Forensic Nurse Examiner Research Articles

Forensic Nurse Examiners — Meeting the Needs of Survivors of Violent Crimes

Forensic Nurse Examiners — Meeting the Needs of Survivors of Violent Crimes

422 Lock-Downs Causing Lock-Ins: The Impact of the COVID Pandemic on Domestic and Intimate Partner Violence Trends Observed by Forensic Nurse Examiners

422 Lock-Downs Causing Lock-Ins: The Impact of the COVID Pandemic on Domestic and Intimate Partner Violence Trends Observed by Forensic Nurse Examiners

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

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. 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. A phenomenological approach was taken, and data were gathered through focus groups and interviews. Themes were identified under the headings of "indicators of empowerment," "empowerment as a process," and "the empowerment approach." 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.

Gonorrheal and chlamydia yield for genital and extragenital testing in children evaluated for sexual abuse

ObjectiveTexas Forensic Nurse Examiners (TXFNE) performs routine testing of genital and non-genital sites for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), and further testing for other sexually transmitted pathogens. The current Centers for Disease Control and Prevention (CDC) guidelines recommend that testing be based primarily on patient history of type of sexual contact, patient age, community prevalence of sexually transmitted infections (STIs), perpetrator risk factors for STIs, and patient symptoms (Centers for Disease Control and Prevention, 2021). In this study, we were interested in determining whether our practice of testing all sites in all prepubertal patients presenting for sexual abuse for CT and NG resulted in identification of infections that would have been missed if testing had been limited to disclosed sites of sexual contact. MethodsWe conducted a retrospective chart review of all children younger than 14 years who presented to a clinical or hospital site for evaluation by TXFNE in Harris County or surrounding counties during the period January 2020–December 2021. ResultsOf the 675 patients tested, 61 patients (9 %) had genital injuries and 45 patients (7 %) had either reported symptoms or examination findings consistent with possible STI infection. There were 11 patients who had positive gonorrhea and/or chlamydia results. Of the 11 patients with a positive result, 10 patients' reported history of type of contact did not fully match sites that tested positive. Diagnosis of STI infection would have been missed for 5 patients if testing had been limited to the disclosed sites of sexual contact. ConclusionPositive results for CT and NG at undisclosed body sites in children presenting with concern for sexual abuse most likely represent infection from sexual contact. Limiting STI testing based on disclosed contact may lead to missed NG and CT infections in prepubertal patients with concern for sexual abuse. This can lead to delayed treatment of the infection and a missed opportunity to ensure the safety of the child.

Implementation of a screening tool for child sex trafficking among youth presenting to the emergency department – A quality improvement initiative

BackgroundIdentification of sex-trafficked youth in the emergency department (ED) is difficult and routine screening is uncommon. ObjectivesOur Quality Improvement (QI) Project aimed to increase ED screening and identification of high-risk youth using the Short Screen for Child Sex Trafficking (SSCST). ParticipantsYouth (11 through 17 years) seeking care at two metropolitan EDs with a high-risk chief complaint triggering a best practice alert (BPA). MethodsA BPA prompted administration of the SSCST and referral of screen ‘positive’ youth for comprehensive evaluation for child sex trafficking by the forensic nurse examiner (FNE). Targeted QI interventions defined three study periods (SP). Outcomes measures included screening 50% of high-risk youth with 50% of those youth referred for FNE evaluation. ResultsOver three study periods, 5454/13,956 (39.1%) youth triggered a BPA for high-risk chief complaint; 4354 (78.6%) received the SSCST screen; 1336 (76.0%) of screen-positive youth were referred for FNE evaluation. Outcomes measures were exceeded during all three study periods. SSCST modifications to increase specificity led to a significant decrease in the percentage of positive screens (42.8% SP1 vs 29.4% SP3). Financial programmatic support and further staff training led to an increase in FNE evaluations (86.4 SP3 vs 5.7% of referred youth SP1). Identification of trafficked patients increased from 1.3% of screen-positive youth to 11.3% (SP1 vs SP3; p < 0.0001). ConclusionsRoutine screening for child sex trafficking can be implemented in the ED setting and increases the identification of at-risk youth.

