In this CVR podcast series, we talk with those doing research and serving victims and learn about the work they've done together.

Tell Us About It, Episode 15: The Role of Research in Forensic Nursing

A convo with Julie Valentine and Nancy DowningJun 07Time: 31:04

On this episode of Tell Us About It, we talk with Julie Valentine and Nancy Downing about their experiences as practicing forensic nurses. We cover the scope of forensic nursing as a practice, as well as the focus and importance of incorporating research and practice into the forensic nursing discipline.

Julie Valentine is a forensic nurse, a certified sexual assault nurse examiner, and an assistant professor of nursing and ethics at the Brigham Young University College of Nursing. She is also the Committee Chair and the Utah Chapter President of the International Association of Forensic Nursing (IAFN) Research Committee.

Nancy Downing is a forensic nurse at Baylor Scott and White Hospital and an assistant professor at Texas A&M University College of Nursing, Forensic Healthcare. She is on the Board of Directors of the International Association of Forensic Nursing, and is the former Founder and President of IAFN Iowa.

Related links:
• Learn more about IAFN from its website: https://www.forensicnurses.org/
• Read the IAFN Logic Model on Research: https://cdn.ymaws.com/www.forensicnurses.org/resource/resmgr/docs/research_agenda_logic_.pdf
• Learn more about the mini-grants awarded by IAFN in 2019: https://www.forensicnurses.org/page/ResearchAwardWinners
• Read the latest issue of the Journal of Forensic Nursing: www.JournalForensicNursing.com

Transcript:

Susan Howley: Welcome to Tell Us About It: Victim Research Condos, a podcast from the Center for Victim Research with support from the Office for Victims of Crime. On each episode of Tell Us About It, we talk to researchers and practitioners about their work, the tools being built for use in the field, and how we can work together to build an evidence base for victim services. Today we’re talking with Julie Valentine, a forensic nurse and assistant professor at the Brigham Young University College of Nursing, and Nancy Downing, a forensic nurse and assistant professor at the Texas A&M University Forensic Nursing program. Julie and Nancy, welcome and can I ask you to introduce yourselves, including your role with the International Association of Forensic Nurses?

Julie Valentine: Yes. I’m Julie Valentine. I’m an assistant professor at Brigham Young University, College of Nursing. I teach both nursing and ethics. I am also a practicing forensic nurse, a certified sexual assault nurse examiner with Wasatch forensic nursing. In addition, I am the committee chair of the International Association of Forensic Nursing Research Committee, working on establishing and implementing a research trajectory internationally. And I also am the International Association of Forensic Nurses, Utah Chapter President, so very involved with the great organization of IAFN.

Nancy Downing: And this is Nancy Downing, thank you so much for having us. I teach and do research at Texas A&M College of Nursing, Forensic Healthcare. I also practice as a forensic nurse at Baylor Scott and White Hospital. I take care of patients who have been victims of child abuse, child sexual abuse, sexual assault, domestic violence, and elder abuse. I’m also currently on the board of directors of IAFN and I am former founder and president of IAFN Iowa.

Susan Howley: That’s great. It sounds like we have the two best experts we could have on this topic today. Now, both of you, when you described your work, talked about forensic nursing beyond sexual assault nurse examiners, which is what most people think about. Can we revisit that point a little bit? How has the concept of forensic nursing changed from the early days when it was just associated with sexual assault?

