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Persons with severe mental illness (MI) are at a high risk of becoming victims of sexual assault (SA). Vulnerability for SA with any type of MI is unknown. This study aimed to identify the prevalence of preexisting MI and other significant factors in patients reporting preexisting MI at the time of their SA medical forensic examinations (SAMFEs).A retrospective SAMFE chart review of patients ( N = 7,455) from 2010 to 2020 was conducted. Sexual assault nurse examiners completed SAMFEs. Inclusion criteria included (a) aged 14 years and older, (b) completed SAMFE with SA kit evidence collection, and (c) reported to law enforcement (restricted cases not included). Descriptive statistics and chi-square analyses were completed.It was found that 46.7% of study participants reported preexisting MI and/or current use of psychotropic medications, more than double the MI prevalence rates in the general population. MI in patients seen for SAMFE was associated with prior history of SA, medical health problems, and physical or mental impairment. In addition, patients with MI reported more violent SAs with increased anogenital and nonanogenital injuries.The high prevalence rate of any MI in patients seen for SAMFE indicates MI in varying severity is a significant vulnerability for SA. The association of preexisting MI with a history of SA, health problems, and physical or mental impairment expands understanding of associated MI factors. These findings support the development of interventions by healthcare providers and stakeholders to address SA vulnerabilities in individuals with MI.

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.

BACKGROUND Documentation of injuries associated with abuse and assault has pivotal impacts on clinical and legal outcomes. Before this study, no reliable and valid tools to consistently document the clinical visibility of bruises existed. The purpose of this study was to systematically evaluate reliability and validity of the Bruise Visibility Scale for documenting bruises visualized in normal (white) light and the Absorption Visibility Scale for documenting bruises visualized using an alternate light source (ALS). METHODS Bruises were induced using a paintball on the upper arms of 157 participants stratified into six skin color categories. Bruises were visualized 21 times over 4 weeks under white light and 10 ALS wavelength/goggle color combinations. Bruise size was measured using a metric ruler; bruise color was measured using a spectrophotometer. Interrater reliability was calculated using kappa and intraclass correlations coefficients. Construct validity was evaluated using generalized linear mixed modeling of associations between bruise size and color with both visibility scales. RESULTS Interrater agreement for bruise detection was over 90% for all but two ALS wavelength/goggle combinations. Kappa values indicated adequate interrater agreement under white light (κ = 0.76) and ALS (κ = 0.78). The visibility scale intraclass correlation coefficients were .91 for normal light and .93 for ALS. Statistical modeling showed greater bruise size was associated with higher visibility using either scale, and greater contrast in color or lightness was associated with higher Bruise Visibility Scale values. IMPLICATIONS FOR PRACTICE Both visibility scales showed satisfactory reliability and validity. Forensic nurses can use the scales to consistently document bruises.

The impact of opioid use disorder (OUD) on children is of increasing concern to providers and communities and is yet to be fully understood. Children and families in rural areas are particularly vulnerable due to decreased access to care, lower socioeconomic status, and lower rates of health insurance coverage. This qualitative secondary data analysis of transcripts from interviews with community stakeholders specifically examined responses when asked how parental OUD impacted children in their rural communities.

Law enforcement reporting following sexual assault is lower than for other violent crimes. Sexual assault nurse examiners (SANEs) provide care for patients in the acute period following sexual assault and are well-positioned to identify and address barriers to reporting. We examined data from medical forensic examination records documented by SANEs for a 5-year period (2011–2015). We examined 347 records of women 18 and older to identify factors associated with law enforcement reporting at the time of the exam using binomial logistic regression to construct odds ratios (OR). A total of 56.5% of patients in the sample reported to law enforcement. Patients who did not voluntarily consume alcohol were more likely to report than those who did (OR = 4.45; p = .001). Patients who were not students were more likely to report than students (OR = 3.24; p = .002). Patients who had a medical forensic exam within 32 hr of the assault were more likely to report than those having exams after 32 hr (OR = 2.68; p = .007). Patients who had anogenital and/or bodily injuries were more likely to report than those who had no injuries (OR = 2.50; p = .008). Patients who were penetrated (vaginally, orally, and/or anally) were more likely to report than those who were not penetrated (OR = 2.50; p = .056). Knowing the assailant, having multiple assailants, and patient and assailant race/ethnicity were not associated with different likelihood of reporting to law enforcement. SANEs and others who work with victims of sexual assault can use data to understand and address barriers to reporting.

