Caring in forensic nursing. Expanding the holistic model

Nurses have practiced forensic nursing for many years without formal recognition of the domain as a discipline for specialized study. Forensic nursing expands the traditional concept of holism to include the medical-legal aspects of potential or actual client problems. The American Nurses Association (ANA) and the International Association of Forensic Nurses (IAFN) recently have designated forensic nursing as a unique specialty. Recognition of forensic nursing as a specialty area of practice within nursing mandates that the specialty define and explicate its major conceptual base. A concept germane to the practice of forensic nursing is that of caring. Caring as a central concept to the role of this specialty is discussed, and the implications for its inclusion in a curriculum preparing forensic nurses are explored.     

Recruitment & retention. A successful model in forensic psychiatric nursing

1. The recruitment and retention of forensic psychiatric nurses in this highly competitive environment has been identified as a critical issue. 2. In response to the need to expand services, the development, implementation, and evaluation of an innovative model that has demonstrated success in the recruitment and retention of nurses for this highly specialized area of practice are described. 3. The successful recruitment and retention of forensic psychiatric nurses may be facilitated by developing and implementing strategies that integrate the goals and objectives of the organization with the needs of individual nurses.     

The clinical practice of juvenile forensic psychiatric nurses

The differences in working with an adolescent population within the nonmedical structure of the juvenile justice system provides a basis for claiming forensic psychiatric nursing has a specialized knowledge and skill base for meeting the needs of this juvenile population. Future development of forensic psychiatric nursing depends on continued articulation of the role of forensic nurses in these highly specialized settings and development of empirically based forensic psychiatric nursing interventions. Juvenile forensic psychiatric nursing requires specific personal attributes and new competencies that extend beyond traditional psychiatric nursing skills. These nurses must be confident in their clinical skills, demonstrate strong leadership capabilities, and be tolerant of the uncertainties associated with these unique environments.     

Mental health promotion in forensic & correctional environments

I hope this brief glimpse into the concept of mental health promotion within forensic and correctional environments will challenge nurses to explore creative ways in which a mental health agenda can be formulated and actualized in practice.     

The role of the medical provider in the evaluation of sexually abused children and adolescents

It was only 30 years ago that the medical community began to develop an increased awareness of child sexual abuse, and the role of the medical provider in the evaluation of sexually abused children has evolved significantly. As clinicians worldwide develop a greater understanding of the impact of the sexual abuse evaluation on the child, the roles of the physician and nurse have changed. In the United States, current practice often uses a multidisciplinary assessment involving skilled forensic interviewing of the child and a medical examination done by a medical provider with specialized training in sexual abuse. In order to minimize child interviews, these assessments are frequently held in settings such as child advocacy centers, where forensic interviewers and medical clinicians, child protective service workers, and police and district attorneys can work jointly to address the legal and protective issues in a coordinated fashion.     

Not <Emphasis Type="Italic">Merely</Emphasis> TLC: Nurses’ Caring Revisited

The profession and practice of nursing has been studied from quite diverse scholarly perspectives in the United States and abroad. Feminist critiques focus on the gendering of caring and its knowledge/skill features, while professionalization advocates view emotive caring as secondary to other critical activities necessary for the occupational advancement of nursing. Based on ethnographic observations 30 in-depth, semi-structured interviews with nurses across different units working at a large urban hospital, this paper examines how nurses define caring as knowledge-based, skilled work. Specifically, nurses described four types of skills—observational, analytical, interactional, and comforting—that they deploy in the accomplishment of caring work at the bedside. My findings go beyond previous literature in this area by showing how nurses think of caring work in line with occupational strategies that emphasize their biomedical knowledge and diagnostic skills and uphold an advocacy or intermediary role in health care. I argue that while this ideological work may reassure nurses of their professional identity and critical role in health care, it may also reinforce the dilemma of nurse professionalization by obscuring the organizational nature of caring, as it remains an unsupported dimension of their work.     

