Assistance to victims of violence in Emergency services from the Forensic Nursing perspective

Citolin, Morgana Oliveira; Vargas, Mara Ambrosina de Oliveira; Santos, Davydson Gouveia; Hilleshein, Andreza Goulart; Brasil, Gisele; Ramos, Flavia Regina Souza

doi:10.1590/1518-8345.6780.4137

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 32 • 2024 • https://doi.org/10.1590/1518-8345.6780.4137 copy

Assistance to victims of violence in Emergency services from the Forensic Nursing perspective^* * Paper extracted from master’s thesis “Enfermagem forense: atuação do enfermeiro nos serviços de emergência frente às vítimas de violência”, presented to Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to analyze nurses’ role in collecting, identifying and preserving traces in Emergency care for victims of violence, from the perspective of these professionals.

Method:

a qualitative study with an exploratory and descriptive approach. It was developed through semi-structured interviews with 21 nurses from hospitals that are part of the intersectoral flow to assist victims of violence from two reference hospitals in this type of care, in a capital city from southern Brazil. Nurses that are members of the multiprofessional team working in the Emergency areas at the respective hospitals were included; in turn, the exclusion criteria corresponded to professionals relocated in Emergency areas during the pandemic. Data analysis was performed according to Thematic Content Analysis.

Results:

the data were discussed in five categories: 1) Professional qualification; 2) Institutional protocol and materials; 3) The professionals’ perceptions; 4) The professionals’ actions; and 5) Team structure.

Conclusion:

Nursing professionals’ skills in collecting, identifying and preserving traces in Emergency assistance provided to victims of violence need to be better organized, structured and standardized. The presence of Nursing professionals in the care of victims of violence in Emergency services is undeniable, but their importance is still underestimated and their potential contribution to the forensic approach is underused.

Descriptors:
Forensic Nursing; Nursing; Violence; Emergency; Nursing Team; Nursing Care

Highlights:

(1) Proper actions in the care of these victims can ensure the chain of custody.

(2) Institutions are still unfamiliar with the topic.

(3) Forensic practices are punctually and indirectly performed by nurses.

Category	Subcategories	Registration units
The professionals’ perceptions	Relationship with the type of assistance provided	• Underage victims (sheltered for considering the personal aspect). • Female victims (due to gender difference). • The professionals do not consider being fit for the service to be provided.
The professionals’ perceptions	Relationship with the professional experience time	• The professionals consider themselves adequate for the service to be provided. • The professionals provide care regardless of the type of victim. • Relationship of appropriate performance to the experience of the profession with physical examinations.
Professional qualification	Institutional provision of courses/training	• The institution does not offer courses to improve the assistance provided to victims of violence.
Professional qualification	Preparation for trace collection and preservation	• The professionals perform the service when necessary, regardless of complementary training. • The professionals relate the technical practice with the opportunity for training in Criminal Forensics. • The professionals seek help from colleagues for service to be provided. • Skills acquired in the practice - more time and demand.
The professionals’ actions	Assistance through physical examination	• Conditioned to the victim’s acceptance, carried out in partnership with the physician on duty. • Trace collection and preservation by a specialized IML ^* * IML = Instituto Médico Legal (Forensic Medicine Institute); team.
	Administrative - referrals	• Referral to a specialist, after clinical actions - administration of prophylactic medications.
	Administrative - communication with the Police	• The Police service is activated with the patient’s consent. • The Police service is triggered if admission is via rescue. • Choice of the victim not to trigger the Police service (the aggressor is the current or former partner).
	Administrative - completion of the Emergency service	• Hospital discharge. • Hospitalization/ICU ^† † ICU = Intensive Care Unit .
Institutional protocol and materials	Existence of protocols without indicating nurses’ role	• The institution does not encourage collection of the corpus delicti and/or secretions by Nursing professionals. • The institution recommends medical guidelines. • The institution has a training project for the assistance to be provided.
	Perspective regarding elaboration of protocols	• Operational protocols are only formulated for sexual violence and there is no specific sector to house these victims (institution in preparation).
	Existence of an intra- and extra-institutional Protocol	• There are no specific protocols for each type of care. • Specific reference and assistance flow protocols are available, but not articulated to the forensic examination. • There are operational protocols from the City Hall. • There are operational protocols from the City Hall, but the institution is developing assistance protocols for improvement.
	Institutional materials	• The institution offers support materials. • The institution offers materials that help, but do not encourage collection of the corpus delicti and/or secretions by Nursing professionals. • The institution does not offer materials that support the activity.
Structure of the multiprofessional team	Composition and distribution in shifts	• Comprised by a social worker, psychologist, physician, nurses and nursing technicians available for joint care. • Reduced at night shift - only physicians and nurses.

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author:
Morgana Oliveira Citolin E-mail: morgana.ocitolin@gmail.com https://orcid.org/0000-0002-1769-0170