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Magdaleno C, Cera J, Struwe L, Blanchard E. The Development and Implementation of a Forensic Education Module for Nebraska Critical Access Providers: A Pilot Study. JOURNAL OF FORENSIC NURSING 2023:01263942-990000000-00070. [PMID: 38165743 DOI: 10.1097/jfn.0000000000000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
BACKGROUND Sexual assault, intimate partner violence, and human trafficking are traumatic events for individuals and communities. As healthcare shortages increase, critical access hospitals must manage resources to ensure comprehensive forensic care effectively. Current literature indicates a lack of forensic healthcare education for providers within critical access hospitals. This forensic education module for critical access healthcare providers aimed to (a) increase forensic examination competencies, (b) improve forensic interviewing skills, (c) increase provider self-efficacy, and (d) show knowledge retention. METHODS This mixed-methods pilot study utilized a convenience sample of 45 healthcare providers in Nebraska critical access hospitals who presented for the forensic education module training. Repeated measures analysis of variance and paired t tests assessed the aims of this study. Structured surveys gathered qualitative data on three themes. RESULTS Implementation of the forensic education module showed a statistically significant increase in forensic interviewing skills, nonstatistically significant changes in general self-efficacy, and sustainability of knowledge and self-efficacy over 6 weeks. Analysis also showed a clinically significant increase in provider self-efficacy over 6 weeks. Structured questionnaire responses showed participants valued the content to address their perceived barriers to providing care. CONCLUSIONS This study validates the need for increased education in Nebraska's rural and medically underserved areas to ensure access to forensic care and provision of services. This pilot study shows the potential for forensic education interventions to increase provider competencies and improve provider self-efficacy, with evidence of retention of knowledge and skills.
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Affiliation(s)
- Catherine Magdaleno
- Author Affiliation: College of Nursing, Omaha Division, University of Nebraska Medical Center
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Gary JC, Charles L, Mitchell S. Sexual Assault Nurse Examiner Education Needs in Texas. JOURNAL OF FORENSIC NURSING 2023; 19:E45-E52. [PMID: 36994994 DOI: 10.1097/jfn.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
ABSTRACT Background: As with many areas of the nation, Texas lacks a robust sexual assault nurse examiner (SANE) workforce. A program in Texas offers courses to educate and expand SANE skills to better provide trauma-informed care to vulnerable populations. Methods: A survey to stakeholders of a SANE educational program, as part of a planned program evaluation, elicited not only barriers to providing care but also specific program needs to better expand access to sexual assault and domestic violence medical forensic examinations in Texas. Results: In January 2022, a total of 40 stakeholders, all registered nurses in the state of Texas, provided vital information on their current program. Analysis of written survey responses provided themes regarding barriers to providing SANE care and suggestions for expanded education. Discussion: The survey provided valuable feedback and comments on the perceptions of the current SANE program. Written responses offered direction for additional learning desires of SANEs associated with the program as well as areas for the program to expand to meet the needs of the learners. This stakeholder guidance has implications beyond this one SANE education program to enhance and expand other programs based on learner needs.
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Affiliation(s)
- Jodie C Gary
- Author Affiliations: School of Nursing, Texas A&M University
| | - Laurie Charles
- Center for Excellence in Forensic Nursing, School of Nursing, Texas A&M University
| | - Stacey Mitchell
- Center for Excellence in Forensic Nursing, School of Nursing, Texas A&M University
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Miyamoto S, Downing NR. Leveraging Telehealth to Address Sexual Assault Nurse Examiner Access Disparities in Rural Communities. JOURNAL OF FORENSIC NURSING 2023; 19:231-239. [PMID: 36917655 DOI: 10.1097/jfn.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND There are persistent gaps in access to sexual assault nurse examiners (SANEs) in rural and underserved areas, yielding health and legal disparities for survivors. These inequities prompted federal investment in novel telehealth programs to improve SANE access. PURPOSE The aim of this study was to examine program case studies from two sexual abuse/assault (SA) telehealth centers, illuminating successes, challenges, and lessons learned. METHODS Two state SA telehealth program directors used a collective instrumental case study approach to understand telehealth SANE (teleSANE) program challenges/lessons learned, outcomes, and recommendations for the field. Cross-program commonalities and differences were examined, pooling experiences to derive recommendations to sustain telehealth to increase SA health equity. RESULTS Collectively, the two programs have served 18 remote sites and provided 335 consultations. Both programs provide access to 24/7 teleSANE consultation, quality assurance, and mentoring. Unique to each program were engagement of hospital leadership in advisory boards, use of telehealth technology, training programs, and fiscal sustainability. Both programs identified flexibility, offering a tailored implementation approach, regular site support and communication, and teleSANE mentoring aligned with the Quality Caring Model as essential to success. Critical needs identified to sustain programs included (a) multilevel community and hospital buy-in, (b) sustainable funding specific to local institution needs, and (c) robust processes to oversee clinical and technology support. CONCLUSIONS Cross-program similarities and differences show the impact telehealth can have on equitable SA care. Program evaluation showed common challenges, lessons learned, and recommendations to advance equitable SA care access in underresourced communities.
