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The purpose of this study is to understand the pre-examination worries of individuals who experience sexual assault, and whether those worries were experienced or resolved during a telehealth-enabled, sexual assault nurse examiner-led sexual assault examination. Patient surveys were administered to understand pre-examination worries, whether those worries were ultimately experienced during the consultation, and patient perceptions of care quality, telehealth consultation, and whether the examination helped individuals feel better. Data analysis was conducted using descriptive statistics and binomial proportion tests. Surveys were collected from 74 adolescents and adults who obtained sexual assault care at 6 rural and 2 suburban hospitals. Study findings showed individuals overcome substantial worries to access care, with 66% having at least 1 worry and 41% endorsing 3 or more pre-examination worries. Most participants felt believed (83%) and did not feel judged (88%) or blamed (85%) during their examination. Analysis of pre-examination worries and worry resolution during the examination showed 88% to 100% resolution of worries related to being believed, judged, blamed or lacking control. Participants highly rated the quality of care received (92%) and 84% stated the examination helped them feel better, suggesting a sexual assault nurse examiner-led examination is an important step toward recovery and healing. These findings have implications for emergency department support for sexual assault nurse examiner-led care and public health messaging to demystify sexual assault care, allay fears, and highlight care benefits. [ABSTRACT FROM AUTHOR]

Background: Nonfatal strangulation has been identified as a common occurrence in intimate partner violence and can be associated with significant injuries and, at times, increased mortality.Objective: This 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.Methods: Early 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.Results: This 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.Conclusions: Professionals 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. [ABSTRACT FROM AUTHOR]

• Emergency departments are key first port of call for medical treatment for victims and/or perpetrators. • Emergency nurses need to have sufficient knowledge and confidence in providing forensic care. • In order for emergency department nurses to manage the forensic process effectively and correctly, it is necessary to develop institutional guidelines/protocols to guide them. Emergency services are the first places where victims and/or perpetrators of different types of violence are brought for medical treatment. Emergency service nurses are the first health workers who first encounter with the forensic case, first communicate and are in an important position in the rapid and accurate continuation of the forensic process. In this study, it was aimed to determine the level of knowledge of emergency department nurses regarding the management of forensic cases. The study was a cross-sectional, descriptive. Ninety-eight emergency nurses working in the emergency departments of three different public hospitals in the same province participated in the study. Study data were collected with the "Nurse Personal Information Form" and the "Knowledge Levels of Nurses related to the Approaches to Forensic Cases Questionnaire". 70.4 % of the nurses participating in the study were women, their mean age was (X ± SD = 27.36 ± 5.21). It is seen that 87.8 % of the nurses have a total working time in the emergency unit between 1 and 5 years and 11.2 % have received training on forensic nursing. "Total Knowledge Score" of undergraduate graduate nurses The mean score was higher and there was a significant difference between the groups (p > 0.05). The nurses who received in-service training and forensically evaluated all cases admitted to the emergency department had a higher mean score in the "Knowledge Score Regarding the Duties of Nurses Regarding Forensic Cases" mean was higher and there was a significant difference between the groups (p > 0.05). We recommend the use of institutional guides/protocols together with in-service training for emergency nurses to provide medically and legally correct forensic care and to have sufficient knowledge. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has contributed to an increase in intimate partner violence (IPV), posing challenges to health care providers who must protect themselves and others during sexual assault examinations. Victims of sexual assault encountered in prehospital and emergency department (ED) settings have legal as well as medical needs. A series of procedures must be carefully followed to facilitate forensic evidence collection and law enforcement investigation. A literature review detected a paucity of published guidance on the management of sexual assault patients in the ED, and no information specific to COVID-19.Objective: Investigators sought to update the San Diego County sexual assault guidelines, created in collaboration with health care professionals, forensic specialists, and law enforcement, through a consensus iterative review process. An additional objective was to create a SAFET-I Tool for use by frontline providers during the COVID-19 pandemic.Discussion: The authors present a novel SAFET-I Tool that outlines the following five components of effective sexual assault patient care: stabilization, alert system activation, forensic evidence consideration, expedited post-assault treatment, and trauma-informed care. This framework can be used as an educational tool and template for agencies interested in developing or adapting existing sexual assault policies.Conclusions: There is a lack of clinical guidance for ED providers that integrates the many aspects of sexual assault patient care, particularly during the COVID-19 pandemic. A SAFET-I Tool is presented to assist emergency health care providers in the treatment and advocacy of sexual assault patients during a period with increasing rates of IPV. [ABSTRACT FROM AUTHOR]

We aimed to deepen our understanding of the concept of compassion in caring for patients with mental illness in forensic psychiatric inpatient care settings. Qualitative analysis was used to illuminate themes from interviews conducted with 13 nurses in a prior study. The audiotaped interviews, which had been transcribed verbatim, were analyzed following a hermeneutic approach. Results revealed the main theme of "being compassionate in forensic psychiatry is an emotional journey" and three themes. Overall, compassion was seen as a changeable asset, but also an obstacle when absent; sensitivity to one's own vulnerability is necessary to overcome that obstacle. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate physicians' and nurses' knowledge and practices regarding forensic cases in the operating room. This is a descriptive study. The sample consisted of 139 physicians and 59 nurses working in the operating rooms of a university hospital. Data were collected via a question form prepared by the researchers. Approximately half of the physicians and nurses did not know whether a patient brought to the operating room was a forensic case. Most of the physicians and nurses working in the operating room felt their knowledge and practice regarding the preservation and storage of evidence in forensic cases was inadequate. The results of this study highlight the necessity of an increased focus on forensic case process. [ABSTRACT FROM AUTHOR]

