Sexual Assault Nurse Examiner Research Articles

Development of a brief bedside tool to screen women sexual assault survivors for risk of persistent posttraumatic stress six months after sexual assault

This study aims to develop and validate a brief bedside tool to screen women survivors presenting for emergency care following sexual assault for risk of persistent elevated posttraumatic stress symptoms (PTSS) six months after assault. Participants were 547 cisgender women sexual assault survivors who presented to one of 13 sexual assault nurse examiner (SANE) programs for medical care within 72 h of a sexual assault and completed surveys one week and six months after the assault. Data on 222 potential predictors from the SANE visit and the week one survey spanning seven broadly-defined risk factor domains were candidates for inclusion in the screening tool. Elevated PTSS six months after assault were defined as PCL-5 > 38. LASSO logistic regression was applied to 20 randomly selected bootstrapped samples to evaluate variable importance. Logistic regression models comprised of the top 10, 20, and 30 candidate predictors were tested in 10 cross-validation samples drawn from 80% of the sample. The resulting instrument was validated in the remaining 20% of the sample. AUC of the finalized eight-item prediction tool was 0.77 and the Brier Score was 0.19. A raw score of 41 on the screener corresponds to a 70% risk of elevated PTSS at 6 months. Similar performance was observed for elevated PTSS at one year. This brief, eight-item risk stratification tool consists of easy-to-collect information and, if validated, may be useful for clinical trial enrichment and/or patient screening.

User Experience of Access to Sexual Assault Nurse Examiner and Emergency Contraception in Emergency Departments in the United States: A National Survey.

Despite the prevalence of sexual assault presentations to emergency departments (ED) in the United States, current access to sexual assault nurse examiners (SANE) and emergency contraception (EC) in EDs is unknown. In this study we employed a "secret shopper," cross-sectional telephonic survey. A team attempted phone contact with a representative sample of EDs and asked respondents about the availability of SANEs and EC in their ED. Reported availability was correlated with variables including region, urban/rural status, hospital size, faith affiliation, academic affiliation, and existence of legislative requirements to offer EC. Over a two-month period in 2019, 1,046 calls to hospitals were attempted and 960 were completed (91.7% response rate). Of the 4,360 eligible hospitals listed in a federal database, 960 (22.0%) were contacted. Access to SANEs and EC were reported to be available in 48.9% (95% confidence interval [CI] 45.5-52.0) and 42.5% (95% CI 39.4-45.7) of hospitals, respectively. Access to EC was positively correlated with SANE availability. The EDs reporting SANE and EC availability were more likely to be large, rural, and affiliated with an academic institution. Those reporting access to EC were more likely to be in the Northeast and in states with legislative requirements to offer EC. Our results suggest that perceived access to sexual assault services and emergency contraception in EDs in the United States remains poor with regional and legislative disparities. Results suggest disparities in perceived access to EC and SANE in the ED, which have implications for improving ED practices regarding care of sexual assault victims.

Meeting Complex Needs of Sexually Assaulted Incarcerated Individuals: Impact of Expert Sexual Assault Nurse Examiner Care via Telehealth.

Sexual violence within prisons is a complex issue. The Prison Rape Elimination Act identifies standards to guide the provision of care to meet the medical and forensic needs of individuals who experience sexual assault (SA) while incarcerated. The standards include access to care by a Sexual Assault Nurse Examiner (SANE) whenever possible. Telehealth is one solution to ensure expert SANE access. This brief report addresses the pre-examination concerns/worries and immediate post-examination perceptions and experiences of six individuals who experienced SA while incarcerated. Findings show resolution of pre-examination worries, high satisfaction with care, high telehealth acceptability rates, and universal endorsement that examinations should occur outside of correctional facilities. Although not generalizable, this report provides preliminary insight into care in an understudied population with unique health care needs.

Quality Improvement: Increasing SANE Utilization of Evidence-Based Practice.