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Affiliation(s)
- Sheridan Miyamoto
- Author Affiliations: Sexual Assault Forensic Examination Telehealth (SAFE-T) Center, Ross and Carol Nese College of Nursing, The Pennsylvania State University
| | - Nancy R Downing
- Center of Excellence in Forensic Nursing, Texas A&M University
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Barron RJ, Faynshtayn NG, Jessen E, Girardin AL, Kamine TH, Schoenfeld EM, Hardy EJ, Baird J, Siero AA, McGregor AJ. Characteristics of acute sexual assault care in New England emergency departments. J Am Coll Emerg Physicians Open 2023; 4:e12955. [PMID: 37193060 PMCID: PMC10182368 DOI: 10.1002/emp2.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/18/2023] Open
Abstract
Objective Interventions such as written protocols and sexual assault nurse examiner programs improve outcomes for patients who have experienced acute sexual assault. How widely and in what ways such interventions have been implemented is largely unknown. We sought to characterize the current state of acute sexual assault care in New England. Methods We conducted a cross-sectional survey of individuals acute with knowledge of emergency department (ED) operations in relation to sexual assault care at New England adult EDs. Our primary outcomes included the availability and coverage of dedicated and non-dedicated sexual assault forensic examiners in EDs. Secondary outcomes included frequency of and reasons for patient transfer; treatment before transfer; availability of written sexual assault protocols; characteristics and scope of practice of dedicated and non-dedicated sexual assault forensic examiners (SAFEs), provision of care in SAFEs' absence; availability, coverage, and characteristics of victim advocacy and follow-up resources; and barriers to and facilitators of care. Results We approached all 186 distinct adult EDs in New England to recruit participants; 92 (49.5%) individuals participated, most commonly physician medical directors (n = 34, 44.1%). Two thirds of participants reported they at times have access to a dedicated (n = 52, 65%, 95% confidence interval [CI], 54.5%-75.5%) or non-dedicated (n = 50, 64.1%; 95% CI, 53.5%-74.7%) SAFE, but fewer reported always having this access (n = 9, 17.3%; 95% CI, 7%-27.6%; n = 13, 26%; 95% CI, 13.8%-38.2%). We describe in detail findings related to our secondary outcomes. Conclusions Although SAFEs are recognized as a strategy to provide high-quality acute sexual assault care, their availability and coverage is limited.
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Affiliation(s)
- Rebecca J. Barron
- Department of Emergency MedicineUMass Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | | | - Erica Jessen
- Baystate Medical CenterSpringfieldMassachusettsUSA
| | - Abigail L. Girardin
- Department of Emergency MedicineUMass Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Tovy Haber Kamine
- Department of SurgeryUMass Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Health Care Delivery and Population ScienceUMass Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Elizabeth M. Schoenfeld
- Department of Emergency MedicineUMass Chan Medical School‐BaystateSpringfieldMassachusettsUSA
- Department of Health Care Delivery and Population ScienceUMass Chan Medical School‐BaystateSpringfieldMassachusettsUSA
| | - Erica J. Hardy
- Departments of Medicine and Obstetrics and GynecologyAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Janette Baird
- Department of Emergency MedicineAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Alan A. Siero
- University of California at RiversideRiversideCaliforniaUSA
| | - Alyson J. McGregor
- Department of Emergency MedicineUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
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Silva RX, Ferreira CAA, Sá GGDM, Souto RQ, Barros LM, Galindo-Neto NM. Preservation of forensic traces by Nursing in emergency services: a scoping review. Rev Lat Am Enfermagem 2022; 30:e3593. [PMID: 35830127 DOI: 10.1590/1518-8345.5849.3593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/02/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to map the scientific production on the preservation of forensic traces by Nursing professionals working in emergency services. METHOD a scoping review, with searches for studies carried out in six databases, in the gray literature available in Google Scholar and in the references of the studies selected. For analysis, the data reduction method was adopted. RESULTS 26 studies were included, organized into five categories: 1) Nursing professionals' knowledge on the preservation of forensic traces; 2) Procedures performed by Nursing to preserve traces in the victim's body; 3) Procedures performed by Nursing to preserve traces in the victim's belongings/objects; 4) Procedures performed by Nursing to document traces; and 5) Actions to maintain the chain of custody performed by Nursing. CONCLUSION the studies showed situations in which the emergency nurse may act in the preservation of forensic traces present in the victim's body and in objects, as well as in the registration of traces, verifying the role of Nursing to ensure integrity of the chain of custody, especially in situations of aggression, firearm injury, sexual violence, child abuse and assistance to trauma victims.
