Sexual Assault Nurse Examiner Research Articles

A confirmatory test for sperm in sexual assault samples using a microfluidic-integrated cell phone imaging system

Rapid and efficient processing of sexual assault evidence to accelerate forensic investigation and decrease casework backlogs is urgently needed. Therefore, the standardized protocols currently used in forensic laboratories can benefit from continued innovation to handle the increasing number and complexity of samples being submitted to forensic labs. To our knowledge, there is currently no available rapid and portable forensic screening technology based on a confirmatory test for sperm identification in a sexual assault kit. Here, we present a novel forensic sample screening tool, i.e., a microchip integrated with a portable cell phone imaging platform that records and processes images for further investigation and storage. The platform (i) precisely and rapidly screens swab samples (<15 min after sample preparation on-chip); (ii) selectively captures sperm from mock sexual assault samples using a novel and previously published SLeX-based surface chemistry treatment (iii) separates non-sperm contents (epithelial cells and debris in this case) out of the channel by flow prior to imaging; (iv) captures cell phone images on a portable cellphone-integrated imaging platform, (v) quantitatively differentiates sperm cells from epithelial cells, using a morphology detection code that leverages Laplacian of Gaussian and Hough gradient transform methods; (vi) is sensitive within a forensic cut-off (>95% accuracy) compared to the manual counts; (vii) provides a cost-effective and timely solution to a problem which in the past has taken a great deal of time; and (viii) handles small volumes of sample (20 μL). This integration of the cellphone imaging platform and cell recognition algorithms with disposable microchips can be a new direction toward a direct visual test to screen and differentiate sperm from epithelial cell types in forensic samples for a crime laboratory scenario. With further development, this integrated platform could assist a sexual assault nurse examiner (SANE) in a hospital or sexual assault treatment center facility to flag sperm-containing samples prior to further downstream testing.

A Needs Assessment and Educational Intervention Addressing the Care of Sexual Assault Patients in the Emergency Department.

Emergency department (ED) providers serve as the primary point-of-contact for many survivors of sexual assault but are often ill-prepared to address their unique treatment needs. Sexual assault nurse examiners (SANEs) are therefore an important resource for training other ED providers. The objective of this project was to create a SANE-led educational intervention addressing this training gap. We achieved this objective by (a) conducting a needs assessment of ED providers' self-reported knowledge of, and comfort with, sexual assault patient care at an urban academic adult ED and, (b) using these results to create and implement a SANE-led educational intervention to improve emergency medicine residents' ability to provide sexual assault patient care. From the needs assessment survey, ED providers reported confidence in medical management but not in providing trauma-informed care, conducting forensic examinations, or understanding hospital policies or state laws. Less than half of the respondents felt confident in their ability to avoid retraumatizing sexual assault patients, and only 29% felt comfortable conducting a forensic examination. On the basis of these results, a SANE-led educational intervention was developed for emergency medicine residents, consisting of a didactic lecture, two standardized patient cases, and a forensic pelvic examination simulation. Preintervention and postintervention surveys showed an increase in respondents' self-perceived ability to avoid retraumatizing patients, comfort with conducting forensic examinations, and understanding of laws and policies. These results show the value of an interprofessional collaboration between physicians and SANEs to train ED providers on sexual assault patient care.

Developing the Role of Sexual Assault Nurse Examiner in South Korea: Using Delphi Method