Background: Varying protocols among sexual assault nurse examiner (SANE) programs lead to inconsistent patient care and indicate that evidence-based recommendations are not being utilized. To address this problem, an evidence-based treatment protocol designed to improve care provided to patients who have experienced sexual assault was implemented at an outpatient rape crisis center (RCC). In addition to implementing the new protocol, a SANE education program was provided. Methods: Retrospective chart reviews were conducted. A total of 21 protocol components were examined pre- and post-implementation of the quality improvement project. Additionally, a knowledge quiz and self-efficacy tool were administered before, immediately after, and 3 months after the SANE education program. Results: Before implementation, the overall compliance with the 21 protocol components was 42.1% for RCC exams and 17.9% for hospital exams. After implementation, the overall compliance increased to 85.3% for RCC exams and 56% for hospital exams. When examining protocol components individually, compliance varied dramatically. There was an improvement in SANE knowledge and self-efficacy when comparing pre- and post-scores; however, the results were not statistically significant and were found to have unequal variances. Conclusion: Nurses are ideally positioned to instigate protocol changes that will positively impact patient outcomes. Other nursing professionals can utilize the quality improvement project content, steps, lessons learned, and results to create similar evidence-based practice quality improvement projects to address gaps in practice.

Sexual Assault Nurse Examiners Lead to Improved Uptake of Services: A Cross-Sectional Study.

Introduction: Sexual Assault Nurse Examiners (SANE), who are trained to provide comprehensive and compassionate specialty care to sexual assault survivors, are increasingly used in the emergency department (ED), but there is little published literature to support their benefit. In this study we aimed to compare services offered and received by sexual assault survivors in the ED when care was provided by a SANE vs those with traditional care teams, hypothesizing that SANE utilization will be associated with improved uptake of recommended services. Methods: This was a retrospective review examining all patient encounters in which a sexual assault was disclosed in a large, urban, adult ED between June 1, 2019-June 30, 2022. We extracted timeline information from the ED encounter, demographic information, resources offered to and accepted by the patient, clinical care data, and continuity of care data from the medical record. We used unadjusted and adjusted analyses to compare patient demographics and services offered and accepted between SANE and non-SANE encounters. Results: We included a total of 182 encounters in the analysis, of which 130 (71.4%) involved SANEs. Demographics were similar between groups, except there was a larger proportion of cisgender men in the non-SANE group (14.0% vs 5.5%), and the timing of visits differed, with non-SANE visits more common during the overnight shift. All recommended testing, prophylaxis, and resources were offered more frequently during SANE visits, and all but one were more frequently accepted by patients during SANE visits, although not all comparisons reached statistical significance. Conclusion: Patients who received care from a SANE were more often offered recommended services and resources and more frequently accepted them. Making SANE care available at all times to these vulnerable patients would both improve patient outcomes and allow hospitals to meet required quality metrics. States should consider expanding legislation to encourage and fund SANE coverage for all hospitals to support access to vital resources in the ED for survivors of sexual assault.

Physicians and nurses professional relationship with criminal investigation in dealing with survivors of sexual abuse: a scoping review

Survivors of sexual abuse and their families seek help from criminal law enforcement agencies and health professionals to obtain justice and health care. Many communities have implemented multi-professional collaborative models so that the victim’s well-being is assured and the truth is established. However, there is a general lack of evidence on how to best articulate these teams with the healthcare professionals caring for the survivors.Therefore, this Scoping Review was conducted in order to analyze and to map the barriers and facilitators of the relationship between health professionals and the criminal investigation team in the care of survivors of sexual abuse. The methodology proposed by the Joanna Briggs Institute for Scoping Reviews was used, and the Bronstein five dimension model of interprofessional collaboration served as the basis for the analysis of barriers and facilitators. Quantitative, qualitative and mixed studies, primary and secondary sources, text and opinion documents were included. Content analysis was performed on the main findings of the collected studies. Twelve articles were identified and analyzed. Collaboration, communication, hierarchy, skills, confidentiality, and leadership emerged as key themes. Multidisciplinary Sexual Assault Nurse Examiner (SANE) and Sexual Assault Response Teams (SARTs) were implemented to coordinate care, but conflicting goals and values among professionals posed challenges. Communication failures and inadequate information sharing hindered collaboration. Neutral leaders who coordinate teams, minimize groupthink, and improve decision-making were found to be valuable. Engaging across disciplinary boundaries and addressing power dynamics were challenging but could be addressed through facilitation and conflict resolution. This review highlights the importance of effective collaboration and interaction within teams and with other professionals in the care of sexual abuse survivors.

