Cassandra Beaumont, Canberra Sexual Health Centre Division of Medicine, Canberra Hospital: A Decade of Sexual Assault Cases and Correlations to General Clinical Forensic Case Work
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Cassandra Beaumont, Canberra Sexual Health Centre Division of Medicine, Canberra Hospital: A Decade of Sexual Assault Cases and Correlations to General Clinical Forensic Case Work

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Cassandra Beaumont, Clinical Nurse Consultant, Clinical Forensic Medical Services (CFMS), Forensic and Medical Sexual Assault Care (FAMSAC), Clinical Forensics ACT (CFACT), Canberra Sexual Health ...

Cassandra Beaumont, Clinical Nurse Consultant, Clinical Forensic Medical Services (CFMS), Forensic and Medical Sexual Assault Care (FAMSAC), Clinical Forensics ACT (CFACT), Canberra Sexual Health Centre Division of Medicine, Canberra Hospital delivered this presentation at the 2013 National Forensic Nursing conference. The annual event promotes research and leadership for Australia’s forensic nursing community. For more information about the conference and to register, please visit the website: http://www.healthcareconferences.com.au/forensicnursing

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Cassandra Beaumont, Canberra Sexual Health Centre Division of Medicine, Canberra Hospital: A Decade of Sexual Assault Cases and Correlations to General Clinical Forensic Case Work Cassandra Beaumont, Canberra Sexual Health Centre Division of Medicine, Canberra Hospital: A Decade of Sexual Assault Cases and Correlations to General Clinical Forensic Case Work Presentation Transcript

  • National Forensic Nursing Conference 21 – 22 February 2013 Cassandra Beaumont RN/RM/MHSM ACT Clinical Forensic Medical Services
  • Overview     Current sexual assault forensic nursing around Australia The ACT experience Sexual assault vs forensic nursing Comprehensive forensic nursing   Cross over of sexual assault skills into general clinical forensics Competency as a forensic nurse
  • What is Forensic Nursing? “Forensic Nursing is the application of nursing science to public or legal proceedings; the application of the forensic aspects of health care combined with the bio-psycho-social education of the registered nurse in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity and traumatic accidents” IAFN 2006:
  • IAFN: Areas of Forensic Nursing Specialty        Sexual Assault Nurse Examiner (SANE) Advanced Practice Forensic Nurse Correctional Nursing Specialist Forensic Nurse Clinical Specialist Forensics Nurse Investigator Nurse Coroner/Death Investigator Legal Nurse Consultant
  • Sexual Assault Nursing in Australia  Where did it start ?          Me in the ACT 2001 (and maybe others) NSW SANE Training 2005 Victoria Monash University - VIFM Course 2006 Queensland 2006 Victoria Scholarship 2007 (36 trained over 3 years) Tasmania 2009 Northern Territory 2010 South Australia RN’s doing police/remand work Western Australia 2010 -Rural remote nurses
  • X RN /Sexual Assault Location/No/Role x New South Wales Sydney 3 SA DV Across state 8 active- SA x Victoria x Melbourne 4 x x Adelaide offenders only 2 x Employed by DASSA 3 CN Western Australia WA-Rural/Remote 108 trained Brisbane 2 SA GF CN DTO Tasmania Northern 5 SA Southern 3 SA x x x x x x x Queensland Across state 25 active x x x Bio Spec Collections 40 Perth 1 SA x x Rural 10 SA GF South Australia x x x x x x x xx Australian Capital Territory Canberra 6 SA GF DV CN Northern Territory Darwin 1 Alice Springs 6 x x xx xx x x
  • Sexual Assault Nursing in the ACT Forensic & Medical Sexual Assault Care  2000 Forensic & Medical Sexual Assault Care (FAMSAC) started    Sexual health centre location Throughput 160 p.a / generates >1000 occasions of service p.a General Forensic Service (CFACT)    2006, contract for general forensic services with AFP On call FMO - 7 days a weeK FMO’s only
  • ACT - How We Have Evolved  FAMSAC ACT Sexual Assault Service  CFACT Services under an agreement with AFP to provide:             Medical care to detainees in police custody Injury interpretation for both victims and offenders Forensic specimen/evidence collection for victims and offenders Attendance at court as a witness / Expert or not? Inter-services education to stakeholders: Police/ACTAS/Counsellors/DPP Medical assessments for police officers / minor work acquired injuries and occupational exposures Attendance at death scenes- suspicious and non- suspicious Contact centre for medical information or advice Fitness for interview assessments Toxicology collection Fitness for custody Medical opinions - prosecution and defence
  • Can We All See The Same Thing Pre survey of FMO’s for trial to include nursing staff on the service How many faces are there?
