Innovative Pedagogical Approaches to Teaching Advanced Forensic Nursing.

Forensic nursing is a specialty in nursing with unique knowledge and skills, founded on a theoretic framework identifying three pillars of knowledge--legal principles, forensic science, and forensic nursing with concepts, context, and content unique to the specialty. To care for patients with trauma backgrounds, who are or have intersected with the legal system, forensic nursing education and subsequent certification today requires educational technology. Transforming learning takes demonstrative activities, changing them into interactive dynamic opportunities that teach metacognitive activities to provide complex trauma-informed care in the aftermath of violence, to forensic nurses.

CE: Trauma-Informed Care in Nursing Practice.

ABSTRACT: Over the past 30 years, researchers have found that childhood trauma and its subsequent stress have a strong and cumulative effect on health in adulthood. Trauma in childhood often leads to mental health problems, skeletal fractures, and early death from conditions such as heart disease, cancer, lung disease, and liver disease. Compounding the effects of traumatic stress, health care systems often create a population of "never-served" persons who avoid health care settings because they've been subject to judgment and marginalization. Trauma-informed care (TIC) is a skill underutilized by health care providers and organizations, yet nurse ethics and respect for human rights require us to care for all patients equally without judgment, including those living with the stress of complex trauma. The TIC approach respects human rights and supports nursing ethics, promoting a welcoming, inclusive environment in health care systems and patient-provider relationships that eschews implicit and explicit bias toward patients, regardless of presentation or personal circumstances. TIC foundational principles guide the application of the nursing process using patient-centered care to create safety, the first principle in TIC. Here, the authors discuss the application of these core principles in nursing through a deidentified case study.

Turner syndrome mosaicism: Challenges in identification and management in primary care.

ABSTRACT: The spectrum of Turner syndrome (TS) includes Turner syndrome mosaicism (TSM), which is typically a nonhereditary chromosomal abnormality. Turner syndrome mosaicism presents uncommonly to primary care providers (PCPs), who often fail to recognize the subtle signs. The average age at diagnosis for common TS and TSM karyotype is 5.4 years, averaging 7.3 years. Often genetic confirmation, management, and recommended surveillance are delayed. Oftentimes, the PCP suspects a genetic etiology of an unusual phenotype, such as pinna placement or other unusual ear configurations, webbed neck with low posterior hairline, wide-spaced nipples, or short stature among other presentations. The PCP or geneticist orders diagnostic studies to confirm the diagnosis, such as a karyotype. After diagnosis, the PCP refers to the geneticist who initiates surveillance and makes recommendations for management. There are potential neurocognitive, cardiovascular, renal, reproductive, and endocrine issues. Treatment literature is vague and parental concerns are linked to quality mental health and quality of life for the family member with TS or TSM. The purpose of this article was to use a case study to introduce the topic of TS and TSM and to assist the PCP in the identification and management of patient and family concerns.

A Concept Analysis of Trauma Coercive Bonding in the Commercial Sexual Exploitation of Children.

BACKGROUND: The sex trafficking of adolescents is known as commercial sexual exploitation of children (CSEC). CSEC is a complex phenomenon where identification requires understanding of developmental disruptions from toxic bonding experiences that increase in complexity over time. These toxic bonding experiences forced through coercive methods disrupt the holistic development of a self in the CSEC victim that interferes with daily functions, decision-making and social and emotional development. Lacking in the literature is a conceptual foundation for trauma coerced bonding. PURPOSE: The purpose of the analysis is to define and clarify the future concept of trauma coerced bonding from trauma bonding as it relates to CSEC victimization. METHODS: The concept analysis used Rodgers' evolutionary method to search four databases (PubMed, CINHAL, Scopus, and Google Scholar [for grey literature]), using terms associated with various descriptions of trauma bonding (for instance, Stockholm syndrome), resulting in twenty papers for review. RESULTS: Attributes, antecedents, and consequences of trauma bonding were delineated and explained. It became apparent through this analysis that the concept of trauma bonding of adolescents exposed to CSEC is very different from other forms of trauma bonding, leading this author to a more precise term, trauma-coercive bonding. Trauma coercive bonding is a long process that is a developmentally disruptive form of bonding that has ramifications throughout the life span. DISCUSSION: Trauma coercive bonding is influenced by more than just an emotional bond. The proposed definition of trauma coercive bonding brings an in-depth description of vulnerabilities and disruptions to childhood when CSEC, which persists long into adulthood. CONCLUSION: Future qualitative research should pursue a grounded theory of trauma coercive bonding to further explain and study this phenomenon.

Understanding Negative Predictive Value of Diagnostic Tests Used in Clinical Practice.