Prosecutor Preference for Forensic Nurse Testimony: Outcome of Expanding a Forensic Program

IntroductionThe objective was to evaluate the impact of using forensic nurse examiners for patients with trauma on prosecutors’ preference for testimony in criminal court. MethodsA retrospective chart review of a database of 562 subpoenas received from January 2012 to December 2017 was conducted for patients with trauma seen in a level 1 trauma center with a comprehensive forensic nursing program. ResultsThe prosecutors’ preferences in 453 of the 562 subpoenas received by the Forensic Nurse Examiners program involving a patient with trauma were analyzed. The prosecutors preferred the use of the forensic nurse examiner alone in 441 of the 453 cases (97.4%), with a decrease (100% to 2.7%) in preference for physicians testifying in criminal court after the expansion of our forensic nursing program compared with previous years before the program expansion. DiscussionThe quality of the expanded Forensic Nurse Examiner program was validated by an increased prosecutor preference for forensic nurse examiner testimony in criminal court as the program matured over the years.

Development and Evaluation of an Elder Abuse Forensic Nurse Examiner e-Learning Curriculum.

In Ontario, Canada, there is a need for an easily accessible training for forensic nurse examiners on the provision of care for abused older adults. In this study, our objective was to develop and evaluate a novel elder abuse nurse examiner e-learning curriculum focused on improving the care provided to older adults. The curriculum was launched on an online learning management system to forensic nurses working across Ontario’s hospital-based violence treatment centers in June 2019 and evaluated using pre- and post-training questionnaires that measured self-assessed changes in knowledge and skills-based competence related to providing elder abuse care. There were significant improvements pre- to post-training in self-reported knowledge and competence across all core content domains: Older Adults and Abuse; Documentation, Legal, and Legislative Issues; Interview with Older Adult, Caregiver, and Other Relevant Contacts; Initial Assessment; Medical and Forensic Examination; and Case Summary, Discharge Plan, and Follow-Up Care. As the curriculum enhanced the knowledge and skills associated with caring for abused older adults, it may have implications for training forensic nurse examiners and associated staff working in more than 25 countries internationally.

Factors Associated With Forensic Nurses Offering HIV nPEP Status Post Sexual Assault.

Nonoccupational, postexposure prophylaxis (nPEP) for human immunodeficiency virus (HIV) is offered inconsistently to patients who have been sexually assaulted. This may be due to Forensic Nurse Examiner (FNE) programs utilizing diverse nPEP protocols and HIV risk assessment algorithms. This study examines factors associated with FNEs offering nPEP to patients following sexual assault at two FNE programs in urban settings. Offering nPEP is mostly driven by site-specific protocol. At Site 1, in addition to open anal or open genital wounds, the presence of injury to the head or face was associated with FNEs offering nPEP (adjusted odds ratio [AOR] 64.15, 95% confidence interval [CI] = [2.12, 1942.37]). At Site 2, patients assaulted by someone of Other race/ethnicity (non-White, non-African American) were 86% less likely to be offered nPEP (AOR 0.14, 95% CI = [.03, .72]) than patients assaulted by Whites. In addition to following site-specific protocols, future research should further explore the mechanisms influencing clinician decision making.

Forensic Nurse Examiners versus Doctors for the Forensic Examination of Rape and Sexual Assault Complainants: A Systematic Review

Within the UK, the complainants of rape and sexual assault are typically referred to regional sexual assault referral centres (SARCs) where their medical and psychological needs are addressed and, if they consent, a forensic medical examination will be conducted, usually by a forensic physician. In the USA, this service is typically nurse-led.

Nonoccupational Postexposure HIV Prophylaxis in Sexual Assault Programs: A Survey of SANE and FNE Program Coordinators

This cross-sectional study describes sexual assault nurse examiner (SANE)/forensic nurse examiner (FNE) program practices related to HIV testing, nonoccupational postexposure prophylaxis (nPEP), and common barriers to offering HIV testing and nPEP. A convenience sample of 174 SANE/FNE programs in the United States and Canada was drawn from the International Association of ForensicNurses database, and program coordinators completed Web-based surveys. Three fourths of programs had nPEP policies, 31% provided HIV testing, and 63% offered nPEP routinely or upon request. Using χ(2) and Fisher's exact tests, a greater proportion of Canadian programs had an nPEP protocol (p=.010), provided HIV testing (p= .004), and offered nPEP (p=.0001) than U.S.-based programs. Program coordinators rated providing pre- and/or posttest counseling and follow-up as the most important barrier to HIV testing, and medication costs as the most important barrier to providing nPEP. Our results indicate HIV-related services are offered inconsistently across SANE/FNE programs.