Nurses work in stressful environments, and this stress has negative consequences on health. Correctional nurses experience unique job stress in their roles. However, there has been limited research exploring how the correctional environment impacts nurse health and wellbeing. This study aimed to evaluate the relationship between the variables of organizational characteristics (i.e., job demands, job control, manager support, peer support, workplace relationships), job stress, and wellbeing levels in a sample of U.S. correctional nurses, while exploring socio-demographic covariates. Using a convenience sampling method, 270 U.S. correctional nurses completed a cross-sectional online survey. Informed by the Job Demands–Resources Theory, a conceptual model was created and tested in this sample. Analysis involved multiple linear regression and structural equation modeling. The model significantly fit the data (CI: 0.71–0.83, CFI = 0.51, SRMR: 0.37, and RMSEA = 0.08) revealing the direct relationship between job stress, job demands, job control, and workplace relationships and wellbeing. This study also provided evidence that job stress mediates the relationship of job control and job demands with wellbeing. Results underscore the opportunity for correctional organizations to consider targeting job demands, job control, workplace relationships, and job stress in future interventions to improve the correctional nursing work environment and support correctional nurse wellbeing. A recent study found evidence for a relationship between organizational characteristics & job stress and U.S. correctional nurse wellbeing. [ABSTRACT FROM AUTHOR]

This study aimed to develop and validate the effectiveness of a hybrid simulation education program designed to enhance the forensic nursing competency of emergency department nurses. Emergency nurses often bear the responsibility of conducting forensic nursing assessments and interventions, such as patient recognition and evidence collection, to safeguard patients' legal rights, given their frequent encounters with emergency department patients. Simulation methods have proven effective in training for forensic nursing care. However, there is still a need for the development of forensic nursing education using simulation methods. This study employed a one-group pre-test/post-test quasi-experimental design. A four-hour simulation education program was developed based on the analysis, design, development, implementation, and evaluation model, with a focus on enhancing forensic nursing competency. Nurses with more than six months of clinical experience in the emergency department in South Korea were divided into an experimental group (n=23) and a baseline comparison group (n=24). Both groups completed self-evaluations of their forensic nursing competency through a survey. The experimental group underwent the simulation education program, and their forensic nursing performance was evaluated before and after the program. Following the training, participants completed a questionnaire to assess their forensic nursing competency and satisfaction with the program. The initial forensic nursing competency of the experimental and baseline comparison groups was found to be similar. However, the forensic nursing competency and performance of the experimental group exhibited significant improvement after the training. Regarding program evaluation, the average scores on a 5-point scale were as follows: theoretical lecture (4.79 SD 0.27), simulation education (4.78 SD 0.29), simulation design (4.42 SD 0.45), and satisfaction with the educational program (4.82 SD 0.28). The forensic nursing competency-based simulation education program herein improved the relevant competency and performance of emergency nurses. [ABSTRACT FROM AUTHOR]

The study is designed as quasi experimental including pre-test and post-test. The sample of the study is consisted of 98 students who are taking the Forensic Nursing course in the second year of the School of Nursing at a university. The mean score obtained from the test on the knowledge of forensic evidence before the training was 23.63 ± 5.24 while the mean score after the training was 33.32 ± 4.54. A statistically significant difference was found when the average scores of the students were compared before and after the course of forensic nursing. It was revealed that the course of forensic nursing taken by the students has a positive effect on the knowledge of forensic evidence of students and increases their knowledge level. The results suggest to add a course of forensic nursing as an elective or mandatory course to the curriculum of nursing programs and disseminate the postgraduate education on forensic nursing. [ABSTRACT FROM AUTHOR]

Abstract Routine administration of the sexual assault medical forensic exam (commonly known as the "rape kit") is one of the most significant healthcare reforms advanced by the U.S. anti-rape movement since the 1970s. To promote reform, nurses acted as practitioner-activists in emergency medicine and created the new specialty of forensic nursing to administer the medical forensic exam independent of physicians. Their efforts suggest a new way of conceptualizing the interface of law and medicine: the proactive invocation of criminal law in clinical medicine for the purpose of institutional reform in healthcare organizations, or what I term legal mobilization in medicine. Using the framework of legal mobilization in medicine, I ask: (1) how did nurses mobilize criminal law and rights to health in emergency medicine to facilitate reform? and (2) what were the effects on clinical practice and knowledge production? To chart this history, I draw on a review of published writings by early forensic nurses, interviews with leaders in the field, and ethnographic observation at the 20th anniversary International Association of Forensic Nurses conference in 2012, commemorating the founders and origins of this new specialty. Bringing together scholarship on law and social movements in socio-legal studies and scholarship on health and social movements in science, technology, and medicine studies, I argue that nurses forged a porous boundary between the overlapping institutional spheres of medicine and law in order to align the objectives of medical care and criminal investigation and, thereby, seek rights to healthcare and rights to justice for patient-victims through the enactment of new medical routines. I demonstrate the historical emergence of a novel, hybrid form of professional jurisdiction and medical practice, and I explore its benefits as well as its unintended consequences. I conclude by discussing the ethical implications of this case for the use of medical evidence to corroborate rape. Highlights • The sexual assault medical forensic exam combines medical care and forensic evidence. • Nurses created the new specialty of forensic nursing to administer the exam. • Their efforts suggest a novel form of legal mobilization in medicine. • I describe the emergence of a hybrid professional jurisdiction and medical practice. • I explore their benefits as well as their unintended consequences. [ABSTRACT FROM AUTHOR]