Nurses review, evaluate, and use diagnostic test results on a routine basis. However, the skills necessary to evaluate a particular test using statistical outcome measures is often lacking. The purpose of this article is to examine and interpret the underlying principles for use of the statistical outcomes of diagnostic screening tests (sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values, with a discussion about use of SpPIn [Specificity, Positive test = rule in], and SnNOut [Sensitivity, Negative test = rule out]) in advanced nursing clinical practice. The authors focus on NPVs because test results with high NPV are useful to practitioners when considering unnecessary, costly, and possibly risky treatments, whether using clinical assessment tool, test, or procedure or using polymerase chain reaction analysis of DNA test results. In this article, the authors emphasize the use of NPV in treatment decisions by providing examples from critical care, neonatal, and advanced forensic nursing, which become a framework for assessing decisions in the clinical arena. This commentary stresses the importance of the NPV of tests in preventing, detecting, and ruling out disease, where PPV may not be relevant for that purpose. Negative predictive value percentages inform treatment decisions when the provider understands the biology, chemistry, and foundation for testing methods used in clinical practices. The art of diagnosis, confirmed in a test's high NPV (meaning the patient probably does not have the disease when the test is negative), reassures provider treatment stewardship to do no harm.

Lessons Learned From Expansion of a Public Health Nursing Doctorate in Nursing Practice Program.

Despite nurses' demonstrated expertise in the public health workforce, there has been a continued erosion of public health nursing (PHN) positions in health departments and academe. The need for a strong public health infrastructure and well-educated public health workforce remains vital in meeting PHN research challenges. In response to these needs, our college of nursing undertook a six-year Health Resources and Services Administration-funded expansion of the PHN Doctor of Nursing Practice (DNP) program. This article illustrates program evaluation, lessons learned, and PHN DNP graduate and workforce outcomes related to supplying culturally diverse PHN leaders, assuring quality improvement, creating sustainable partnerships, and improving poor health outcomes.

Qualitative Analysis of the Lived Experience of First-Time Nurse Responders in Disaster.

The study purpose was to examine the reflections of the lived experiences of nurses in shelters or temporary community medical clinics responding for the first time to a civilian disaster. The disaster-nursing literature echoes the need for development of disaster content in the nursing curriculum. However, little thematic analysis-supporting curriculum from the lived experience of first-time responders exists in the literature. This study's purpose is to identify the essential thematic knowledge and skills necessary to provide care to disaster survivors in communities and for determining the themes necessary to formulate education in emergency preparedness curricula. A narrative inquiry, with a phenomenological analysis, to explore the lived experiences of nurses who responded once to a community disaster was the methodology used to identify themes. Thematic findings demonstrated a lack of prior knowledge about volunteering during a disaster response, that previous mass casualty exercises did not help with their actual responses, and that the participant RNs identified specific and assessment skills necessary for disasters.

Assessment of the Feasibility of Barber-Led Sexual Education for African-American Adolescent Males.

This study explored the feasibility of a sexual health promotion barbershop program in the African-American urban areas of a large mid-southern city. A cross-sectional descriptive design was used with a random survey. The sample consisted of 56 barbers and adult community patrons of sample barbershops. A questionnaire assessed current barbershop topics, current opinions of barber reliability, and the desire for participation in a barber-led health promotion intervention. Barbers unanimously supported the needfor such a program and reported willingness to participate in training to provide evidence-based information to teens. Findings suggested that a barber-led health promotion program would be facilitated by the facts that barbers serve as mentors, barbers resemble father figures, and the level of barber-client trust is high. Barriers consisted offinancial constraints, time constraints, and lack of parental consent. Future studies should focus on program development, focusing on comprehensive health promotion activities in addition to sexual health.

Case series of sexual assault in older persons.

In this article, sexual assault of older persons is analyzed in a literature review and case series, and exemplar pseudocases of suspected older person sexual assault are discussed.

Women, Infant and Children (WIC) peer counselor contact with first time breastfeeding mothers.

OBJECTIVE: This study was designed to determine whether singleton women who had not previously breastfed and who had a women, infant and children (WIC) peer counselor were more likely to initiate breastfeeding than women not exposed to the WIC peer counselor. DESIGN AND SAMPLE: The retrospective cross-sectional study used data from the 2009 Texas Department of State Health Services (DSHS) WIC Infant Feeding Practices Survey (IFPS) administered through 73 local WIC agencies. Of the 5,427 responses to the 2009 Texas DSHS WIC IFP Survey, 56.6% (N = 3,070) were included in this study. MEASURES: The Texas DSHS WIC IFPS, a 55-item survey with multiple-choice and two open-ended questions, was used to evaluate breastfeeding beliefs, attitudes, and practices among women receiving WIC services. RESULTS: Women who had peer counselor contact during pregnancy, in the hospital, and after delivery were more likely to initiate breastfeeding than women without such contacts, OR = 1.36, 2.06, 1.85, respectively. CONCLUSION: Women's decision to initiate breastfeeding is significantly associated with WIC peer counselor contacts. Continued WIC peer counselor program services may increase breastfeeding initiation rates among WIC participants.

