Forensic Nursing Research Articles

Innovative Assessments for Retention of Sexual Assault Nurse Examiners.

The Southeast Kansas (SEK) comprehensive rural Sexual Assault Nurse Examiners (SANE) program was developed as part of an effort to increase the availability of SANE services nationwide. The primary goal of the program is to provide education to assist with training and certification of registered nurses and advanced practice registered nurses in SEK to conduct sexual assault forensic examinations and become certified. This will provide better physical and mental health care for survivors and better evidence collection and higher prosecution rates in a rural, medically underserved area. The project established a rural academic-practice-community partnership to provide longitudinal immersive SANE clinical training. The success of the project in SEK will be impacted by the retention of SANEs; therefore, the integration of the Professional Quality of Life (ProQOL) self-assessment was seen as an important component of the grant implementation. ProQOL determines compassion satisfaction, burnout, and secondary traumatic stress. The data collected from SANEs on their self-assessments with the ProQOL lead to early identification of SANEs experiencing negative effects of forensic nursing and the ability to intervene for decreased attrition.

The Forensic Psychiatric Network of Observation and Documentation: At the Intersection of Review Board Hearings and Nursing Practice.

Forensic psychiatric nursing is a specialty at the junction of two well-researched intersecting systems with two mandates: criminal justice and health care. Nurses' involvement at one of the systems' points of juncture, review board (RB) hearings, has largely been left unexplored. At RB hearings, a panel of legal and healthcare professionals determines if persons unfit to stand trial (UST) or not criminally responsible on account of mental disorder (NCR) represent significant threats to the safety of the public and orders conditions aimed at keeping the community safe. The aim of this article is to present the results of a critical ethnography that explored how psychiatric and public safety discourses construct the identity of persons UST or NCR during RB hearings as well as nurses' contribution to such identity construction. The main finding is that the forensic psychiatric structure leverages nursing interventions and documentation as evidence of deviancy, so that persons UST or NCR can be objectified and produced as dangerous. Structures sustaining the forensic psychiatric system inscribe nursing care within a disciplinary scheme, rendering the care-and-custody dichotomy insufficient to explain the complex processes at play in forensic psychiatry. These findings have implications for the practice of nurses working in forensic psychiatric settings and for that of other nurses who practice on the medicolegal borderland.

Safewards Secure: A Delphi study to develop an addition to the Safewards model for forensic mental health services.

Accessible SummaryWhat is known on the subject? The Safewards model has been introduced to forensic mental health wards with mixed results.Research has identified a need to consider the addition of factors that may be relevant to forensic mental health services to enhance the introduction of Safewards. What the paper adds to existing knowledge? This study elicits factors specific to forensic mental health settings missing from the original Safewards model, which have the potential to enhance nursing care, improve safety and improve adherence to Safewards in a forensic mental health setting. What are the implications for practice? This study provides the adaptation required in a forensic mental health setting to enhance the implementation of the Safewards model of care, originally developed to assist nurses to prevent and manage conflict and containment in acute general mental health settings.The development of Safewards Secure has incorporated perspectives from expert Safewards and forensic mental health nurse leaders and healthcare clinicians and is inclusive of consumer and carer perspectives to ensure the model is applicable and broadly acceptable. IntroductionSafewards is a model designed specifically for acute mental inpatient wards. Research investigating the introduction of Safewards has identified a need to consider factors relevant in forensic mental health services, such as offence and risk issues.AimTo identify adaptations needed to address gaps in the Safewards model to assist forensic mental health nurses to prevent and manage conflict and containment.MethodA Delphi study was employed to engage a group of international Safewards and forensic mental health experts (n = 19), to elucidate adaptation of the Safewards model.ResultsExperts identified necessary elements and reached consensus on key considerations for Safewards interventions. To ensure the Safewards Secure model was robust and developed on a platform of research, all items suggested by Delphi experts were cross‐referenced and dependent on empirical evidence in the literature.DiscussionThis study identified a number of key differences between civil and forensic mental health services, which informed the development of Safewards Secure, an adjunct to the original Safewards model.Implications for PracticeThe development of person‐centred models of nursing care adapted to specific settings, such as forensic mental health, provides a potential solution to preventing and managing conflict and containment, and improving consumer outcomes.Relevance StatementManaging conflict and containment in mental health services remains an ongoing challenge for mental health nurses. Safewards is a model of care designed for acute mental health inpatient settings to prevent conflict and containment. To date, there has been mixed results when introducing Safewards in forensic mental health settings, and reported reluctance and scepticism. To address these issues, this study employed a Delphi design to elicit possible adaptions to the original Safewards model. From this study, Safewards Secure was developed with adaptations designed for forensic services, to enhance the management of conflict and containment, assist implementation and improve consumer outcomes.

