Author Affiliations:Department of Psychology.
Center for Statistical Training & Consulting, Michigan State University.
J Forensic Nurs. 2021;17(1):3-13. doi: 10.1097/JFN.0000000000000315.
The International Association of Forensic Nurses (2018) affirms the importance of evidence-based, trauma-informed, patient-centered forensic nursing services that engage patients as autonomous decision makers. Past research indicates that forensic nurses consistently respect patients' choices and control as they navigate the decisions of medical forensic examinations (MFEs) and sexual assault kit (SAK) collection. Building on that work, this study examined which options patients decline and what factors are associated with those declination decisions.
We collected prospective data from seven state-funded sexual assault nurse examiner programs. Forensic nurses recorded information about all adult sexual assault patients (N = 783) regarding four primary decisions: whether to have a MFE, whether to consent to all parts of the MFE or to decline specific services, whether to have a SAK collected, and whether to release the SAK to law enforcement for forensic DNA testing.
Most patients consented to a MFE (95%), to all parts of the MFE (81%), to SAK collection (99%), and to release the SAK for forensic DNA testing (80%). Younger patients and those with disabilities were more likely to decline some options. Patients who had not disclosed the assault to others before seeking sexual assault nurse examiner care were also more likely to decline a MFE. Whether patients sought post assault care for more health-focused reasons or legally focused reasons was associated with declination decisions.
Healthcare providers should communicate clearly about each step in post assault care and allow patients to decline services as they choose.
国际法医护士协会（2018 年）肯定了基于证据、创伤知情、以患者为中心的法医护理服务的重要性，这些服务使患者成为自主决策者。过去的研究表明，法医护士在患者进行医疗法医检查（MFE）和性侵犯套件（SAK）采集的决策时，始终尊重患者的选择和控制。在此基础上，本研究探讨了患者拒绝哪些选择，以及哪些因素与这些拒绝决策有关。
我们从七个由州资助的性侵犯护士检查计划中收集了前瞻性数据。法医护士记录了所有成年性侵犯患者（N=783）的信息，包括四个主要决策：是否进行 MFE，是否同意 MFE 的所有部分或拒绝特定服务，是否进行 SAK 采集，以及是否将 SAK 释放给执法部门进行法医 DNA 测试。
大多数患者同意进行 MFE（95%）、同意 MFE 的所有部分（81%）、同意 SAK 采集（99%）和同意将 SAK 释放用于法医 DNA 测试（80%）。年轻患者和残疾患者更有可能拒绝某些选择。在寻求性侵犯护士检查护理之前未向他人透露袭击事件的患者也更有可能拒绝 MFE。患者寻求性侵犯后护理是出于更注重健康的原因还是更注重法律的原因与拒绝决策有关。
医疗保健提供者应清楚地沟通性侵犯后护理的每一步，并允许患者根据自己的选择拒绝服务。
