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Survivors of intimate partner violence (IPV) often experience violent blows to the head, face, and neck and/or strangulation that result in brain injury (BI). Researchers reviewed the de-identified forensic nursing examination records of 205 women. More than 88% of women were subjected to multiple mechanisms of injury with in excess of 60% experiencing strangulation. About 31% disclosed various symptoms consistent with BI. Women experiencing strangulation were 2.24 times more likely to report BI-related symptoms compared to those who reported no strangulation. In conclusion, women experiencing IPV are prone to BI suggesting early screening and appropriate management are warranted. [ABSTRACT FROM AUTHOR]

Access to quality sexual assault (SA) care in rural communities is limited by challenges surrounding building and sustaining a skilled SA nurse examiner workforce. Telehealth can facilitate access to expert care while cultivating a local sexual assault response. The Sexual Assault Forensic Examination Telehealth (SAFE-T) Center aims to decrease disparities in SA care by providing expert, live, interactive mentoring, quality assurance, and evidence-based training via telehealth. This study examines multidisciplinary perceptions of pre-implementation barriers and SAFE-T program impact using qualitative methods. Implications for the implementation of telehealth programs to support access to quality SA care are considered. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this qualitative study was to explore the subjective experiences of consumers and staff members regarding the availability of electronic nicotine delivery systems (ENDS) in inpatient mental health units. Methods: Mental health consumers and staff members (n = 16) from rehabilitation and forensic inpatient units were interviewed in 2022. Thematic analysis of the transcripts was undertaken. Results: Our study identified four themes: The high salience of nicotine use in inpatient units, delivering nicotine in a resource scarce environment, weighing up the harms of ENDS as a smoking cessation tool, and a need for fair and consistent policy. Conclusions: The main positive aspects identified were recognition of rights of consumers, a relative harm reduction compared to tobacco use, and ENDS as a positive factor in the therapeutic relationship. The main challenges identified were resourcing issues, ENDS being a potential source of tension and conflict and a lack of overarching policy guiding their use. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the present study is to describe the patterns of health service use and of prescription claims in the year preceding an offense leading to a verdict of not criminally responsible on account of a mental disorder (NCRMD). Methods: Provincial health administrative databases were used to identify medical services, hospitalizations, and ambulatory prescription claims among 1,014 individuals found NCRMD in Québec. Contacts in the year preceding the offense were analyzed using descriptive analyses and latent class analysis. Results: Overall, 71.4% of subjects were in contact with services for mental health reasons within a year of their NCRMD offense. Among those that received services and not hospitalized for psychiatric reasons at the time of the offense, 20.7% committed the NCRMD offense within a week of the most recent mental health contact. Among those that had at least one prescription claim for an antipsychotic, 45.8% were not taking any antipsychotic at the time of the offense. Latent class analysis provided a multidimensional representation of mental health service use and showed that 58.4% of subjects had no or very rare contact with services. Conclusions: Many forensic patients are likely to have experienced service disruption or discontinuity while in the community, for reasons that may relate to perceived need for care, to service organization, or to the acceptability, availability, and accessibility of services. Given the serious impact of the "forensic" label on the lives of service users, not to mention the increased pressure on resources, the considerable economic costs, and the impact on victims, there is reason to advocate for a greater involvement of mental and physical health service providers in early prevention of violence, which requires reorganizing resources to share the forensic knowledge upstream, before an offense is committed. [ABSTRACT FROM AUTHOR]

Data on effects of strangulation in victims with a disability are lacking despite this population experiencing intimate partner violence at higher rates than women without a disability. A retrospective review was conducted on medical records of patients seeking care at a community-based, forensic nurse examiner program following an intimate partner violence-related strangulation event. The presence of disability was not associated with differences in reporting other types of victimization, additional abusive events, perpetrator characteristics, strangulation actions, or injury findings. Patients with a disability were more likely to report experiencing anoxic, hypoxic, and other physical symptoms following strangulation compared to patients without a disability. [ABSTRACT FROM AUTHOR]