Sexual Assault Nurse Examiner (SANE) program: Long-term impact on confidence and attitudes on SANE trainees

Aim/ObjectiveThe current study examined the long-term impact of SANE programming on the confidence of SANE trainees and on their attitudes toward the SANE role after obtaining SANE certification. BackgroundNationally, sexual assault examiners (SANEs) are in short supply. However, the shortage of SANE nurses takes on a special meaning in the medically underserved United States– Mexico border region where human trafficking is seen as a threat in the region and sexual assaults may be less likely to be reported. In recent years, SANE training programs have established across the country to address the shortage of SANEs. Although positive outcomes have been reported among SANE training programs, the long-term outcomes of programming for trainees are not known. DesignA descriptive longitudinal study with repeated measures was conducted. MethodA total of N = 66 registered nurses who had more than 2 years of nursing work experience were recruited to participate in a SANE training program. The current study included only n = 27 participants who completed the questionnaire at 3 points (Time 1) baseline, (Time 2) 6 months after SANE certification, and at (Time 3) 12 months after SANE certification. General linear modeling and repeated measures analysis of variance were used to analyze the data. Type 1 error was set at p = 0.10. An original 43-item questionnaire was developed to measure the SANE trainees’ confidence and their attitudes toward the SANE role. ResultsInitially, an increased sense of self-confidence was found among trainees at least six months after completing SANE certification; however, this slowly diminished after one year. Likewise, attitudes toward the SANE role deteriorated six months after obtaining SANE certification. ConclusionLack of support and infrastructure to integrate SANE into the wider medico-legal community could explain the diminishing confidence and attitudes of SANE toward the role. The findings of this study have implications for the establishment of support infrastructures in the workplace and community to enhance the recruitment of nurses in SANE programs, the retention of SANEs in the workforce, the sustainability of SANE programs in underserved communities, and the establishment of protocols to integrate SANEs into sexual assault response teams (SARTs), especially in medically underserved US–Mexico border regions.

The Working Relationship Between Emergency Room Nurses and Medical Rape Victim Advocates: A Qualitative Examination of Nurses' Perceptions of the Influence of Nurse Training and Experience on Nurse-Advocate Interactions.

Nurses and medical advocates respond to sexual assault survivors seeking hospital services. Ideally, both providers work collaboratively. However, this does not always happen. Extant research on the nurse-advocate relationship focuses on Sexual Assault Nurse Examiners (SANEs). This study examines how ER nurses perceive their training and experience influence the working relationships between emergency room (ER) nurses (not exclusively SANEs) and medical advocates. Key findings indicate nurses perceive increased training improves (a) role understanding, (b) trust, (c) respect, (d) rapport, and (e) appreciation. Less training was associated with poorer role understanding and trust.

Emergency Department Preparedness to Care for Sexual Assault Survivors: A Nationwide Study.

Emergency departments (ED) provide trauma-informed care to sexual assault (SA) survivors and connect them with comprehensive services. Through surveying SA survivor advocates, we aimed to 1) document updated trends in the quality of care and resources offered to SA survivors and 2) identify potential disparities according to geographic regions in the US, urban vs rural clinic locations, and the availability of sexual assault nurse examiners (SANE). We conducted a cross-sectional study between June-August 2021, surveying SA advocates who were dispatched from rape crisis centers to support survivors during ED care. Survey questions addressed two major themes in quality of care: staff preparedness to provide trauma-response care; and available resources. Staff preparedness to provide trauma-informed care was assessed through observations of staff behaviors. We used Wilcoxon rank-sum and Kruskal-Wallis tests to analyze differences in responses according to geographic regions and SANE presence. A total of 315 advocates from 99 crisis centers completed the survey. The survey had a participation rate of 88.7% and a completion rate of 87.9%. Advocates who indicated that a higher proportion of their cases were attended by SANEs were more likely to report higher rates of trauma-informed staff behaviors. For example, the recalled rate of staff asking patients for consent at every step of the exam was significantly associated with SANE presence (P < 0.001). With respect to access to resources, 66.7% of advocates reported that hospitals often or always have evidence collection kits available; 30.6% reported that resources such as transportation and housing are often or always available, and 55.3% reported that SANEs are often or always part of the care team. The SANEs were reported to be more frequently available in the Southwest than in other US regions (P < 0.001) and in urban as opposed to rural areas (P < 0.001). Our study indicates that support from sexual assault nurse examiners is highly associated with trauma-informed staff behaviors and comprehensive resources. Urban-rural and regional disparities exist regarding access to SANEs, suggesting that elevating nationwide quality and equity in care of survivors of sexual assault requires increased investments in SANE training and coverage.

