Lockdowns Causing Lock-Ins: Impact of the COVID Pandemic on Trends Observed by Forensic Nurse Examiners
DOI:
https://doi.org/10.29173/jafn924Keywords:
Forensic Nurse, COVID-19, Sexual violence, intimate partner violenceAbstract
This study consists of a secondary, longitudinal analysis of chart data pulled from a forensic nursing program at a large Level I Hospital in Colorado between 2018–2023 to explore trends in forensic assessments conducted during pandemic lockdown periods. Descriptive analyses and logistic regression were used to examine the number and severity of consultations performed by the forensic nursing team across COVID-19 pandemic timepoints. A total of 9,944 patients received a consult from the forensic nursing program between 2018–2023, with 2,144 seen during a COVID-19 lockdown period. The odds of forensic nurses conducting exams for traumatic brain injury, sexual assault, and intimate partner violence were significantly higher during various COVID lockdowns or timepoints. No changes in the odds of patients reporting strangulation were observed during COVID-19 lockdowns. While the odds of patients being examined for risk of intimate partner violence (IPV) increased during the second lockdown and reopening periods, the severity of reported IPV did not vary compared to other timepoints. Older adult patients were less likely to be seen during COVID-19, with significant declines in patients screened for elder abuse. This analysis provides valuable insight into the changes in patient volumes, types of assault, and severity of these patient experiences before and after the pandemic and over time. Observed trends emphasize the importance of coordinated responses and screenings in the emergency department setting as well as the value of the in-depth care that forensic nurses provide before, during, and after a time of global crisis.
References
Abdo, C., Miranda, E. P., Santos, C. S., de Bessa Júnior, J., & Bernardo, W. M. (2020). Domestic violence and substance abuse during COVID19: A systematic review. Indian Journal of Psychiatry, 62(Suppl 3), S337–S342. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_1049_20
Agüero, J. M. (2021). COVID-19 and the rise of intimate partner violence. World Development, 137, Article 105217. https://doi.org/10.1016/j.worlddev.2020.105217
Alimoradi, Z., Broström, A., Tsang, H. W., Griffiths, M. D., Haghayegh, S., Ohayon, M. M., Lin, C.-Y., & Pakpour, A. H. (2021). Sleep problems during COVID-19 pandemic and its' association to psychological distress: A systematic review and meta-analysis. EClinicalMedicine, 36, Article 100916. https://doi.org/10.1016/j.eclinm.2021.100916
American Hospital Association. (2024). Fast facts on US hospitals. https://www.aha.org/statistics/fast-facts-us-hospitals
Ashworth, H., Lewis-O'Connor, A., Grossman, S., Brown, T., Elisseou, S., & Stoklosa, H. (2023). Trauma-informed care (TIC) best practices for improving patient care in the emergency department. International Journal of Emergency Medicine, 16(1), Article 38. https://doi.org/10.1186/s12245-023-00509-w
Berishaj, K., Boyland, C. M., Reinink, K., & Lynch, V. (2020). Forensic nurse hospitalist: The comprehensive role of the forensic nurse in a hospital setting. Journal of Emergency Nursing, 46(3), 286–293. https://doi.org/10.1016/j.jen.2020.03.002
Bonsaksen, T., Ruffolo, M., Leung, J., Price, D., Thygesen, H., Schoultz, M., & Geirdal, A. Ø. (2021). Loneliness and its association with social media use during the COVID-19 outbreak. Social Media + Society, 7(3), Article 20563051211033821. https://doi.org/10.1177/20563051211033821