본 연구는 국내 실정에 맞는 성폭력 전담 간호사의 역할을 개발하여 전국의 성폭력 피해자 지원기관에서 근무하는 간호사의 역할을 표준화하고 전문영역으로 자리매김하는데 기여하고자 시도되었다. 문헌고찰을 통해 국내외 성폭력 전담 간호사의 역할을 정리하고, 이를 토대로 관련 전문가 16명에게 3차례의 델파이 조사로 의견 합치 후, 법적 타당성 검토를 시행하였다. 3차 델파이 조사에서 연구 설계 시 설정한 합의도 0.75 이상, 수렴도 0~0.5, 내용타당도 비율 0.49 이상에 대한 기준을 모두 충족하였다. 연구 결과 5개 역할, 6개 영역, 61개 간호활동을 도출하였으며, 국내 성폭력 전담 간호사의 역할은 보건의료 정책과 의료법의 차이로 인해 국외와는 다르게 나타났다. 본 연구로 도출된 역할을 국내 성폭력 피해자 지원기관에 적용하고, 간호사의 역량이 부족하게 나타나는 부분에 대해 교육을 실시하여 업무 수행 능력을 향상시킨다면 궁극적으로 성범죄의 감소에 기여할 수 있을 것이다.This study aimed to develop the role of sexual assault nurse examiners (SANE) in South Korea. This will attempt to standardize the role of nurses in Sexual Violence Victim Support Centers across the country. This research was conducted with three steps: integrated literature review, Delphi study, and legal validity review. Three-round Delphi surveys were undertaken with 16 Korean experts. In the 3rd round, there was consensus in the degree of consensus, degree of convergence, and content validity ratio (CVR). The result of the study identified five roles, six domains, and 61 nursing activities. The role of the Korean SANE was found to be different from that in other countries due to differences in the Korean medical system and law. If this study is applied to practice in Sexual Violence Victim Support Centers and nurses are accordingly educated, performance of SANEs is predicted to improve. This will then contribute to the reduction of sexual crimes.

Developing the Role of Sexual Assault Nurse Examiner in South Korea: Using Delphi Method

Developing the Role of Sexual Assault Nurse Examiner in South Korea: Using Delphi Method

Initial Stages of Development for an Intersectoral Network on Trans-Affirming Practice to Better Support Sexual Assault Survivors in Ontario

Background: Sexual violence against transgender (trans) persons is a complex public health issue that requires the coordinated effort of multiple sectors to address. A 2017 survey of Sexual Assault Nurse Examiners (SANEs) working within Ontario’s 36 Sexual Assault/Domestic Violence Treatment Centres (SA/DVTCs) revealed a need for training in the provision of trans-affirming care and highlighted a gap in knowledge related to local trans-positive organizations. In response, the successful design, pilot, and evaluation of a curriculum on trans-affirming care for SANEs was completed in 2018. However, there remained a pressing need to connect SANEs with trans-positive service providers across sectors to enhance the provision of care to trans survivors throughout Ontario.&#x0D; Goals and Objectives: To initiate the development a provincial intersectoral network on trans-affirming practice to better support sexual assault survivors by mobilizing knowledge on the new curriculum and connecting SA/DVTCs with local trans-positive community organizations.&#x0D; Approach: Guided by the Lifecycle Model of Network Development, seven regional meetings across the province were facilitated with leaders from SA/DVTCs and local trans-positive organizations. Key insights from meeting activities were transcribed and analyzed.&#x0D; Results: 106 representatives from 96 SA/DVTCs and trans-positive organizations attended a meeting between 7 June and 11 July 2019. 93 organizations expressed interest in being a part of the ongoing development of the network, in addition to 31 organizations unable to attend the meetings. 18 themes related to regional and provincial intersectoral collaboration to address sexual violence against trans communities were identified.&#x0D; Implications: As indicated by high meeting attendance and ongoing interest in developing a network, sexual violence against trans persons is a timely issue relevant to the enhancement of public health policy and practice across sectors. Informed by data gathered across the meetings, we aim to further consolidate the network, including working toward its maturation and sustainability.

Interprofessional collaboration practice: Are you doing it well? Individual perceptions within Sexual Assault Response Team (SART)

Abstract Purpose The purposes of this study were 1) to describe the individual member, group and organizational perception of collaboration of the Sexual Assault Response Team (SART) and 2) to focus on the individual levels of Interprofessional Collaboration (motivation, role expectations, personality style, professional power). Methods A cross sectional exploratory descriptive design. Data was collected from an online Qualtric© survey that incorporated the Perception of INterprofessional Collaboration Model Questionnaire (PINCOM) with some open ended questions. A convenience sample of SART members (n = 159) from the United States. Results The constructs for the individual level on interprofessional collaboration and the themes were categorized for the Sexual Assault Nurse Examiner, Advocate, Law Enforcement and Attorney. Three of four disciplines had a strong connection with individual motivation. Two disciplines had scores that reflected an unfavorable perception of collaboration. Scores on personality styles hindered interprofessional collaboration in all four disciplines. Conclusion Curriculum development based on the IPEC competencies may be a viable to unique groups such as the SART.