Julie Valentine: Yes. This is Julie and I’m glad you bring that up, because many people do think of forensic nursing and think it just encompasses sexual assault nurse examiners, when actually the term forensic nursing is a broader term. And under that umbrella term, we have forensic psych mental health nurses. So those nurses that care for individuals impacted – and not just individuals, communities as well – impacted by violence. They may work with offenders and they may also work with survivors, and additionally, the secondary survivors. We also have forensic nurses that specialize in caring for child abuse victims, whether that be sexual assault or other forms of child abuse. We have forensic nurses that specifically work with elders, so focus more on elder abuse issues and the identification of elder abuse. We have forensic nurses that work within the prison system. We have forensic nurses that focus more on working with the criminal justice system, such as nurse attorneys. So the term forensic nursing is quite broad because of the background and education of forensic nurses, with increased education on trauma and the impact of trauma on individuals. We also have forensic nurses that respond to communities where there are a natural disasters because they have expertise in identifying trauma and injuries, caring for those injuries, but also the mental health impact of the trauma. That’s really a key part of forensic nursing, is helping individuals that have been impacted by violence, helping them start to heal. So it’s very broad spectrum.

Susan Howley: Now, Nancy, IAFN has recently reinvigorated its focus on research. So as a board member, what can you tell us about what prompted that focus?

Nancy Downing: Sure. I think most of it is really just this natural progression of our profession. We are a relatively young specialty, although there have been people practicing taking care of patients who’ve been impacted by sexual violence for decades and really centuries, If you look back on it. It didn’t become an official identity or additional professional role until the 1990s. IAFN was begun when a group of people who realized they were providing this specialty care came together in 1992 and founded IAFN. So since then, as we have grown enormously, there are now SANE programs, sexual assault nurse examiner programs, in every state of the United States and in several international countries as well. It’s really become the gold standard of care for patients who’ve been impacted by violence. So I think part of it is just this natural progression that we’re maturing as a profession and we need to make sure that we are the people who are in control of generating the evidence base to support what we do. I think it’s really just a matter of, we’ve reached this point in our professional growth where we need to take on and make sure that we are really firmly grounding our practice in science, and the best people to do that science is us as forensic nurses.

Julie Valentine: This is Julie and I think I would add in with that – forensic nursing is a very unique field of nursing because it combines information from nursing, forensic science, criminal justice, psychology, sociology. So we found that we have gained a lot of knowledge and science about our profession from other disciplines. For example, Dr. Rebecca Campbell at Michigan State University has done a lot of work with forensic nurses and caring for victims following sexual violence that has really elevated our profession and grown our science.

Susan Howley: That’s great. Nancy, what steps did IAFN take to map out a strategy to promote and incorporate research? As you said, this is part of an evolution. So now how did how did IAFN come up with a plan?

Nancy Downing: Sure. So it was actually a very exciting process. Our chief executive officer, Jennifer Pierce-Weeks, decided to devote really an entire board retreat to this last year. And so she brought in a consultant and this consultant, who is also a nurse researcher, helped us really spend an entire day mapping out a research agenda. And at first I was skeptical that we could accomplish an entire research agenda in a day. But the fact that we did, I think really points to the fact that we were ready. That we were just sitting on this ready to go and we were able to pull it all together and come up with a really nice model for how we should proceed. It was really important for us to develop a clear mission for our research committee, which is also a relatively young committee. Again, being so practice-focused for so long we are still emerging. And so the research committee, under the leadership of Julie Valentine, has really increased our ability to address this really important issue. So we drafted this research agenda – and Julie will tell you more about how they are now actualizing it – but it really wanted to focus on what things forensic nurses, us, ourselves, find to be the most important issues that we need to strengthen through our research and how to, also, at the same time, be strengthening our profession through the research we do. So we really wanted it to focus on the differences that forensic nursing makes to patient outcomes, to justice outcomes, to health outcomes more broadly and to prevention of interpersonal violence. So I’m really proud of our logic model and the steps we’re taking to really push the research forward.

Susan Howley: That’s quite an agenda. Julie, do you have anything to add to that?

