As the official journal of the International Association of Forensic Nurses (IAFN), the Journal of Forensic Nursing is dedicated to the advancement of forensic nursing scholarship. In doing so, we publish articles that create, translate and disseminate knowledge relevant to forensic nurses globally. However, given the depth and breadth of forensic nursing, ensuring the content of the journal reflects the totality of the specialty, can at times be somewhat daunting. As forensic nurses, regardless of where we “hang our hats” the way in which we embrace our professional responsibilities is a reflection of who we are as individuals, as influenced by our personal values, political ideologies, beliefs, ethics, worldviews, and histories. As a self-professed lifelong learner, I truly believe that regardless of which specialty of forensic nursing one aligns with, we all possess a vision of what our practice ought to look like in the promotion of healthier and safer communities for all concerned! Clearly there is much to learn from not only our like-minded colleagues, but from those whose practice is contrary to our own.
This issue of the Journal of Forensic Nursing showcases articles that embody the complexity and the diversity of contemporary forensic nursing. Submissions are from authors located in Canada, the United States, Spain, and Sweden. Papers in this issue represent unique interprofessional perspectives, clinical contexts, and methodological insights; collectively they all draw attention to the significant role that forensic nurses play in contributing to the health and well-being of patients and clients, and of nurses themselves.
Forensic nurses are well versed regarding the importance of interprofessional and intersectoral collaborations in practice, regardless of the settings in which their practice occurs. In “Caught in a web of confusion: Assessing the readability of university webpages for victims of sexual assault” Duncan, Yeatts, Kapusta, Allen, Wilson, and Tilley, illustrate the limited effectiveness of university webpages for communicating critical information to students who have experienced a sexual assault. Limitations, including readability and a lack of consistent definition of terms, leaves students to unravel the intricacies of the “guidance” that is purportedly designed to assist them. Clearly such shortcomings necessitates further collaboration between forensic nurses, campus sexual assault teams, and institutions of higher education.
Jordan, Steelman, Leary, Valera-Gonzalex, Lassiter, Motiminty, and Bellow further illustrate the importance of interprofessional education and collaboration in their article “Pediatric sexual abuse: An interprofessional approach to optimizing emergency care.” The importance of the health professional team working together is highlighted by these authors, as emergency departments are generally the point of entry into the healthcare system for children who have experienced sexual abuse. Following a didactic interprofessional educational intervention designed to appraise the self-efficacy of emergency care providers in the recognition and management of children who have experienced sexual abuse, registered nurses, social workers, nurse practitioners, physician assistants, behavioral health workers and law enforcement officers, participated in focus group interviews. The authors concluded that sustained multimodal continuing education and interprofessional collaborative team work is essential to the provision of high quality care to ensure the safety and protection of children, to enhance communication among team members (including law enforcement and child protective services), and to ensure the integrity of evidence collection. Furthermore they emphasized the need for nurse members of the team to seek pediatric sexual assault nurse examiner certification.
The importance of interprofessional collaboration is also explored by Woods, Leidl, Luimes, and Butler in their article “Exploring the delivery of healthcare in the police detention center through remote presence technology.” Attending to the health care needs of detainees in police custody, is particularly challenging for law enforcement, as they are often forced to make health-care decisions for which they are ill prepared. Utilizing an exploratory qualitative design, the researchers examined how a new intervention pathway utilizing remote presence technology could be implemented to meet the health care needs of detained persons. Four themes emerged from the focus group interviews with law enforcement (superintendents, inspectors, detentions center sergeants, and patrol officers) and emergency department personnel (nurse manageress, emergency medical services coordinators and attendants, and directors): role conflict, risk management, resource management, and access to services. Paramount to detainee health outcomes, the authors concluded that the use of advanced technologies like remote presence, could facilitate timely communication between police service personnel and emergency healthcare providers. Significant investment from a fiscal and human resource perspective however would be necessary.
I can’t help but wonder about the use of remote presence technologies in other areas of forensic nursing practice, where bridging the gap between systems, and timely access to the right services and professionals is warranted.
Health Care Professionals
Zhang, El Gaziri, Dugan, and Castor examined the work and health correlates of sleep quantity and quality among correctional nurses. And while sleep among nurses is a topic that has been researched previously, the uniqueness of the correctional environment, and its relationship to nurses’ sleep is underexplored. Utilizing a web-based survey, correctional nurses responded to questions regarding their sleep quantity and quality, workplace conditions, and health and work outcomes. The researchers concluded that correctional nurses experienced a high prevalence of short sleep (≤6 hours/night) and poor sleep quality. Considering the high stress work environment common to the correctional milieu, coupled with nurses’ vigilance regarding patient and personal safety, the importance of sleep is not only important from a self-care perspective, but a security perspective as well. Not surprising, night shift work was significantly associated with short sleep duration among the nurses who participated in this cross-sectional study. Sleep as a self-care strategy is critical to all forensic nurses.
