences, anxiety, depression, posttraumatic stress disorder, acute stress disorder, distress, poor health outcomes, social withdrawal, and suicidal tendencies were identified as common themes. Conclusion This concept analysis is a first step in the further development and implementation of trauma-related shame in nursing. It will be vital to the provision of holistic care for the profession to conduct research and publish literature related to shame for survivors of interpersonal traumatic events.

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Assessing Trauma and Training Needs of Sexual Assault Nurse Examiners Across the United States.

Much of the research on sexual assault nurse examiners (SANEs) focuses on program outcomes rather than the individual experiences of SANEs. The present research therefore sought to examine the individual experiences of SANEs regarding trauma, support, training needs, and challenges. A national sample of SANEs participated in an online survey. In addition to a series of questions on work-related challenges and training needs, participants also completed the Secondary Traumatic Stress Scale (Bride et al., 2004) and the Professional Quality of Life Scale Stamm, 2009). Written survey responses were analyzed for themes regarding support services and training needs. One hundred twelve SANEs from 24 U.S. states participated in our survey. Of these, 74 SANEs completed the Secondary Traumatic Stress Scale, and 69 SANEs completed the Professional Quality of Life Scale. Overall, SANEs reported little secondary trauma or burnout. Furthermore, SANEs identified key areas in which additional training would be beneficial, including trial preparation, photography, and hands-on training. Self-reported trauma and burnout findings are discussed in light of the high use of support services such as therapy, decompressing with other SANEs, and leisure activities. Our findings provide valuable information for supervisors and training providers of SANEs and have important implications for future SANE research.

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Perceptions Among Mental Health Professionals Regarding the Intrusiveness of Coercive Measures

ABSTRACT Background Although hotly disputed, coercive measures are widely used in mental health services globally. In Denmark, to ensure the rights of patients, special psychiatric legislation that emphasizes the imperative to always use the least intrusive intervention has been implemented. This raises the question of which coercive measures are perceived as being less intrusive than others. Aim The aim of this study was to investigate the perceptions of Danish mental health professionals regarding the intrusiveness of various coercive measures used in mental health settings. Methods We conducted a web-based survey among 132 mental health professionals (response rate: 22%). The participants rated the intrusiveness of different coercive measures using the visual analog scale (VAS). Results Mental health professionals perceived mechanical restraint as being the most intrusive coercive intervention (belt and strap fixation received a VAS rating of 92 out of 100). Conversely, body searches and observation were perceived as being among the least intrusive measures, with VAS ratings of 35 and 50, respectively. Participants with different professional backgrounds, including general and forensic mental health workers, tended to perceive the coercive measures included in this study as being equally intrusive. Conclusion The participating mental health professionals generally perceived belt fixation as a highly intrusive measure, whereas seclusion, which is currently illegal under Danish law, was considered less intrusive. Because of the small sample size in this study, caution should be exercised when drawing conclusions based on the findings. Nevertheless, the study may add to how the principle of using the least intrusive measure is interpreted.

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Cross-Cultural Adaptation and Psychometric Properties Testing of the Persian Version of the Emergency Department Forensic Nursing Survey.

Forensic nursing is an evolving specialty focusing on healthcare when legal issues are involved. Valid tools are needed to assess emergency department (ED) nurses' performance of forensic nursing role behaviors and their corresponding perceptions. We aimed to translate and culturally adapt the original English version of the "Emergency Department Forensic Nursing Survey" (EDFNS) into Persian and evaluate its psychometric properties among ED nurses. This methodological study was conducted in 2022. The EDFNS was translated into Persian. Face and content validity, along with construct validity (exploratory/confirmatory factor analyses) and reliability (internal consistency/test-retest reliability), were assessed. The EDFNS-P (EDFNS-Persian) items were appropriate, clear, and relevant in face validity assessment. Content validity was satisfactory for all items (content validity ratio = 0.66/content validity index = 0.92). In total, 274 nurses completed the questionnaires. The EDFNS-P consisted of five factors, namely, identifying forensic cases, acting as a forensic nurse specialist, assisting with legal investigations, providing holistic supportive care, and protecting forensic evidence, explaining 56.49% of the total variance. Confirmatory factor analysis assessment showed a good model fit. The EDFNS-P demonstrated acceptable internal consistency and stability (α = 0.902/intraclass correlation coefficient = 0.938). The concept of forensic nursing role behaviors within Iranian EDs is multidimensional. The EDFNS-P is a 37-item reliable and valid scale. It can help identify areas requiring improvement, promote better collaboration among healthcare professionals, and increase recognition of the specialty. Future studies examining the factor structure in different contexts are suggested to validate the findings. Further research is needed to assess the Persian version of the EDFNS in countries where forensic nursing roles are increasingly emerging.

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Child Maltreatment Data After Implementation of Hospital-Wide Protocol and Utilization of Sexual Assault Forensic Examiners for Child Maltreatment Cases.