Julie Valentine: Well, I would add that we are working hard to accomplish this agenda. We have outlined some very specific tasks, some of which we have met or are in the process of meeting. One of the goals, both for short term and medium, which affects the long term goals, is to increase resources for IAFN members to be more engaged in research. And so we launched a grant within IAFN – a grant total of $15,000, so for some smaller grants. And we received eight applications, excellent applications, so we’re in the process right now of reviewing those to award those grants that will be specifically focused on exactly the outcomes that Dr. Downing talked about. That will be focused on looking at the role of forensic nurses and improving health outcomes, criminal justice system outcomes, forensic science outcomes, with the ultimate goal to improve patient care and also the prevention of violence. So we’ve done the grants. We also, one of the goals has been to increase utilization of research by IAFN members. And so we have launched right now it’s two webinars per year. So those are two big goals that we’ve been working on and have been successful in implementing, again with the long range goal of improving patient outcomes.

Susan Howley: That’s great. So you’ve got two different ways to really engage your members in research. Either they could apply for a grant and start doing the research themselves or if they’re not quite ready they can be learning about research and how to from these webinars that you’re putting on. I know that IAFN also has a journal. How does that play in?

Julie Valentine: This is Julie, I was just going to jump in and add that as well. So in the webinars we are working with the Journal of Forensic Nursing to spotlight researchers that have published in the journal. Again to increase the utilization of those research findings, those items published in the Journal, and apply those to practice. An additional item is our annual international conference, which will take place in September of 2019. There will be a research track. So the research tract will be shorter sessions, 30 minute sessions, where practicing forensic nurses can attend these shorter research sessions to learn about the research and the practical applications of what it means to them and their care of patients. So we’re really excited about launching that as well this fall.

Nancy Downing: Yeah, and I would add to that some of the other activities that we have done – I know that Julie has also done some of this – is that at the IAFN international conferences, we both really liked presenting there. And I think part of our passion in presenting is to really make research sound exciting and feasible and to demystify it somewhat. Because I think part of our challenge has been to help forensic nurses feel a little less intimidated by research, and that it really is just a fancy word for evidence-based practice or what you do in demonstrating the positive outcomes that we all know that we have. But the importance of demonstrating that through the use of the scientific method. So one of the presentations I gave last time at IAFN was called “Research is for Everyone,” and I think in previous years, a session like that may not have been as popular as it was, but I really feel like the fact that the room was packed made me very excited and confirms really that our time is now. Because the interest in that room, the excitement of those bedside nurses that we want to engage and empower to do this research, was really palpable. And so we’re trying to really address this at many levels. Another idea we have to make research less intimidating and more accessible is we’re going to start a section in our Journal of Forensic Nursing that will put some of the most relevant research findings into lay language, so that our bedside nurses can implement some of the research into practice and make it really real accessible to them.

Susan Howley: So intimidation has been one of the challenges where research just sounds foreign or like something that’s outside of someone’s daily career track or career activities. What are some of the other practical challenges that can come into play that might keep a bedside nurse from engaging in research?

Nancy Downing: Right. That is so important, I think, just that image of what research is. But again, I have so many more reasons to be hopeful and excited about where we are right now. So again, I think when I approached clinical forensic nurses about engaging with me in a research partnership, there was a lot more hesitation and now I’m sensing more excitement. And so that is really exciting. And I think in addition to being intimidated by research, is just the lack of knowing how to do it. And so breaking it down into digestible pieces and teaching bedside nurses about the process has been really exciting and rewarding and it really demystifies it, as well as helps to show the value of it. So one of the challenges has been just in that education of the forensic nurses, but I think they’re really getting it now. Some of the other challenges we have are some of the more practical pieces such as: how do you file an IRB application and how do you work up a data management plan? How do you make a collaborative agreement with an institution? How do you put together contracts between an academic institution and a healthcare institution? So a lot of those practical pieces have been challenging for me, and have really delayed some of the research I’ve wanted to do. But I think that with time, the process is going to get easier and easier and faster and it’s going to become the norm, for the people that I’m working with, that we’re going to do research and we are going to make a difference. And getting those nurses excited about that and smoothing the processes has been a challenge but also really, really rewarding.

Susan Howley: Well, I’m excited about it.

