In this issue, a potpourri of articles that illustrate the complexity and diversity of forensic nursing are showcased, highlighting contributions from across the United States, Australia, Iceland, and Canada. Collectively, their contributions exemplify the diversity of contemporary forensic nursing research and practice. In the first group of articles, issues related to forensic mental health and correctional nursing are explored, followed by articles focused on intimate partner violence, sexual assault, and specific care environments.
The lead article, entitled "Women's Lived Experience of the Interconnectedness of Trauma, Substance Use, and Prison" by Vilhjalmsdotti and colleagues from Iceland, challenges forensic nurses to contemplate primary prevention further in their daily practice. The incarcerated women who participated in the study had horrific traumatic experiences in childhood and adolescence, which continued into their adult lives, leading to substance use, intimate partner violence, and incarceration, and those who were mothers had lost custody of their children. Although the importance of trauma-informed correctional care is emphasized, the vignettes included in this article underscore the need for early intervention, thereby preventing, or minimizing, the long-term sequelae subsequent to their adverse childhood experiences.
Working with criminal justice-involved persons, whether in carceral facilities and/or forensic mental health settings, can be particularly challenging for forensic nurses. In "Forensic Mental Health Nurses' Experiences of Clinical Supervision," Newman and colleagues from Australia discuss the importance of clinical supervision as a personal and professional growth experience when working in environments where nurses regularly face therapeutic, ethical, and practice-based challenges. Although this study focused on those working in a high-security forensic mental health hospital, all forensic nurses regardless of their practice settings can benefit from clinical supervision, as a way of improving communication with colleagues, being supported in their career development, and developing strategies that reflect on emergent ethical and clinical issues.
Forensic mental health nurses typically transcend two intersecting systems, namely, criminal justice and health care systems, which contribute to ethical and clinical issues experienced in practice. In "The Forensic Psychiatric Network of Observation and Documentation at the Intersection of Review Board Hearings and Nursing Practice," Canadian researchers Domingue and colleagues discuss the role of nurses in review board hearings that ultimately determine if a person is unfit to stand trial (UST) or is found not criminally responsible on account of mental disorder (NCR). In their critical ethnography, the researchers concluded that secure forensic psychiatric structures "leverage nursing interventions and documentation as evidence of deviancy, so that persons UST or NCR can be objectified and produced as dangerous." As one peer reviewer, an experienced forensic mental health nurse, originally noted, this article was both "thought provoking and discomforting." Clearly, there are lessons to be learned.
Inpatient violence in forensic psychiatric units is both challenging and discomforting for forensic mental health nurses. In "Predictive Utility of the Imminent Risk Rating Scale: Evidence from a Clinical Pilot Study," American-based researchers Georgia and associates examined the predictive validity of the Imminent Risk Rating Scale (IRRS) and concluded that their findings lend support for the IRRS as potentially useful in predicting verbal and physical aggression but also noted that further rigorous research is required. Given that forensic nurses are generally involved in the prediction of and, moreover, the prevention of inpatient violence, this scale holds promise as an additional clinical tool for use in practice.
Another important clinical tool for forensic nurses is illustrated in "Improving the Documentation of Injuries Through Alternate Light: A Researcher-Practitioner Partnership." Scafide and colleagues introduce a translation-into-practice project regarding the development and evaluation of an alternate light source (ALS) multiphase implementation program, designed to improve the assessment of bruises among adults with a history of sexual and interpersonal violence. The authors believe that the use of ALS in diverse populations, including patients of color, may provide more equitable forensic nursing practice and more reliable medicolegal documentation, thereby potentially improving response by law enforcement and prosecution. It is hoped that the development of evidence-based guidelines will contribute further to widespread adoption of ALS. Of note, the importance of understanding the role of alternate light in forensic documentation, this article was selected as the Nursing Continuing Professional Development Article. Lippincott Professional Development will award 2.5 contact hours for this accredited activity. Members of the International Association of Forensic Nurses will be charged a fee of $17.50 as they receive a 30% discount, whereas nonmembers pay $24.95.