Sexual assault nurse examiners (SANEs) are another group of forensic nurses who may be at risk for poor sleep quantity and quality, given many are on call day and night, or are employed on a casual on-call bases on top of another full time position. Examining the impact of factors influencing sleep quality and quantity among SANEs, and other forensic nurses would contribute further to our understanding of sleep and its importance to self-care among forensic nurses.
Another article featured in this issue speaks to the health of forensic health care professionals. Carmona-Torres, Cobo-Cuenca, Recio-Andrade, Dios-Guerra, Lopez-Soto, Hidalgo-Lopezosa, and Rodríguez-Borrego in a descriptive, multi-center, cross sectional study explored intimate partner violence (IPV) experienced by health care professionals employed within the Spanish Public Health System. Of the 794 female participants (nurses, physicians, and nursing assistants) who participated in the study, the researchers found that 270 women (34%) had experienced IPV. Interestingly, and perhaps not surprising, less than one third of the women who experienced IPV had actually spoken to someone about the violence they experienced, and married health care professionals living with their partner, who lived in an urban setting, and who had their own salaries were the least likely to speak about their abuse. The researchers, concluded of those who did talk to someone about their abuse, many discussed their experience with a trusted colleague, rather than seeking professional assistance. Furthermore, since health care professionals are often the first point of contact for persons experiencing IPV, the researchers have recommended that there is a role for the workplace in establishing effective measures to support health care professionals who are expected to respond sensitively to others, while experiencing their own related problems.
Forensic Mental Health
Two uniquely different papers of concern to forensic mental health, both from Sweden, are included in this issue, one focused primarily on the nurse-patient relationship: the other on the physical environment. Kumpula, Gustafsson, and Ekstrand in their paper “Nursing staff talk: Resource or obstacle for forensic psychiatric care?” explore the complexities of practicing at the intersection of the health care system and the Swedish legal system. Utilizing a qualitative methodology, underpinned by social constructionism, 12 members of the nursing staff participated in semi-structured interviews. Three interpretive repertoires emerged from the data: taking responsibility for correcting patients’ behavior, justifying patient care as contradictory practice, and patients as unpredictable. The authors concluded that talk is not neutral, rather it is contradictory, as talk is given meaning by its context, and can justify nursing behaviors that could result in patients care needs being neglected.
Wijk, Degl’Innocenti, Jullgren, and Alexion’s research is also situated in forensic mental health. Utilizing a prospective longitudinal study, these authors explored the impact of the physical and psychosocial environment on patients’ perceptions of quality care as reported in their article “Evidence based design has a sustainable positive effect on patient’s perceptions of quality care in forensic psychiatry: A 3-year follow-up study.” Crowded, noisy, poorly designed environments can be stress-inducing, lead to increases in aggressive behavior, and work against therapeutic treatment outcomes. Drawing on previous research that indicates that the physical environment is a critical component to patient-centered care, the researchers explored patients’ perceptions of the ward atmosphere and quality of care, following a move to new forensic psychiatric clinics. The results of the study provide evidence that patients’ perceptions of the quality of care increased when they moved to the new facilities constructed in accordance with evidence based design (including private rooms, with private bathroom facilities, access to gardens, views of nature, quiet living environment). Of note, the authors conclude with a somewhat novel recommendation; both forensic patients and nurses should be consulted when new facilities are being constructed.
Dhaliwal, King-Shier and Hirst explore the utility of utilizing a grounded theory approach for building foundational knowledge to advance correctional nursing practice in their article entitled “The suitability of grounded theory research for correctional nursing.” By comparing two approached to grounded theory, specifically that of Glaser and Strauss and Strauss and Corbin they skillfully discuss the philosophical underpinnings of these research approaches, and conclude that adopting the approach of Strauss and Corbin, may be more applicable to studying or exploring areas of practice requiring further refinement and development, and in their case, correctional nursing. Grounded theory, is a process oriented, inductive research methodology that is relevant to not only correctional nursing, but to all areas of forensic nursing practice.
New to the journal this year, is a regular online only feature, dedicated to communication from the IAFN. In this issue the Position Statement on Reducing Gun Deaths and Injuries in the United States is featured. Tragically gun violence has become a public health concern. As influential members of their communities, forensic nurses have critical roles to play in the reduction of gun deaths and injuries. The IAFN Board of Directors is to be applauded for taking a stand on gun violence.
Each paper featured in this issue focuses on a distinctive primary concern of relevance to contemporary forensic nursing. Collectively, they draw attention to the ways in which forensic nurses are advancing the specialty – the strength of forensic nursing may well be its diversity. As always, I look forward to your comments, your questions and your concerns. But moreover, I look forward to receiving your manuscripts.