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Affiliation(s)
- Rute Xavier Silva
- Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Campus Pesqueira, Pesqueira, PE, Brasil
| | | | | | | | - Lívia Moreira Barros
- Universidade da Integração Internacional da Lusofonia Afro-Brasileira, Departamento de Enfermagem, Redenção, CE, Brasil
| | - Nelson Miguel Galindo-Neto
- Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Campus Pesqueira, Pesqueira, PE, Brasil
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Silva RX, Ferreira CAA, Sá GGDM, Souto RQ, Barros LM, Galindo-Neto NM. Preservación de los rastros forenses que realizan los enfermeros en los servicios de emergencias: revisión de alcance. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5849.3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumen Objetivo: mapear la producción científica sobre la preservación de rastros forenses por profesionales de enfermería que trabajan en los servicios de emergencias. Método: revisión de alcance, con búsqueda de los estudios realizados en seis bases de datos, en la literatura gris disponible en Google Scholar y en las referencias de los estudios seleccionados. Para el análisis, se adoptó el método de reducción de datos. Resultados: se incluyeron 26 estudios organizados en cinco categorías: 1) Conocimiento de los profesionales de enfermería sobre la preservación de rastros forenses; 2) Procedimientos que realizan los enfermeros para preservar rastros en el cuerpo de la víctima; 3) Procedimientos que realizan los enfermeros para preservar rastros en las pertenencias/objetos de la víctima; 4) Procedimientos que realiza el personal de enfermería para documentar los rastros; y 5) Acciones que llevan a cabo los enfermeros para mantener la cadena de custodia. Conclusión: los estudios demostraron que hay situaciones en las cuales el enfermero de emergencias puede actuar para preservar los rastros forenses presentes en el cuerpo de la víctima y en los objetos, así como también registrar los rastros, lo que comprueba la actuación del enfermero para garantizar la integridad de la cadena de custodia, particularmente en situaciones de agresión, heridas con arma de fuego, violencia sexual, abuso infantil y asistencia a víctimas de trauma.
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Affiliation(s)
- Rute Xavier Silva
- Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Brazil
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Sekula LK, Colbert AM, Currie M. Development of the Duquesne University School of Nursing Sexual Assault Nurse Examiner Training Model. JOURNAL OF FORENSIC NURSING 2022; 18:39-45. [PMID: 35170883 DOI: 10.1097/jfn.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Lack of preceptors and hands-on training opportunities has long been an impediment to nurses pursuing sexual assault nurse examiner (SANE) practice and certification after completing a SANE didactic course. In addition, nurses in rural and underserved areas often lack the professional support and mentoring needed. To address this gap and increase the number of certified practicing SANEs, the Duquesne University School of Nursing (DUSON) received funding from the Department of Health Resources and Services Administration for a program designed to provide advanced nursing education to increase the number of nurses who are trained and certified as nurse examiners. APPROACH The DUSON developed a hands-on clinical preceptor course and other support programming to supplement the existing SANE didactic course training. The goal was to create a comprehensive model that took students from initial SANE training through to certification. LESSONS LEARNED In the first two- and three-quarter years of the program, 36 nurses achieved certification, and another 116 completed a didactic course and initial hands-on skills training and are preparing for certification. Approximately 41.5% of participants are from rural and/or underserved areas. Challenges included the adaptations required by the COVID-19 pandemic and engagement of nurses once they returned to their home institution to complete additional hours. CONCLUSIONS The DUSON comprehensive model provides a solid pathway for nurses who want to become SANEs, and the structure of the program seems especially conducive for training nurses in rural and underserved areas.
