Understanding Forensic Nursing Principles: Providing Trauma-Informed Care

Julie Valentine, Assistant Professor, PhD, RN, CNE, SANE-A; Linda Mabey, Assistant Teaching Professor, DNP, APRN, PMHCNS; Leslie Miles, Assistant Teaching Professor, DNP, APRN-BC

Nurses work with many individuals who have suffered trauma. BYU College of Nursing faculty—Dr. Julie Valentine and Dr. Linda Mabey (along with Dr. Leslie Willden Miles and several undergraduate nursing students)—are researching the neurobiology of trauma, the repercussions of experiencing trauma, and interventions to improve the lives and functioning of traumatized individuals. They are specifically focusing on the impact of sexual assault trauma.

The most frequently encountered traumas involve a life-threatening accident, a natural disaster, or witnessing a traumatic event. A nurse who is caring for a patient who has experienced significant trauma should remember that it is not the event that determines whether something is traumatic to someone but the individual’s experience of the event and the meaning they make of it. Those who feel supported after the event (through family, friends, spiritual connections, etc.) and who had a chance to talk about and process the traumatic event are often able to integrate the experience into their lives, like any other experience.

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Dr. Leslie Miles

It is important for nurses to understand and remember that there are no right or wrong reactions to trauma, as there is significant variability in behaviors. Some patients cry uncontrollably while others may become nonresponsive or emotionally displaced. During trauma, a hormonal flood is released, triggering a fight, flight, or freeze response. While some individuals fight or flee during trauma, others freeze—a response known as tonic immobility. Sexual-assault victims often experience tonic immobility, which makes them unable to run, fight, or yell.1

In addition to meeting basic needs and physical care, it is vitally important to address the psychological needs of the traumatized patient. During and after a traumatic event, individuals feel a loss of control. Nurses can help patients regain a feeling of control by informing them of what will happen next and providing choices in their care. Research supports that when nurses express compassion, believe victims, explain care, and provide choices to victims of sexual assault trauma, the victims report that the nurses’ actions help in their emotional recovery from the trauma.2

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Dr. Linda Mabey

The influence of these professors’ studies is reaching outside of the nursing community. Last year Valentine, Mabey, and Miles co-authored a chapter on the neurobiology of trauma in a textbook published by Sigma Theta Tau.

Mabey recently completed and published a literature review on the treatment of post-traumatic stress disorder in patients with severe mental illness. Her mental-illness materials suggest that nurses should be part of the efforts to develop, test, and implement treatment models.

For the past two years, Valentine worked with the police department of West Valley City (WVC), Utah, and with the Utah Prosecution Council (UPC) to train officers on the impact trauma has on sexual-assault victims. This collaboration led to implementing new protocols that aim to ensure compassionate treatment and support for sexual-assault victims.

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Dr. Julie Valentine

After reviewing the cases of 2014, the results of Valentine’s work with WVC showed that sexual-assault prosecution jumped from 6 percent to 24 percent. Her work helped validate the importance of the Trauma Informed Victim Interview, which takes into account the effect of trauma on a victim’s memory and behavior. With that impact in mind, investigators conducting the interviews were more successful and comprehensive when compared to interviews gathered with previous investigative techniques. Valentine conducted a survey of the victims and found high levels of satisfaction. She also analyzed the data regarding screening and prosecution rates.

There are plans to expand the study to other law enforcement agencies and prosecutors’ offices, depending on funding.

  Before Study During Study
Screening of Adult Sexual-Assault Cases 33% 68%
Declination Rate 75% 56%
Charges Filed 9% 32%
Prosecuted 6% 24%

NOTES

  1. Campbell, R. (2012). The neurobiology of sexual assault. An NIJ Research for the Real World Seminar. Retrieved from http://nij.gov/multimedia/presenter/presenter-campbell/Pages/presenter-campbell-transcript.aspx

 

  1. Bryant, R. A., Friedman, M. J., Spiegel, D., Ursano, R., & Strain, J. (2011). A review of acute stress disorder in DSM‐5. Depression and anxiety, 28(9), 802–817.

 

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