Forensic Nursing Research Articles

Treands of forensic nursing and medicine

Treands of forensic nursing and medicine

Exploring adaptations to the clinical reasoning cycle for forensic mental health nursing: Aqualitative enquiry.

Forensic mental health nurses (FMHN) provide care to address the needs of people who have mental illnesses across a range of diverse settings. The Clinical Reasoning Cycle (CRC) has been identified as a potential framework to assist FMHNs; however, adaptations were required to reflect the unique nature of the clinical setting. This study aimed to explore adaptations made to determine suitability prior to implementation in practice. Nominal Group Technique was used to explore suggested adaptations determined from a previous study and reach a consensus on the changes. Fourteen senior nurses from a state-wide Forensic mental Health (FMH) service participated. A consensus was reached for two proposed changes. Data were analysed using thematic analysis. Three main themes were interpreted from the data; FMH adaptations are warranted, the focus of the CRC, and who owns the cycle? Nurses in this study considered the need to include offence and risk issues due to the impact these factors have on the therapeutic relationship and cognitive bias; however, they also identified the need to focus on recovery-oriented care while engaging in clinical reasoning. Nurses in this study also expressed some reluctance for nursing to 'own' the model, due to concern that ownership may cause division among the team or result in inconsistency in care. However, some participant's suggested the CRC with adaptations assisted FMH nurses to articulate their specialist skills and knowledge to others and highlight the nursing contribution to care. Further work is needed to finalize adaptations with a focus on engaging the consumer carer workforce and interdisciplinary team.

Voices of Female Sexual Assault Survivors: Striving for Survivor-Centered Reporting Processes in the U.S. Criminal Justice System

In the present qualitative study, we analyzed voices of female sexual assault survivors to enhance the survivor-centered framework. We reviewed over 1,000 comments from a survey asking participants to share experiences following their sexual assault. Participants were 460 female survivors, including 163 reporters (those who reported their sexual assault to police officers) and 297 nonreporters. We identified four core themes ( safety, empowerment and choice, collaboration, and explanation of procedures) as desired characteristics for the five key response personnel groups: patrol officers, detectives, sexual assault forensic examiner nurses, State's Attorney's Office staff, and victim advocates. We identified the strengths and weaknesses of each group based on the shared experiences of culturally marginalized and nonmarginalized reporters. A general free-text question answered by participants reflected on the four core themes, but also stressed the need for multiple layers of intervention in responding to sexual assault, as seen in two secondary themes ( extra support and systemic change). Nonreporters also stressed barriers to reporting and regrets about not reporting. The power of survivors’ narratives can be used to guide the criminal justice system to uphold a truly survivor-centered approach. The complexities of gender and power inequality between the perpetrators, survivors, and response personnel should also be addressed.

Evaluation of teaching forensic nursing course on undergraduate nursing student’s forensic nursing knowledge

BackgroundThe aim of the forensic nursing (FN) education is to provide nursing students with the basic knowledge of FN that they can use in the clinical area.ObjectiveThe study evaluated the effect of integrating forensic nursing into the undergraduate nursing curriculum on 2nd- and 4th-year students’ knowledge level of FN.ParticipantsThe target population of this study was composed of 2nd- and 4th-year students in the nursing department at a foundation university in Istanbul. The study was conducted with 95 nursing students who agreed to participate in the study.MethodsThe research was planned as cross-sectional and descriptive. The questionnaire form was developed with the help of literature by experts in the field. Each correct answer was scored as 4 points, and the total score could range from 0 to 100.ResultsThe average age was 21.64 ± 1.16, and 66.3% (n = 63) was female. Out of the 95 students, 50.5% (n = 48) were in 2nd year, and 49.5% (n = 47) were in 4th year. A total of 47.4% (n = 45) of the students took a FN course, and 52.6% (n = 50) did not take FN course. The average level of knowledge for those who took FN course was 52.09 ± 12.31 and for those who did not take FN course was 46.16 ± 12.18. According to the status of taking FN course, a significant difference was found between the average level of knowledge (p < 0.05).ConclusionsThese results emphasize the importance of integration of FN into the undergraduate nursing curriculum.