  • The Forensic Nurse !!! The Doctors Are Not Alone!!!          Survey of FMO’s pre RN’s / Not so keen 2009 nurses started working in police custody centre – Regional Watch House (RWH) RN’s completed post grad qualifications (Monash Uni) 4 RN’s working 0.63 FTE, triage for all cases while on duty Started with nurses on at high throughput times in RWH T, F,S,S night shifts. Police & medical staff satisfaction with nursing service high 2011, moved to a 7 day nursing service with S,M,T,W evening & T,F,S nights RN on for SA cases while working at the RWH 2013- 6 RN’s all paid according to nursing EBA for all work hours / on call / call outs
  • Some Duties Are For FMO’s Only  FMO Only Duties  Attendance at death scene (the nurse may attend with the FMO). Nursing staff provide feedback of autopsy findings to the FMO.  Fitness for interview assessments  Fitness for custody – (every observation is a FFC)  High level injury interpretation  Medical opinions
  • 12 Months on Comments About FNE’s by the FMO Survey Results 2010    ―I am very happy with the reduction in workload now that we have the nurses. I feel more able to do more shifts, and I think I can stay with the service for longer with their assistance‖ ―Nursing trial has very positively affected my work life balance. It has markedly reduced stress of being on call prior to full workday‖. Unfortunately has also significantly decreased income from callouts, but this seems to be a reasonably fair trade off with keeping the on calls sustainable for the future. Would be nice to have had less drop in income but there are pro's and con's as always with diverting workload to others (RN's). I look to now stay on the service for the foreseeable future all things remaining equal‖ "Improves initial assessment, avoids expensive unnecessary call outs, continuity of care over night, I have someone that I can ask opinions of as well as vice versa―
  • Comments From FMO About FNE’s  “I hope that the trial has been successful because I don't think I can do the job without them”  “They need medals for staying in the watch house for a whole shift”  “The handovers from the nurses have been very good. They've done a thorough assessment and have a plan which they communicate clearly. Not sure how well they handover between themselves only because I don't see this, not a criticism. They do talk about it which suggests it is happening”  “Are we dumbing down our doctors by using the nurses more”??  “Less requirement to attend for trivia” – love it  "Ongoing supervision and follow up of patients. Medication administration reliable. Some things can be managed without the need for FMO call out. Have learnt a good score of recipes!“ High satisfaction/minimal staff turnover Survey of police - high satisfaction Survey of RN’s - high satisfaction
  • RN’s Skills Learnt From Sexual Assault Examinations    Building a rapport in difficult situations Taking a comprehensive clinical & events history Documentation     Injury Interpretation Chain of custody Use of clinical judgment    Statement of facts Discussion with FMO, police, stakeholders Court reports / expert statements Court process
  • RN’s Skills Learnt From Working in Police Custody Centre        Drug, alcohol and mental health skills Negotiating with the police A range of law enforcement insights/process Being able to speak the lingo That alleged offenders can be victims too Getting more of the picture Three kinds of truth
  • We Don’t Always Recognise Skills Can you see the face in the grass Skills take time and we cannot always see them without a little help Can you see the face
  • Moving to a Comprehensive Forensic Nursing Service  DV - Intimate partner violence or FV (2011)       Attempted Strangulation General Assault Forensic evidence collection Trauma (FNE attends with the FMO) Areas of maltreatment – (elder abuse) Victim vs Suspect assessments
  • What Has Been Added ? In House Education Sessions   Head injury Comprehensive assessments           Glasgow Coma Scores Drug and alcohol effects Alcohol Withdrawal Scale Strangulation assessments Glue techniques Tympanic examination Advanced Life Support Case reviews – discussion / injury interpretation / medical care etc All RN’s provided with cameras - practice makes perfect Court reports support - all reviewed on the job, by senior FMO
  • Location Location Location Where… Governs What The RN Can Do?  Legislation Differs NSW VIC WA QLD TAS ACT NT
  • NSW- New South Wales Consolidated Acts CRIMES (FORENSIC PROCEDURES) ACT 2000 - SECT 3 Division 2 – Persons involved in forensic procedures Persons who may carry out forensic procedures (1) The table to this section shows, for each forensic procedure specified in the first column of the table, the persons who may carry out the procedure under this Act. A person not specified in the second column of the table is not authorised to carry out a forensic procedure under this Part except as mentioned in section 52. 
