In this Bell Work Talk Dr. Troy discusses the findings from a study fulfilling requirements for her Doctor of Philosophy degree in Nursing. Nurses are required to utilize trauma- informed practices, often without mitigating their childhood trauma.  Forgiveness is a mediator of  trauma and does not require benevolence toward the transgressor rather includes release of self from fault and shame. Forgiveness does not imply that justice will not be pursued, only that the motivation is not vengeful. The impact of  abuses (ACEs) on nurses’  ability to care, was measured by the construct of compassion satisfaction (CS). Demographics in this study predicted forgiveness and (CS). This study  evaluated ACEs in nurses and their impact on choice of clinical practice, forgiveness ability and (CS).

From a  convenience sample of 255 nurses, results indicated the participants had four or more ACEs, (n = 60) 24%, which is  double the 12.1% found in the original ACE study.  Nurses with high ACEs reported less self-forgiveness. Race predicted self-forgiveness. Correlations were found between forgiveness and (CS).  The ACE category of participants statistically significantly correlated to their work specialty.
  
Pointing to resilience, despite multiple childhood adversities, participants achieved academically.  Forgiveness has implications for nursing education, practice, and policy. Nursing must take the lead in caring for our own with the same enthusiasm shown to others.

Dr. Troy has been a nurse for 44 years. Graduating with a BSN from Rutgers University she has been a life-long student, clinician, and educator. Presently she has the privilege of working daily with the bravest children in Louisiana, as they present to the CARE Center of Children’s Hospital. In her role as a forensic pediatric nurse practitioner , Dr. Troy obtains incident histories from children due to concerns for all forms of maltreatment. Often, she is trusted with the first disclosure from the non-offending parents, as they outcry about previously unspoken abuses in their own childhood. 

Additionally, in her role as Associate Professor of Nursing at the University of Holy Cross, Dr. Troy has heard from generations of students who have voiced that their own childhood experiences greatly impacted their choice of career specialty in Nursing. All of which culminated in her pursuit of knowledge around these constructs, as the survivors of abuse were often more unforgiving of themselves than of their abusers from adversities experienced as children. Dr. Troy has been invited to present these findings to national and international audiences. Her work has involved testifying over a hundred times in criminal and civil courts throughout LA.

Episode 25: The Impact of Adverse Childhood Experiences and Forgiveness on Nurses

In this Bell Work Talk Dr. Dugan will discuss what TBI is, how to screen for it during the forensic medical exam, and considerations for Nurse Forensic Medical Examiners who testify in court.

Dr. Dugan is a Board Certified Pediatrician, Fellow of the American Academy of Pediatrics, Credentialed Adult/Pediatric Forensic Medical Examiner, General Child Abuse Pediatrician, and Director of Forensic Services of the Shasta Community Forensic Care Team. He is Medical Director of the California Clinical Forensic Medical Training Center (CCFMTC) and an instructor for both adult and pediatric Sexual Assault Forensic Examination (SAFE) training courses. He has been working full time at Shasta Community Health Center in Redding, CA since 2012.  His areas of expertise include Child and Family Maltreatment, ACEs, Physical/Sexual/Emotional Child Abuse and Neglect, Domestic Violence, Strangulation, Traumatic Brain Injury, Elder Abuse, and Human Trafficking.  After taking charge of the pediatric sexual assault medical team in 2016, Dr. Dugan founded the SCAN (Suspected Child Abuse or Neglect) program in 2017.  He authored the SCAN policy that was implemented at many hospitals and clinics across the north state. Dr. Dugan expanded the program to include adults in 2019 and is the founder of the Shasta Community Forensic Care Team. He is a founding member of the Children's Legacy Center, the first Child Advocacy Center in Shasta County.  He is the Board Chair of Pathways to Hope for Children aka the Shasta County Child Abuse Prevention Coordinating Council. He is the founder of the Strangulation/Domestic Violence Clinic at One Safe Place. Dr. Dugan is a member of the Helfer Society and the Medical Advisory Committee for the Training Institute on Strangulation Prevention. Within the institute he has conducted several nationwide and international trainings on Strangulation and Traumatic Brain Injury.  Dr. Dugan also serves as the Medical Director for the Siskiyou, Shasta, and Tehama Sexual Assault Response Teams.  In 2021, Dr. Dugan received the Neal Snyder Outstanding Service Award from the California Professional Society on the Abuse of Children.