In recent years, telemedicine has seen an increase in usage across a number of settings and increasingly more widely used in emergency departments. In "Factors Affecting Telemedicine Implementation in Emergency Departments and Nurses' Perceptions of Virtual Sexual Assault Nurse Examiner Consultation for Sexual Assault Survivors," Allison and colleagues explored the feasibility and utility of teleSANE consultations in emergency departments. Assessing and treating persons who have been sexually assaulted via telemedicine, in general, is far more intimate than treating other patients, because of their unique needs related to privacy, confidentiality, sensitivity to the impact of trauma, and forensic evidence collection, particularly in rural settings. The researchers also noted that state-level funding and technical assistance were facilitators of teleSANE, whereas barriers included clinician discomfort being on video as well as access to ongoing training on teleSANE and sexual assault care. In short, there is much to be learned regarding the implementation of teleSANE as well as its impact on patients and staff members.
It is well known that college and university students are at an increased risk of experiencing a sexual assault during their studies. In "Improving Access to Postassault Healthcare for College Students: Creating a Campus Based Sexual Assault Examiner Program," Campbell and colleagues describe how they created a campus-based SANE program at Michigan State University. The impetus for this project was in part related to the institutional crisis at Michigan State University following the disclosures that Dr. Larry Nassar had been sexually assaulting patients for decades, in his practice and in his volunteer work with local gymnastics clubs. To begin, the authors worked on guiding principles for program development, followed by engaging with campus and community stakeholders, identifying program location, and designing a trauma-informed space. Through the program development, policies were developed while navigating the Family Educational Rights and Privacy Act and other acts and policies. A staffing plan and healthcare-focused curriculum followed, while also establishing collaborative partnerships with other disciplines, and finally opening during the COVID-19 global pandemic. The authors have plans to expand, as capacity warrants, to include forensic nursing care of clients experiencing intimate partner violence and strangulation. Of note, the Journal of Forensic Nursing will be publishing a special issue addressing sexual violence and intimate partner violence on college campuses in 2024.
In "Nonoffending Caregiver Support After Child Sexual Assault: Essentials for the Forensic Nurse," Hornor discusses the importance of supporting the nonoffending caregiver, as this is integral to positive outcomes for children who have experienced child sexual abuse (CSA). A disclosure of CSA affects both the child and the nonoffending caregiver. This article provides a good overview of resilience in children, the importance of providing nonoffending parent/caregiver support, parental/caregiver resilience, and moreover, implications for forensic nursing practice. To conclude, practical strategies when working with nonoffending caregivers are provided, so they are positioned to assist their children in a positive long-term trajectory. Finally, Hornor notes that forensic nurses are uniquely positioned to ensure effective interventions for children and families experiencing CSA.
It is recognized that persons with mental illness are at a substantial risk for experiencing violence including sexual violence. In "Preexisting Mental Health Illness Among Victims of Sexual Assault: Case Studies to Inform Sexual Assault Nurse Examiner Practice," Scott Tilley and colleagues discuss three unique cases of women with preexisting mental health problems who were sexually assaulted and presented for sexual assault examination. Each case featured illustrates the importance of prioritizing safety, ethical issues surrounding consent, and the importance of clear and empathic communication. Moreover, the authors address the importance of SANEs gaining additional knowledge of common mental illnesses and how to work effectively with patients who present with preexisting mental illness. The authors remind us that people with mental illness frequently experience stigma and how stigmatization of this group in general can interfere with the provision of quality care.
In closing, the collection of articles featured in the pages that follow draw attention to the ways in which forensic nursing is evolving as a dynamic specialty. As always, I am grateful to the authors for sharing their research, for contributing to patient well-being, for discussing practical solutions and innovations, and for creating opportunities for forensic nurses across international borders and practice settings.