“You Know Where the Boundary Is When You Cross It” - A Phenomenological Understanding of Vulnerability as Experienced by Carers in Forensic Inpatient Care

In forensic nursing, carers must balance caring and limiting actions in encounters with patients. Interpreting suffering in others raises awareness of one’s own vulnerability. Hence, the aim of this study was to describe the phenomenon of vulnerability as experienced by carers in forensic inpatient care. Nine participants were recruited at a major forensic hospital, and their narratives were analysed with a reflective lifeworld approach. The findings revealed that vulnerability was both a strength and a burden. Vulnerability comprised becoming aware of one’s boundaries, being genuine and protecting oneself. Dealing with vulnerability enables carers to open up to patients.

Forensic Mental Health Nurses' Experiences of Clinical Supervision.

Clinical supervision may support forensic mental health nurses with personal and professional growth in a work environment characterized by therapeutic, ethical, and practical challenges. The aim of this study was to describe the experiences of forensic mental health nurses participating in a clinical supervision program. Seven forensic mental health nurses and two allied health professionals, working in a high-security forensic mental health hospital, were interviewed regarding their experiences of participating in a clinical supervision program. Participants expressed a need for clinical supervision and were motivated to participate in the program. Benefits of clinical supervision experienced by participants included improved communication with their colleagues, being supported in their career development, and developing habits and techniques to reflect on practice issues. Participants described being able to connect with their supervisor, enabled by both trust and confidence in the supervisor's expertise. Staff showed engagement in the clinical supervision process and expressed experiencing positive outcomes related to personal and professional growth and development. To support nurses with the forensic mental health context-specific challenges they face, organizations should enable and promote access to clinical supervision. Considerations for forensic mental health organizations to increase uptake and effectiveness of clinical supervision include use of externally based clinical supervisors with adequate skills and experience with providing clinical supervision to clinical staff who work in a secure environment.

Examining the Implementation of the National Protocol for Sexual Assault Medical Forensic Examinations.

The National Protocol for Sexual Assault Medical Forensic Examinations, Adult/Adolescent, 2nd edition, or SAFE Protocol, is a voluntary guide that assists local and state jurisdictions with their responses to sexual assault by institutionalizing best practices around survivor care and evidence collection, particularly for sexual assault nurse examiners (SANEs) completing medical forensic examinations. We examined the uptake of the SAFE Protocol in communities across the United States by analyzing data from a set of national surveys of forensic nursing programs and victim advocates within the same communities. We studied four implementation outcomes: the acceptability, adoption, reach, and sustainability of the SAFE Protocol. SANEs and advocates reported that stakeholders responding to sexual assault-including forensic nurses, advocates, law enforcement, and prosecutors-have high implementation of the Protocol, which indicates how important individual stakeholder engagement is in actively facilitating the adoption of it. However, when information from SANEs and advocates from the same community are compared, the extent to which the SAFE Protocol is reported to be implemented with fidelity across U.S. jurisdictions is mixed.

Trauma-Informed Approaches to Medicolegal Death Investigation: A Forensic Nursing Perspective.