The current study examined the long-term impact of SANE programming on the confidence of SANE trainees and on their attitudes toward the SANE role after obtaining SANE certification. Nationally, sexual assault examiners (SANEs) are in short supply. However, the shortage of SANE nurses takes on a special meaning in the medically underserved United States– Mexico border region where human trafficking is seen as a threat in the region and sexual assaults may be less likely to be reported. In recent years, SANE training programs have established across the country to address the shortage of SANEs. Although positive outcomes have been reported among SANE training programs, the long-term outcomes of programming for trainees are not known. A descriptive longitudinal study with repeated measures was conducted. A total of N = 66 registered nurses who had more than 2 years of nursing work experience were recruited to participate in a SANE training program. The current study included only n = 27 participants who completed the questionnaire at 3 points (Time 1) baseline, (Time 2) 6 months after SANE certification, and at (Time 3) 12 months after SANE certification. General linear modeling and repeated measures analysis of variance were used to analyze the data. Type 1 error was set at p = 0.10. An original 43-item questionnaire was developed to measure the SANE trainees' confidence and their attitudes toward the SANE role. Initially, an increased sense of self-confidence was found among trainees at least six months after completing SANE certification; however, this slowly diminished after one year. Likewise, attitudes toward the SANE role deteriorated six months after obtaining SANE certification. Lack of support and infrastructure to integrate SANE into the wider medico-legal community could explain the diminishing confidence and attitudes of SANE toward the role. The findings of this study have implications for the establishment of support infrastructures in the workplace and community to enhance the recruitment of nurses in SANE programs, the retention of SANEs in the workforce, the sustainability of SANE programs in underserved communities, and the establishment of protocols to integrate SANEs into sexual assault response teams (SARTs), especially in medically underserved US–Mexico border regions. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia is a common surgical presentation. Evidence for its causation regarding occupational and recreational physical exposures is limited. The aim of this study is to conduct a systematic review objectively evaluating the evidence for a causal link between a single strenuous event and the development of an inguinal hernia.Method: A systematic review was carried out in accordance with PRISMA guidelines. PubMed, Ovid Embase, SCOPUS, and Cochrane Library were searched. In addition, the ISRCTN register, ClinicalTrials.gov, ICTR Platform, and EU Clinical Trials Register were searched. Identified publications were collated and both reviewers independently reviewed their contents.Findings: 5508 records were identified, resulting in 5 studies being selected. These 5 studies were all case series. Of 957 patients identified, 1003 hernias were described, of which 983 were inguinal hernias which 255 (26%) were attributed by patients to a single strenuous event. Only two of these studies applied Smith's Criteria (causation of a hernia from a single strenuous event): officially reported, severe pain at the time of the event, no prior history of inguinal hernia, and the diagnosis was made by a doctor within 30 days (preferably 3 days). Only 2 of 54 patients (4%) met all four criteria and so could be considered as having an inguinal hernia relating to a single strenuous event.Conclusion: Many patients associate hernias to a single episode, however upon application of more stringent criteria such as Smith's, a much smaller proportion are deemed to be actually attributable to a single strenuous event. [ABSTRACT FROM AUTHOR]

English high-secure hospitals have contained individuals deemed mentally disordered, and dangerous, since the mid-nineteenth century. With the development of gender sensitive services female patients have been moved out of these institutions into smaller secure settings. Female staff continue to work in high secure hospitals, but are often in a minority in these services. Little is known about how female staff experience the everyday world of work. This paper is based on in-depth interviews with female nurses employed in a unit caring for detained male sexual offenders with a diagnosis of personality disorder. It forms part of a much larger discourse-analytic study of nine patients, with a history of sexual offending, and eighteen mental health nurses, which focused on talk about pornography and criminality. The findings from this project have been previously reported in Mercer and Perkins (2014). This paper demonstrates how patriarchy remains an enduring cultural characteristic of caring for men detained under the Mental Health Act (1983, 2007) because of sexually violent crimes against women and children. It textures the ward environment and the relationships between people who work within it, constructing women as 'outsiders' and producing a masculine culture which leaves female staff feeling vulnerable and at risk. The analytic focus of the paper is concerned with exploring how women experience working in the male-dominated environment of a high-security Personality Disorder Unit (PDU). Three discursive repertoires are identified: the institutional space as male, the impact of working with men detained as a result of sexual offending, and the construction of therapeutic work as a 'job for the boys'. In this world, female staff, as a product of their gender, constructed themselves both as at risk and inviting risk. [ABSTRACT FROM AUTHOR]

