Forensic nursing in the context of sexual assault: comparing the opinions and practices of nurse examiners and nurses

Police Investigators' Perceptions of the Challenges Associated With Interviewing Adult Sexual Assault Complainants

Although police organizations have devoted considerable effort to training investigators in evidence-based witness interviewing techniques, there is some suggestion that current practices do not meet the multifaceted requirements of sexual assault cases. Here, we assessed the specific challenges inherent in conducting interviews with adult sexual assault complainants, by conducting in-depth interviews with 21 experienced investigators from both Australia and New Zealand. The challenges that investigators identified fell into three broad themes: meeting the evidential needs of sexual assault investigations, establishing credibility, and managing complainant vulnerabilities. We discuss how the investigative interview process might be modified in line with these challenges.

A cross-sectional study on the effect of post-rape training on knowledge and confidence of health professionals in South Africa

OBJECTIVE

To determine whether a national training program on post-rape care in South Africa resulted in improvements in knowledge and confidence in health professionals, and to distinguish baseline factors related to these changes in knowledge and confidence.

METHODS

Data for this cross-sectional study were collected over four training sessions in 2008 using questionnaires and multiple choice question papers given to 152 health professionals. Information was collected on demographics, service provision, and previous training. The change in knowledge and confidence was calculated from baseline and post-training scores. Factors related to these changes in knowledge and confidence were tested through the development of two models.

RESULTS

Seventy-four percent of the health professionals (n=112) who attended the training had completed all components of the data collection. The average age of the professionals was 41.6 years, 71% were females, and 68% nurses. Health professionals showed significant increases in percentage knowledge (40% at baseline vs 51% post training; P<0.001) and confidence (67% at baseline vs 80% post training; P<0.001) after the training. In the final multivariate models, empathy was significantly associated with a change in knowledge (coefficient -1.2; 95% CI, -1.9 to 0.4; P=0.005), while the facility level and baseline knowledge and confidence were significantly associated with change in confidence.

CONCLUSION

The training program was found to improve levels of knowledge and confidence in health professionals. Rollout of this program is critical with expansion into undergraduate curriculums.

Knowledge and confidence of South African health care providers regarding post-rape care: a cross-sectional study

BACKGROUND

In South Africa, providers are trained on post-rape care by a multitude of organisations, resulting in varied knowledge and skills. In 2007, a national training curriculum was developed and piloted in the country. The objectives of this paper are to identify the factors associated with higher knowledge and confidence in providers at the commencement of the training and to reflect on the implications of this for training and other efforts being made to improve services.

METHODS

A cross-sectional study using questionnaires was conducted. Providers who attended the training provided information on socio-demographic background, service provision, training, attitudes, and confidence. Knowledge was measured through multiple choice questions. Bi-variable analysis was carried out in order to test for factors associated with high knowledge and confidence. Variables with a p value of <0.20 were then included in backward selection to develop the final multivariable models.

RESULTS

Of the 124 providers, 70% were female and 68% were nurses. The mean age of the providers was 41.7 (24 - 64) years. About 60% of providers were trained in providing post-rape care. The median percentage knowledge score was 37.3% (0% - 65.3%) and the median percentage confidence score was 75.4% (10% - 100%). Having a more appropriate attitude towards rape was associated with higher knowledge, while older providers and nurses had lower odds of having high knowledge levels. Working in a crisis centre in the facility, having examined a survivor in the last 3 months, and seeing more than 60% of survivors who came to the facility were associated with higher confidence. Higher confidence was not associated with greater knowledge.

CONCLUSION

The study indicated that although confidence was high, there was poor knowledge in providers, even in those who were previously trained. Knowledge seems to be critically dependant on attitude, which highlights the need for educating providers on rape and the seriousness of the problem. There is a need to train more providers in post-rape care in country, and to ensure that training is comprehensive, and that providers who are trained remain knowledgeable and skilled in current best practices.

Assault related substance use as a predictor of substance use over time within a sample of recent victims of sexual assault