The transgender population experiences disproportionate rates of sexual assault (SA) compared with the cisgender population. Sexual assault nurse examiners (SANEs) have specialized education to provide care to victims of SA across the lifespan; however, training related to the care of transgender individuals following sexual assault is not always represented in SANE education. This leads to a lack of knowledge and confidence in providing care to transgender victims and can result in inequitable care and poor outcomes. To explore forensic nurses’ knowledge and confidence in the care of the transgender population following SA, a descriptive, cross-sectional survey design was employed and distributed to two professional forensic nursing organizations. A total of 240 survey responses were received. The majority of participants reported that content related to transgender sexual assault (TGSA) was not part of their SA education. Nearly 60% perceived their knowledge and confidence in providing TGSA care as “beginner” or “developing” and almost all “agree” or “strongly agree” that additional TGSA education would be beneficial to them. As over half of participants have provided care to a TGSA patient and more than 80% expect to provide care in the future, it is imperative include standardized content related to TGSA care as part of core SANE curriculum and to offer continuing education to address the gap in current SANE TGSA knowledge and practice. [ABSTRACT FROM AUTHOR]

Sexual assault is an irrefutable trauma; an insult to the autonomy of the person forced into sexual acts. Sexual assault sequelae range from physical injury and acute traumatic stress, to pregnancy and sexually transmitted infections, including human immunodeficiency virus (HIV). HIV post-exposure prophylaxis (HIV PEP) following sexual assault may decrease the likelihood of HIV transmission. Many patients seeking healthcare post-sexual assault either do not initiate HIV PEP or do not complete the 28-day medication regimen. In this qualitative interpretive description, we interviewed sexual assault patients (N =11) about HIV PEP discussions/reactions, attitudes and understanding related to HIV and PEP, and barriers and facilitators of HIV PEP acceptance and adherence. Participants described a process of losing and reclaiming control throughout post-assault care and follow-up; and how this affected HIV PEP-related decision-making. Most HIV PEP decisions were described as a process of reclaiming control over one outcome while simultaneously losing control of another. [ABSTRACT FROM AUTHOR]

Elderly persons can get involved in the criminal justice system as victims or as perpetrators. The interaction of elderly persons with mental illness at various cross-sections of the judicial process needs thoughtful consideration. Through this review, the authors approach this less studied aspect of forensic psychiatry. Concerning the evaluation of a prisoner, three scenarios need focused consideration: evaluation for fitness to stand trial before a competent court, evaluations for an insanity defense, and fitness for sentencing. At the same time, incarcerated elderly who developed dementia or a severe mental illness at any point of time during the trial or in prison need specific approaches. In this article, the authors discuss the acts and case laws relevant to navigating these legal scenarios. We discuss existing mental health care provisions for protecting the health interests of elderly care in prison. [ABSTRACT FROM AUTHOR]

Patients receiving medical forensic examinations following sexual assault often do not receive important follow-up care. To address this gap, we developed and tested a bidirectional text-messaging protocol, Text-SAFE (sexual assault forensic exams). Text-SAFE included automated text messages over 37 days, covering mental health, sexually transmitted infections, medications, and pregnancy. Patients could also send and receive messages. We evaluated feasibility for broader application by examining enrollment rates, patient responses and evaluations, protocol completion and reliability, and nurse compliance with the protocol. A total of 25 patients participated: 24/25 sent at least one text; 21/25 received all messages. Participants found Text-SAFE comfortable and helpful. We identified areas for improvement. [ABSTRACT FROM AUTHOR]

Objectives: Forensic mental health services (FMHS) have higher rates, duration and frequency of restrictive practices (seclusion, physical restraint and mechanical restraint). Data generated by services can be used to set targets (benchmarks) with like services to reduce or eliminate restrictive practices. The aim of this study was to develop restrictive practice benchmarks for Australian and New Zealand FMHS. Method: A participatory action research methodology was used by conducting a Delphi study. FMHS experts provided de-identified service-specific restrictive practice data, which was used to stimulate reflection towards the development of restrictive practice benchmarks. Results: Consensus decision-making was reached on benchmarks for the rate, duration and frequency of seclusion and physical restraint. Mechanical restraint was found to be a rare event, requiring event specific review in each service. Conclusions: Benchmarking with FMHS may assist in working to reduce restrictive practices and encourage the scrutiny of service practice. Establishment of a FMHS network might assist to embed the proposed benchmarks. [ABSTRACT FROM AUTHOR]

The book spans ten chapters which can be broadly split into three themes: I Theoretical Aspects i of face matching in humans and AFR (chapters 2, 3, 6, 9), I Practitioner Perspectives i (chapters 1, 7, 8) and I Bridging the Gap i between the lab and the real- world (chapters 4, 5, 10). Edited by Markus Bindemann, Forensic Face Matching: Research and Practice. Interestingly, the selection process does not mention basic assessment of the control staff's face matching ability which varies greatly in the general population (as reviewed in detail in chapter 6), including national security staff ([6]). [Extracted from the article]