Bracewell, K., Hargreaves, P., & Stanley, N. (2020). The consequences of the COVID-19 lockdown on stalking victimisation. Journal of Family Violence, 37, 95–101. https://doi.org/10.1007/s10896-020-00201-0
Campbell, J. C. (1986). Nursing assessment for risk of homicide with battered women. Advances in Nursing Science, 8(4), 36–51. https://doi.org/10.1097/00012272-198607000-00006
Campbell, J. C., Webster, D. W., & Glass, N. (2009). The danger assessment: Validation of a lethality risk assessment instrument for intimate partner femicide. Journal of Interpersonal Violence, 24(4), 653–674. https://doi.org/10.1177/0886260508317180
Centers for Disease Control and Prevention. (2022). CDC Museum COVID-19 timeline. https://www.cdc.gov/museum/timeline/covid19.html
Chang, E. S., & Levy, B. R. (2021). High prevalence of elder abuse during the COVID-19 pandemic: Risk and resilience factors. The American Journal of Geriatric Psychiatry, 29(11), 1152–1159. https://doi.org/10.1016/j.jagp.2021.01.007
Chiaramonte, D., Simmons, C., Hamdan, N., Ayeni, O. O., López‐Zerón, G., Farero, A., Perilla, J. L., Nichols, A. J., & Sullivan, C. M. (2022). The impact of COVID‐19 on the safety, housing stability, and mental health of unstably housed domestic violence survivors. Journal of Community Psychology, 50(6), 2659–2681. https://doi.org/10.1002/jcop.22765
City of San Antonio Office of Emergency Management. (2020). Social distancing doesn't mean safety distancing. Department of Government and Public Affairs. https://www.sanantonio.gov/gpa/News/ArtMID/24373/ArticleID/18724/Social-distancing-doesn
Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K., Czeisler, C. A., Howard, M. E., & Rajaratnam, S. M. W. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. Morbidity and Mortality Weekly Report, 69(32), 1049–1057. https://doi.org/10.15585/mmwr.mm6932a1
de Souza Santos, D., Bittencourt, E. A., de Moraes Malinverni, A. C., Kisberi, J. B., de França Vilaça, S., & Iwamura, E. S. M. (2022). Domestic violence against women during the Covid-19 pandemic: A scoping review. Forensic Science International: Reports, 5, Article 100276. https://doi.org/10.1016/j.fsir.2022.100276
Executive Order No. D 2020 017. (2020). https://www.colorado.gov/governor/2020-executive-orders
Executive Order No. D 2020 044. (2020). https://www.colorado.gov/governor/2020-executive-orders
Executive Order No. D 2021 122. (2021). https://www.colorado.gov/governor/2020-executive-orders
Farina, M. P., & Ailshire, J. A. (2022). Sociodemographic and health status differences in delaying medical care during the COVID-19 pandemic among older adults: Findings from the Health and Retirement Study. BMC Public Health, 22(1), Article 1720. https://doi.org/10.1186/s12889-022-14118-4
Gioia, G., & Collins, M. (2006). Acute concussion evaluation (ACE). Trauma, 4(8). https://pedsconcussion.com/wp-content/uploads/2021/09/Acute-Concussion-Evalutation-ACE.pdf
Godara, M., Everaert, J., Sanchez-Lopez, A., Joormann, J., & De Raedt, R. (2023). Interplay between uncertainty intolerance, emotion regulation, cognitive flexibility, and psychopathology during the COVID-19 pandemic: A multi-wave study. Scientific Reports, 13(1), Article 9854. https://doi.org/10.1038/s41598-023-36211-3
Graham, L. M., Messing, J. T., & Campbell, J. (2022). The Danger Assessment: An instrument for the prevention of intimate partner homicide. In R. Geffner, J. W. White, L. K. Hamberger, A. Rosenbaum, V. Vaughan-Eden, & V. I. Vieth (Eds.), Handbook of interpersonal violence and abuse across the lifespan: A project of the National Partnership to End Interpersonal Violence Across the Lifespan (NPEIV) (pp. 2761–2781). Springer Nature Switzerland AG. https://doi.org/10.1007/978-3-319-89999-2_145