Intimate partner violence is a worldwide problem violating fundamental human rights. The aim of this study was to analyse the sociodemographic characteristics of women who have experienced intimate partner violence, the type and prevalence of violence, the mechanisms of injury as determined by forensic reports, the characteristics of the perpetrator, and the women's statements. This was a single-site descriptive study conducted at the Office of Domestic Violence and Violence Against Women of a Court of Law located in the city of Izmir in western Turkey. The researchers reviewed forensic medicine case reports and prosecutorial writs in this office's files for women over 18 who had experienced violence over the period 2016–2019. The study sample consisted of the judicial application files of women who had experienced intimate partner violence and met the inclusion criteria (n = 350). The data in the files were entered into a standard form prepared by the researchers according to the file content. Written permission was obtained from the Ministry of Justice and Ege University Ethics Committee, and the verbal consent of the Prosecuting Officer was also obtained for the research. The ages of the women ranged from 19 to 80 years (mean age 35, SD 9.6), with 43.1% ranging from 30 to 39 years old. Of the women, 46.6% had a maximum primary school education, and 65.4% were homemakers. Incidents of intimate partner violence mainly occurred at home for 89.1% of women. A combination of verbal and physical violence was the most frequent form of violence affecting 303 women (83.4% of cases). The facial area was predominantly the target of attack for 59 (16.9%) victims, only the upper extremity for 55 (15.7%) and the face and upper extremity for 36 (10.2%) women. The statements of the victims of violence who described their experience were evaluated, and it was determined that the reasons for the emergence of violence were frequently alcohol and substance use, financial problems, jealousy, sexual problems, communication problems, and cheating. Most of the women in the study who had applied to law enforcement due to intimate partner violence were victims of physical violence. The descriptive information obtained from these files constitutes essential data for health professionals in their efforts to deliver primary healthcare to women who are victims of intimate partner violence. Health professionals can provide immediate protection by identifying women at high risk of violence, monitoring them more frequently, and activating the support mechanisms they need. • We described the victim women's characteristics of Intimate Partner Violence (IPV) with examined courthouse files. • Women are most exposed to verbal and physical IPV. • Medicine case reports and prosecutorial writs related to IPV and the affecting factors were examined. • This kind of data is essential to improve the management of IPV. [ABSTRACT FROM AUTHOR]

• 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. [ABSTRACT FROM AUTHOR]

Although there is a sizeable body of empirical literature examining the health consequences of exposure to drug use and manufacture in childhood, little is known about how drug endangered children themselves perceive their environment and situation. This study examines the types of information obtained from forensic medical evaluations that include the collection of verbal accounts from children about their situations. Forensic medical examination reports of 173 children removed from residences where methamphetamine manufacturing was suspected of occurring were analyzed. The children's verbal accounts highlight themes of hazards and toxins in the home, criminal and delinquent activity among children and caregivers, knowledge of drug-related activity, poor health and well-being, and traumatic law enforcement encounters. Drug endangered children represent a shadow population often overlooked in responses to the drug problem. Drug-related research and responses should prioritize children and their long-term well-being. Further research on the short- and long-term impacts of exposure as well as the social and physical development of these children is needed. [ABSTRACT FROM AUTHOR]

This study revisited the forensic literature to compile case-specific characteristics of the tandem-bullet phenomenon (TBP). A systematic review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and The Joanna Briggs Institute's manual. The protocol was registered in Open Science Framework. Ten primary databases and two sources of grey literature were searched, with descriptive studies on TBP, with information about the victim, weapon, ammunition and injuries, being included. From an initial sample of 2360 studies, 13 were eligible. The studies reported 11 male and 2 female victims, with ages between 14 and 63 years (mean = 39.45 ± 14.51 years); seven were victims of suicide (or suicide attempt); most of the victims (69.23%) were shot in the head and neck; and most (84.61%) had an entry and exit wound ratio of 1:0, respectively. The use of image exams to assess injuries and bullets was reported in 12 cases (92.30%). The most frequent reasons for the TBP were the mismatch between weapon and ammunition and the use of defective cartridges (76.92%). Forensic professionals must be aware of the case-specific characteristics of the TBP to overcome confounding factors in wound ballistics and medicolegal examinations. [ABSTRACT FROM AUTHOR]

• Forensic psychiatric patients with ASD and/or ID are willing to use biocueing. • Biocueing may help to recognize changes in arousal (both stress and calmness). • The ability to personalize biocueing settings to the patients' needs is important. • There is a need for embedding biocueing interventions within treatment. • Simple and direct explanations on what biocueing can(not) do must be provided. 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. [ABSTRACT FROM AUTHOR]