Episode 26: TBI for the SANE

In this Bell Work Talks, Coroner O’Neal will discuss the role of nurses in the medicolegal death investigation professions.  Coroner O’Neal will discuss her background and training which led to her election as the Charleston County Coroner in November of 2020, the importance of nurses in this profession and her role as the President of the International Association of Coroners and Medical Examiners (IACME)

Bobbi Jo O'Neal, a Registered Nurse and a Board-Certified Fellow with the American Board of Medicolegal Death Investigators, has served in the Coroner’s Office since 1998, including serving as Chief Deputy Coroner from 2011-2020. She was elected Charleston County Coroner in 2020.

With her leadership, the Charleston County Coroner’s Office is one of only 26 coroner offices in the country that is accredited by the International Association of Coroners and Medical Examiners. Additionally, as a grant writer for the Coroner's Office, O'Neal has successfully brought in over $840k in funds to Charleston County.

O’Neal is the President of the International Association of Coroners and Medical Examiners and serves on the Executive Committee for the Lowcountry Healthcare Coalition, which has taken a lead in the coronavirus preparation and response locally.

An experienced emergency room nurse, O'Neal received her Bachelor of Science in Nursing from Belmont University in Nashville, Tennessee. She is and has been actively involved in the specialty of forensic nursing, first in the area of sexual assault and then as a death investigator.

She is a member of the National Association of Medical Examiners, a Fellow with the American Academy of Forensic Science, a member of the South Carolina Coroner's Association, and a member of the Organization of Scientific Area Committees for Forensic Science Medicolegal Death Investigation subcommittee among others.  

A former Director-at-Large for the International Association of Forensic Nurses, O'Neal is the author of the book "Investigating Infant Deaths" and has had the unfortunate distinction of working the mass fatalities of the Charleston Super Store fire and the Emanuel AME church mass shooting.

Resources: 
The International Association of Coroners and Medical Examiners (IACME), www.theiacme.org

American Board of Medicolegal Death Investigators (ABMDI), www.abmdi.org 

Death Investigation: A Guide to Scene Investigators  https://www.ojp.gov/pdffiles/167568.pdf

Sudden Unexpected Infant Death Investigation Reporting Form
https://www.cdc.gov/sids/SUIDRF.htm

Episode 27: The Role of a Nurse Coroner

In this Bell Work Talks, Dr. Tabor discusses stalking and correlation with intimate partner violence and stalker's behaviors.  There will also be discussion about The Stalking and Harassment and Risk Profile Tool.

Dr. Tabor holds a DNP in forensic practice, is a Board-Certified Advance Forensic Nurse and holds an RN license.  She served two terms on the Board of Directors for the International Association of Forensic Nurses and earned the Distinguished Fellow recognition. Dr Tabor lectures at the state, national and international level; and serves the Department of Defense in military trials.  She served as the inaugural director for two programs: Arkansas Infant & Child Death Review Program and the first hospital-based sexual assault unit in Arkansas.  She has testified before the legislature on numerous occasions and has consulted at the Pentagon.

Resources:

Stalking and Harassment Assessment and Risk Profile (SHARP)
https://ukcdar.uky.edu/ls/index.php/57925/ 

Stalking and Harassment Assessment and Risk Profile
Available at www.stalkingrisk.com 

Coercive Control
SHARP can be found at this site plus articles and data
www.coercivecontrol.org 

Stalking Laws by State available at:
     http://victimsofcrime.org/our-programs/stalking-
     resource-center/stalking-laws/criminal-stalking-laws-by-
     state  

Stalking Resource Center (2018) available at
https://www.google.com/search?q=stalking+resource+center&oq=stalking+resource+&aqs=edge.0.0j69i57j0j0i22i30l4.8369j0j7&sourceid=chrome&ie=UTF-8

Episode 28: Stalking: Lethal Hide and Seek

In this Bell Works Talks, Dr. Tanner will identify and explain the four major approaches adult sex offenders use to groom and manipulate child victims. Regardless of your profession, anyone who works with victims or perpetrators will come away with a deeper understanding of critical elements of the grooming process and how it relates to their occupation.