Grodal, S., Anteby, M., & Holm, A. L. (2021). Achieving rigor in qualitative analysis: The role of active categorization in theory building. Academy of Management Review, 46(3), 591–612. https://doi.org/10.5465/amr.2018.0482
Grossman, S., Cooper, Z., Buxton, H., Hendrickson, S., Lewis-O'Connor, A., Stevens, J., Wong, L. Y., & Bonne, S. (2021). Trauma-informed care: Recognizing and resisting re-traumatization in health care. Trauma Surgery & Acute Care Open, 6(1), Article e000815. https://doi.org/10.1136/tsaco-2021-000815
Hamadani, J. D., Hasan, M. I., Baldi, A. J., Hossain, S. J., Shiraji, S., Bhuiyan, M. S. A., Mehrin, S. F., Fisher, J., Tofail, F., Tipu, S. M. M. U., Grantham-McGregor, S., Biggs, B. A., Braat, S., & Pasricha, S. R. (2020). Immediate impact of stay-at-home orders to control COVID-19 transmission on socioeconomic conditions, food insecurity, mental health, and intimate partner violence in Bangladeshi women and their families: An interrupted time series. The Lancet Global Health, 8(11), e1380–e1389. https://doi.org/10.1016/S2214-109X(20)30366-1
Hartnett, K. P., Kite-Powell, A., DeVies, J., Coletta, M. A., Boehmer, T. K., Adjemian, J., Gundlapalli, A. V., & National Syndromic Surveillance Program Community of Practice. (2020). Impact of the COVID-19 pandemic on emergency department visits—United States, January 1, 2019–May 30, 2020. Morbidity and Mortality Weekly Report, 69(23), 699–704. https://doi.org/10.15585/mmwr.mm6923e1
Hassan, K., Prescher, H., Wang, F., Chang, D. W., & Reid, R. R. (2020). Evaluating the effects of COVID-19 on plastic surgery emergencies: Protocols and analysis from a level I trauma center. Annals of Plastic Surgery, 85(Suppl 2), S146–S150. https://doi.org/10.1097/sap.0000000000002459
Holland, K. M., Jones, C., Vivolo-Kantor, A. M., Idaikkadar, N., Zwald, M., Hoots, B., Yard, E., D'Inverno, A., Swedo, E., Chen, M. S., Petrosky, E., Board, A., Martinez, P., Stone, D. M., Law, R., Coletta, M. A., Adjemian, J., Thomas, C., Puddy, R. W., Peacock, G., Dowling, N. F., & Houry, D. (2021). Trends in US emergency department visits for mental health, overdose, and violence outcomes before and during the COVID-19 pandemic. JAMA Psychiatry, 78(4), 372–379. https://doi.org/10.1001/jamapsychiatry.2020.4402
International Association of Forensic Nurses. (2023). Directory of forensic programs. https://myonline.forensicnurses.org/rolodex/searchOrganizationDirectory
Jahrami, H., BaHammam, A. S., Bragazzi, N. L., Saif, Z., Faris, M., & Vitiello, M. V. (2021). Sleep problems during the COVID-19 pandemic by population: A systematic review and meta-analysis. Journal of Clinical Sleep Medicine, 17(2), 299–313. https://doi.org/10.5664/jcsm.8930
Kafka, J., Jamison, E., & Bol, K. (2019). Mortality from intimate partner violence in Colorado, 2007-2017 (Colorado Violent Death Reporting System Report No. 110). Colorado Department of Public Health and Environment. https://cdphe.colorado.gov/center-for-health-and-environmental-data/registries-and-vital-statistics/colorado-violent-death-reporting-system
Kaukinen, C. (2020). When stay-at-home orders leave victims unsafe at home: Exploring the risk and consequences of intimate partner violence during the COVID-19 pandemic. American Journal of Criminal Justice, 45(4), 668–679. https://doi.org/10.1007/s12103-020-09533-5