Forensic nursing was recognized as a nursing subspecialty after the perceived need for forensic nurses to bring about their nursing duties while at the same time helping legal authorities to deliver justice. With the increased rate of cases that are presenting to the forensic centers in Saudi Arabia, there was a need for the presence of nurses to work side by side to physicians. This study was aimed at determining the forensic qualifications of nurses working in emergency departments in the area of Dammam and their knowledge about principles of forensic nursing. A self-administered questionnaire was distributed to registered nurses who are working in Emergency departments of secondary hospitals in the area of Dammam. Questions included knowledge, awareness and attitude toward forensic nursing. A total of 96 participants responded to the questionnaire with females representing 78% ( n : 75). Diploma was the highest earned nursing degree in 95% ( n : 91) of participants. Only 33% ( n : 32) were aware of the term forensic nursing and the majority of the respondents gave invalid or didn't know the answers to knowledge questions. A total of 77% ( n : 74) agreed that they are not adequately trained for handling forensic cases. Saudi nurses need forensic education. The presence of qualified forensic nurses would help delivering optimal forensic services and would assist in bringing justice. [ABSTRACT FROM AUTHOR]

To assess the quality and diagnostic accuracy of pediatric sexual abuse forensic examinations conducted at rural hospitals with access to telemedicine compared with examinations conducted at similar hospitals without telemedicine support. Medical records of children less than 18 years of age referred for sexual abuse forensic examinations were reviewed at five rural hospitals with access to telemedicine consultations and three comparison hospitals with existing sexual abuse programs without telemedicine. Forensic examination quality and accuracy were independently evaluated by expert review of state mandated forensic reporting forms, photo/video documentation, and medical records using two structured implicit review instruments. Among the 183 patients included in the study, 101 (55.2%) children were evaluated at telemedicine hospitals and 82 (44.8%) were evaluated at comparison hospitals. Evaluation of state mandatory sexual abuse examination reporting forms demonstrated that hospitals with telemedicine had significantly higher quality scores in several domains including the general exam, the genital exam, documentation of examination findings, the overall assessment, and the summed total quality score ( p < 0.05 for each). Evaluation of the photos/videos and medical records documenting the completeness and accuracy of the examinations demonstrated that hospitals with telemedicine also had significantly higher scores in several domains including photo/video quality, completeness of the examination, and the summed total completeness and accuracy score ( p < 0.05 for each). Rural hospitals using telemedicine for pediatric sexual abuse forensic examination consultations provided significantly higher quality evaluations, more complete examinations, and more accurate diagnoses than similar hospitals conducting examinations without telemedicine support. [ABSTRACT FROM AUTHOR]

Introduction: Sexual Assault Nurse Examiners (SANEs) are specialized nurses who provide sexual assault (SA) examinations and forensic evidence collection. Currently, Adult/Adolescent (A/A) SANEs in Massachusetts are trained and certified to care only for patients 12 years and older who present acutely to EDs. The purpose of this study was to describe the attitudes of SANEs regarding the possibility of cross-training to care for younger patients (<12 years). Methods: This qualitative, descriptive study included a sample of 45 A/A SANEs who participated in a series of 6 focus groups. The focus groups were audiotape-recorded and transcribed verbatim. Content analysis was used to analyze the raw data. Units of in vivo coding assisted in the identification of initial broad categories that were winnowed to represent final themes that described the participants’ attitudes. Results: Although the majority of SANEs enthusiastically endorsed the option of pediatric cross-training, a smaller portion of participants expressed strong opposition to the proposal. The SANEs’ concerns included the emotional toll of caring for children who have been sexually assaulted, and the need for an adequate infrastructure within the SANE Program to educate, train, and support the cross-training effort. Discussion: This research fills a gap in the forensic and ED nursing literature by providing insights into the attitudes and concerns of SANEs who care for some of the most vulnerable patients. The findings of this study can inform the acute care and evidence collection practices that are used when caring for pediatric patients who have experienced SA. [Copyright &y& Elsevier]

Identification of sex-trafficked youth in the emergency department (ED) is difficult and routine screening is uncommon. Our Quality Improvement (QI) Project aimed to increase ED screening and identification of high-risk youth using the Short Screen for Child Sex Trafficking (SSCST). Youth (11 through 17 years) seeking care at two metropolitan EDs with a high-risk chief complaint triggering a best practice alert (BPA). A 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. Over 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). Routine screening for child sex trafficking can be implemented in the ED setting and increases the identification of at-risk youth. • High-risk youth can be screened for trafficking in the Emergency Department. • An embedded validated tool can assist in standardized screening for trafficking. • Screening requires trained staff and collaboration with community partners. • Youth identified as at-risk for trafficking will need additional resources. [ABSTRACT FROM AUTHOR]

Forensic nursing is an emerging sub-specialty in India holding the potential to rejuvenate the medico-legal system of the country. Also, in India, with its rampant increase in crime rates, the greatest promise of forensic nursing is the emergence of a new holistic approach to legal issues surrounding patient care in the hospital and community setting. The Indian Nursing Council has introduced forensic nursing as a subject in the graduate nursing program in the year 2021. The inclusion of forensic nursing as a subject in the nursing curricula introduces the students to a wider role in contemporary nursing practice that contributes to our own and to public health safety. The implementation of graduate and postgraduate programs in forensic nursing further reduces the gap between health care systems and judiciary systems. The knowledge and practice-related realms of forensic nursing are still in the infancy stage among nursing aspirants of India. The integration of forensic nursing in the existing forensic medical science might be more gainful to improve professionalism. Though forensic nursing has a broad scope, there are certain issues related to the feasibility, ethical and legal implications regarding the mode of service delivery of forensic nursing practice in the Indian setting which needs central attention. The article highlights and discusses the evolution, scope, promises, caveats, and future directions of forensic nursing in the Indian setting. [ABSTRACT FROM AUTHOR]