Dr. Tanner has been a justice system professional since 1970. He earned his Ph.D. in Sociology from the University of Illinois with specialties in Cognitive Social Psychology, Sociology of Law, and Evaluation Research.  His applied experience includes operating secure detention facilities, halfway houses for juveniles and adults, day reporting centers, probation/parole services, intensive treatment programs, and computer forensics.   His primary interests are the adaptation of cognitive sciences in treatment of offender populations, secondary trauma, cyber crime analysis, and improving the efficacy of sex offender management. He is an internationally recognized authority on sex offender management and sex offenders in a digital world.  He is court qualified as an Expert Witness in the areas of Cognitive Sets and Grooming Strategies of Sex Offenders, Corrections, and Computer Forensics. He additionally serves as an invited member of the Europol Panel of Experts on Child Exploitation and was the recipient of the American Probation and Parole Association’s University of Cincinnati Award in Corrections in 2017 for his life-time contributions to corrections in the US and Canada.

Dr. Tanner has presented hundreds of seminars and workshops for the U.S. Department of Justice, U.S. Department of Defense, U.S. Secret Service, U.S. Department of Homeland Security, American Probation and Parole Association, Center for Sex Offender Management, National Law Enforcement and Corrections Technology Center, High Technology Crime Investigation Association (HTCIA), Internet Crimes Against Children Task Force (ICAC), Crimes Against Children Conference, Conference on Crimes Against Women, Probation/Parole Departments in 32 states, Irish Penal Reform Trust, Northern Ireland Police Service, U.K.’s National Policing Improvement Agency, Correctional Services of Victoria Australia, Correctional Services of Australian Capital Territory, Mental Health Organizations in 13 states, Child Advocacy Centers in 12 states, Child Welfare agencies in 15 states, and a wide variety of private organizations.

Resources:

Exploring Sex Offender Grooming by Jim Tanner, Ph.D. and Stephen Brake, Ph.D.   http://www.kbsolutions.com/Grooming.pdf  

Colorado Special Conditions Report, Jim Tanner, Ph.D. 
http://www.kbsolutions.com/SAC.pdf 

Additional materials found on Dr. Tanner’s website, available at: 
http://www.kbsolutions.com/html/resources.html

Episode 29: Sex Offender Grooming of Child Victims

In this Bell Work Talks Debra Holbrook discusses the practice of forced organ harvesting. She will discuss how breaking down silos and working with various stakeholders to advocate for victims. Awareness of what healthcare should be alert for in identifying potential victims is discussed. As a form of human trafficking Doctors Against Forced Organ Harvesting aims to provide the medical community and society with objective findings of unethical and illegal organ harvesting. Forced organ harvesting, the removal of organs from a donor, without obtaining prior free and voluntary consent, is considered a crime against humanity, as well as a threat to medical science in general.

Mrs. Holbrook attended The Union Memorial Hospital School of Nursing, in Baltimore, Maryland and completed both undergrad and graduate studies through the Wilmington University.  After working in the field of critical care, Mrs. Holbrook founded a Forensic Nurse Examiner Program in Delaware that became a model of the United States (US Senate Subcommittee / Biden, 2002).

In 2002 she testified on Capital Hill before a Senate Judicial Subcommittee on Crime and Drugs on behalf of the Bill that was signed into law in 2005 as the DNA Justice Act. She is the recipient of numerous international awards, including the ANCC Magnet International Nurse of the Year, the Delaware Nurse of the year, the International Association of Forensic Nurses Pioneer Award, the 2014 Most Influential Marylanders in Healthcare, Distinguished Fellow – Academy of Forensic Nursing, and the prestigious Fellow American Academy of Nursing.  She has authored grants totaling over 15 million dollars to benefit victims of major person’s crimes and lectures nationally for the Office for Victims of Crime, educating medical professionals across the country. She has conducted over 200 pediatric and adult SANE educational offerings both nationally and internationally. She recently presented at the World Summit on combating and preventing forced organ harvesting.