Kourti, A., Stavridou, A., Panagouli, E., Psaltopoulou, T., Spiliopoulou, C., Tsolia, M., Sergentanis, T. N., & Tsitsika, A. (2023). Domestic violence during the COVID-19 pandemic: A systematic review. Trauma, Violence, & Abuse, 24(2), 719–745. https://doi.org/10.1177/15248380211038690
Laboratory to Combat Human Trafficking. (2019). The Colorado Project: Action plan. https://combathumantrafficking.org/programs/research/colorado-project-2019/
Leslie, E., & Wilson, R. (2020). Sheltering in place and domestic violence: Evidence from calls for service during COVID-19. Journal of Public Economics, 189, Article 104241. https://doi.org/10.1016/j.jpubeco.2020.104241
Lettiere-Viana, A., Baraldi, N. G., Carlos, D. M., Fumincelli, L., Costa, L. C. R., & Castro, P. C. D. (2021). Coping strategies for violence against children, adolescents and women in the context of social isolation due to covid-19: Scoping review. Texto & Contexto-Enfermagem, 30, Article e20200443. https://doi.org/10.1590/1980-265X-TCE-2020-0443
Makaroun, L. K., Beach, S., Rosen, T., & Rosland, A. M. (2021). Changes in elder abuse risk factors reported by caregivers of older adults during the COVID-19 pandemic. Journal of the American Geriatrics Society, 69(3), 602–606. https://doi.org/10.1111/jgs.17009
McIndoe, E. (2023). A cross-sectional study on the impact of the COVID-19 pandemic on sport-related concussion clinical presentation within adolescents and adults [Master's thesis, University of Arkansas]. ScholarWorks@UARK. https://scholarworks.uark.edu/etd/5112
Messing, J. T., Campbell, J., Dunne, K., & Dubus, S. (2020). Development and testing of the Danger Assessment for Law Enforcement (DA-LE). Social Work Research, 44(3), 143–156. https://doi.org/10.1093/swr/svaa005
Mohler, G., Bertozzi, A. L., Carter, J., Short, M. B., Sledge, D., Tita, G. E., Uchida, C. D., & Brantingham, P. J. (2020). Impact of social distancing during COVID-19 pandemic on crime in Los Angeles and Indianapolis. Journal of Criminal Justice, 68, Article 101692. https://doi.org/10.1016/j.jcrimjus.2020.101692
Moreira, D. N., & Da Costa, M. P. (2020). The impact of the Covid-19 pandemic in the precipitation of intimate partner violence. International Journal of Law and Psychiatry, 71, Article 101606. https://doi.org/10.1016/j.ijlp.2020.101606
Muldoon, K. A., Denize, K. M., Talarico, R., Fell, D. B., Sobiesiak, A., Heimerl, M., & Sampsel, K. (2021). COVID-19 pandemic and violence: Rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors. BMC Medicine, 19, Article 20. https://doi.org/10.1186/s12916-020-01897-z
National Commission on COVID-19 and Criminal Justice. (2021, February 23). Impact report: COVID-19 and domestic violence trends. https://covid19.counciloncj.org/2021/02/23/impact-reportcovid-19-and-domestic-violence-trends/
National Domestic Violence Hotline. (2019). A year of impact. https://www.thehotline.org/wp-content/uploads/media/2020/09/Impact-Report-2019.pdf
Navarroli, J. E. (2023). Forensic nursing in the emergency care setting [Joint position statement]. International Association of Forensic Nurses and Emergency Nurses Association. https://enau.ena.org/URL/ForensicNursingintheEmergencyCareSettingPositionStatement
New York City Police Department. (2020). Domestic violence reports. https://www1.nyc.gov/site/nypd/stats/reports-analysis/domestic-violence.page
Pallansch, J., Milam, C., Ham, K., Morgan, P., Manning, J., Salzman, J., Lewis, M., Anderson, C., & Ramos, M. (2022). Intimate partner violence, sexual assault, and child abuse resource utilization during COVID-19. Western Journal of Emergency Medicine, 23(4), 589–594. https://doi.org/10.5811/westjem.2022.4.55231