Sexual Assault Nurse Examiner Education Needs in Texas.

Background: As with many areas of the nation, Texas lacks a robust sexual assault nurse examiner (SANE) workforce. A program in Texas offers courses to educate and expand SANE skills to better provide trauma-informed care to vulnerable populations. Methods: A survey to stakeholders of a SANE educational program, as part of a planned program evaluation, elicited not only barriers to providing care but also specific program needs to better expand access to sexual assault and domestic violence medical forensic examinations in Texas. Results: In January 2022, a total of 40 stakeholders, all registered nurses in the state of Texas, provided vital information on their current program. Analysis of written survey responses provided themes regarding barriers to providing SANE care and suggestions for expanded education. Discussion: The survey provided valuable feedback and comments on the perceptions of the current SANE program. Written responses offered direction for additional learning desires of SANEs associated with the program as well as areas for the program to expand to meet the needs of the learners. This stakeholder guidance has implications beyond this one SANE education program to enhance and expand other programs based on learner needs.

Leveraging Telehealth to Address Sexual Assault Nurse Examiner Access Disparities in Rural Communities.

There are persistent gaps in access to sexual assault nurse examiners (SANEs) in rural and underserved areas, yielding health and legal disparities for survivors. These inequities prompted federal investment in novel telehealth programs to improve SANE access. The aim of this study was to examine program case studies from two sexual abuse/assault (SA) telehealth centers, illuminating successes, challenges, and lessons learned. Two state SA telehealth program directors used a collective instrumental case study approach to understand telehealth SANE (teleSANE) program challenges/lessons learned, outcomes, and recommendations for the field. Cross-program commonalities and differences were examined, pooling experiences to derive recommendations to sustain telehealth to increase SA health equity. Collectively, the two programs have served 18 remote sites and provided 335 consultations. Both programs provide access to 24/7 teleSANE consultation, quality assurance, and mentoring. Unique to each program were engagement of hospital leadership in advisory boards, use of telehealth technology, training programs, and fiscal sustainability. Both programs identified flexibility, offering a tailored implementation approach, regular site support and communication, and teleSANE mentoring aligned with the Quality Caring Model as essential to success. Critical needs identified to sustain programs included (a) multilevel community and hospital buy-in, (b) sustainable funding specific to local institution needs, and (c) robust processes to oversee clinical and technology support. Cross-program similarities and differences show the impact telehealth can have on equitable SA care. Program evaluation showed common challenges, lessons learned, and recommendations to advance equitable SA care access in underresourced communities.

Gender-Affirming Sexual Assault Nurse Examiner Care: A Program Evaluation and Quality Improvement Project at a Community-Based Rape Crisis Center.

Transgender and non-binary (trans*) individuals face disproportionately high rates of sexual violence yet experience discrimination at rape crisis centers (RCCs). Sexual assault nurse examiners (SANEs) who receive targeted education are better equipped to care for the trans* community. This quality improvement project aimed to increase SANEs' self-perceived competence in caring for trans* assault survivors. The secondary purpose was to promote a trans*-inclusive environment at an RCC based on an environmental assessment. The project involved creating and implementing a virtual continuing education course on providing gender-affirming and trans*-specific care for sexual assault survivors and an environmental evaluation at an RCC. A questionnaire measured SANEs' perceived competency pretraining and posttraining, and paired t tests were conducted to examine the change in competencies. A modified assessment tool was used to evaluate the RCC's capacity for addressing trans* survivors needs. The training increased self-perceived competency in all four components measured ( p < 0.005). More than one third of participants (36.4%, n = 22) indicated having no expertise, and 63.7% reported having some expertise in caring for trans* clients. Two thirds (66.7%) had prior trans*-specific training; however, only 18.2% received trans*-specific content in their SANE training. Most strongly agreed (68.2%) they would benefit from additional training. The organizational assessment identified key areas for improvement. Trans*-specific training can significantly impact SANEs' self-perceived competency in caring for trans* assault survivors and is feasible and acceptable. This training could have a global impact on SANEs if disseminated more widely, particularly with inclusion in SANE curriculum guidelines.