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Mitchell SA, Charles LA, Downing N. Increasing Access to Forensic Nursing Services in Rural and Underserved Areas of Texas. JOURNAL OF FORENSIC NURSING 2022; 18:21-29. [PMID: 35170882 DOI: 10.1097/jfn.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sexual assault is prevalent in the Unites States. Many areas of the country lack access to sexual assault nurse examiners (SANEs), especially in rural areas. The U.S. Health Resources and Services Administration Advanced Nursing Education-Sexual Assault Nurse Examiner educational grant provided an opportunity to improve equity and reduce disparity in rural and underserved communities by offering education and simulation experiences in the care of sexual assault patients. Through the Texas A&M Health Center of Excellence in Forensic Nursing, Texas A&M University College of Nursing developed an innovative program using simulated medical forensic examinations and mock testimony education. Rapid cycle quality improvement was utilized to adapt quickly to feedback and meet overarching goals. This article describes development and adaptation of the program using rapid cycle quality improvement processes and progress in recruitment, retention, and certification of nurses to provide sexual assault care in rural and underserved areas of Texas.
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Affiliation(s)
- Stacey A Mitchell
- Author Affiliations: Texas A&M University College of Nursing and Texas A&M Health Center of Excellence in Forensic Nursing
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Silva RX, Ferreira CAA, Sá GGDM, Souto RQ, Barros LM, Galindo-Neto NM. Preservation of forensic traces by Nursing in emergency services: a scoping review. Rev Lat Am Enfermagem 2022. [PMID: 35830127 PMCID: PMC9264862 DOI: 10.1590/1518-8345.5849.3540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: to map the scientific production on the preservation of forensic traces by Nursing professionals working in emergency services. Method: a scoping review, with searches for studies carried out in six databases, in the gray literature available in Google Scholar and in the references of the studies selected. For analysis, the data reduction method was adopted. Results: 26 studies were included, organized into five categories: 1) Nursing professionals’ knowledge on the preservation of forensic traces; 2) Procedures performed by Nursing to preserve traces in the victim’s body; 3) Procedures performed by Nursing to preserve traces in the victim’s belongings/objects; 4) Procedures performed by Nursing to document traces; and 5) Actions to maintain the chain of custody performed by Nursing. Conclusion: the studies showed situations in which the emergency nurse may act in the preservation of forensic traces present in the victim’s body and in objects, as well as in the registration of traces, verifying the role of Nursing to ensure integrity of the chain of custody, especially in situations of aggression, firearm injury, sexual violence, child abuse and assistance to trauma victims.
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Affiliation(s)
- Rute Xavier Silva
- Instituto Federal de Educação, Ciência e Tecnologia de Pernambuco, Brazil
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Bechtel K, Bhatnagar A, Joseph M, Auerbach M. Sexual Assault in an Adolescent Female: A Pediatric Simulation Case for Emergency Medicine Providers. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10942. [PMID: 32875091 PMCID: PMC7449576 DOI: 10.15766/mep_2374-8265.10942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 01/25/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Many emergency medicine (EM) physicians have limited training in the care of sexual assault patients. Simulation is an effective means to increase the confidence and knowledge of physicians in such high-stakes, low-frequency clinical scenarios as sexual assault. We sought to develop and implement a sexual assault simulation with a structured debriefing for EM residents and to determine its impact on resident learners' attitudes and knowledge skills in the care of patients with sexual assault. METHODS The simulation blended psychomotor skills (e.g., collecting forensic evidence), cognitive skills (e.g., ordering laboratory studies and medications), and communication skills (e.g., obtaining relevant patient history, responding to psychosocial concerns raised by team members and simulator). Our emergency department checklist was available as a cognitive aid for each step of the evidence collection process. A content expert answered questions in real time during the simulation and provided structured debriefing following the simulation. Trainees completed an anonymous survey within a week after the intervention and a follow-up survey within 8 months. RESULTS Nineteen EM trainees participated. Presimulation, 39% reported never having received training in the medical care of a patient with sexual assault. The proportion of trainees agreeing or strongly agreeing with the statement "I am comfortable and confident managing a case of sexual assault" increased from 21% to 74% following the simulation (p < .05). DISCUSSION This intervention was associated with EM trainees' increased confidence with and knowledge of medical and forensic evaluations for an adolescent with sexual assault.
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Affiliation(s)
- Kirsten Bechtel
- Associate Professor, Departments of Pediatrics and Emergency Medicine, Yale chool of Medicine
| | - Ambika Bhatnagar
- Research Associate, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine
| | - Melissa Joseph
- Assistant Professor, Department of Emergency Medicine, Yale School of Medicine
| | - Marc Auerbach
- Associate Professor, Departments of Pediatrics and Emergency Medicine, Yale chool of Medicine
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