Forensic nurses engaged in medicolegal death investigations experience trauma-induced responses in responding to, investigating, and documenting sudden unexpected deaths. The trauma of these repeated experiences often results in diminished performance, job dissatisfaction, and burnout. The principles of trauma-informed care are not new but have not been incorporated into death investigation practices. When coupled with medicolegal death investigation procedures, application of these principles can help to alleviate distress for forensic nurses, colleagues, and decedents of concerned families. This case series illustrates how the principles of trauma-informed care can be implemented to enhance communication, deescalate emotional or threatening situations, and prevent retraumatization in the context of medicolegal death investigations.

Mobile Phone Apps for Intimate Partner and Sexual Violence Prevention and Response: Systematic Search on App Stores.

BackgroundSince the 2008 advent of the smartphone, more than 180 billion copies of apps have been downloaded from Apple App Store, with more than 2.6 million apps available for Android and 2.2 million apps available for iOS. Many violence prevention and response apps have been developed as part of this app proliferation.ObjectiveThis study aims to evaluate the prevalence and quality of freely available mobile phone apps targeting intimate partner violence (IPV) and sexual violence (SV) prevention and response.MethodsWe conducted a systematic search of violence prevention and response mobile phone apps freely available in Apple App Store (iOS; March 2016) and Google Play Store (Android; July 2016). Search terms included violence prevention, sexual assault, domestic violence, intimate partner violence, sexual violence, forensic nursing, wife abuse, and rape. Apps were included for review if they were freely available, were available in English, and had a primary purpose of prevention of or response to SV or IPV regardless of app target end users.ResultsUsing the Mobile Application Rating Scale (MARS), we evaluated a total of 132 unique apps. The majority of included apps had a primary purpose of sharing information or resources. Included apps were of low-to-moderate quality, with the overall subjective quality mean for the reviewed apps being 2.65 (95% CI 2.58-2.72). Quality scores for each of the 5 MARS categories ranged from 2.80 (engagement) to 4.75 (functionality). An incidental but important finding of our review was the difficulty in searching for apps and the plethora of nonrelated apps that appear when searching for keywords such as “rape” and “domestic violence” that may be harmful to people seeking help.ConclusionsAlthough there are a variety of mobile apps available designed to provide information or other services related to SV and IPV, they range greatly in quality. They are also challenging to find, given the current infrastructure of app store searches, keyword prioritization, and highlighting based on user rating. It is important for providers to be aware of these resources and be knowledgeable about how to review and recommend mobile phone apps to patients, when appropriate.

Nonoffending Caregiver Support After Child Sexual Abuse: Essentials for the Forensic Nurse.

Child sexual abuse (CSA) is a pediatric health problem of epidemic proportions. CSA can result in significant lifelong physical and mental health consequences. A disclosure of CSA affects not only the child but also everyone close to the child. Nonoffending caregiver support after a disclosure of CSA is key to optimal victim functioning. Forensic nurses play an integral role in the care of CSA victims and are uniquely positioned to ensure best outcomes for both child victims and their nonoffending caregivers. In this article the concept of nonoffending caregiver support is explored, and = implications for forensic nursing practice delineated.

Basics of Victimology for Medical Personnel

Forensic physicians, gynecologists, forensic nurses, emergency medical officers and other doctors are coming across victims of violence and they need to know the basics of victimology. They need to know how to deal with them to recognize the investigative, therapeutic, judicial, social and cultural needs of the victims. They should know that victims have the right. A brief exploration of the various aspects of victimology which can be useful to the medical stakeholders is being introduced and discussed in this paper. Starting from the history of victimology to the various theories of its origin, victim's rights, victimology ethics, and the financial burden on the society are being discussed in this paper so that medical professionals can get aware of these aspects of victimology and ultimately this knowledge can guide and help them to deal with the victims rightfully.