“It’s the last resort’’ forensic mental health nurses experience on the use of seclusion; implications for use and elimination in clinical practice

ABSTRACT Seclusion is one of the extreme measures of managing violence and aggression. Despite the evidence base for the effectiveness and therapeutic value of seclusion being limited, there arguably remains a compelling case for its use. This qualitative study aimed to explore forensic nurse’s experiences and perspective on the use of seclusion in clinical practice and establish: •What are the factors that influence and inhibit the use of seclusion? •What skills are required when caring for patients in seclusion? A purposive sample of 12 registered and non-registered nurses from a UK high-security hospital consented to engage in a focus group. Thematic analysis was used to interrogate the data. The results included two emerging themes: ‘Keeping everyone safe’ and ‘The challenges’, including the identification of binary oppositions. A rationale for the use of seclusion; it’s a last resort. Evidence of challenges to the therapeutic relationship and communication barriers. Findings illustrate the need to critically examine the practise of seclusion, accuracy of risk assessment, also to balance safety and security proportionately and ensure therapeutic value. The use of a daily dynamic risk assessment and staff relational training is recommended to improve communication and reduce excessive and prolonged use of seclusion

Forensic nursing in South Korea: Assessing emergency nurses’ awareness, experience, and education needs

• Most Korean emergency department nurses lacked adequate forensic nursing knowledge. • Consequently, they were unprepared to provide appropriate forensic nursing care. • Simulation and continuous education methods were the most preferred by Korean nurses. • Country-specific forensic nursing education programs should be developed.

Justice Denied: A Call to Action for Forensic Nurses.

Sexual violence is a major public health problem that negatively affects millions of Americans. Persons who have experienced sexual violence may choose to undergo a medical forensic examination and complete a sexual assault kit to collect and preserve evidence. DNA evidence is an impactful tool that has the potential to confirm an assailant's identity, reveal previously unknown offenders, connect serial predators to other crime scenes, exonerate the wrongly convicted, and prevent future acts of sexual violence. However, many of these kits have become "backlogged," meaning that evidence was not submitted by law enforcement for testing or DNA analysis was not completed by the crime laboratory, thereby denying justice and closure for victims. The purpose of this article is to illustrate the backlog of untested sexual assault kits in the United States and describe a case in which a serial offender was apprehended because of the testing of backlogged kits. In addition, this call to action aims to raise awareness regarding kit processing and promote advocacy among forensic nurses.

Journal of Forensic Nursing 2021 Articles of the Year

Journal of Forensic Nursing 2021 Articles of the Year

Child Sexual Abuse and Suicide: Essentials for the Forensic Nurse.

Child Sexual Abuse and Suicide: Essentials for the Forensic Nurse.

Dissemination Strategies of a Nonfatal Strangulation Program: Success of an Interagency Initiative

BackgroundNonfatal strangulation has been identified as a common occurrence in intimate partner violence and can be associated with significant injuries and, at times, increased mortality. ObjectiveThis article describes a county interagency nonfatal strangulation initiative that efficiently disseminated an educational program for police, emergency medical services, emergency department staff, forensic nursing teams, and prosecuting attorneys, along with a forensic nurse response program. Prior to initiation of this program, no educational programs existed and no forensic examinations were being offered to victims of nonfatal strangulation. MethodsEarly cooperation between agencies was crucial, particularly between the two major health care systems in the county. A standardized forensic evaluation tool was developed, along with nonfatal strangulation courses. Education of forensic nurses together with prosecutors was unique and training of police, emergency medical services, and emergency department staff was coordinated. Forensic nurses traveled to meet victims for standardized examinations at 11 emergency departments. Creation of a secure Research Electronic Data Capture database captured forensic examination information and a strangulation task force provided means to assess the goals. ResultsThis initiative educated > 80% of the county’s first responders and 79% of emergency department staff within 3 months. During the first year of the program, 259 forensic nurse examinations for nonfatal strangulation were recorded. Police reported a total of 367 arrests for felony assault by strangulation. ConclusionsProfessionals providing legal and medical care to victims of nonfatal strangulation can be educated and forensic nurse examinations can be implemented successfully in an expeditious period of time with a county collaborative program approach.

A critical ethnographic perspective on risk and dangerousness in forensic psychiatry.

In the Canadian forensic psychiatric context, the concepts of risk and dangerousness interact, intersect, and morph into the notion of significant threat to the safety of the public. Stemming from the results of a critical ethnography of the Ontario Review Board, this article unpacks the central role of forensic psychiatric nursing, as an example of a 'psych' discipline (e.g., psychiatry and psychology), in a system that is built to produce risky persons and to legitimize their detention and supervision. By using excerpt of interviews conducted with nurses, ethnographic observations of Review Board hearings, and other documentary artifacts, the findings illustrate how rationalizations of risk and dangerousness are contingent on space, time, and observer. Depending on the time of the assessment or on the health-care professional who performs it, different elements including, but not limited to, mental illness, interpersonal relationships, financial instability, and sexual vulnerability, are relied upon in very fluid, interchangeable, and discretionary ways to justify findings of dangerousness. Such a dynamic expands the reach of psychiatry's legitimacy at identifying risky conduct and controlling risky persons to domains very loosely associated with the notion of dangerousness. The work of Foucault and Castel provides the theoretical backdrop on which rests the discussion and the implications for nursing.