2216. ROAR ED-SANE: A Retrospective Observational Assessment Review of an Emergency Department Sexual Assault Nurse Examiner Program’s Adherence to CDC Guidelines for Sexually Transmitted Infections

Abstract Background Sexual assault survivors are at increased risk for sexually transmitted infections. Due to patient vulnerability, institutions have implemented Sexual Assault Nurse Examiner (SANE) protocols to care for these patients. These protocols guide evidence collection, testing, treatment, and medical follow-up to ensure optimization of sexually transmitted infections (STIs) treatment, monitoring and follow-up. Previous gap analyses have identified decreased prescribing of prophylactic STI medications and scheduling follow-up appointments compared to guideline recommendations. The purpose of this study was to assess adherence of medication prescribing and follow-up scheduling practices to Centers for Disease Control (CDC) guidelines. Methods This study was a single-center, retrospective, observational, descriptive assessment which evaluated adherence rates to CDC guidelines, to scheduling medical follow-up, and patient attendance at scheduled appointments. Pediatric and adult patients who presented to the emergency department at Mayo Clinic Health System in La Crosse, WI from January 2018 through December 2021 were included. Data collected through chart review included demographics and laboratory data necessary for prescribing prophylactic HIV medications, antibiotics for STIs, emergency contraception, and vaccine administration. Descriptive statistics were used to evaluate results. Results One hundred three patients were evaluated. Majority of patients were female and presented within 3 days of assault. Medication adherence to CDC guidelines was ≥ 80% for chlamydia and gonorrhea whereas &amp;lt; 80% was noted for trichomoniasis and HIV prophylaxis. Adherence to post-ED discharge follow-up was 40%. Conclusion Opportunities to improve adherence of ED-SANE protocols for medication prescribing and medical follow-up for trichomoniasis and HIV prophylaxis exist. Disclosures All Authors: No reported disclosures.

328 Emergency Department Preparedness to Care for Sexual Assault Survivors: A Nationwide Study

Ideally, emergency departments (EDs) provide trauma-responsive care to sexual assault (SA) survivors and connect them with longitudinal physical and mental health services. However, qualitative studies indicate that ED care may retraumatize survivors, and a 2013 survey found that only ∼20% of US hospitals provide comprehensive services. The aims of this study were to 1) document updated trends in the quality-of-care and resources offered to SA survivors, and 2) identify potential disparities according to geographic regions in the US, urban versus rural clinic locations, and the availability of sexual assault nurse examiners (SANEs).

An Account From a Sexual Assault Nurse Examiner on Caring for a Transgender Survivor: A Case Report.

Transgender individuals represent a gender minority population that has been underserved within the healthcare system and underrepresented in population health and sexuality research, specifically as it pertains to sexual assault. This case report aims to explore how sexual assault nurse examiners (SANEs) approach the care of transgender people who have survived sexual assault. Key components and findings related to the SANE's encounter will be examined including an evaluation of the biases and assumptions held by the SANE and other healthcare providers. Concepts such as cisnormativity, heteronormativity, and intersectionality will be examined in terms of how these can shape the experience of the survivor, influence the care provided by SANEs, and interact with gender stereotypes and nonaffirming practices faced by transgender people. This case report highlights the importance of acknowledging and undermining nursing approaches that can (re)traumatize sexual assault survivors and explores ways in which SANEs can help to shift views of gender and bodies with the goal of providing better care for gender minority populations.

An evaluation of a rapid conversion to teleSANE in response to COVID-19.

Sexual Assault Nurse Examiners (SANEs) provide expert, comprehensive medical forensic care to patients who present for services following a sexual assault. Because SANEs are not consistently available, telehealth technology is being explored as a means to provide access to this expert care (i.e., teleSANE). During the COVID‐19 pandemic, teleSANE offered additional potential benefits by reducing the length of time spent and number of providers in patient exam rooms, the need for personal protective equipment that was in high demand and short supply, and provider anxiety related to providing in‐person care. In the summer of 2020, the Massachusetts SANE program rapidly and temporarily converted five hospitals from in‐person SANE care to teleSANE. An evaluation team interviewed 23 providers using a rapid research and evaluation methods approach to assess the temporary model and inform the future of SANE care. Evaluation findings reveal it is possible to rapidly and temporarily convert hospitals from in‐person to teleSANE care in a time of broad uncertainty, and that such a change requires intensive and thoughtful planning; a shared commitment to being supportive, flexible, and responsive; and specific experience and expertise. Considerations for communities exploring how best to ensure consistent, equitable access to SANEs are discussed.