Online video games and patient-staff power relations. A qualitative study of care and custody in forensic psychiatry.

Accessible summaryWhat is known on the subject? Frontline forensic mental health staff often face challenges when providing recovery‐orientated care, as they must balance between caring for the forensic psychiatric patient and at the same time ensuring safety and security for all other patients and staff at the ward.Research shows that balancing between care and custody in everyday clinical practice is possible, but more practical nursing studies showing ways of balancing power relations are needed to guide clinical practice.Online video games are increasingly recognized as promising new tools to promote social relations, establish competencies and re‐articulate power relations in therapeutic environments. What the paper adds to existing knowledge? This paper provides insights into how using online video gaming interventions may influence the establishment of social power relations of staff and forensic psychiatric patients. It adds to existing research by providing a conceptual way to study and understand how mental health nurses may balance between care and custody, delivering care to accommodate patients' needs without compromising safety and security at the ward.This study answers a call in current research by providing qualified knowledge regarding the use of online video gaming to build and sustain therapeutic relations in mental health care. What are the implications for practice? Our paper suggests that balancing between care and custody is possible by using online video gaming interventions in forensic psychiatry. It moreover provides practice‐close knowledge that may inspire and guide clinical mental health nurses to further develop online video gaming interventions in mental health care for the benefit of their patients. IntroductionIn recovery‐oriented care, forensic psychiatric nurses must engage in care relationships with forensic psychiatric patients (FPs) whilst focussing on ward security. Online video games (OVGs) may provide a platform for negotiating power and social relations. Studies showing how OVG interventions may influence power balances in forensic psychiatric care are needed to guide clinical practice.AimOur aim was to study how power relations were articulated between FPs and staff in an OVG intervention in a Danish forensic psychiatric ward.MethodData consist of three months of observational data and interviews with three staff members and six patients. We used sociologist Pierre Bourdieu's framework of field, power and capital to analyze data.ResultsThe OVG intervention consisted of two power fields, “in‐game” and “over‐game.” In‐game concerned the practice of gaming. Over‐game described the organization of the gaming intervention. Specific logics, skills and symbolic capitals drove power in each field.DiscussionPower in‐game was open to FPs and staff, leading to symmetric power relations. Power over‐game was open to staff only, resulting in asymmetrical power relations.Implications for practiceOnline video game interventions may facilitate power balancing in forensic psychiatry. These insights may guide the development of new OVG interventions for patients and nurses in mental health care.

Strategies Employed by Forensic Community Mental Health Nurses to Resolve Difficulties in Supporting Offenders With Mental Disorders Under the Medical Treatment and Supervision Act in Japan.

This study aimed to identify the strategies used by forensic community mental health nurses to resolve difficulties in supporting offenders with mental disorders under the Medical Treatment and Supervision Act in Japan. Interviews were conducted with 13 nurses, and the data were analyzed using content analysis. The study identified the strategies for difficulties in (a) assessing and managing risk potential of forensic service patients, (b) addressing offending behavior, (c) managing the transition of patients, (d) supporting patients to understand the impact of justice processes and applying knowledge of legislation to nursing, and (e) promoting the role of forensic community mental health nurses within the multidisciplinary team. The findings can benefit and support forensic community mental health nurses' practices. The Japanese forensic community mental health nurses experiencing difficulties and providing home visits to patients can utilize the identified strategies.

Enfermagem forense em urgência e emergência: uma nova perspectiva de abordagem

The aim of this article is to describe the performance of the forensic nurse in the Urgency and Emergency service. About the production took place from 2015 to 2021. For that, a narrative research of the literature was carried out, with qualitative approaches, where a synthesis of each production was developed, using the comparisons of the main results, the data analysis occurred in the form descriptive, allowing the evaluation of the articles according to the response and the selected studies were grouped in an analytical framework. Three categories were elaborated: Contextualizing Forensic Nursing, The Nurse in the Urgency and Emergency service and The performance of the forensic nurse in urgency and emergency. It was evidenced that the forensic nurse acts in the evaluations and collection of traces, in case of violence suffered by the patients outside/inside the hospital context and that he is the professional who first receives the victims who arrive at the emergency/urgency services, where he represents a important professional in a multidisciplinary team in the criminal investigation, where they are faced with opportunities to apply principles of Forensic Sciences, linked to their unique nursing skills. It is concluded that forensic nurses have the potential to act in urgent and emergency situations, as they have specific skills, in addition to working in the prevention and promotion of future cases.