Abstract: Forensic nursing is an emerging specialty field of practice for nurses. Nurses have been challenged to share responsibility with the legal system to augment the resources available to patients with liability-related injuries, crime victims, and perpetrators or suspects in police custody. These challenges have prompted collaboration between faculty from nursing and law enforcement technology criminal justice to develop an introductory forensic nursing course utilizing an interdisciplinary teaching approach. Health care and the law often become enmeshed during the critical moments when patient care supersedes the concern for social justice. This interdisciplinary course was designed to increase awareness and practical application of principles of forensic science in the professional nurse. This article describes an interdisciplinary collaboration focusing on student and faculty perceptions of utilizing an interdisciplinary approach for teaching introductory forensic nursing principles. [Copyright &y& Elsevier]

Abstract: Introduction: Studies of long-term outcome of the shaken baby syndrome (SBS) are scarce, but they usually indicate poor outcome. Objectives: To describe long-term outcome of a child having sustained a SBS, to ascertain possible delayed sequelae and to discuss medicolegal issues. Methods: We report a single case study of a child having sustained a SBS, illustrating the initial clinical features, the neurological, cognitive and behavioural outcomes as well as her social integration. Results: The child sustained diffuse brain injuries, responsible for spastic right hemiplegia leading to secondary orthopaedic consequences, as well as severe cognitive impairment, worsening over time: the developmental quotient measured at 15 months of age was 55 and worsened as age increased. At 6 years and 8 months, the child''s IQ had fallen to 40. Behavioural disorders became apparent only after several months and precluded any social integration. The child eventually had to be placed in a specialised education centre at age 5. Discussion and conclusion: The SBS has a very poor outcome and major long-standing sequelae are frequent. Cognitive or behavioural sequelae can become apparent only after a long sign-free interval, due to increasing demands placed on the child during development. This case report confirms severity of early brain lesions and necessity for an extended follow-up by a multi-disciplinary team. From a medicolegal point of view, signaling the child to legal authorities allows protection of the child, but also conditions later compensation if sequelae compromise autonomy. [Copyright &y& Elsevier]

This article is an exploration of the visualization of sexual assault in the context of adult women. In investigating the production of visual evidence, we outline the evolution of the specialized knowledge of medico-legal experts and describe the optical technologies involved in medical forensic examinations. We theorize that the principles and practices characterizing medicine, science and the law are mirrored in the medico-legal response to sexual assault. More specifically, we suggest that the demand for visual proof underpins the positivist approach taken in the pursuit of legal truth and that the generation of such evidence is based on producing discrete and decontextualized empirical facts through what are perceived to be objective technologies. Drawing on interview and focus group data with 14 sexual assault nurse examiners (SANEs) in Ontario, Canada, we examine perceptions and experiences of the role of the visual in sexual assault. Certain of their comments appear to lend support to our theoretical assumptions, indicating a sense of the institutional overemphasis placed on physical damage to sexually assaulted women's bodies and the drive towards the increased technologization of visual evidence documentation. They also noted that physical injuries are frequently absent and that those observed through more refined tools of microvisualization such as colposcopes may be explained away as having resulted from either vigorous consensual sex or a “trivial” sexual assault. Concerns were expressed regarding the possibly problematic ways in which either the lack or particular nature of visual evidence may play out in the legal context. The process of documenting external and internal injuries created for some an uncomfortable sense of fragmenting and objectifying the bodies of those women they must simultaneously care for. We point to the need for further research to enhance our understanding of this issue. [Copyright &y& Elsevier]

Summary: Emergency Departments (ED) are providing care for increasing numbers of patients who present as a result of criminal or interpersonal violence and patients may be victims, suspects or perpetrators. As a result, the role of emergency nurses in the recognition, collection and preservation of forensic evidence is increasing. There is little published literature about the role and responsibilities of emergency nurses regarding the collection and preservation of evidence in the state of Victoria and this is complicated by a lack of department and organisation policy and the need for more specific educational preparation of emergency nurses in this area. While it is well accepted that the primary focus of nursing care will always be the physical and emotional care of the patient, the increasing importance of the role of emergency nurses in the recognition and collection of forensic evidence in Victoria is now being recognized and the need for education of emergency nurses in this area understood. This paper reviews the literature related to the recognition, collection and preservation, of forensic materials in EDs by emergency nurses in the state of Victoria and discusses the role of emergency nurses in Victoria in caring for patients who present as victims of violence and in whom the collection and preservation of forensic evidence is required. [Copyright &y& Elsevier]

Summary: The law in relation to clinical practice is specialised and complex. Most practitioners have a rudimentary understanding of the basic concepts. This chapter explores the principles of duty of care, breach and causation, and how—using case law—they are applied to neonatal care. It considers the roles and responsibilities of the practitioner and the organisation in providing standards of care that are supportable in the current clinical governance and medicolegal climate. The problems facing practitioners who find themselves involved in a case many years after the actual clinical events are also discussed, and some risk management suggestions are made. Detailed and good-quality published data on the extent and nature of neonatal cases is lacking in the UK but should be improved by the changes that have occurred following the establishment of the National Health Service Litigation Authority. Finally, consideration is given to the difficulties parents, practitioners and experts can face in dealing with information and expectations in adverse clinical outcomes when litigation is inevitable. [Copyright &y& Elsevier]