Resources:

https://dafoh.org/

Episode 30: Forced Organ Harvesting

In this Bell Works Talks, Dr. Nicole Short discusses findings from a large, multisite, prospective observational cohort study on the prevalence of acute and persistent pain post-sexual assault, and how posttraumatic stress symptoms may account for the transition from acute to chronic pain. She will focus on the clinical implication of these findings for healthcare providers working with sexual assault survivors.

Nicole A. Short, PhD is an Assistant Professor of Anesthesiology at the University of North Carolina at Chapel Hill. She earned her PhD in clinical psychology from Florida State University in 2019 after completing her clinical internship at the Charleston Consortium. Dr. Short’s research focuses on the etiology and prevention of trauma and anxiety-related disorders utilizing a translational approach. She is interested in identifying and characterizing cognitive-affective and other risk factors (e.g., anxiety sensitivity, sleep disturbance) for the development of posttraumatic stress and related symptoms (e.g., substance use disorder); better understanding how these risk factors relate to underlying biological processes; and utilizing this knowledge to develop novel preventions and treatments for these disorders, particularly by leveraging technology-based interventions. She is especially interested in improving mental health and substance use outcomes post-sexual assault. She has published over 70 peer-reviewed articles in these areas, and has received funding from the National Institute on Drug Abuse (NIDA), American Psychological Foundation, and MayDay Fund to support her work. Clinically, Dr. Short is a licensed psychologist focused on cognitive behavioral treatments for posttraumatic stress, anxiety, and sleep disturbance, as well as comorbid chronic pain.

Resources:

Short, N. A., Tungate, A. S., Bollen, K. A., Sullivan, J., D'Anza, T., Lechner, M., ... & McLean, S. A. (2022). Pain is common after sexual assault and posttraumatic arousal/reactivity symptoms mediate the development of new or worsening persistent pain. Pain, 163(1), e121-e128.

McLean, S. A., Soward, A. C., Ballina, L. E., Rossi, C., Rotolo, S., Wheeler, R., ... & Liberzon, I. (2012). Acute severe pain is a common consequence of sexual assault. The Journal of Pain, 13(8), 736-741.

Ulirsch, J. C., Ballina, L. E., Soward, A. C., Rossi, C., Hauda, W., Holbrook, D., ... & McLean, S. A. (2014). Pain and somatic symptoms are sequelae of sexual assault: results of a prospective longitudinal study. European journal of pain, 18(4), 559-566.

Better Tomorrow Network: https://www.med.unc.edu/itr/better-tomorrow-network/

Episode 31: Acute & persistent pain after sexual assault: Outcome possibly driven by PTSD

In this Bell Work Talk, Dr. Clements discusses the traumatic responses – both obvious and subtle – that repeated exposure to current national events (shootings at schools, hospitals, churches, places of employment) can have on the daily lives of those exposed directly or through ongoing media coverage. He discusses the importance of a significant shift toward providing self-care and care for others (especially children) to minimize traumatic affective impact and to maintain healthy daily living.

Dr. Paul Thomas Clements is a forensic psychiatric clinical specialist, a Certified Gang Specialist, and Certified in Danger Assessment. Clements has provided hospital consultation for EMT’s, Child Protective Agency personnel, trauma/emergency nurses, psychiatric providers, hospital systems, and corporate executives - each regarding vulnerability risk assessment, bullying, and decreasing the number of violent incidents in the workplace. Clements has three textbooks: Violence against women: Contemporary examination of intimate partner violence, Mental health issues in child maltreatment, and Nursing approach to the evaluation of child maltreatment. Additionally, he currently has a forthcoming book:  Gender violence across the spectrum: A trauma-informed approach. 

Dr. Clements has numerous peer review publications and conference presentations regarding stress, trauma, violence and aggression, coping after violent death, safety promotion, and exposure to interpersonal violence and crime. Clements has also spent time in Bolivia, working with provincial judges, prosecutors and forensic psychologists regarding enhanced assessment and intervention with children victimized by sexual aggression and other forms of violence.

Clements holds a Doctor of Philosophy in Forensic Psychiatric Nursing from The University of Pennsylvania with research and clinical practice that have examined the traumatic presentations and behaviors of children exposed to the homicide of a family member or other forms of violent crime and death. Clements was inducted as a Distinguished Fellow in the International Association of Forensic Nurses in 2002, and more recently, as a Distinguished Fellow in the Academy of Forensic Nurses in 2021.