Examining trends in non-fatal strangulation among sexual assault survivors seeking Sexual Assault Nurse Examiner care from 2002 to 2017.

Non‐fatal strangulation associated with sexual assault is a public health problem affecting female survivors, especially those assaulted by current/former partners or strangers.

Rural health, forensic science and justice: A perspective of planning and implementation of a sexual assault nurse examiner training program to support victims of sexual assault in rural underserved areas

The long-standing history of low or no reporting of sexual assault in rural areas, creates health disparities and justice inequity for these rural communities. In this brief perspective piece, a rural sexual assault nurse examiner (SANE) program is described in the hopes that dissemination will lead to increased numbers of rural SANEs, increased reporting of sexual assaults in rural and underserved communities, increased prosecution rates of sexual assault perpetrators, and program sustainability through the provision of a nurse-centered approach to training and support.

Using Telehealth for Sexual Assault Forensic Examinations: A Process Evaluation of a National Pilot Project.

This project describes the first time live sexual assault nurse examiner (SANE) services were provided via telehealth to support site clinicians conducting sexual assault forensic medical examinations for adult and adolescent patients. It involved six sites in three states, including rural, tribal, military, and community hospitals. The purpose of this process evaluation was to determine the extent to which patients consent to telehealth technology, examine how the technology worked, and explore the types of assistance. We reviewed information for sexual assault patients who presented at emergency departments (N = 215) and conducted telephone and online surveys with 178 clinicians who provided or received telehealth services. Between May 1, 2015, and March 31, 2018, 129 patients and site clinicians received services via telehealth and an additional 86 site clinicians received consultation advice via telehealth. Most patients consented and accepted SANE services via telehealth (86% overall and 97% in non-U.S. Navy sites). No significant technology problems were experienced for most interactions (92%). The assistance provided remotely by SANEs to site clinicians included guiding clinicians through history taking and documentation, forensic examination and evidence collection techniques, identifying and documenting injuries, and guiding clinical practice. Site clinicians reported, on average, a positive impact of the assistance on their confidence in providing an effective examination, their ability to provide their patient with the best care, and their sense of feeling supported. Results of this pilot suggest that using live telehealth services for sexual assault forensic examinations is a promising practice.

Laying the Foundation for the National TeleNursing Center: Integration of the Quality-Caring Model Into TeleSANE Practice.

In 2012, the Massachusetts Department of Public Health Sexual Assault Nurse Examiner (SANE) Program was awarded a grant from the Department of Justice, Office for Victims of Crime, to pilot the use of telemedicine technology to extend the reach of SANE expertise to six diverse communities across the United States. To meet the goals of this project, the National TeleNursing Center (NTC) developed a three-phase professional practice model integrating the Quality-Caring Model (QCM) to support the delivery of NTC teleSANE services. Using the QCM as a foundation for teleSANE practice ensures that patients experiencing a recent sexual assault who participate in teleSANE encounters receive quality forensic nursing care. In this article, we briefly review elements of the QCM, describe the application of the model to the NTC Professional Practice Model, and detail how teleSANEs integrate the QCM Caring Behaviors into all three phases of its model. The NTC Professional Practice Model provides a quality-based teleSANE model that may be translatable to other areas of telenursing practice.