Forensic Nursing: Challenges & Opportunities in the Present Day Healthcare Scenario

Forensic Nursing: Challenges & Opportunities in the Present Day Healthcare Scenario

Educational Needs of U.S. Emergency Nurses Related to Forensic Nursing Processes.

Forensic nursing is a specialty deployed in patient care areas, including emergency departments, intensive care units, labor and delivery suites, and psychiatric units treating persons who have suffered trauma from a violent or criminal act. The recognition of violence-related injuries in patients presenting to health care facilities is critical to an appropriate care trajectory. These patients require specialized resources beyond the treatment of physical injuries to include psychosocial and legal care that supports patient recovery and pursuit of criminal justice. The purpose of this study is to obtain a broad view of current forensic knowledge and training for emergency nurses working in U.S. emergency departments and to identify gaps in nursing skills and practice such that appropriate education can be developed for this nursing specialty. The study was conducted using a quantitative exploratory, descriptive approach via an emailed cross-sectional survey sent to a convenience sample of U.S. emergency nurses. A total of 43,775 emails were sent out to members of the Emergency Nurses Association. Of that group, 2,493 recipients opened the email, and 1,824 completed the survey, resulting in a total response rate of 4% and a 73% response rate from those who opened the email. Few respondents self-reported competence in the care of patients who experienced child abuse (13.1%), elder abuse (12.4%), interpersonal violence (17.6%), sexual assault (19.2%), human trafficking (7.4%), developmental challenges (7.2%), strangulation (12.5%), or who were suspected of committing a violent crime (11.4%). There is a compelling need to expand forensic education to advance knowledge and skill acquisition in emergency nursing practice and provide staff with additional resources that support a holistic trauma-informed approach to patient care.

Clinical Judgment Development: Six Steps to Establish Professional Identity and Role-Specific Competencies in Caring for a Sexual Assault Survivor

Background: Clinical judgment is a specific role that establishes a professional identity. The purpose of this paper is to prepare nursing students to make better judgments in the clinical setting and realign learning and teaching. Methods: We used six steps to arrive at a competent clinical judgment suggested by the National Council State Board of Nursing (NSCBN) as a clinical judgment model 1) recognizing cues, 2) analyzing cues, 3) prioritizing hypotheses, 4) generating solutions, 5) taking an action, and 6) evaluating outcomes during the head-to-toe examination of the patient. Results: The primary outcomes are stabilization of the hemodynamics of the patient and prevention of further blood loss. Fluids are being given to help keep the vascular volume from being depleted, but they cannot solve the underlying problem. Continued assessment, intervention, and monitoring of vital signs through the course of the hospital stay ending with the patient’s discharge. Discussion: Survivors of sexual assault are unique for a nurse to provide care. The nurse needs to assess, intervene, monitor, and pay attention to detail of the 6 steps to clinical judgment, resulting in positive outcomes for their patient. Conclusions: Forensic nursing is a field of nursing that focuses on sexual assault survivor care and works to make the aftermath of their tragic situation easier to cope with. Strengthening clinical judgment skills could remedy significant mistakes made by novice forensic nurses. Critical thinking and clinical ethical reasoning are the building blocks of clinical judgment.

Access to Reproductive Healthcare for Persons Who Have Experienced Sexual Violence.