Resources:

Disaster distress helpline  1-822-985-5990

https://www.samhsa.gov/find-help/disaster-distress-helpline

Episode 32: Care During Chaos: Navigating Self-Care during Era of Repeated National Traumatic Events

In this Bell Works Talks, the producers of the Sexual Assault Medical Forensic Examination Virtual Practicum, Grace Frances and Jacque Basset, and forensic nursing expert Tamara Jackson discuss how the new online program improves care for diverse patient populations, including transgender and incarcerated sexual assault survivors. The Practicum’s Interactive lessons and patient simulations teach each step of the medical forensic exam. Presenters also describe other popular features of the Practicum like the Crime Lab and the Courtroom that teach DNA analysis and prepare medical professionals to testify in court. They provide information for how to download the free program that offers up to 19.5 hours of continuing nursing education.

Jacque Bassett, MNLM is the Chief Operations Officer for End Violence Against Women International (EVAWI). In that role, she supervises staff and volunteers, and maintains organizational policies and procedures. She oversees all live training events, including the annual conference, regional trainings, and online webinars. She focuses on developing corporate partnerships to expand EVAWI’s work to improve criminal justice and community responses to sexual assault survivors. Jacque also serves as grant manager for cooperative agreements awarded by the Office for Victims of Crime and the Office on Violence Against Women at the US Department of Justice. Since 2020, she has co-managed the Sexual Assault Medical Forensic Examination (SAMFE) Virtual Practicum project to update and expand the program first launched in 2008.

Grace Frances, MPA is the Director of Community Partnerships for End Violence Against Women International and leads the collaborative partnership that created the new Sexual Assault Medical Forensic Exam Virtual Practicum. She also focuses on fund development to expand EVAWI’s ability to improve criminal justice and community responses to sexual assault survivors. She worked for the Florida Council Against Sexual Violence (FCASV) for 16 years, where she initiated and ran the state’s first trauma-informed sexual assault investigations program for law enforcement, dispatchers, and prosecutors, which trained thousands of professionals. She also helped establish and oversaw the Council’s Sexual Assault Nurse Examiner Training Program.

Tamara Jackson, MSN, RN, SANE-A, SANE-P, SANE is a forensic nurse examiner and the Clinical Programs Coordinator for Ascension Illinois. She oversees 10 sites that offer medical forensic services to survivors of sexual assault/abuse, child abuse, domestic violence, elderly abuse, strangulation, and human trafficking. Ms. Jackson graduated with her Bachelor’s degree in Nursing in 2012 and began working as an emergency department nurse in 2005. In 2018, Ms. Jackson earned her Master’s degree in Nursing. Ms. Jackson is a Board Member of the Academy of Forensic Nursing. She has been a long-standing member of the International Association for Forensic Nursing and is a current member for the Illinois chapter and has worked as a forensic nurse for over fifteen years. 
Ms. Jackson is the co-chair for the Ascension Health Peer Review Committee. In 2018, she introduced the organization’s Non-Fatal Strangulation policy and procedure. She is a contributor for the workbook Resilience 2018 Training Supplement for Medical Professionals. She was recognized by Ascension Health (formerly Amita Health) as a person to know in 2018, and she was a finalist in the 2010 Nursing Spectrum Excellence Award for clinical care.

Resources:

SAMFE Virtual Practicum https://evawintl.org/vp/

Episode 33: Improving Patient Care with the SAMFE Virtual Practicum

In this podcast, Drs. Holt and Clements examine the related factors toward this increase risk for IPV occur during pregnancy, including the increased stress and potential for loss of control after the birth.  Additionally, they explore what can we do as nurses and other direct providers to enhance assessment and promote safety.  Ultimately, the most critically important first step is to screen for violence during interface with any pregnant person.  44% of all women in the United States report experiencing unwanted sexual contact. However, in spite of this significantly high rate, currently, only 16% of nurses report regularly screening for violence. 

The CDC’s national and annual examinations of pregnancy and homicide have been lauded by public health experts for recognizing this pervasively overlooked phenomenon. Dovetailing with the Healthy People 2030 objective/target regarding the reduction of physical abuse of assaults by a current or former intimate partner for people aged 12 years or older (U.S. Department of Health and Human Services [USDHHS], 2020,  it is imperative for nurses and other care providers to expand their awareness of this often overlooked group in significant need for targeted and consistent assessment and referral.