Intimate Partner Violence, Sexual Assault, and Child Abuse Resource Utilization During COVID-19.

IntroductionKey measures in preventing spread of the virus that causes coronavirus disease 2019 (COVID-19) are social distancing and stay-at-home mandates. These measures along with other stressors have the potential to increase incidences of intimate partner violence (IPV), sexual assault, and child maltreatment.MethodsWe performed a retrospective review of county police dispatches, emergency department (ED) visits, Sexual Assault Nurse Examiner (SANE) consults, Domestic Violence Healthcare Project (DVHP) team consults, and Child Protection Team consults at a large, tertiary, Level I trauma center. We queried International Classification of Diseases Revision 10 codes most specific to IPV, sexual assault, and child maltreatment from March–October 2020 compared to 2019. Similarly, the number of consults performed by SANE, DVHP, and our Child Protection Team were collected. We compared all ED visits and consultations to total ED visits for the reviewed time period. Finally, the total number of calls and referrals to a child advocacy center and resource call line for victims were recorded during this timeframe.ResultsPolice dispatches for IPV-related assaults increased by 266 reports from 2019 to 2020 (P = 0.015). Emergency department visits related to IPV increased from 0.11% of visits in 2019 to 0.15% in 2020 (P = 0.032), and DVHP consults increased from 0.31% in 2019 to 0.48% in 2020 of ED visits in the first three months (P < 0.001). Child maltreatment visits increased from 0.47% of visits in 2019 to 0.81% of visits in 2020 (P = 0.028), and a higher percentage of patients required Child Protection team consults from 1% in 2019 to 1.6% in 2020 (P = 0.004). Sexual assault-related visits and SANE consults both showed a small increase that was not statistically significant. Fewer calls and referrals were made to our child advocacy center and resource call line, decreasing by 99 referrals and 252 calls, respectively.ConclusionDespite decreased ED volumes throughout the pandemic, we observed an increase in police dispatches, ED visits, and utilization of hospital consult services related to IPV and child maltreatment following the initiation of stay-at-home orders. However, use of community resources, such as the local child advocacy center, declined.

The Invisible Voice.