Bruises are often difficult to detect on victims of violence, potentially impacting investigation and prosecution. The purpose of our randomized controlled trial was to measure the effectiveness of an alternate light source (ALS) within visible and long ultraviolet spectrums at improving bruise detection compared to white light over time. We also examined the effects of skin color, age, gender, localized fat, and injury mechanism on bruise detection. Participants included 157 healthy adults with balanced sampling across six skin color categories. Bruises were created under the controlled application of a paintball pellet and dropped weight to one upper and lower arm, respectively. Using a crossover design, both bruises were examined 21 times over 4 weeks. Ten different wavelength (350–535 nm) and filter (yellow, orange, red) combinations were used. Multilevel models were used to analyze 2903 examinations on both upper and lower arms. Results in multivariable models showed after controlling for other covariates 415 and 450 nm using a yellow filter had greater odds of detecting evidence of bruising than white light (Upper Arm: 415 nm: OR = 5.34, 95% CI: 4.35–6.56; 450 nm: OR = 4.08, 95% CI: 3.36–4.96). Under either light source, being female and having more localized fat had increased odds of detecting bruises created by the dropped weight (female: OR = 2.96, 95% CI: 2.37–3.70; fat: OR = 1.21, 95% CI: 1.09–1.34). Our results support ALS as an appropriate tool to enhance concurrent physical assessment of bruises in the presence of known history of injury. Future development and evaluation of clinical practice guidelines for ALS application are needed.

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

PURPOSE: Individuals with Huntington disease (HD) experience progressive cognitive decline that may appear years before motor manifestations of the disease. These declines have a profound effect on health-related quality of life (HRQOL) over the disease course, and thus it is important that self-report measures of cognitive function are validated for use in longitudinal studies. METHODS: 359 individuals with premanifest or manifest HD completed baseline and at least one follow-up (12- and 24-month) assessment. Neuro-QoL™ Cognitive Function was administered at each time-point. Participants completed a self-reported global rating of cognitive change, as well as performance-based cognitive changes (using the Symbol Digit Modalities Test). Standardized response means (SRMs) and general linear models evaluated whether Neuro-QoL™ Cognitive Function was responsive to change over time with respect to self-reported and performance-based anchors. Test–retest reliability and known-group validity were also examined. RESULTS: Responsiveness was supported by effect sizes that were small in magnitude, but in the expected direction relative to self-reported and performance-based change. General linear models generally supported 12- and 24-month responsiveness relative to self-reported cognitive change and 12-month responsiveness relative to performance-based change. Test–retest reliability was excellent, and the measure exhibited known-group validity. CONCLUSION: Longitudinal analyses generally indicate that the Neuro-QoL™ Cognitive Function measure is sensitive to change over time in individuals with HD. Neuro-QoL Cognitive Function changes reflect self-reported cognitive change at 12 and 24 months and performance-based change at 12 months. This measure may be useful in clinical trials or longitudinal observation studies.

Detection and documentation of bruises on survivors of intimate partner violence (IPV) can provide valuable evidence to support investigation and subsequent prosecution of these crimes. Detection of bruises in persons with darker skin tones is often difficult, contributing to disparities in health and criminal justice responses to IPV. The purpose of this secondary data analysis was to determine whether use of an alternate light source (ALS) increased the predictive probability of successfully detecting bruises on diverse skin tones following a history of physical trauma. In this study, data were analyzed from a convenience sample of 157 subjects inclusive of six skin tones (very light, light, intermediate, tan, brown, dark) with induced bruises. Bruises were assessed under white light and an ALS 21 times over four weeks using 10 different ALS wavelength and goggle color combinations. Data analyzed included 31,841 skin observations obtained over 2897 participant assessments. Multilevel modeling was used to account for the correlation among the repeated measurements for each bruise. Across all categories of skin pigmentation, ALS wavelengths 415 nm and 450 nm viewed through a yellow filter had the most frequent detections of bruises (415 nm: n = 2777, 11.2%; 450 nm: n = 2747, 11.1%) and greater predictive probability of a positive finding (415 nm: 0.90-0.99; 450 nm: 0.85-0.99) than white light (n = 2487; 10%; 0.81-0.90). These two ALS wavelengths were the only combinations that provided greater probability of detection than white light on groups with darker skin (brown or dark), whereas additional ALS wavelengths/filters worked equally well on groups with lighter skin. Findings suggest use of an ALS in clinical assessments of patients of color who report IPV may help reduce health and criminal justice-related disparities.

As a growing profession, forensic nursing requires research to establish best practice guidelines leading to evidence-based practice. In addition, forensic nursing quality improvement projects are necessary to evaluate and improve practices and policies. The purpose of this article is to provide step-by-step guidelines on research and quality improvement projects to encourage all forensic nurses to actively contribute to and utilize research in practice. Research will expand our forensic nursing science and knowledge base. Ultimately, forensic nursing research will benefit our patients and communities by establishing enhanced, evidence-based care.