Julie Valentine: This is Julie. I just want to jump in there a little bit more on challenges, and we could talk lots about challenges. But a couple of other things that I think have historically been challenges – and exactly what Nancy talked about – is helping the practicing nurses say, well, what does this mean to me? And the Journal of Forensic Nursing has a section, every article has to address implications on practice within every article. And I think that that is very useful in making that make sense. But I know personally, Nancy and I both are practicing forensic nurses, but we both are forensic nurse researchers. And I think that’s very helpful because we’re not sitting in ivory towers doing research, but not having our pulse on what is actually happening because we’re still seeing patients. We still can connect what is going on in the practical side of caring for patients and how does that direct our research. And it’s cyclical, then how does the research help inform our practice? So I think that’s important when we talk about challenges, we have to always talk about the money too, right? Because for any researcher, that is a significant challenge. And I know for me personally, as well as others that have done research in this field, I have gotten more funding on the criminal justice and forensic science side, rather than funding mechanisms focused on health outcomes. We’re hoping that that changes. In the past, there really has not been a large amount of funding directed to how does violence impact people’s health? And I think with the move towards more trauma-informed care, which we really – we have to always consider what has happened in somebody’s life that is affecting their health now. With that movement, I’m hoping that we start to see an increase in funding so that we can look at health outcomes for our patients. Because that is an area that really has been lacking on funding and an area that we need and still remains a significant challenge.

Nancy Downing: This is Nancy. I would agree with that. Another area of funding that has been more prevalent right now has been really related to programmatic issues. So several places in the United States were awarded HRSA grants and those were workforce grants to increase the sexual assault nurse examiner workforce. And we have one of those here at Texas A&M. So that’s really directed at, not basic research, but ultimately down the line will lead to, we know, improved health outcomes, but that is not directly what we’re measuring. So Julie’s right that it’s more of a challenge obtaining funding for those things. And as nurses, that’s really what we really care most about is what is that outcome for those patients. So I’ve been really spending a lot of my research funding opportunities looking for some of these more program-oriented grants to support my research, but then doing what I’m most interested in, which is looking at what risk factors are there for PTSD following sexual assault and chronic pain. So we’re finding challenging ways, but also some other ways to really support the research we want to do, while promoting an understanding of the need to support research that is focused on health outcomes.

Susan Howley: So it sounds like funding is both a challenge and an opportunity, depending on which area is paying attention to forensic nursing at the time.

Nancy Downing: Exactly, yes.

Julie Valentine: Absolutely.

Susan Howley: What about the challenge of time? I know that time can be a real barrier to practitioners in other fields and I would think that with forensic nursing where so often you’re not really in charge of your workload or your daily schedule because it could be interrupted at any point by an emergency. How does the practitioner, how does the bedside nurse carve out time for research?

Nancy Downing: This is Nancy. I do think that is another one of the reasons why we’re not seeing more research in this domain being done by forensic nurses, is because we are very busy people. And most forensic nurses have another full time job in addition to taking call as a forensic nurse. And those that do do it full time, the coordinators most of the time, are also exceedingly busy and juggling many, many different challenges. So there are very, very few doctorally-prepared forensic nurses and we need to grow that as well. So one of the challenges is growing more researchers. That also points to the importance of including the bedside nurses, the bedside forensic nurses in what we do because it really is about all of us. And I’m trying to help people see that you don’t need to have a PhD or DNP or even a Master’s degree to really make a difference in this domain. And we can partner together and do this research and make it meaningful and focus on the outcomes that we really think are important. But we also at the same time want to grow more forensic nursing researchers.

