Front-line health professionals' recognition and responses to nonfatal strangulation events: An integrative review

An exploration of frontline health professional's current understanding of non-fatal strangulation

AIM

To explore frontline health professionals' current understanding of non-fatal strangulation and their need for and support for a comprehensive education and screening package to support health delivery.

DESIGN

A descriptive mixed-method approach was chosen to analyse responses to an anonymous, online survey consisting of ten Likert scale, open-ended and five demographic questions. 103 frontline health professionals (nurses, doctors, paramedics, midwives) participated in this study.

METHODS

Content analysis of the Likert scale and open-ended questions describing the subjective experiences and perceptions of the participants was undertaken along with percentage and frequency counts of the rated Likert responses.

RESULTS

The findings identified that 51.1% of health professionals do not ask about strangulation routinely and that 59% of health professionals reported receiving no formal education or professional development on NFS to enhance their knowledge or inform clinical practice. No health professionals identified mild traumatic brain injury as a consequence or sign of strangulation, nor did they identify an understanding that 50% of people may have no visible injuries after being strangled. Health professionals also do not routinely document the different agencies referred to or involved in supporting the person who experienced NFS.

CONCLUSION

Findings suggest that frontline health professionals lack the confidence, skills and education needed to meet medical obligations to their patients and to fulfil their duty to 'do no harm'. Frontline health professionals would welcome a comprehensive education and screening package to guide recognition and response to non-fatal strangulation in their clinical settings. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The purpose of the study was to understand and explore health professionals' knowledge about non-fatal strangulation so that improved education around better screening, and management of trauma-focused care to people who have been subjected to non-fatal strangulation could occur.

NO PATIENT OR PUBLIC CONTRIBUTION

This review contains no patient or public contribution since it examines health professionals' knowledge of identifying non-fatal strangulation and the screening and assessment tools used in clinical practice.

Enhancing Mental Health Assessment for Non-Fatal Strangulation in Clients with a History of Intimate Partner Violence

Intimate partner violence (IPV) against women is widely recognized as a significant global problem, a major public health issue in the United States, and one of the most widespread violations of human rights. Recent research has noted that non-fatal strangulation (NFS) has been a significantly overlooked indicator and by-product for victims of IPV and often may be undisclosed or can be confounded with other mental health symptoms; for example, those that are common with conditions seen in psychiatric facilities. Traumatic brain injury (TBI) and nonfatal strangulation are often unrecognized forms of IPV and can lead to significant short and long-term neurologic sequelae. It is possible that some mental health disturbances and anxiety symptoms may be better explained as a medical consequence of TBI and repeated NFS-or a signal of homeostatic disruption. In such cases, providing psychopharmacological treatment might help the patient with the symptoms, but will not address the underlying cause. This reinforces the critical need for mental health nurses to not only assess for IPV, but simultaneously screen for TBI-related neurological disorders and injuries, including recent and/or past unconsciousness, and facilitate linkage to IPV interventions and mental health treatment.

The Nurse-Police Assistance Crisis Team (N-PACT): A new role for nursing

AIM

This study aimed to gain insights into forensic nurses' perspectives and approaches to behavioural crisis situations, comparing them to disciplines traditionally involved in first-line behavioural crisis response.

DESIGN

This study used a descriptive, qualitative exploratory design and was informed by Systems Theory.

METHODS

The study was carried in the United States, between 2022 and 2023. Data were gathered through four focus groups: police officers (n = 12), co-response (mental health) clinicians (n = 13), sexual assault nurse examiners (n = 6) and correctional nurses (n = 4). Thematic analysis was performed.

REPORTING METHOD

The Standards for Reporting Qualitative Research (SRQR) guidelines were used.

RESULTS

Findings revealed temporal themes in crisis response: (1) Searching for Historical Information; (2) Safety and Acting at the Present Scene; and (3) Future Strategies and Interventions. Common priorities (e.g. safety and de-escalation) were identified across groups. Notably, nurses demonstrated a comprehensive approach, addressing physical and mental health assessments, substance involvement, and physical injury evaluation.

CONCLUSION

This study proposes the creation of a novel nursing role within first-line multidisciplinary teams (MDTs) for crisis response-the Nurse-Police Assistance Crisis Team (N-PACT). Nurses bring expertise and comprehensive assessment skills to enhance crisis responses, particularly in cases involving mental health emergencies, medical crises, and drug-related incidents.

IMPLICATIONS

Forensic nurses, with their diverse competencies and comprehensive training, are highly valuable assets within MDTs. Their expertise extends to proficiently conducting mental and physical assessments, ensuring safety and adeptly navigating situations that intersect with the legal system.

IMPACT

The N-PACT concept can improve outcomes and streamline the allocation of resources, particularly considering the number of police calls involving behavioural crises.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.