Disproportionate impact of abortion restriction: Implications for emergency department clinicians.

Individuals experiencing intimate partner violence (IPV) and/or human trafficking (HT) are at increased risk of severe health consequences as a result of legislation criminalizing and/or restricting abortion, which is expected to increase as a result of the Supreme Court decision Dobbs v. Jackson. These risks are further stratified by race, socioeconomics, and other marginalizing demographic attributes. IPV and HT introduce barriers to maintaining physical and mental health, due to control of access to transportation and funds by the abuser, fear of retribution for seeking healthcare, and other barriers. Individuals experiencing IPV or HT often lack reproductive autonomy, as a result of facing reproductive coercion at the hands of their abusers. Following the Dobbs decision, these vulnerable patient populations will face further limitations on their reproductive autonomy and increased obstacles to obtaining an abortion if they medically need or desire one. This will likely result in more patients presenting to the emergency department due to complications from unsafe or unsupervised self-managed abortions, as well as patients being reluctant to report having obtained an unlawful abortion due to fear of legal consequences. This is particularly relevant to individuals experiencing IPV and HT, as they may be more likely to use these methods for obtaining an abortion due to numerous barriers. Emergency medicine clinicians are vital in providing care to these patients, as they frequently present to emergency departments. A multi-pronged approach to better support these patients is essential, involving an increased index of suspicion for IPV, HT or the complications of unsupervised abortion, improved organizational structures, specialized training for staff, improved screening methods, reflection on implicit bias, and recommendations for mindful documentation and legal considerations.

Improving the Forensic Documentation of Injuries Through Alternate Light: A Researcher-Practitioner Partnership.

ABSTRACT: An alternate light source (ALS) is a practitioner-driven technology that can potentially improve the documentation of injuries among victims of interpersonal violence. However, evidence-based guidelines are needed to incorporate and document an ALS skin assessment into a forensic medical examination that accurately reflects the science, context of forensic nursing practice, trauma-informed responses, and potential impact on criminal justice stakeholders. This article introduces the forensic nursing community to a current translation-into-practice project focused on developing and evaluating an ALS implementation program to improve the assessment and documentation of bruises among adult patients with a history of interpersonal violence. Our researcher-practitioner collaboration uses theory-based approaches that consider both the developed program's practice context and stakeholder impact. The goal is to provide evidentiary support for adult victims of violence and a more equitable forensic nursing practice that benefits diverse patient populations.

Didn't put a label on it: Examining intimate partner strangulation within a diagnostic framework.

AIMS: The aim was to examine and describe women's emergency department visits and care-seeking experiences, including recognition, evaluation and communication of symptoms, injuries and health risks after non-fatal intimate partner strangulation. DESIGN: Using a diagnostic process framework, this mixed-methods study explores concordance and discordance of interview and medical records data to highlight opportunities for clinical diagnostic improvement. METHODS: In-depth, semi-structured interviews with women after an emergency department visit for non-fatal intimate partner strangulation, concurrent with medical records reviews, were conducted between March 2018 and January 2019. A constant comparative approach was used to analyse interview and medical record data using an a priori codebook designed based on the National Academies of Science, Engineering and Medicine's conceptual model of the diagnostic process and prior intimate partner violence research. RESULTS: Interviews reflected participants did not have a sense of long-term health risks from their strangulation beyond addressing emotional trauma. Women noted that forensic and emergency nursing support was treatment in and of itself that allowed them to be heard and validated. Medical record clinical impressions and final diagnoses included domestic violence, domestic abuse or sexual assault, but not specifically strangulation. CONCLUSION: This study contributes to the growing literature regarding strangulation diagnosis and care. Our findings provide new details of women's emergency department care-seeking experiences which, whilst overall aligned with medical records documentation, were not reflected in final diagnostic impressions nor in patient recollection of long-term health risks. IMPACT: Nurses are strongly positioned as clinical practice leaders and policy advocates to improve collective responses to this dangerous violence mechanism. Actions such as improving patient education, referral and follow-up options to better communication and address long-term strangulation risk are one example. Further research on non-fatal intimate partner strangulation and care-seeking is warranted to expand this knowledge, particularly in longitudinal cohorts and varied geographical areas.

Use of an alternative light source to assess strangulation victims.

Alternative light sources (ALSs) are commonly used at crime scenes and in forensic laboratories to collect evidence such as latent fingerprints, body fluids, hair, and fibers. This article describes the use of this technology to reveal soft tissue injuries that are not visible to the naked or unaided eye in patients who report strangulation. The value of this information to the medical, nursing, and judicial systems is discussed. The records of the 172 strangulation patients seen in our forensic nurse examiner program between 2009 and 2010 were reviewed. The SPEX Crimescope (SPEX Forensics, Edison, New Jersey) was used during the assessment of all of them. Ninety-three percent of the patients had no visible evidence of external injuries on physical examination. The ALS revealed positive findings of intradermal injuries in 98% of that group. Information obtained with ALS devices helps medical and nursing practitioners understand the gravity of patients' injuries, influences medical treatment decisions and follow-up care, and supports the prosecution of the perpetrators of crimes of violence. Educational programs about the application of ALS and the interpretation of its findings are valuable for medical, nursing, and other forensic disciplines.