Background: According to the literature reviewed, although families living with a mentally ill relative often face violence, this issue has been little studied in nursing. Methods: We conducted a qualitative research study to explore the experience of families dealing with this complex reality. We adopted Jacques Donzelot's theory of the government of family as our theoretical framework and used grounded theory as our research methodology. In total, 14 participants who had been victims of violence perpetrated by relatives with severe mental illness were interviewed. Findings: Qualitative analysis led to the identification of five themes: (a) medico-legal apparatus; (b) experience of violence; (c) the family's responsibility toward the violent relative; (d) exclusion and stigmatisation; and (e) suffering and resilience. The present paper focuses on the study's central theme: the family's responsibility toward the violent relative. [ABSTRACT FROM AUTHOR]

Sexual assault forensic examiners (SAFEs) have a complex role that entails providing health care and medical forensic evidence collection. The literature indicates that there are two orientations that guide SAFEs in this role. A patient-centered orientation emphasizes attending to emotional needs, offering options, and respecting survivors' decisions, which has been linked to positive emotional outcomes. A prosecutorial orientation places emphasis on evidence collection and has been associated with providing fewer comprehensive services. SAFE training may play a pivotal role in guiding new SAFEs to adopt a patient-centered orientation. However, there is a paucity of research examining how training can bolster the adoption of this orientation. Thus, the current qualitative study explored if and how a national blended SAFE training influenced participants' adoption of a patient-centered orientation. Semistructured qualitative interviews were conducted with 64 health care professionals who participated in a national SAFE training. Utilizing analytic induction, the results suggest that the majority of participants entered the training with a prosecutorial orientation but shifted to a patient-centered orientation. Multiple elements of the training influenced this shift including (a) content that dispelled misconceptions of survivors; (b) providing explanations of how attending to survivors' well-being can lead to positive outcomes; (c) earlier placement of patient-centered content to allow instructors to explain how patient-centered care can be applied to each component of the SAFE role including the medical forensic exam; and (d) continual emphasis on patient-centered care. [ABSTRACT FROM AUTHOR]

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

Although jurisdictions have attempted to improve their response procedures, sexual assault cases are often insufficiently investigated. This study examines the survey responses of 460 female sexual assault survivors regarding their experiences with response personnel. Overall satisfaction with response services was 66.1%. Victim advocates and forensic nurses received higher satisfaction ratings than did patrol officers, detectives, and State's Attorney's Office staff. The present study also found that 65% of the variance in overall satisfaction was accounted for by four personnel behaviors: respectful treatment, clearly explained procedures, believed their stories, and demonstrated cultural sensitivity. Policy implications and suggestions for future research are discussed. [ABSTRACT FROM AUTHOR]

Those caring for patient-prisoners experience distinct challenges that may impede effective treatment. Previous studies have investigated these issues from the perspective of forensic or correctional nurses, yet overlooked the lived experiences of nurses based in public health hospitals caring for patient-prisoners. In this study, semi-structured interviews were conducted with five nurses caring for patient-prisoners in public hospitals in Kenya. Interviews were analysed using interpretative phenomenological analysis. Four superordinate themes were identified: fear of patient-prisoner, time constraint, labelling, and optimism on recidivism. The fear of patient-prisoner theme included two sub-themes: perceived dangerousness and communication hindrance. The time constraint theme included three sub-themes: workload, short hospital stay, and task-oriented system. The labelling theme contained the loss of individual identity and representative of a group of sub-themes. Optimism on recidivism involved two sub-themes: reformation and rebuilding one's life. Future research should investigate the extent to which these impact on the patient-prisoner experience. [ABSTRACT FROM AUTHOR]

In this article, we explore perceptions and presumptions in relation to rape, raped women, and rapists, among medico-legal professionals who perform forensic medical examinations in rape cases. We draw upon data from in-depth interviews conducted with forensic medical examiners and forensic nurse practitioners in one area of England. Findings reveal that many of these personnel hold particular views centered broadly on the vilification of victims and the vindication of perpetrators. We conclude that these perceptions and presumptions may hold concerning implications for both victim experiences and evidentiary and judicial outcomes. [ABSTRACT FROM PUBLISHER]