  • Table From NSW Crimes (Forensic Procedures) Act 2000 pg 22 external examination of the genital or anal area or the buttocks or the breasts of a female or a transgender person who identifies as a female medical practitioner nurse appropriately qualified police officer or person the taking of a sample of blood medical practitioner nurse appropriately qualified police officer or person the taking of a sample of saliva, or a sample by other-administered buccal swab medical practitioner dentist dental prosthetist nurse appropriately qualified police officer or person the taking of a sample of pubic hair medical practitioner nurse appropriately qualified police officer or person taking of a sample by swab or washing from external genital or anal area or the buttocks or the breasts of a female or a transgender person who identifies medical practitioner nurse appropriately qualified police officer or person as a female the taking of a sample by vacuum suction, scraping or lifting by tape from the external genital or anal area or the buttocks or the breasts of a female or a medical practitioner nurse appropriately qualified police officer or person transgender person who identifies as a female external examination of a part of the body other than the genital or anal area or the buttocks or the breasts of a female or a transgender person who identifies as a female that requires touching of the body or removal of clothing medical practitioner nurse appropriately qualified police officer or person the taking of a sample of hair other than pubic hair the taking of a sample from a nail or from under a nail medical practitioner nurse appropriately qualified police officer or person
  • South Australia Criminal Law (Forensic Procedures) Act 2007 24—Who may carry out forensic procedure (1) A person who carries out a forensic procedure must be— (a) a medical practitioner; or (b) a person who is qualified as required by the regulations to carry out forensic procedures of the relevant type. South Australia Criminal Law (Forensic Procedures) Regulations 2007 under the Criminal Law (Forensic Procedures) Act 2007 Persons qualified to carry out forensic procedures (1) For the purposes of section 24(1)(b) and 55(5) of the Act— (a) a person who is a registered nurse is qualified to carry out a forensic procedure of any type except the taking of a dental impression; and (b) a police officer or a person authorised by the Commissioner of Police is qualified to carry out a forensic procedure (other than an intrusive forensic procedure) consisting of— (i) the taking of prints of the hands, fingers, feet or toes; or (ii) an examination of a part of a person's body; and
  • Western Australia- RN Certified
  • ACT Australian Capital Territory Crimes (Forensic Procedures) Act 2000 A doctor or a registered nurse can carry out an intimate forensic procedure An intimate forensic procedure is any of the following forensic procedures: (a) an external examination of the genital or anal area, the buttocks, or, for a female or a transgender or intersex person who identifies as a female, the breasts; (b) the taking of a sample of blood; (c) the taking of a sample of pubic hair; (d) the taking of a sample by swab or washing from the external genital or anal area, the buttocks, or, for a female or a transgender or intersex person who identifies as a female, the breasts; (e) the taking of a sample by vacuum suction, by scraping or by lifting by tape from the external genital or anal area, the buttocks, or, for a female or a transgender or intersex person who identifies as a female, the breasts; (f) the taking of a dental impression; (g) the taking of a photograph or video recording of, or an impression or cast of a wound from, the genital or anal area, the buttocks, or, for a female or a transgender or intersex person who identifies as a female, the breasts.
  • If RN’s Can – Should We? Gaining Experience, Leading to Competency         Requires the specialty of an FMO Coordinator role – FMO or RN Defined areas of practice Clinical preceptor/ buddy training Simulation sessions Peer review QA, QI - File review between staff Acceptance- working with other agencies
  • I cannot teach anybody anything I can only make them think Socrates (BC489-BC 599) Greek philosopher of Athens Education as a key WA SARC 2 ½ day training (patented course with completion cert) Yarrow Place 2 day training (patented course) NSW ECAV online workshops sessions (Feb 18th 2013) In house – Teleconferences Case reviews Peer support and or Newsletters – QLD, WA, VIC-(The F-Word) Post Grad University of Notre Dame Australia (Fremantle) Grad Dip Forensic Nursing Custodial Nursing ? Cannot find specific post grad Overseas Dundee Masters/ USA multiple Grad Cert & Masters courses / Doctorate of Forensic Nursing
  • Competency  ANMC National Competency Standards for RN’s  Have been individualised by other specialities      Australian Nursing Federation   ASHNNA – Australasian Sexual Health & HIV Nurses Ass AHA – Australasian Hepatology Emergency Nurses – College of Emergency Nurses Australasia Victoria – not published The Competency Standard is a brief active statement of what the nurse does. Elements are also active statements, but are about how the nurse does what he/she does to demonstrate that particular competency. Performance criteria are statements of outcomes of the nurses’ behavior and actions. IAFN Scope and Standards of Practice of a SANE  Competency Standards for SANE’s is defined as "the knowledge, skills, ability and behaviours that a person possesses in order to perform tasks correctly and skillfully" (O'Shea, 2002, p. 175).