Papagiouvanni, I., Kotoulas, S. C., Vettas, C., Sourla, E., & Pataka, A. (2022). Sleep during the COVID-19 pandemic. Current Psychiatry Reports, 24(11), 635–643. https://doi.org/10.1007/s11920-022-01371-y
Payne, J., Morgan, A., & Piquero, A. R. (2020). Covid-19 and social distancing measures in queensland australia are associated with short-term decreases in recorded violent crime. Journal of Experimental Criminology, 18, 89–113. https://doi.org/10.1007/s11292-020-09441-y
Piquero, A. R., Jennings, W. G., Jemison, E., Kaukinen, C., & Knaul, F. M. (2021). Domestic violence during the COVID-19 pandemic: Evidence from a systematic review and meta-analysis. Journal of Criminal Justice, 74, Article 101806. https://doi.org/10.1016/j.jcrimjus.2021.101806
Rhodes, H. X., Petersen, K., Lunsford, L., & Biswas, S. (2020). COVID-19 resilience for survival: Occurrence of domestic violence during lockdown at a rural American College of Surgeons verified level one trauma center. Cureus, 12(8), Article e9931. https://doi.org/10.7759/cureus.10059
Sabri, B., Hartley, M., Saha, J., Murray, S., Glass, N., & Campbell, J. C. (2020). Effect of COVID-19 pandemic on women's health and safety: A study of immigrant survivors of intimate partner violence. Health Care for Women International, 41(11-12), 1294–1312. https://doi.org/10.1080/07399332.2020.1833012
Sediri, S., Zgueb, Y., Ouanes, S., Ouali, U., Bourgou, S., Jomli, R., & Nacef, F. (2020). Women's mental health: Acute impact of COVID-19 pandemic on domestic violence. Archives of Women's Mental Health, 23(6), 749–756. https://doi.org/10.1007/s00737-020-01082-4
Staunton, P., Gibbons, J. P., Keogh, P., Curtin, P., Cashman, J. P., & O'Byrne, J. M. (2021). Regional trauma patterns during the COVID-19 pandemic. The Surgeon, 19(2), e49–e52. https://doi.org/10.1016/j.surge.2020.08.003
Valentine, J. L., Sekula, L. K., & Lynch, V. (2020). Evolution of forensic nursing theory—Introduction of the constructed theory of forensic nursing care: A middle-range theory. Journal of Forensic Nursing, 16(4), 188–198. https://doi.org/10.1097/JFN.0000000000000287
Wei, Q. (2021). Analyzing the increase in elder abuse during the COVID-19 pandemic. Journal of Sociology, 9(2), 41–45. https://doi.org/10.17265/2159-5526/2021.02.001
Weissberger, G. H., Lim, A. C., Mosqueda, L., Schoen, J., Axelrod, J., Nguyen, A. L., Fenton, B. T., & Han, S. D. (2022). Elder abuse in the COVID-19 era based on calls to the National Center on Elder Abuse resource line. BMC Geriatrics, 22(1), Article 689. https://doi.org/10.1186/s12877-022-03385-w
Weller, S. J., Tippetts, D., Weston, D., Aldridge, R. W., & Ashby, J. (2021). Increase in reported domestic abuse in integrated sexual health (ISH) services in London and Surrey during COVID-19 'lockdown': Successful application of national guidance on routine enquiry during rapid transition to remote telephone consultation (telemedicine). Sexually Transmitted Infections, 97(3), 245–246. https://doi.org/10.1136/sextrans-2020-054722
Xu, Y., Parkin, J. A., & Cunningham, N. (2024). The impact of COVID-19 on clinical forensic medicine and forensic psychiatry: A literature review. Medicine, Science and the Law, 64(3), 235–245. https://doi.org/10.1177/00258024241229830
Yaffe, M. J., Wolfson, C., Lithwick, M., & Weiss, D. (2008). Development and validation of a tool to improve physician identification of elder abuse: The Elder Abuse Suspicion Index (EASI)©. Journal of Elder Abuse & Neglect, 20(3), 276–300. https://doi.org/10.1080/08946560801973168
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