Julie Valentine: I just want to really quickly add in there on the making it meaningful for the bedside nurses and the issue of time. Sometimes the nurses are asked to do additional work and not compensated. And we really can’t have that. You know, there’s many areas of the country where a forensic nurse just gets paid per case, so if she sees a patient. If he or she is on call, they do not receive payment. They may not receive payment for the continuing education, which involves learning about research and applying the research. So I think the payment structure for forensic nursing is one thing that needs to be examined to help us utilize research more. And the forensic nursing team that I’m employed with, Wasatch Forensic Nurses, we have a research journal article every month that’s an online discussion. Every nurse is responsible to read that article and then post comments regarding the article. Now it’s an expectation, but at the end of the year, there is a bonus system based upon how many – we have educational meetings every month – how many meetings they attended, how many times did they respond to the journal article. And so they actually end up getting compensated for that very important time of increasing their education and looking at the research.

Susan Howley: What a fabulous idea. A sort of a journal club with incentives and bonuses built in to promote participation. I hope a lot of fields pick that up and I hope a lot of other chapters of forensic nurses pick up that idea.

Nancy Downing: Yeah, I love that idea. I’ll try to start that here.

Susan Howley: So with all of this research bubbling up now and this new attention and willingness to engage on the part of the nurses themselves, where do you see this area of research going? What are the really compelling research questions that you see on the horizon?

Nancy Downing: Sure. There’s just so much to do, and I know Julie can also agree that there’s so much to do and there’s so little time and so few of us to do it. And we talked about the challenges of having that time and that energy. Really I think we are most invested in wanting to see what we can do to demonstrate improved health outcomes. So sometimes that involves advocating and for policy changes and even legislative changes that will support funding opportunities for that kind of research. We know, as researchers, that obtaining funding for basic research through the National Institutes of Health, for example, is much more challenging funding then some of the justice grants or the programmatic grants. So sometimes it comes down to advocacy. I think that we really need to push that forward and so I think that demonstrating our impact through the projects that we’re doing is going to generate more funding opportunities, compelling research questions. There are just so many I can think of. I do think of ideas every day. Ideas, I have aplenty. Time and a research team? Those are the other things that I lack. We need research assistance, and it’s sort of a chicken and egg kind of thing, because you need the grants to fund the research assistance, but you also need the research assistance to generate those preliminary data to obtain the more competitive grants. So there’s so much for us to do and I’m sure Julie, you want to weigh in on where you feel like this research is going?

Julie Valentine: Yeah. So, when people are in school learning about research, they always say, well, look at the literature and identify gaps in the literature because that’s a research need. The area we work in, it’s not gaps. It’s grand canyons. We have a massive amount of research that needs to be done and the huge limitations are time. For those of us that are actively engaged in doing this research, we are also full-time professors, and Dr. Downing and I both also work clinically as forensic nurses. So the time issue is a significant problem. For my area of research, I have developed a lot of focus on the forensic science side because I have this wonderful research collaboration with our state crime lab and I’m able to get more funding looking on the forensic and criminal justice side than I have been able to on the health outcomes side of research. But when we look at just, for example, the forensic science, there has been massive improvements in DNA analysis techniques – I mean, now we can develop DNA profile from epithelial cells. Just a couple of weeks ago, I did a webinar about evidence collection in groping sexual assault cases, so evidence from touch DNA. We have this growth in technology on the forensic science aspect, but really have not looked at, so what does that mean in practice? So that’s just one area where we need a large amount of research to help inform the forensic examiners, so forensic nurses, as well as informing the forensic scientists because that really is an important partnership. And then it impacts law enforcement, it impacts the criminal justice system, it impacts the outcomes for patients regarding their cases. And we also need to pull in the victim advocates as part of this also, because they help provide education for the patients. So, yes, a large amount within all the different varieties that impact forensic nursing. So forensic science, health care, criminal justice, and nursing care with the bottom line of how does this improve patient outcomes?

Susan Howley: Well, this has been a wonderful opportunity to think about merging research and practice in a way that, as you just said, really gets us at patient outcomes, at victim recovery from all types of forms of abuse where forensic nursing could play a role. Thank you both so much for sharing your work and your vision for where IAFN and the field is going today.

Nancy Downing: Thank you so much for having us.

Julie Valentine: Well, thank you for having us.