Pre-admission nursing assessment is a widely accepted practice in forensic mental health services, yet has never been described or evaluated. The costs and merits of this practice have not hitherto been the subject of systematic investigation. This article describes the practice of pre-admission assessments and details a method for estimating the cost of forensic nursing assessments in terms of the investment of nursing time. The method was then employed to evaluate the cost of nursing assessments to a Welsh medium secure unit over a 9-year period. The results showed that the demand for, and location, of pre-admission nursing assessment varied considerably over 9 years. Assessments were expensive in the demands that they placed on the resources of the nursing department. Due to the high investment costs, evidence is required to support such practice. [Copyright &y& Elsevier]

Pre-admission forensic nursing assessment is a tradition that has no research evidence base, little documentary support and is an expensive drain on nursing resources from clinical environments. Such an expensive practice warrants some evaluation of the quality of these nursing assessments. This study assessed the quality of nursing risk assessments through comparison with the HCR-20, a well-established and widely validated violence risk assessment instrument. There was a high degree of correspondence between nurse assessments and the contents of the HCR-20. The results offer support for forensic nurses’ abilities to develop effective measures and practices based upon nursing knowledge and experience where no formal evidence base previously existed. [Copyright &y& Elsevier]

Forensic mental health is a challenging workplace, with nurses subject to various trauma exposures in their professional role. To identify the key concepts related to the nature, extent and impact of workplace trauma for forensic mental health nurses. A scoping review, informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool. Sources of evidence were identified and assessed for inclusion using an explicit search strategy. Relevant information was extracted and synthesised to present a descriptive summary of existing evidence. Of the 16 articles on workplace trauma for forensic mental health nurses included in the review, nine reported data related to extent (incidence and severity) and 14 described the impact. The incidence (per bed/per year) of each workplace trauma type ranged from 0.95 – 7.15 for physical violence, 0.39–5.12 for verbal abuse, 0.03–0.12 for sexual violence, and 1.47–7.9 for self-harming behaviour. The proportion of incidents at the lowest severity rating ranged from 15.1% to 84.7%, and the range for the highest severity rating was 0% to 38.7%. In the single study that examined the incidence of vicarious trauma, 14.9% reported low levels and 27.7% reported high levels. Psychological distress was the most commonly reported impact of workplace trauma, identified in eight studies. Seven studies reported limited data for physical injury from workplace trauma. The impacts of exposure to workplace trauma reported in the remaining studies included needing to access psychological support, experiencing physiological symptoms, feeling less safe at work, and requiring time off work. With the exception of two studies providing limited data related to absenteeism, the impact for organisations was not explored in existing literature. While studies indicated that forensic mental health nurses are frequently exposed to various forms of workplace trauma, reports of severe assaults on staff were rare. Although limited, these findings suggest that cumulative exposure to workplace trauma over time, or exposure to more severe forms of physical violence, increase forensic mental health nurse vulnerability to experiencing detrimental impacts on their personal and professional wellbeing. • Forensic mental health nurses are exposed to potentially traumatic experiences as part of their every-day work. • Whilst the impact to nurses of exposure to workplace violence has been explored in mental health professionals more broadly, the impact for forensic mental health nurses has received less attention in the literature. • Forensic mental health nurses are frequently exposed to workplace trauma related to physical violence and self-harming behaviours, although exposure to verbal abuse is likely to be underreported. • Staff who are subject to milder or multiple forms of workplace trauma over a prolonged period of time, or are exposed to severe incidents of violence, are likely to be at increased risk of experiencing detrimental impacts of workplace trauma. [ABSTRACT FROM AUTHOR]

• Modifiable predictors of readmission to forensic psychiatric facilities in the United States include disposition, restraint/seclusion, and shorter length of stay. • African American race have a higher risk of readmission in both civil and forensic admission but older civil and not forensic population may have a relatively lower risk of readmission compared to their younger counterparts. • Discharge to home rather than jail and not having episodes of restraints and seclusion were associated with lower risk of acute and late psychiatric readmission. Inpatient psychiatric readmissions are increasingly prevalent and associated with worse prognostic outcomes and high economic costs, regardless of the medicolegal ramifications that necessitate them. Unlike most general medical readmissions, psychiatric readmissions are commonly warranted for both medical and legal purposes. However, studies focusing on analyzing the predictors of inpatient psychiatric readmission and their relationship to civil versus forensic readmission are limited. The purpose of this study was to examine the predictors of psychiatric readmission among civil and forensic patients admitted to a psychiatric hospital. In this retrospective chart review, we extrapolated data from medical records of 741 patients admitted from 2012 to 2017 with follow up until 2019. Analyses involved chi-square tests for comparing the distribution of demographic and clinical variables between forensic and civil readmission, and Cox regression to determine predictors of time to first readmission. Our results show that race, diagnosis, restraint/seclusion, type of admission, and disposition are significantly associated with an increased risk of psychiatric readmission. This study has important implications for healthcare providers and policy makers in revising mental health policies and improving systems-based practices for the mental health system. Future efforts in improving community psychiatric services and enhancing inpatient therapeutic environment may reduce psychiatric readmissions. [ABSTRACT FROM AUTHOR]