Child maltreatment is a significant global health concern with significant morbidity and mortality. Sexual assault forensic examiners (SAFEs) provide a valuable skill set and may be utilized in child maltreatment evaluations. The purpose of the study was to describe patient characteristics and trends after implementation of a hospital-wide standardized child maltreatment protocol including forensic examiners in child maltreatment cases. Data from January 2017 through December 2022 were retrospectively collected and reviewed on all children under 18 years old who had a child maltreatment evaluation after initiation of a standardized child maltreatment screening process and protocol incorporating SAFE forensic evaluations at a tertiary care Level 1 trauma center. From January 2017 through December 2022, there were 764 child maltreatment evaluations of 742 total patients completed, with 763 (99.9%) evaluations completed by a trained SAFE. There were 378 examinations (49%) completed in children under 2 years old, 281 (37%) in children 2 years old until the 10th birthday, and the remaining 105 (14%) in children 10 years and older. The overall number of cases increased since the initiation of standardized screening and protocol from 68 cases in 2017 to 158 cases in 2022, with peak of 167 cases in 2020. SAFE-trained providers can be successfully incorporated in the multidisciplinary evaluation of child maltreatment patients and can add invaluable education, forensic documentation, and standardization of practice in the care of this vulnerable population.

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Forensic Mental Health Nurses' Perceptions and Experiences of Trauma-Informed Care in a High-Secure Hospital.

Implementation of trauma-informed care (TIC) into forensic clinical practice may contribute to positive outcomes for both patients and staff. The current study aimed to describe forensic mental health nurses' perceptions and experiences of using TIC within a high-secure forensic hospital. Twenty-seven forensic mental health nurses were interviewed regarding their experiences of using TIC within a high-secure hospital. Participants recognized the importance of understanding the past traumatic experiences of patients in their care but described a number of barriers to the implementation of TIC. A lack of organizational support, the negative impact of patient psychopathology on nurse well-being, and environmental factors were all perceived to negatively impact the successful delivery of TIC. Participants also discussed a widespread lack of knowledge and confidence in the application of TIC but expressed great desire for training to improve service delivery. The application of TIC into daily clinical practice appears to be suboptimal. To support nurse and patient well-being and contribute to a highly skilled trauma-informed workforce, further training in this area is vital. Training in TIC may contribute to enhanced patient outcomes and promote nurse well-being and should be supported organizationally with sufficient resources.

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A Canadian Sexual Assault Nurse Examiner's Personal Reflection and Ongoing Questioning of Vicarious Trauma.

The objective of this article was to provide a first-person account of the vulnerable aspects of my life where I questioned if VT had influenced my thought processes and to uncover the potential health risks associated with exposure to patients' repeated stories of trauma. I questioned whether I was experiencing VT or other disorders such as burnout, posttraumatic stress disorder, or compassion fatigue. The scholarly literature was reviewed after my personal reflection to analyze my personal experiences and to gain clarity on how VT and/or other related concepts may impact the professional and personal lives of SANEs. Methods used to produce my personal stories have been done via self-reflection and journaling. Three stories that I believe may resemble VT are shared and analyzed vis-à-vis the literature. My personal vignettes are compared with signs and symptoms of VT and illustrate how they may manifest in the daily lives of SANEs. To date, researchers have neglected to explore concrete examples of the personal depth VT may exhibit in an individual's life. By disclosing and synthesizing my personal stories, I hope to encourage SANEs to be open about their experiences, spread awareness and prevention strategies regarding VT, and, ultimately, further enhance well-being and promote increased longevity in their careers.

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Emergency Department Workers' Perceived Support and Emotional Impact After Workplace Violence.

Workplace violence (WPV) is a common experience among healthcare workers in the United States. Although WPV may affect workers physically, WPV can also affect workers' mental health. Emergency department (ED) workers' perceptions of available and necessary WPV support have not been previously reported. A cross-sectional survey design was used to examine ED workers' perceived level of WPV support and emotional impact that WPV causes them. This study was conducted at six Midwestern U.S. EDs. Respondents confidentially completed an adapted version of the Survey of Violence Experienced by Staff. Data analysis included descriptive statistics, t test, and Kruskal-Wallis test. Respondents (N = 206) who experienced WPV served as the analytical sample. Respondents predominantly agreed or strongly agreed that support was available after WPV (n = 129, 63.2%). The predominant source of support after WPV was another colleague from the department (n = 127, 62.3%). Less than half of respondents (n = 96, 47.1%) indicated they agreed/strongly agreed that managers were supportive after verbal abuse, but 63.6% (n = 126) indicated that managers were supportive after physical assault. There was no statistical difference between the emotional impact of verbal abuse compared with threats/assaults. Forensic nurses and emergency nurses with forensic nursing training are situated to combine their expertise in trauma-informed care, evidence collection, and expert testimony to support victimized ED workers. Timely support should be offered regardless of the category of WPV experienced. Insight into why support is perceived as available and accessible but may not be used warrants further study.

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