Effect of a forensic nursing virtual education course on knowledge and clinical decision-making of master’s nursing students in Iran: a non-equivalent control group pre- and post-test study

Forensic nursing is a specialty in the nursing profession based on legal procedures. This study aimed to assess the effect of a forensic nursing virtual education course on knowledge and clinical decision-making among master’s nursing students. In a quasi-experimental study with a pre- and post-test, 106 master’s nursing students at Guilan (n=65) and Mazandaran (n=41) Universities of Medical Sciences, Iran were enrolled. Data were collected using census sampling from March to April 2021. Participants in the intervention group received a forensic nursing virtual education course in three 90-minute sessions for 2 days. A total of 88 out of 106 master’s nursing students were enrolled in this study. The mean post-education score for knowledge in the intervention group was significantly higher than in the control group (12.52 vs. 7.67, P<0.001). The mean post-education score for clinical decision-making in the intervention group was significantly higher than in the control group (16.96 vs. 13.64, P<0.001). The level of knowledge and clinical decision-making of master’s nursing students regarding forensic evidence improved after the forensic nursing virtual education course in the intervention group compared to the control group. Nursing managers and policymakers can develop appropriate strategies to improve the knowledge and clinical decision-making of nursing students by using forensic nursing education courses in the curricula of nursing programs, especially in postgraduate education as an elective or mandatory course.

Burnout among Professionals Working in Corrections: A Two Stage Review.

Burnout is a state of emotional, physical, and mental exhaustion often caused by excessive and prolonged stress. Given the emotionally and often physically demanding nature of the work of correctional professionals, they are at substantial risk of suffering the adverse consequences of burnout. We systematically reviewed (Stage 1) the influence of burnout amongst forensic psychologists, psychiatrists, case workers, nurses, and correction officers. Interventions were then reviewed (Stage 2) at the individual and collective level to examine the effectiveness or efficacy of treatments for burnout among professionals working in corrections.

Exploration of the graduate nursing program in a forensic mental health setting: A qualitative enquiry

BackgroundForensic mental health nursing is a specialised practice area. Graduate programs are essential for recruitment and retention. There have, however, been very few studies exploring forensic mental health graduate programs. AimThe aim of this study was to explore the experience of graduate nurses who completed a 2-year graduate program in a forensic mental health service in the state of Victoria Australia, and the nurses who support the graduates in the program. MethodsAn exploratory study was conducted gathering data via one-to-one interviews, with purposive sample of 20 forensic mental health nurses. FindingsAnalysis resulted in the interpretation of two themes; essential ingredients and ‘hitting hurdles’. DiscussionGraduate nurses commence with limited knowledge, experience challenges, and organisational pressures. ConclusionTransition to practice was enhanced with consistent support, university education, and program structure.

Violence Is a Public Health and Healthcare Issue.

Violence is a global issue that destroys the quality of life in communities and societies. Violence includes intentional and unintentional injury found in individuals who seek health care after acts of family violence, intimate partner violence, child abuse, elder abuse, sexual assault, trafficking, youth-on-youth violence, gang warfare, terror, war, disaster, and violence in schools, workplaces and prisons. The nature of violence is evolving. Death as a result of crime victimization now exceeds that of armed conflict. It is the position of the International Association of Forensic Nurses that forensic nurses are uniquely positioned to improve health outcomes that result from violence, including early identification of patients at risk of victimization or perpetration.

Virginity Testing

Virginity testing is a human rights violation involving an examination of the female genitalia, often by a healthcare professional, intended to correlate the appearance of the hymen in women or girls with previous sexual intercourse. Virginity testing examinations are conducted under a variety of circumstances and settings: before marriage to establish virginity, to disprove or prove an allegation of sexual violence, to legally assess the allegation of a woman or girl not being a virgin in the absence of bleeding on her wedding night, and to intimidate political activists and detainees. Despite the United Nations Human Rights Office, United Nations Women, and World Health Organization calling for a ban on this practice, it remains common practice in various regions around the world. It is the position of the International Association of Forensic Nurses that virginity testing cannot accurately determine if consensual sexual activity or sexual abuse has occurred and can result in significant physical, psychological, and social consequences.