• New Zealand emergency nurses have limited knowledge correctly identify forensic patients. • Poor knowledge around evidence preservation and collection. • Limited knowledge around legislation or legal processes governing clinical care. • 84% of all participants felt that having forensic knowledge was important for their practice. Violence is a major public health problem worldwide. Emergency nurses are often in a unique position to identify, assess, evaluate, and treat these patients, but there is limited forensic knowledge and skills to enable emergency nurses to feel confident to guide their practice in New Zealand. The purpose of this study was to establish the level of forensic knowledge and skills currently known and used by nurses in clinical practice working in New Zealand District Health Boards (DHB)'s emergency departments. The study aimed to develop a tertiary education course based on the needs and the knowledge required, to enable nurses to practice confidently and safely with Forensic patients in the emergency department setting. A descriptive approach using online questionnaires including both quantitative and qualitative components was sent to all emergency departments in New Zealand DHB's as well as the New Zealand Nurses Organisation (NZNO) emergency nurses' section. Open-ended questions were analysed by thematic analysis. Closed questions were analysed by SPSS version 15 data analysis software (SPSS Inc, Chicago, IL). Themes identified focused on the knowledge and skills emergency nurses currently possess and the level of specialist education required to ensure patients receive the best medicolegal care. Results of the questionnaire revealed limited knowledge in being able to correctly identify all forensic patients, insufficient knowledge around evidence preservation and collection and limited knowledge around legislation or legal processes governing clinical care were discovered. However, 84% of all participants felt that having forensic knowledge was important for their practice, indicating a need for increased forensic education. Practice implications indicate that forensic education is warranted, needed and desired among ED nurses within the clinical setting. As forensic patients generally require emergency medical attention, it is important that nurses as part of the front-line first responders have forensic knowledge around preservation and collection of evidence during the provision of medical care. It was found that, emergency nurses do not have enough knowledge around forensic issues indicating that forensic education is warranted, needed and desired among ED nurses within the clinical setting. The study also provides support for the implementation of tertiary forensic science nursing postgraduate study in New Zealand. [ABSTRACT FROM AUTHOR]

Transgender (trans) persons experience high rates of sexual victimization, often face discrimination by healthcare providers, and may have unique and diverse needs post-victimization. However, there remains a lack of comprehensive trans-specific training among healthcare professionals, including nurses. Our primary objective was to develop and evaluate a novel curriculum for its efficacy in improving the competence of forensic nurses in providing sensitive, informed, and appropriate healthcare services for trans survivors of sexual assault. The curriculum was evaluated among forensic nurses working in sexual assault treatment centres across Ontario, Canada. Forty-seven nurses participated in this study, all of whom were selected by their respective programs to receive in-depth formal Sexual Assault Nurse Examiner training. Changes in participants' perceived expertise and competence in providing trans-affirming care were assessed on a 5-point Likert scale (5 being the highest level) using pre- and post-training questionnaires. Participants were asked to indicate their level of agreement with 31 competency-based statements, which were organized thematically into four domains: Initial Assessment, Medical Care, Forensic Examination, and Discharge and Referral. A clinical vignette assessed participants' demonstrated competence in providing care across four questions. Participants level of expertise improved significantly from pre- to post-training (Mean [ M ] = 1.89, Standard Deviation [ SD ] = 0.84 vs. M = 3.47, SD = 0.62, p < 001), as well as their competence across all content domains: initial assessment (M = 3.79, SD = 0.63 vs. M = 4.70, SD = 0.31, p <.001), medical care (M = 3.33, SD = 0.73 vs. M = 4.69, SD = 0.33, p <.001), forensic examination (M = 3.40, SD = 0.75 vs. M = 4.72, SD = 0.35, p <.001), and discharge and referral (M = 3.62, SD = 0.80 vs. M = 4.59, SD = 0.40, p <.001). There were also significant improvements in competence associated with the clinical vignette pre- to post- training (M score = 2.13, SD = 1.06 vs. M score = 3.23, SD = 0.87, p <.001). The success of this curriculum may have relevance to the more than 5000 members of the International Association of Forensic Nurses who practice and support forensic nursing across the globe, as well as to other healthcare professionals. • Transgender (trans) persons experience high rates of sexual victimization. • Comprehensive trans-specific training for healthcare professionals is lacking. • Curriculum developed on trans-affirming sexual assault care for forensic nurses. • Training improved the perceived and demonstrated competence of forensic nurses. • This novel curriculum may have relevance to forensic nursing programs globally. [ABSTRACT FROM AUTHOR]

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 R 2 , 0.76. After intervention, this association was absent, with an R 2 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. Image 1 Contribution to Emergency Nursing Practice • The only method of preventing the human immunodeficiency virus (HIV) in sexually assaulted patients is the prompt administration of nonoccupational postexposure prophylaxis. • Implementing a simulation course and checklist for emergency nurses improved the timeliness of administering nonoccupational postexposure prophylaxis. • Data demonstrate that, with simulation, emergency nurses are better prepared to address the needs of sexually assaulted patients. [ABSTRACT FROM AUTHOR]