Pushing the Boundaries: The Impact of the Role of the Clinical Nurse /Midwife Specialist (CN/MS) Sexual Assault Forensic Examination (SAFE) in Ireland

Introduction: Landmark research of Magee et al. (2002) (n=3,120) found that in Ireland , 4 in 10 women (42%) and almost 3 in 10 men (28%) experienced sexual assault or abuse in their lifetime. Subsequently, a National Review of Sexual Assault Treatment Services found sexual assault remains one of the most underreported and under recorded violent crimes in Ireland (O’Shea 2006). Key recommendations included expansion of existing services and introduction of a pilot programme in forensic nursing in Ireland, where nurses would undergo a higher diploma and apply for accreditation as CN/MS (SAFE). Short description of practice change implemented: Expansion of Sexual Assault Treatment Units (SATU) from four to six units in Cork, Dublin, Letterkenny, Waterford, adding Galway, Mullingar (2009). Successful implementation of nurse training following pilot programme CN/MS (SAFE). Aim and theory of change: Patients attending SATU may be physically and /or psychologically traumatised making difficult, life changing decisions. SATUs need to be appropriately staffed and available around the clock to provide prompt medical /supportive care and collect forensic evidence. As a nationally agreed service with defined multiagency guidelines (National SATU Guidelines 2014) and choice of care pathways, the CN/MS (SAFE) can consolidate the initial healthcare response to the under-reported crime of rape/sexual assault by utilising specialistic clinical nursing/midwifery knowledge and critical thinking skills to provide optimum patient care. This change also addresses the issue of recruitment/retention of doctors to carry out forensic examinations (O’Shea 2006). Targeted population and stakeholders: All male /female patients age 14 or older who present to SATU following recent rape/sexual assault. The optimisation of the role of nurses /midwives as Forensic Clinical Examiners realises advantages to Patients, SATU services, Nursing/Midwifery, the wider Inter-disciplinary Team, Inter-disciplinary working ,Criminal Justice System. Timeline: 3 groups of CN/CM (SAFE) graduated 2010-16 developing, assimilating, integrating a broad in-depth knowledge base in this speciality through a structured academic and clinical framework. Highlights: Innovations, Impact, Outcomes CN/MS (SAFE) has transformed the care/services for patients significantly advancing and extending the breadth /depth of SATU services namely: availability of trained staff on a 24 hr basis streamlined response times, accessibility, efficiency of healthcare/forensic service delivery (see Table 1) implementation of patient focused care initiatives including increased patient care pathways influential in driving quality improvement in SATUs nationally participation in patient, staff, community education / risk reduction programmes contribute to development, evaluation and implementation of national strategies Table 1 table of case numbers from 2009 to present day will not load! Sustainability: Some CN/MS (SAFE) have advanced skills in both the academic and practice arena and the enhancement and expansion of this nursing/midwifery role to Registered Advance Nurse Practitioner (RANP (SAFE) would support national policy direction promoting quality patient care. Realisation of the RANP (SAFE) would also ‘assist sustainability, the long range thinking’ (Markowitz 2009) for this unique and extremely challenging area of healthcare practice. Transferability: Transferable skills to other health related services e.g. sexual health, paediatric sexual assault forensic examination etc. Scope for other jurisdictions internationally to adopt and develop the Irish model of CN/MS (SAFE) training and role into their own programmes of care. Discussions & Key findings: CN/CM (SAFE) are attached to a SATU strategically located nationally so that the patient has no more than a three hour drive to the nearest SATU. SATU availability helps to minimise patient distress and ensures timely collection of forensic evidence (O’Shea 2006). The CN/CM (SAFE) initiative is unique to Ireland. It demonstrates international leadership, supported at Government level and by the many different disciplines /agencies involved including An Garda Siochana, the Rape Crisis Centres. Since 2009, Forensic Clinical Examiners in Ireland are either Medical Doctors or CN/MSs (SAFE). Conclusions: To date, CN/MS (SAFE) in the realms of rape / sexual assault in Ireland have forged a path through a previously unknown clinical area. Working as Forensic Clinical Examiners, the CN/MS (SAFE) use a consistent, standardised, patient focused approach with the interdisciplinary team to improve outcomes and reduce the long term sequelae for each patient regardless of the circumstances of the incident or a person’s engagement, or not with the criminal justice system. Expansion of SATU services in Ireland and availability of CN/MS (SAFE) has greatly improved accessibility for patients following rape /sexual assault.