Nursing students and intimate partner violence education: improving and integrating knowledge into health care curricula.

This study measured intimate partner violence (IPV) curriculum content exposure; knowledge, attitudes, beliefs, and self-reported behaviors; and IPV prevalence within doctor of nursing practice and doctor of philosophy nursing programs at a university in the southern United States. The survey instrument was an adaptation of the Physician Readiness to Manage Intimate Partner Violence Survey modified with language that focused on students in the health care arena. Three summary scales-Perceived Preparedness, Perceived Knowledge, and Actual Knowledge-were also created. Mann-Whitney U tests and exploratory multivariable and logistic regression analyses were employed to analyze the data. Results indicated that nursing students who received IPV training prior to graduate school had significantly higher perceived preparation and perceived knowledge ratings than those reporting no IPV training prior to graduate school. Results also showed that 40% of nursing students surveyed had personally experienced some type of domestic violence including IPV. Identifying and responding to curricular shortcomings and ascertaining student IPV prevalence are critical steps in strategizing and implementing comprehensive curriculum revision, enabling students to enter the nursing profession with the capacity to directly impact the care and treatment of IPV victims.

Analysis of possible sexual assault or abuse in a 67-year-old female with early dementia post-brain attack.

The case analysis explores an emergency department visit by a 67-year-old female with early dementia post-brain attack, with complaints of possible sexual assault or abuse. This patient resides in a long-term skilled nursing facility. The case outlines the forensic care provided by the Advanced Practice Forensic Nurse (APFN) once medically cleared by the emergency department Advanced Practice Nurse (APN). The case discussion includes issues related to sexuality in aging populations, consent, sexual abuse or assault in institutions, and forensic care of older persons. Expected genital injuries in older women that result from sexual assault and abuse are also explored. The case discussion will analyze the key elements for critical thinking and clinical reasoning and demonstrate standards of care for the APFN and APN practice.

Preliminary findings of the relationship of lower heart rate variability with military sexual trauma and presumed posttraumatic stress disorder.

Decreased heart rate variability (HRV) occurs with physical and psychological disorders and is a predictor of cardiac and all-cause mortality. This study was the first of which we are aware to examine and report the relationship between military sexual trauma (MST) and HRV measures. In a historical cohort study of female veterans with (n = 27) and without (n = 99) MST who received Holter and electrocardiogram evaluation at a Veteran Affairs medical center during 2007-2010, we examined the relationship between MST and the standard deviation of all R-R intervals (SDNN) and the square root of the mean of the sum of the squares of differences between adjacent R-R intervals (RMSSD). Female veterans with MST were younger, p = .002, frequently had a probable posttraumatic stress disorder diagnosis, 80% versus 15%, p = < .0001, and had lower SDNN, p = .0001, and RMSSD, p = .001, than those without MST. The SDNN and RMSSD of a 25-year-old female veteran with MST were comparable to that of female veterans aged 69 to 81 years without MST. Further research is needed to evaluate relationships between MST and HRV measures.

Evaluation of image quality of digital photo documentation of female genital injuries following sexual assault.

With the patient's consent, physical injuries sustained in a sexual assault are evaluated and treated by the sexual assault nurse examiner (SANE) and documented on preprinted traumagrams and with photographs. Digital imaging is now available to the SANE for documentation of sexual assault injuries, but studies of the image quality of forensic digital imaging of female genital injuries after sexual assault were not found in the literature. The Photo Documentation Image Quality Scoring System (PDIQSS) was developed to rate the image quality of digital photo documentation of female genital injuries after sexual assault. Three expert observers performed evaluations on 30 separate images at two points in time. An image quality score, the sum of eight integral technical and anatomical attributes on the PDIQSS, was obtained for each image. Individual image quality ratings, defined by rating image quality for each of the data, were also determined. The results demonstrated a high level of image quality and agreement when measured in all dimensions. For the SANE in clinical practice, the results of this study indicate that a high degree of agreement exists between expert observers when using the PDIQSS to rate image quality of individual digital photographs of female genital injuries after sexual assault.

Vulnerable populations: drug court program clients.

Substance abuse and addiction are chronic conditions characterized by an inability to control one's urge to use mood- or mind-altering drugs. Recognition of the association between addictions and crime to support the addiction, along with the relapsing nature of addictions, presents treatment and management challenges for clinicians and frustration for patients and their families. Pressures to reduce the burgeoning jail population have resulted in collaboration between the treatment community and the court--a diversion program called drug court. This article reviews the drug court programs, the clients, and the processes of accountability that direct the progress toward sobriety in the drug court clients. It also argues that the drug court clients have unique health needs requiring interventions best suited for the recovering addict enrolled in a diversion program within the criminal justice system. Nurses have the ability to influence these systems and provide safety-net clinics to drug court clients through outreach, case finding, and culturally and linguistically appropriate care that can ultimately help this population to reach a higher level of wellness.