Substance use at time of assault is reported by a significant subgroup of rape victims. This study examined: (1) prevalence of assault related marijuana or alcohol use among women seeking post-rape medical care; (2) sensitivity, specificity, positive and negative predictive power associated with reported use at time of assault in association with use in 6 weeks pre-assault, post-assault use, and post-assault abuse; and (3) trajectories of use and abuse over time as a function of use in 6 weeks pre-assault/assault time frame use, exposure to brief intervention, and interaction of pre-assault/assault time frame use with intervention. Participants were 268 women seeking post-sexual assault medical services completing one or more follow-up assessment at: (1) <3 months post-assault; (2) 3 to 6 months post-assault; and (3) 6 months or longer post-assault. Use of alcohol or marijuana at time of assault was a fairly sensitive and specific indicator respectively, of reported use of specific substance in the 6 weeks preceding assault and use or abuse at follow-up. Growth modeling revealed that use of alcohol or marijuana at the time of the assault or in the 6 weeks prior to assault predicted higher Time 1 follow-up alcohol and marijuana use and abuse. Although there was relatively little change in use or abuse over time, alcohol use at time of the assault or in the 6 weeks prior also predicted a steeper decline in alcohol use over the course of follow-up. Interestingly, women who reported using marijuana at the time of the assault or in the 6 weeks prior who also received a video intervention actually had lower initial marijuana use, a pattern that remained stable over time. Implications for evaluating screening, brief intervention and referral to treatment services among sexual assault victims seeking post-assault medical care are discussed.

Sexual assault nurse examiners' perceptions of their relationship with doctors, rape victim advocates, police, and prosecutors

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.

Sexual assault nurse examiners' perceptions of the revictimization of rape victims

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.

Sustainability of an HIV PEP Program for Sexual Assault Survivors: "Lessons Learned" from Health Care Providers

This study explored challenges to continuing an HIV post-exposure prophylaxis (PEP) program of care provided to sexual assault survivors in the province of Ontario, Canada. Data were collected as part of an implementation and evaluation of a universal offering of HIV PEP (known as the HIV PEP Program) at 24 of 34 provincial hospital-based sexual assault treatment centres. Experienced health care providers were surveyed (n = 132) and interviewed in four focus groups (n = 26) about their perceptions of what, if any, factors threatened their ability to maintain the HIV PEP Program. All focus groups were audio-recorded and the recordings transcribed. The transcriptions and open-ended survey responses were analyzed using content analysis. Administrator, nurse, physician, social worker, and pharmacist respondents perceived important barriers to sustainability of the HIV PEP Program. Eight constructs were identified within four broad themes: resources (inadequate funds, overworked and unacknowledged staff), expertise (insufficient external supports, insufficiently trained and knowledgeable staff), commitment (lack of institutional support, physician resistance to offering HIV PEP), and accommodation (lack of flexibility in addressing specific client and community needs, inaccessibility and lack of clarity of tools). We discuss the implications of these findings and the actions that were taken to address the challenges.

Development of a sexual assault evidence collection kit - the need for standardization in Turkey

Sexual offences are recognized to be one of the most critical of crimes throughout the world. In Turkey, forcible rapes show, in the sexual crime rates, an increase of approximately 3% every year. It becomes even more critical, when realizing that less than half of all rapes, which are believed to occur, are reported to law enforcement, and of those few assailants who are arrested even fewer are convicted of rape. Often, little or no knowledge of the correct methods of locating, recovering, packaging, and preserving evidence specimens are the causes for compromising the forensic examination in court. This problem occurs when medical personnel are not adequately trained or properly advised in the evidentiary aspects and medical features of treating a victim. The current survey is aimed to increase the awareness of the need of an initial and continuing education by health care policies to cope with increasing professional demands for forensic practice sexual assault cases, to take judicial and social precautions, and medico-legal evidence. To determine the likelihood of obtaining corroborating evidence this paper presents the results of a study referring to this problem. An updated questionnaire has been applied at random to medical personnel, a total of 543 participants, throughout Turkey. Taking certain criteria into consideration the findings revealed a significant deficiency of knowledge regarding medical-legal examination. In comparison, a one-semester course of basic forensic sciences proved to be sufficient to recognize the amount of knowledge required to work as a forensic professional. Based on the results, recommendations are presented in the form of a sexual assault evidence collection kit (SAECK). A kit, which takes into consideration the needs of crime laboratories, law enforcement agencies, medical personnel, and above all the victim. This is the first step in building a responsible and successful evidence collection program that will survive the rigors of courtroom challenge.

An exploratory study of forensic nursing education in North America: constructed definitions of forensic nursing

The aim of this study was to explore forensic nursing knowledge as a specialty area of study, and factors influencing its educational development. A purposeful sample of nurse educators who had established some of the earliest forensic nursing programs in North America were sought for their perspective to answer predominantly qualitative questions. Unexpected findings from this study resulted in the concept of forensic nursing being described, differentiated, and defined. Since the inception of forensic nursing, numerous definitions have been written to articulate the knowledge of the specialty. The constructed definitions of forensic nursing from this study not only validated prior definitions developed by individuals and associations by nonresearchable methods, but also led to a discussion of what concepts are important to include in definitions of forensic nursing.