A Novel Approach to Sexual Assault Nurse Examiner Training: A Pilot Program

BackgroundSexual assault nurse examiners are highly specialized trained nurses. MethodsIn order to meet our institution's need to recruit and train experienced registered nurses as sexual assault nurse examiners, we developed a multimethod, simulation-based training model designed to streamline the educational process and preserve the quality of education. The training program incorporated human manikin-based simulation and specially trained actors. ResultsIn less than one year, this program trained enough registered nurses to provide 24-hour coverage for our institution's five facilities. ConclusionSimulation-based training that incorporates simulated sexual assault victims is an effective model that meets the goals of staffing specially trained sexual assault nurse examiners.

Transforming Care for Victims of Violence.

In this month's Magnet® Perspectives column, Anne Boatright, MSN, RN, SANE, describes her efforts to develop a comprehensive forensic nursing program at Methodist Hospital in Omaha. Ms Boatright transformed a sexual assault nurse examiner (SANE) program into one that provides 24/7 coverage at Methodist's 2 SANE locations and cares not only for victims of sexual assault but also for the victims domestic violence, sex trafficking, strangulation, elder abuse, and neglect. Her work extends beyond the walls of Methodist to the community, where she serves as a core member of the Nebraska Human Trafficking Task Force. She works collaboratively with the Federal Bureau of Investigation and helped Nebraska state senators draft legislation to create a sexual assault payment program. In recognition of her determination to make a difference for victims of violence, she received the 2016 National Magnet Nurse of the Year Award for Transformational Leadership.

Determining the effectiveness of an Elder Abuse Nurse Examiner Curriculum: A pilot study

ObjectivesTo pilot and evaluate a novel Elder Abuse Nurse Examiner Curriculum and its associated training materials for their efficacy in improving Sexual Assault Nurse Examiner (SANE)s' knowledge of elder abuse and competence in delivering care to abused older adults. MethodsPilot training was held with 18 SANEs from across Ontario, Canada. A 52-item pre- and post-training questionnaire was administered that assessed participants' self-reported knowledge and perceived skills-based competence related to elder abuse care. A curriculum training evaluation survey was also delivered following the training. Qualitative non-participant observational data were collected throughout the training. ResultsThere were statistically significant improvements in self-reported knowledge and perceived skills-based competence from pre-training to post-training for all content domains of the curriculum: older adults and abuse (p<0.0001), documentation, legislative, and legal issues (p<0.0001); interview with the older adult, caregiver, and other relevant contacts (p<0.0001); assessment (p=0.0018); medical and forensic examination (p<0.0001); case summary, discharge plan, and follow-up care (p<0.0001). The post-training evaluation survey demonstrated satisfaction among participants across all components of the curriculum and its delivery, particularly with reference to the comprehensiveness of the curriculum, and the clarity and appropriateness of the training materials. ConclusionsThe Elder Abuse Nurse Examiner Curriculum and associated training materials were efficacious in improving SANEs' self-reported knowledge of and perceived competence in delivering elder abuse care. Future steps will further evaluate these materials as a component of a pilot of a larger comprehensive Elder Abuse Intervention at multiple sites across Ontario.

Qualitative Analysis of Prosecutors' Perspectives on Sexual Assault Nurse Examiners and the Criminal Justice Response to Sexual Assault.

The aim of this study was to understand prosecutors' perspectives on the contribution of Sexual Assault Nurse Examiners (SANEs) to evidence collection and trials in sexual assault cases. Several studies have suggested that a sexual assault case is more likely to progress in the criminal justice system when a SANE conducts the forensic medical examination. However, little is known about how prosecutors perceive SANEs and what they value about SANEs versus other medical professionals. Semistructured interviews, conducted in one jurisdiction with eight assistant district attorneys who prosecute sexual assault cases, included questions about the value of SANEs in evidence collection and trials. Interview transcripts were analyzed to identify common themes and variability among prosecutors. Most prosecutors identified advantages for SANEs in evidence collection, trial preparation, and testimony. Specific advantages cited by one or more prosecutors included superior documentation, thoroughness of the physical examination, better identification of injuries, quality of relationships with patients, professionalism, skill in trial preparation and testifying, and credibility with jurors. These findings help validate SANEs' contribution to the criminal justice response to sexual assault, despite the study's limitations in sample size and inclusion of only one jurisdiction. The study also suggests the value of further education about SANEs for prosecutors who may not have the opportunity to learn about the range of skills SANEs possess.