During my overnight shift in the emergency department, around 0230, I had finished up with another patient when I saw that a sexual assault victim had just been checked in for evaluation. After quickly skimming the patient's chart, I entered the room to find a petite young woman, sitting timidly on the stretcher with an emotional reservation creased into her face. With tight yoga pants and a loose fitting satin top, she seemed inappropriately dressed for the piercing, subzero winter night in New Hampshire. Her companion stood in stark contrast: a tall obese male wearing a down jacket, with distracting facial piercings, disheveled hair, and multiple stenciled tattoos on his hands and neck. In the initial silence, the peculiarity of the dynamics between the two suffocated the room. The man displayed a forced distress, as he clasped the patient's hand and moaned, “Does my size even matter if I cannot protect my wife?!” I gently pulled my chair next to the stretcher, trying to convey compassion and engender the patient's trust. As I started the interview, I became unnerved that whenever I asked the patient a question, her eyes would dart nervously toward her looming companion, and he would answer. Sensing my concern, he preemptively stated, “She had a violent boyfriend previously and so she feels uncomfortable around males.” Nodding gingerly, I requested to do a physical exam: once again, the patient looked to her companion for approval, which he gave. While my role focused on medical concerns, I felt incomplete without more situational context, and so I asked her to elucidate what had happened that night, a role typically left to the sexual assault nurse examiner (SANE). The companion promptly narrated an illogical, essentially implausible story, of a rape that left me feeling flabbergasted; thankfully my face mask and eye-pro hid my facial expressions. I looked at the patient for any engagement, her head had remained bowed during the companion's narration, but she glanced up at me; her eyes spoke volumes for her silence. Excusing myself, I communicated my concern for coercion and possible human trafficking to our SANE nurses. The SANE nurses spent 2 h in the patient's room and returned stating, “I am pretty sure he is prostituting her out.” The man had become increasingly more aggressive: refusing to leave the room for any part of the examination, preventing the collection of serum samples but allowing the collection of a urine sample. In addition, during their physical examination of the patient, the SANE nurses had found multiple “defensive wounds” and had discerned an additional history of strangulation. As a result, we ordered a CTA neck to rule out a dissection, but also to separate the patient from her companion and provide her with resources. When the attending and I entered the room, I sat next to the victim and the attending sat closer to the door. As the attending began to speak about obtaining advanced imaging, the companion interjected with incredulity, stating that they had “been there for hours.” Despite our calm explanation regarding the imaging and offering them food vouchers, the man perpetually interrupted my attending, demanding an antibiotic prescription for the patient for any possible STIs. He fomented increasing hostility in the room and assumed a threatening posture against my attending, a petite woman. “You are not listening to her,” he yelled, referencing his “wife” whom we had not heard from the entire night, “We will walk right out of here. Give us the paperwork!” In the subsequent seconds, I felt an uncomfortable warmth layer the back of my neck, as I mentally prepared myself for a physical confrontation to protect my attending. Thankfully, my attending defused the situation saying that the imaging could be obtained as an outpatient and that they could be discharged. I felt nauseous leaving the room. As she was escorted by her companion into the frigid morning, the patient's silhouette rapidly enveloped into darkness the farther she walked from the gleam of the illuminated red emergency room sign. When she stepped into the pick-up truck some distance away and shut the door, the passenger window fogged up in a staccato of rapid breaths: tearful pleas, her phonation appeared hobbled and pitiful, … but we never heard her voice.

Innovative Assessments for Retention of Sexual Assault Nurse Examiners.

The Southeast Kansas (SEK) comprehensive rural Sexual Assault Nurse Examiners (SANE) program was developed as part of an effort to increase the availability of SANE services nationwide. The primary goal of the program is to provide education to assist with training and certification of registered nurses and advanced practice registered nurses in SEK to conduct sexual assault forensic examinations and become certified. This will provide better physical and mental health care for survivors and better evidence collection and higher prosecution rates in a rural, medically underserved area. The project established a rural academic-practice-community partnership to provide longitudinal immersive SANE clinical training. The success of the project in SEK will be impacted by the retention of SANEs; therefore, the integration of the Professional Quality of Life (ProQOL) self-assessment was seen as an important component of the grant implementation. ProQOL determines compassion satisfaction, burnout, and secondary traumatic stress. The data collected from SANEs on their self-assessments with the ProQOL lead to early identification of SANEs experiencing negative effects of forensic nursing and the ability to intervene for decreased attrition.

Factors Affecting Telemedicine Implementation in Emergency Departments and Nurses' Perceptions of Virtual Sexual Assault Nurse Examiner Consultation for Sexual Assault Survivors.

Emergency department (ED) nurses play a critical role in caring for sexual assault patients, but many have not received training on how to conduct a proper sexual assault forensic medical examination. Live or real-time sexual assault nurse examiner (SANE) consultation provided via telemedicine (known as "teleSANE") during sexual assault examinations is a promising new practice to address this issue. The purpose of this study was to assess ED nurses' perceptions of influences on telemedicine use, as well as the utility and feasibility of teleSANE, and identify potential influences on teleSANE implementation in EDs. Guided by the Consolidated Framework for Implementation Research, this developmental evaluation involved semistructured qualitative interviews with 15 ED nurses from 13 EDs. Interviews revealed facilitators and barriers to current telemedicine use across Consolidated Framework for Implementation Research levels. Facilitators included state-level grant funding and technical assistance. Barriers included clinician discomfort being on video and access to ongoing training. Participants believed teleSANE consultation would improve patient care and forensic evidence collection but had concerns for patient privacy and acceptability. Most participants worked in EDs that have the information technology support and telemedicine equipment needed to support teleSANE implementation, although many requested ongoing education and trainings on teleSANE and sexual assault care to improve clinician confidence and account for high staff turnover. Findings highlight the unique needs of sexual assault survivors receiving telemedicine services in EDs, particularly those in rural communities with heightened privacy concerns and limited access to specialty care.