Risk assessment of forensic patients: nurses' role

One of the unique roles of forensic nurses is to conduct risk assessments. Establishing a therapeutic nurse-patient relationship helps forensic nurses perform accurate and useful risk assessments. Accurate risk assessments can facilitate formulation of individualized risk management plans, designed to meet patients' needs and ensure public safety. The importance of forensic nurses' knowledge and application of appropriate communication and proper documentation cannot be overemphasized.     

Mental health disparities in the older Afro-Caribbean population living in the United States: cultural and practice perspectives for mental health professionals

Cultural characteristics play an important role in the lives of many older Afro-Caribbean as they continue to migrate, acculturate, and assimilate in the United States. Many among this unique cultural subgroup will develop mental illness; however, despite the availability of effective treatment, seeking appropriate care within the formal mental health system continues to be a challenge for this group as a consequence of their cultural heritage. This review describes how these cultural determinants often lead to mental health disparities among older Afro-Caribbean living in the United States. Suggestions are also included for how mental health nurses and other professionals can incorporate research and practice into the caring model of cultural humility as they continue to come in contact with this population in various clinical settings.     

Girl Scouts Beyond Bars: a unique opportunity for forensic psychiatric nursing.

The interplay of victim and perpetrator roles experienced between daughters and their mothers provides for intricately complex interactions within a family and the community. Unique opportunities exist for forensic psychiatric nurses to articulate their nursing roles against health promotion and illness prevention programs for incarcerated women and their families. Participation in community-based projects allows forensic psychiatric nurses to observe and respond to the total environment of offenders and their families.     

Predictors of secondary traumatic stress among children's advocacy center forensic interviewers

This study examined various predictor variables that were hypothesized to impact secondary traumatic stress in forensic interviewers ( n = 257) from children's advocacy centers across the United States. Data were examined to investigate the relationship between organizational satisfaction, organizational buffers, and job support with secondary traumatic stress using the Secondary Traumatic Stress Scale. The most salient significant result was an inverse relationship between three indicators of job support and secondary traumatic stress. Also significant to secondary traumatic stress were the age of interviewer and whether the forensic interviewer had experienced at least one significant loss in the previous 12 months. Implications for future research, training, program practice, and policy are discussed.     

Predictors of Secondary Traumatic Stress among Children's Advocacy Center Forensic Interviewers

This study examined various predictor variables that were hypothesized to impact secondary traumatic stress in forensic interviewers (n = 257) from children's advocacy centers across the United States. Data were examined to investigate the relationship between organizational satisfaction, organizational buffers, and job support with secondary traumatic stress using the Secondary Traumatic Stress Scale. The most salient significant result was an inverse relationship between three indicators of job support and secondary traumatic stress. Also significant to secondary traumatic stress were the age of interviewer and whether the forensic interviewer had experienced at least one significant loss in the previous 12 months. Implications for future research, training, program practice, and policy are discussed.     

Psychological effects of violence on forensic nurses

1. Forensic nurses frequently work in violent settings without regard for self-preservation to save the lives of injured individuals or investigate the deaths of deceased individuals. 2. Cases involving children and victims with disfiguring injuries, and incidents when their personal safety was compromised are most disturbing to forensic nurses. 3. Providing means for health care professionals to cope appropriately encourages healthy healing. 4. Forensic nurses must learn to self-assess and recognize the signs and symptoms associated with unhealthy coping, depression, or posttraumatic stress disorder.     

Burnout and Secondary Trauma Among Forensic Interviewers of Abused Children

This study examined factors associated with burnout and secondary trauma among forensic interviewers of abused children. Sixty-six forensic interviewers who are affiliated with advocacy centers across the United States completed an online survey. The Oldenburg Burnout Inventory and Secondary Traumatic Stress Scale were used to measure burnout and secondary trauma, respectively. Results indicate that organizational satisfaction has a moderate inverse relationship with burnout and a slight inverse relationship with secondary trauma. The number of forensic interviews conducted or length of employment in forensic interviewing did not have a strong relationship with either burnout or secondary trauma.     