In response to the negative and inefficient treatment of rape victims by emergency room personnel, the first Sexual Assault Nurse Examiner (SANE) programs began in the late 1970s. While SANEs, doctors, rape victim advocates, police officers and prosecutors work together to ensure the most comprehensive and sensitive care of rape victims, they all have very different roles and objectives. This research explores SANEs’ perceptions of their relationships with other professionals who treat or interact with rape victims. Data from interviews with 39 Sexual Assault Nurse Examiners from four East Coast states indicate positive relationships are marked by open communication, respect shown towards SANEs as well as rape victims, and a sense of appreciation among SANEs. On the contrary, negative relationships result when SANEs believe police treat victims poorly, when advocates overstep boundaries and question SANEs about evidence collection or the exam, and when prosecutors fail to properly prepare them to testify during a trial. [ABSTRACT FROM AUTHOR]

We examined how Australian telehealth service providers perceived and addressed ethical, medico-legal and clinical governance matters arising from service delivery. Thirty-seven telehealth clinicians and managers were interviewed and a qualitative content analysis was conducted. The services covered six Australian jurisdictions and a range of clinical disciplines. There were 11 medical specialities, surgery, mental health, paediatrics, nursing and allied health. Thirty services (83%) used video consulting and 25 (68%) delivered services to rural areas. Telehealth was reported to be beneficial by reducing adverse events, improving health outcomes, offering increased patient choice of service delivery, and improving access to services for rural areas and home care. There were observations of gains or no change in patient-provider rapport compared to face-to-face communication, with some patients reportedly preferring video. Those interviewed reported some problems with privacy and security, and variable informed consent practices. No examples of malpractice were raised, although there was a common misperception that distant providers were not responsible for clinical care. With respect to clinical governance, telehealth was seen as enabling improved quality, integration and implementation of evidence-based care, and to be a major support for the rural health workforce. Although there were potential ethical, medico-legal and governance problems in Australian telehealth services, these had been easily managed in practice. [ABSTRACT FROM AUTHOR]

While Sexual Assault Nurse Examiner programs have improved the treatment of rape victims by offering more compassionate and thorough treatment, SANEs believe victims continue to face revictimization by the medical, criminal justice and legal systems. The purpose of this research is to explore SANEs’ perceptions of the revictimization of rape victims by the police, legal system and medical system. Data from interviews with 39 Sexual Assault Nurse Examiners from four East Coast states reveal that most SANEs believe that the medical, criminal justice, and legal systems wield the power to revictimize rape victims. SANEs were more likely to cite the criminal justice system as a source of revictimization, followed by the medical system and legal system. According to SANEs, police contribute to victims’ distress through failure to ask questions in a sensitive manner, failure to proceed with investigations, and by asking victim-blaming questions. Revictimization by the legal system results when charges are never filed, cases are postponed or dropped, plea bargains are unsatisfactory, and victims’ character and credibility are questioned. Revictimization by the medical system is marked by long waits for medical attention. [ABSTRACT FROM PUBLISHER]

Sexual assault survivors often feel traumatized by the care received in traditional hospital emergency departments. To address these problems, Sexual Assault Nurse Examiner (SANE) programs were created to provide comprehensive medical care, crisis intervention, and forensic services. However, there is limited research on the actual experiences and emotional impact of sexual assault survivors who seek treatment from SANEs. This qualitative study examined twenty rape survivors’ experiences with forensic nurse examiners of a Midwestern SANE program. Findings suggest that SANEs provided survivors with care and compassion, clear explanations, and choices. Taken together, these positive experiences were perceived as “humanizing”. However, some survivors perceived forensic nurses as hurtful when they were not provided with choices, explanation, and/or acted cold and distant. Implications for future research on SANE care and practice are discussed. [ABSTRACT FROM AUTHOR]

Research has documented that few reported rapes are prosecuted by the legal system. The purpose of this study is to explain how the interactions between victims and detectives can strengthen or weaken the investigation itself. Twenty rape victims were interviewed to examine how law enforcement detectives’ manner of questioning affects rape victims’ level of disclosure. Using qualitative methodology, the results show that the detectives’ manner of questioning can play a role in victims’ disclosure. Detectives using a gentle manner of questioning with victims can help produce stronger victim statements and thus build stronger cases for prosecution. [ABSTRACT FROM PUBLISHER]

The authors sought to give voice to women victims of sexual assault whose stories otherwise remain muted. The study reported here provided rare insights into victims who sought emergency services at a hospital following a sexual assault. The data (N = 745) were collected by sexual assault nurse examiners in one northeastern state between 1997 and 2007. [ABSTRACT FROM PUBLISHER]