Predicting Sexual Assault Kit Submission Among Adolescent Rape Cases Treated in Forensic Nurse Examiner Programs

Following a sexual assault, victims are usually advised to have a medical forensic exam and sexual assault forensic exam kit (SAK). Once completed, the SAK is to be transported by law enforcement to the crime lab for analysis. However, many kits are never transported to the crime lab, thereby preventing forensic evidence obtained in the kit to be used during the prosecutorial process. The current study examined rates of SAK submission for 393 adolescent sexual assault cases in two Midwestern communities and explored what factors predicted law enforcement officers' submission of SAKs to the crime lab for analysis. Findings reveal that more than 40% of the adolescent cases did not have their SAK submitted, and several factors, including the age and race of the victim, the number of perpetrators in the assault, and the number of assaultive acts, predicted SAK submission. Implications for SAK community protocols are discussed.

Whose Credibility Is It Anyway: Professional Authority and

There is an inherent tension in the information gathering and recording stages of the forensic medical examination of rape survivors. Medical practitioners do not wish to record information that can undermine a complainant’s credibility, but at the same time must ensure that they do not problematise their own credibility by appearing partisan (for instance, by omitting information that might be relevant). Drawing upon semi-structured interviews with Forensic Nurse Examiners (FNEs) and their trainers (Forensic Medical Examiners) in England, and Sexual Assault Nurse Examiners (SANEs) in Ontario, this paper will investigate the strategies that both sets of nurses employ in order to document medical, sexual and assault histories, as well as physical phenomena (injuries, tattoos and piercings). FNEs collect more potentially prejudicial information than SANEs; this is a result of their greater anxiety in regards to their perceived credibility and professional authority.

Forensic nursing science: Global strategies in health and justice

Forensic nurse examiners (FNE) are becoming integral partners in contemporary medicolegal systems worldwide. Existing forensic services have been proven inadequate to sufficiently address the vast crimes against women and children, victims of sexual and domestic violence, sociocultural crimes, abusive religious rituals, and atrocities that accompany armed conflict. Considering that nurses comprise the largest group of healthcare providers worldwide, forensic nurse examiners represent a previously unrecognized resource in universal healthcare and embody an ideal group to advance international considerations in global healthcare and social justice. Although specific legal concerns within the healthcare communities vary from country to country, all nations struggle with issues of public health and safety. A comprehensive multidisciplinary forensic education and training program for nurses will facilitate improved management of existing interpersonal and sexual violence crises while reducing an unnecessary back log of cases for forensic physicians. The addition of a forensic specialist in nursing science will provide a valuable resource to assist in the substantiation of prosecutors’ claims or aid in the exoneration of suspects who are falsely accused. Their unique contributions increase coordination and cooperation, share medical/forensic expertise, enhance the care of victims of crimes while augmenting forensic services, and act as a liaison in applicable responsibilities between healthcare institutions and law enforcement agencies. The relevant literature indicates that once the Forensic Nurse Examiner Response Team is trained, specialists in forensic nursing science practice independently under the auspices of a Director of Clinical Forensic Medicine or Chief Medical Examiner. This new generation of health and justice professionals will produce affirmative outcomes where the science of forensic nursing is practiced. The positive treatment of victims of gender based crime, an increase in successful prosecution, and the assurance of best specimens in evidence recovery will provide confidence in the community at large that justice has been served through these combined forensic services...medicine, nursing and the law.