  • Competency assessment involves more than a checklist and a test Increased caseload Leads to Increased experience Leads to Knowledge / Skill Critical thinking Which leads to Advanced Practice
  • Once We Have The Skills How Do WE Keep Them ? Organisational Correlations to Resilience   The organisation can significantly affect the resilience of its workers and the level of stress Peer support often just happens but program design can foster increased support and professional relationships             High case load  Role ambiguity  Goal diffusion  Prosecution focused – what is the mission?  Level of working facilities  Satisfaction with Compensation structure and Compensation satisfaction  Continuing work based training  Good relationships with interagency teams  Good peer support  Having organisational support  Age  Increased education  ( worked based education  ) Experience – working longer in the field 
  • Resilient Carers      Professionalism & self worth Planning & problem solving Personal growth Strong sense of team Effective stress management systems } Facilitated by an expert
  • We Progress With Caution       Aiming for competency increased supports for increased resilience Cannot proceed without support of the FMO’s Staffing mind set change Staff willingness to see other pt groups Changes of practice      Develop tools, proforma, process and documentation Education +++ Ongoing supervision and peer review Continue with stakeholder engagement Goal to orchestrate excellence
  • Thanks To: NSW WA SA QLD NT VIC TAS ACT  RN Mandy Ashton, Dr Maria Nittis Dr Maire Kelly, RN Lorraine Hanks Dr Lyndall Young, SAPOL Siobhan McInerney Dr David Griffin, RN Dianne Farrell RN Sonja Bonnet, Dr Tracey Johns RN Adele O’Hehir, RN Chris Biesiekierski Sexual Assault Response Coordinator Morgen Hughes Dr Vanita Parekh and our whole team of Nurses and Doctors And thanks to everyone else that I emailed or spoke to about their area of service delivery
  • References Enhancing Effectiveness in Assessing Forensic Nursing Staff Competency Phyllis J. Miller Journal of Forensic Nursing Volume 3, Issue 2, pages 72–77, June 2007 Integrating forensic nursing into the undergraduate nursing curriculum: a solution for a disconnect. Freedbrug Pauline. J Nurs Educ. 2008 May;47(5):201-8. Forensic nursing: The maturing of a discipline. Lawson, Louanne. Journal of Forensic Nursing, Vol 4(4), Dec 2008, 147149. Forensic nursing educational development: an integrated review of the literature A. KENT-WILKINSON. Journal of Psychiatric and Mental Health Nursing Volume 18, Issue 3, pages 236–246, April 2011 Have you read your Forensic Nursing: Scope and Standards of Practice? Cindy Peternelj-Taylor RN, MSc, DF-IAFN Journal of Forensic Nursing Volume 6, Issue 2, pages 55–56, June 2010 Orchestrating Excellence, Robert M. Golub, MD Editorial | September 7, 2011, JAMA. 2011;306 Occupational burnout, eating behavior, and weight among working women Am J Clin Nutr April 2012 95: 934 Organizational correlates of secondary traumatic stress and burnout among sexual assault nurse examiners Stephanie M. Townsend PhD1, Rebecca Campbell. Journal of Forensic Nursing. Volume 5, Issue 2, pages 97–106, June 2009 Research and Evaluation of Clinical Nurse Mentoring: Implications for the Forensic Context. Andrew Cashin, Emily Potter. Journal of Forensic Nursing Volume 2, Issue 4, pages 189–194, December 2006 The SAFE CARE model: Maintaining competency in sexual assault examinations utilizing patient simulation methods Cynthia Ferguson CNM, MSN, FNE-A, SANE-A, D-ABMDI1, Diana Faugno MSN, RN, CPN, SANE Journal of Forensic Nursing Volume 5, Issue 2, pages 109–114, June 2009 Why health care needs resilient practitioners, Julie Scholes. Nursing in Critical Care Volume 13, Issue 6, pages 281–285, November and December 2008 Webinar IAFN Comprehensive Forensic Nursing Service. Jennifer Pierce- Weeks Vicarious Traumatization: Concept analysis. Pamela Diane Tabor DNP, WHNP-BC, APN, SANE-A. Journal of Forensic Nursing Volume 7, Issue 4, pages 203–208, December 2011 ANMC National Competency Standards for Registered Nurses. Australian Nursing Federation Competency Standards. ASAHHNA Competency Standards. Australasian. Hepatology Association Competency Standards
  • How Many Black Dots Can You See Questions?