An Injustice to the Justice-Involved: A Brief Report on the Impact of Traumatic Brain Injury on Incarcerated Mothers.

Traumatic brain injury (TBI) is one of the leading causes of death and long-term disability among young adults worldwide and in the United States. TBIs are often associated with a high prevalence of morbidity, mortality, and other behavioral and cognitive problems. Several studies have shown that women living with TBIs have significantly higher odds of committing criminal acts, yet the impact of TBI on incarcerated women remains an underresearched area. By contrast, the effect of TBI on men is more prevalent in current literature, particularly relating to sports-related injuries. Given that an estimate of 80% of incarcerated women are mothers, we conducted a literature review in two phases focused on TBI in incarcerated mothers. The initial search of TBI in incarcerated mothers returned no results, so we proceeded in two phases. Phase 1 searched maternal outcomes of TBI, using the terms "maternal health" and "traumatic brain injury," whereas Phase 2 searched "traumatic brain injury" and "incarcerated women." Because so little information is available regarding TBI in incarcerated mothers, we used what we could find in these two phases to highlight the scarcity of knowledge about this population. This brief report addresses the knowledge gap that exists for incarcerated mothers living with TBI to encourage regular TBI screening to raise awareness and advocate for accommodated care. Correctional forensic nurses are perfectly placed to do TBI screening and to provide continuous rehabilitation after release to prevent reoffending.

The Clean and Proper Self: The Relevance of Kristeva's Concept of Abjection for Nursing.

Nurses regularly encounter feelings of disgust in practice, from bodily fluids and wounds to the criminal histories of patients. Though these experiences are widespread in nursing practice, there exists a culture in which they are regularly and intentionally ignored by nurses, and have received little attention in the literature. French-Bulgarian philosopher Julie Kristeva described these feelings of disgust within her psychoanalytic concepts of abjection and the clean and proper self. When nurses experience abjection, they work to protect and maintain the boundaries of the clean and proper self. This paper will employ a conceptual analysis to explore the implications of abjection and the maintenance of the clean and proper in nursing practice, with a specific focus on forensic nursing. A literature review of scientific articles and monographs addressing issues of disgust and abjection was conducted. The work of Kristeva provides the theoretical framework for this analysis. The analysis illustrates that nurses erect boundaries between themselves and patients, with significant consequences for patient care. An enactment of rituals to avoid the uncomfortable feelings of abjection and an effort to maintain the clean and proper self is widespread in nursing practice. Acknowledging the presence of abjection in nursing practice, recommendations are given on how to both embrace and overcome this experience.

Acceptance and potential clinical added value of biocueing in forensic psychiatric patients with autism spectrum disorder and/or intellectual disability

Autism spectrum disorder (ASD) and intellectual disability (ID) are prevalent in forensic psychiatric samples. People with ASD and/or ID often experience difficulties in emotion processing which can lead to aggressive or self-harming behavior. The use of biocueing (using wearable technology to constantly monitor and provide feedback on bodily changes) shows promise for improving emotion processing and, thus, potentially reducing aggressive behavior in this population. Both qualitative and quantitative methods were used to examine the feasibility and acceptance of Sense-IT, a biocueing application, in a sample of forensic psychiatric patients with ASD and/or ID and their forensic psychiatric nurses. To our knowledge, the current study is the first to examine first-person experiences with biocueing in forensic psychiatric patients with ASD and/or ID. Results show that, in general, participants experienced the biocueing application as positive and are willing to use biocueing. This is an important finding since forensic patients are often unmotivated to engage with therapeutic techniques. An exploration of trends in aggression and self-harm prior to and during the use of biocueing showed no significant changes. Future research should focus on the way biocueing can be implemented in clinical practice.

Child Sexual Abuse and Suicide: Essentials for the Forensic Nurse.

Sexual abuse can result in significant negative sequelae for victims. One particularly harmful consequence is suicidal ideation, which can lead to suicide attempts and even death. It is essential to screen children and adolescents for suicidal ideation when providing medical forensic care after disclosure of acute or nonacute sexual abuse/assault. Forensic nurses must feel confident in their abilities to assess suicide risk and provide appropriate intervention and referrals. A thorough understanding of the relationship between sexual abuse and suicidal ideation and behaviors can assist the forensic nurse in the development of practice behaviors to better identify, intervene, and prevent suicidal ideation and behaviors among youth experiencing sexual abuse.