The purpose of this study is to examine how professionals and paraprofessionals involved with a Sexual Assault Response Team (SART) understand and navigate different professional statutory requirements for victim confidentiality. Telephone surveys are conducted with 78 professionals: medical (27.8%), criminal justice (44.3%), and victim advocacy (27.8%). The majority of participants (58.2%) disagree with the statement that maintaining victim confidentiality posed a challenge to coordination on SART, 10.1% were neutral, and 31.7% agreed with the statement. Significantly more victim advocates than criminal justice and medical professionals perceive that maintaining victim confidentiality posed a challenge to coordination on SART. Consensus on how best to conceptualize victim confidentiality within SART has not been attained. Findings show that not all criminal justice and medical professionals understood the statutory provision of privilege to communications between rape crisis victim advocates and victims. Implications for practice and research are discussed. [ABSTRACT FROM AUTHOR]

The Emergency Department (ED) is a key source of care for victims of sexual violence but there is little information available about the extent to which EDs are prepared to provide this care. This study examines the structural and process factors that the ED has in place to assist victims. A survey of all 82 publicly accessible EDs in the Commonwealth of Virginia was conducted (RR 76%). In general, the EDs provide the recommended medical care to victims. However, at least half do not have the needed resources in place to effectively assist victims and most (80%) do not provide regular training to their medical staff about sexual violence. Further, almost one-quarter do not have a relationship with a local rape crisis center. It is recommended that each ED partner with local rape crisis centers to provide training to their staff and to ensure continuity of support for victims. It is also suggested that the state government explore ways in which a forensic (SANE) nurse be made available to every victim of sexual violence that presents to the ED for medical assistance. Ideally, each ED would become part of a community-wide Sexual Assault Response Team (SART) in order to provide comprehensive care to victims and thorough evidence collection and information to law enforcement. [ABSTRACT FROM AUTHOR]

In sexual assault nurse examiner (SANE) programs, specially trained forensic nurses provide 24-hour-a-day,first-response medical care and crisis intervention to rape survivors in either hospitals or clinic settings. This article reviews the empirical literature regarding the effectiveness of SANE programs in five domains: (a) promoting the psychological recovery of survivors, (b) providing comprehensive and consistent post rape medical care (e.g., emergency contraception, sexually transmitted disease [STD] prophylaxis), (c) documenting the forensic evidence of the crime completely and accurately, (d) improving the prosecution of sexual assault cases by providing better forensics and expert testimony, and (e) creating community change by bringing multiple service providers together to provide comprehensive care to rape survivors. Preliminary evidence suggests that SANE programs are effective in all domains, but such conclusions are tentative because most published studies have not included adequate methodological controls to rigorously test the effectiveness of SANE programs. Implications for practice and future research are discussed. [ABSTRACT FROM AUTHOR]

Occupational stress and burnout in nurses is now well documented. Community mental health nursing has been shown to be particularly stressful. The field of forensic psychiatry has in recent years seen the emergence of the role of the forensic community mental health nurse (FCMHN). There is little documented evidence about these nurses or their experience and perceptions of the work they do. This study forms part of a larger study investigating the levels and sources of stress and burnout among this group of nurses. Preliminary findings suggest that, as a group, FCMHNs are an experienced group of nurses with an average 15 years or more in psychiatric nursing. They tend to occupy higher grades and are almost equally made up of men (53.8%) and women (46.2%). The majority are happy with life in general, do not use maladaptive coping strategies, have good job security (67.1%), feel supported by their manager (87.2%) and carry an average caseload of 13.15 patients. Caseload issues and organisational issues were reported as the most stressful elements of work. Peer support and good supervision were the main coping strategies reported. Consideration for training and reducing the isolation of FCMHNs as they expand into new areas with increased risk of role ambiguity is indicated. [ABSTRACT FROM PUBLISHER]

This article presents the author's views on the ethical and legal issues which a psychiatrist confronts when asked to provide a forensic psychiatric report. The author says that doctors are duty bound to keep all important communications between them and their patients confidential. He further states that in medico-legal cases, when some evidence is needed concerning a patient being treated by the psychiatrist, his first duty is to the patient, although it may be compromised in some cases.

Studies the competencies and skills expected of nurses working in forensic areas in British Columbia. Importance of competencies and skills; Frequency the skills are used; Degree of competence or mastery expected; Additional practice required by forensic nurses; Nurses' preferences for programming and instruction in forensic nursing.