Anogenital injuries in childhood sexual abuse victims treated in a pediatric Forensic Nurse Examiner (FNE) program

Medical forensic exams for victims of childhood sexual abuse (CSA) can be a helpful resource for addressing patients' complex medical, psychological, and legal needs. These exams can be performed by physicians or forensic nurses to identify and treat injuries, evaluate the risk for sexually transmitted infections and pregnancy, and collect evidence. In this study, we examined CSA cases treated in a midwestern, community-based forensic nurse examiner (FNE) program to document rates of anogenital injury and identify what factors predict the presence of such injuries (N= 203). Overall, 39% of the cases had anogenital injury. Victims who were examined for suspected vaginal and/or anal assault were significantly more likely to have anogenital injuries, and patients examined within 24 hours of an assault were also significantly more likely to have documented injuries. Patients who were seen for vaginal and/or anal assaults and who had bathed since the assault were significantly less likely to have injury. Nurses who had less experience with pediatric medical forensic exams were somewhat more likely to document anogenital injuries. Findings suggest that clinical pediatric practice would benefit from additional practitioner training in injury detection to avoid false positives.

A comparative study of the prosecution of childhood sexual abuse cases: The contributory role of pediatric Forensic Nurse Examiner (FNE) programs

This study used a rigorous quasiexperimental design to compare prosecution outcomes for childhood sexual abuse (CSA) cases examined in a pediatric Forensic Nurse Examiner (FNE) program (the "intervention group") (n= 95) to a comparison sample of CSA cases examined by non-FNE medical professionals prior to the inception of the FNE program (the "comparison group") (n= 54). The types of cases in the intervention and comparison groups were different such that the FNE program had significantly more cases with younger victims where it was unknown or ambiguous whether they had penetration and/or fondling. Multivariate logit modeling was used to explore what factors predict legal case outcomes. Prosecution rates were significantly higher in the FNE group as opposed to the comparison group. In addition, cases with older victims who sustained penetration were the most likely to be prosecuted. Implications for forensic nursing practice are discussed.

Comparison of Cervical Os Versus Vaginal Evidentiary Findings During Sexual Assault Exam

Evidence collection post sexual assault varies across the nation. The Ohio Department of Health has a standardized kit for evidence collection used during the forensic exams of sexual assault survivors. The protocol includes obtaining 4 swabs: 2 from the vaginal pooled fluid and 2 from the cervical area. The purpose is to determine if augmenting the state protocol with cervical os swabs and a comparison slide will improve evidentiary findings in adolescent and adult female rape survivors. A descriptive study of 30 months for sexual assault female survivors over the age of 13 treated at a level II emergency department by a trained sexual assault nurse examiner (SANE). The comparisons of cervical os specimens versus vaginal pool findings were analyzed by the Canton-Stark County Crime Laboratory (C-SCCL). Eighty-six cases were completed. After investigation, local law enforcement officials turned in 36 kits (42%) to be processed at the C-SCCL for the standard vaginal pool swabs and slide. The average estimated time interval between assault and treatment time was 20.46 hours (range, 2.83 to 80.83 hours). The average age of the survivor was 23.7 years, (range, 15 to 48). Eight percent (3/36) had only cervical os semen evidentiary findings. Forty-four percent (16/36) had positive semen evidentiary findings in vaginal pool and cervical os. Successful convictions were aided by the cervical os research study, especially because vaginal pool evidence diminishes when collected after 24 hours, but may be present longer in the cervical os.

An Informal Discussion of Emergency Nurses' Current Clinical Practice: What's New and What Works

The opinions expressed are those of the respondents and should not be construed as the official position of the institution, ENA, or the Journal. Mary-Helen Scales is Coordinator, Sexual Assault Response Program, Emergency Department Staff Nurse, Doylestown Hospital, Doylestown, Pa. Jennifer Lewchick is Emergency Department Staff Nurse, Forensic Nurse Examiner, Sexual Assault Response Program, Doylestown Hospital, Doylestown, Pa. Jody Bauer is Emergency Department Staff Nurse, Forensic Nurse Examiner, Sexual Assault Response Program, Doylestown Hospital, Doylestown, Pa. Alina Kiljanski is Staff Nurse/Forensic Nurse Examiner, Emergency Department, Doylestown Hospital, Doylestown, Pa. For correspondence, write: Mary-Helen Scales, RN, CEN, SANE-A, Doylestown Hospital, Doylestown, PA; E-mail: HokiEbells@Juno.com. J Emerg Nurs 2007;33:480-3. 0099-1767/$32.00 Copyright n 2007 by the Emergency Nurses Association. doi: 10.1016/j.jen.2007.06.007

Forensic Nurse Examiners

Forensic Nurse Examiners