Pregnancy resulting from abuse is a public health concern that millions of persons will experience in their lifetimes. Access to professional and safe reproductive healthcare, including sex education, contraception, and abortion, is essential to protecting the rights of persons to control their reproductive health. Currently, access to safe and timely reproductive healthcare is at particular peril. Affirming a patient's right to choose or, advocating autonomy in healthcare decisions is a key component of trauma-informed care. It is the position of the International Association of Forensic Nurses that access to, and autonomy in decision making about reproductive healthcare, including safe and legal contraception and abortion, is a basic human right.

When Compassion Hurts: An Autoethnographic Experience of Vicarious Trauma by a Forensic Nurse

Caring for victims of violence includes obtaining history, examining and collecting evidentiary matter, and providing expert testimony in the court of law. In this paper, the researcher shared her own experiences as a forensic nurse on how being compassionate and listening to the stories of victims of violence and witnessing the sustained injuries led to some emotional stress which is referred to in the literature as vicarious trauma. Working every day with victims led to an altered worldview that impacted the researcher’s psychological, physiological, and social being. A qualitative autoethnographic approach was explored to describe the researcher’s experiences working with victims of sexual assault in a designated center within a public hospital. Personal narratives were used as a data collection method and thematic approach to analyze and describe the experiences. Although the researcher acknowledges that not every forensic nurse may suffer symptoms resulting from vicarious trauma, the shared experiences may add value to individuals who have an interest in enrolling for a clinical forensic nursing course in becoming conversant with the concept, to think of ways to handle vicarious trauma and seek interventions on time. Moreover, organizational managers may know the ordeal, forensic nurses’ experience and provide the necessary support.

Increasing Access to Forensic Nursing Services in Rural and Underserved Areas of Texas.

Sexual assault is prevalent in the Unites States. Many areas of the country lack access to sexual assault nurse examiners (SANEs), especially in rural areas. The U.S. Health Resources and Services Administration Advanced Nursing Education-Sexual Assault Nurse Examiner educational grant provided an opportunity to improve equity and reduce disparity in rural and underserved communities by offering education and simulation experiences in the care of sexual assault patients. Through the Texas A&M Health Center of Excellence in Forensic Nursing, Texas A&M University College of Nursing developed an innovative program using simulated medical forensic examinations and mock testimony education. Rapid cycle quality improvement was utilized to adapt quickly to feedback and meet overarching goals. This article describes development and adaptation of the program using rapid cycle quality improvement processes and progress in recruitment, retention, and certification of nurses to provide sexual assault care in rural and underserved areas of Texas.

Exploration of the utility of the Nursing Process and the Clinical Reasoning Cycle as a framework for forensic mental health nurses: A qualitative study.

Forensic mental health nursing (FMHN) is a specialized field, designed to meet the needs of people who have a serious mental illness across the criminal justice system, inpatient services and community. Frameworks can assist assessment, planning, intervention, documentation and evaluation of nursing care. However, there is no prior research investigating frameworks in FMHN. This study aimed to explore the Nursing Process (NP) and the Clinical Reasoning Cycle (CRC), with nurses, to determine a suitable framework for use service-wide. A Nominal Group Technique was used to facilitate exploration of the two frameworks, where open-ended verbal and written responses collected from a Nominal Group were thematically analysed, and the participants voted on their preferred framework. Seventeen nurses from a state-wide forensic mental health (FMH) service participated. The four main themes were as follows: challenges to current practice, limitations of the NP, perceived benefits of the CRC and addressing implementation. Consensus was reached with the nurses selecting the CRC as the framework of choice. This is the first study to explore frameworks to guide practice in FMHN. Nurses in this study considered the CRC to be a suitable framework for novice through to expert, offering a contemporary framework to guide nursing care in complex FMH settings. Some adjustments to the existing cycle were suggested to emphasize recovery-oriented practice, and inclusion of family and carers. Any changes to the cycle warrant exploration with the interdisciplinary team and consumer carer workforce.