Framing nursing practice within a forensic outpatient service

The role of the outpatient forensic nurse is evolving as a specialized area of nursing practice in the community. Nurses must have comprehensive knowledge of the patients, keen intuition, and sound judgment in the continuous clinical assessment of the criminogenic factors that help determine the patients' level of risk. In addition, it is crucial to know and understand the court system, the process of the ORB, and the implications of the disposition order. The comprehensive, client-centered care provided by the Forensic Outpatient Service encompasses multifunctional and complex roles and responsibilities and clearly demonstrates the importance of the forensic outpatient nurse in working with this group of patients.     

There is No Place Like Home: The Body as the Scene of the Crime in Sexual Assault Intervention

ABSTRACT

“The body is the scene of the crime,” is an oft-repeated phrase among nurses conducting sexual assault forensic examinations. This instruction reminds nurses that the object under scrutiny, the sexually violated body, is the location and source of establishing legal evidence. The nurses' interest lies in recovering evidentiary materials towards deriving a future juridical truth and providing a means for remedy or restitution. The constitution of truth obscures how the subject comes to be at home and dwell in a world where rape occurs. This article argues that regarding the body as a crime scene is more than a rhetorical or pedagogical move made by forensic practitioners. Rather, forensic examination is constituted through rigorous and meticulous techniques that scrutinize the body of the sexually violated subject in such a way that the harming and healing capacities of the domestic are disarticulated from one another. What is at stake is the state's reliance on a notion of the domestic as a sphere to which one might return and heal, even in instances where the domestic itself is the source or site of injury, such as incest and domestic violence.     

Forensic Patients and Forensic Mental Health in Victoria: Legal Context,Clinical Pathways,and Practice Challenges

Forensic mental health services in Australia have evolved and developed considerably over the past two decades. To clinicians unfamiliar with them, the contemporary practice environments in which professionals deliver specialised forensic mental health services and the legislation governing offenders with a mental illness can appear extremely complex. This article outlines the legislation applying to individuals found not guilty of a serious offence on the grounds of mental impairment in the State of Victoria, describes the characteristics of the forensic patient population, and delineates the clinical pathway forensic patients typically take, using an illustrative case example. The competencies and attributes required by forensic practitioners are highlighted, along with the clinical challenges they face, including the inherent need to address risk in a service that has become recovery-focused in orientation. A central theme of the discussion is how social workers adapt their practice within these highly regulated settings to effectively meet forensic patients' needs.     

Working with Dave. Application of Peplau's interpersonal nursing theory in the correctional environment.

Achieving therapeutic relationships with forensic patients is dependent upon nurses' awareness of personal needs, reactions to the patient, recognition of their participation in the pattern, the effects of this participation on others, and the changes they needed to make. Nurses have more extensive contact with the forensic patients than other health care professionals. Consequently, the potential exists for nurses--through interpersonal relationship--to have the greatest therapeutic impact or to engage in patterns that replicate pathology-producing situations (Peplau, 1978). The goal is not that nurses be perfect, but that they be aware of imperfections and capable of exploring them.     

Outcry Consistency and Prosecutorial Decisions in Child Sexual Abuse Cases

This study examines the correlation between the consistency in a child’s sexual abuse outcry and the prosecutorial decision to accept or reject cases of child sexual abuse. Case-specific information was obtained from one Texas Children’s Advocacy Center on all cases from 2010 to 2013. After the needed deletion, the total number of cases included in the analysis was 309. An outcry was defined as a sexual abuse disclosure. Consistency was measured at both the forensic interview and the sexual assault exam. Logistic regression was used to evaluate whether a correlation existed between disclosure and prosecutorial decisions. Disclosure was statistically significant. Partial disclosure (disclosure at one point in time and denial at another) versus full disclosure (disclosure at two points in time) had a statistically significant odds ratio of 4.801. Implications are discussed, specifically, how the different disciplines involved in child protection should take advantage of the expertise of both forensic interviewers and forensic nurses to inform their decisions.