Dr. Karyn Holt is a Professor in Residence at the University of Nevada, Las Vegas in the School of Nursing. She is an Advanced Practice Nurse in the field of nurse midwifery (CNM) earning her Masters in Nursing with a specialization in Nurse Midwifery at Georgetown University and her Doctor of Philosophy degree from Touro University, New York.

Holt spent the first part of her nurse midwifery career delivering over 1000 newborns while in the Air Force. While serving in the Air Force, she began teaching in the maternal child arena within higher education and developed a passion for playing a part in assisting in students’ educational endeavors as well as her obstetric midwifery practice. She shares many stories about these times.

Dr. Paul Thomas Clements is a forensic psychiatric clinical specialist, and Certified in Danger Assessment. Clements has provided hospital consultation for EMT’s, Child Protective Agency personnel, trauma/emergency nurses, psychiatric providers, hospital systems, and corporate executives - each regarding vulnerability risk assessment, bullying, and decreasing the number of violent incidents
in the workplace.

Clements has three edited textbooks, including: Violence against women: Contemporary examination of intimate partner violence (co-authored with Dr. Holt) and he has numerous peer review publications and conference presentations. Clements has also spent time in Bolivia, working with provincial judges, prosecutors and forensic psychologists regarding enhanced assessment and intervention with children victimized by sexual aggression and other forms of violence.

Resources:

RAINN (Rape, Abuse, and Incest National Network)   the nation's largest anti-sexual violence organization, helps survivors recover through the National Sexual Assault Hotline   (1-800-656-HOPE or 4673) and the Department of Defense (DoD) Safe Helpline (877-995-5247).

Episode 34: Assessment of Interpersonal Violence (IPV) and Pregnancy-Related Homicide Risk

In this Bell Work Talks, Dr. Farst will discuss common challenges faced in courtroom settings by medical providers when presenting the facts that the majority of children who have been sexually abused will not have residual visible physical injuries on examination. This could include being summoned to pre-trial hearings, formulating strategies to explain the issue to judges/jurors and use of published articles to mis-represent the established standard of care that the absence of physical findings does not discount the possibility of prior sexual abuse.

Dr. Farst has worked as a child abuse pediatrician with the Team for Children at Risk at Arkansas Children’s Hospital since 2004. She completed undergraduate and medical school training at Texas Tech University. Following residency training in internal medicine and pediatrics, she was in primary care private practice for 3 years. During this time, she served as a volunteer medical provider for a community-based CAC and decided to pursue child abuse pediatrics as a career. After completing a fellowship in child abuse pediatrics at Cincinnati Children’s Hospital she returned to practice at AR Children’s Hospital and now serves as the medical director for the Team for Children at Risk and is a professor of pediatrics with the Department of Pediatrics of the University of Arkansas for Medical Sciences. 

Dr. Farst has provided numerous local and national presentations regarding the medical evaluation and management of child abuse and neglect and directs the Support for Health Involved Professionals at Safety Centers for the CAC’s of Arkansas.

Resources:

* Adams J, et al. Interpretation of Medical Findings in Suspected Child Sexual Abuse: An Update for 2018. J Pediatr Adolesc Gynecol 2018. Jun;31(3):225-231 https://pubmed.ncbi.nlm.nih.gov/29294380/  (open access)

* Hornor G. A normal ano-genital exam: Sexual abuse or not? J Pediatr Health Care 2010;24(3).

* Smith T. Anogenital Findings in 3569 Pediatric Examinations for Sexual Abuse/Assault. J Pediatr Adolesc Gynecol 2018;31:79e83

* Kotze. Child sexual abuse: The significance of the history and testifying on non-confirmatory findings. PHCFM, 2019 https://phcfm.org/index.php/phcfm/article/view/1954/3152  (open access)

* Frasier and Makoroff. Medical evidence and expert testimony in child sexual abuse. Juv and Family Court Journal 2006;57(1)

Episode 25: The Impact of Adverse Childhood Experiences and Forgiveness on Nurses

Academy of Forensic Nursing - Bell Work Talks

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