Cinsel Saldırı Konusunda Çalışan Adli Hemşireye Duyulan Gereksinim

Cinsel saldırılar dünyadaki suçların en kritiklerinden biri olarak kabul edilmektedir. Türkiye’de ırza geçme suçu bütün suçlar içinde yılda % 3’lere yaklaşan bir oran göstermektedir. Daha da önemlisi, cinsel saldırı olaylarının yarıdan fazlası resmi kayıtlara geçmemekte ve tutuklanmış faillerin çok azı hüküm giymektedir. Çünkü saldırıya uğrayanlar genellikle toplum tarafından kötü gözle bakılma ya da suçlanma endişesiyle olayı polise ve yargıya bildirmeyip, gizli tutmayı tercih etmektedir. Öte yandan delillerin belirlenmesinde, toplanmasında, paketlenmesinde ve korunmasında kullanılacak doğru yöntemlerin bilinmemesi ya da az bilinmesi de mahkemede bu adli incelemeyi zorlaştırmakta ve neticesiz kalmasına neden olmaktadır. Bu sorun sağlık çalışanlarının, mağdurun muayenesi ve delil alınması konusunda yeterli ve uygun bir eğitim almadığı için meydana gelmektedir. Bu çalışmada, bir olguda destekleyici delillerin alınma ihtimalini belirlemek amacıyla yapılmış bir araştırmanın sonuçları mevcuttur. Bunun için Türkiye’de rasgele seçilmiş 543 sağlık çalışanlara güncellenmiş bir anket uygulandı. Belirli kriterler göz önüne alındığında, bulgular adli tıp incelemelerinde bilgi eksikliğinin önemli bir yer tuttuğunu gösterdi. Yapılan karşılaştırmada, bir yarıyıl temel adli hemşirelik dersini almış olanların, diğerlerine göre, teorik olarak daha bilgili olduğu sonuçları görülmüştür. Bu da, bu alanda profesyonel olarak çalışmak isteyenlerin, iyi bir eğitimden geçmeleri gerektiğini göstermektedir. Sonuçlara dayanarak, SANE’nin gerekli olduğu gösterilmiştir. Adli hemşireliğin bu özelleşmiş alanından cinsel saldırı olguları ile ilgilenen yeni bir profesyonellik alam doğmuştur: Cinsel saldırı konusunda çalışan adli hemşire (SANE). SANE yalnız başına kapsamlı bir tıbbi bakımı ve adli delillerin toplanmasını sağlayabilecek niteliğe sahip olması için gerekli yoğun eğitimi almış hemşiredir. SANE modelinin öncelikli hedefi iyi eğitim almış tek bir profesyonelin verimli, tutarlı ve nitelikli bir sağlık hizmetini ve delil toplama işlemini gerçekleştirmesini mümkün kılmaktır. Bu, zorlu mahkeme süreçlerinin sürüncemelerine karşı koyabilecek, sorumlu ve başarılı bir delil toplama sürecinin oluşturulmasında bir ilk adım olacaktır.Anahtar Kelimeleri: Adli hemşirelik, SANE, cinsel saldırı, delil toplanması, Türkiye

Forensic Markers in Elder Female Sexual Abuse Cases

Evidence exists that older adults are victims of sexual assault and rape. The scope of the problem, prevalence, and correlates of these sex crimes are relatively unknown. Such knowledge deficits are major barriers to detecting, prosecuting, and preventing sex crimes against older adults. Understanding how intentional sexual injuries are inflicted on older adults is a growing concern as the population over 65 increases. This study contributes critical information to guide the identification of physical and psychologic markers of elder sexual abuse to be integrated by clinicians and law enforcement as forensic medical evidence.

Cooperation or co-optation?: Assessing the methodological benefits and barriers involved in conducting qualitative research through medical institutional settings

In this article, the authors highlight some benefits of and barriers to doing qualitative research in association with hospital-based services. They first describe an ongoing qualitative research project that involves interviewing women about their post-sexual assault medicolegal experiences in hospital-situated sexual assault centers across a large Canadian province. Their methodological journey led them to engage program coordinators at these centers to assist with locating participants and qualified interviewers, and with negotiating the demands of their respective research ethics boards. They outline the ways in which their project was shaped, positively and negatively, by working with them in medical institutions. They conclude by recommending that hospitals and hospital ethics boards counteract tendencies toward paternalism by recognizing the value of feminist qualitative research contributions to the activities of their own sexual assault centers and to the recovery of sexually assaulted women. Such recognition might be productively engaged by adopting an ethics-in-process approach.