When There is No Sexual Assault Nurse Examiner: Emergency Nursing Care for Female Adult Sexual Assault Patients

When There is No Sexual Assault Nurse Examiner: Emergency Nursing Care for Female Adult Sexual Assault Patients

Evaluation and Management of Female Victims of Sexual Assault.

Sexual assault is characterized by any sexual contact or behavior that occurs without explicit consent. Classifications vary based on the status of the perpetrator's relationship to the victim (eg, stranger, acquaintance) and characteristics of the victim herself (eg, child, elder adult, mentally disabled adult). Regardless of the classification, sexual assault is a significant individual as well as public health issue affecting women of all ages. While the majority of sexual assault cases are not initially reported to law enforcement, the best available data suggest the lifetime prevalence of sexual assault in the United States is approximately 20% among adult women. With such a significant proportion of women affected by sexual assault, women's health care providers in both ambulatory and emergency care settings play key roles in the evaluation, management, and advocacy of these victims. Establishing standard protocols based on state laws and on victim-centered practices to avoid revictimization of the patient is critical. The primary goals of care include the assessment and treatment of physical injuries, psychological assessment and support, pregnancy assessment and prevention, and therapy for prevention of sexually transmitted infections. In addition, evidentiary collection is a critical component of the sexual assault evaluation and subsequent legal proceedings. This report focuses specifically on the immediate evaluation and management of adult female victims of sexual assault. Best practices include the utility of the Sexual Assault Nurse Examiner and Sexual Assault Forensic Examiner programs, as well as standardized treatment protocols.

Justice Denied: Low Submission Rates of Sexual Assault Kits and the Predicting Variables

Following sexual assaults, victims are advised to seek health care services with forensic evidence collected and packaged in sexual assault kits (SAKs). This large (N = 1,874), retrospective study examined rates of SAK submissions by law enforcement to the state crime laboratory for analysis from 2010 to 2013 at four sites in a Western state in the United States with established sexual assault nurse examiner (SANE) programs. Variables of legal and extralegal characteristics in sexual assault cases were explored through generalized estimating equations (GEE) modeling to determine what factors statistically predicted SAK submissions. For submitted SAKs, the length of time between the dates of assault and dates of submission was categorized, and bivariate and multivariate analyses were calculated to discover legal and extralegal characteristics affecting time of submission. The study sites represented 40% of the state's law enforcement agencies and 65% of the state's population. Out of the 1,874 SAKs in the study, only 38.2% were submitted by law enforcement to the state crime laboratory for analysis. When SAK submissions were examined based on time between assaults and submission dates, 22.8% were submitted within a year of the assault and 15.4% were submitted more than a year after the assault following media and community pressure for law enforcement agencies to submit SAKs in storage. Significant variability of SAK submission rates and the time submitted from the assault dates were found between the sites. Site location was found to be the main determinant of whether or not SAKs were submitted. The lack of SAK submissions for analysis results in justice denied for victims and raises public safety concerns. The finding that the location in which the sexual assault occurred was the primary factor on SAK submissions represents an inequity of justice.

SANE-A-PALOOZA: Logistical Development and Implementation of a Clinical Immersion Course for Sexual Assault Nurse Examiners.

SANE-A-PALOOZA, a continuing education program that utilizes hands-on practice with standardized patients and human simulators, was developed to fulfill a portion of the required supervised clinical experience for certification as a sexual assault nurse examiner. The program is designed to provide concentrated clinical skill practice application, eliminate the time gap between gaining and applying clinical knowledge, and decrease discontinuity among multiple preceptors. This article provides an overview of SANE-A-PALOOZA logistics, with the goal of aiding other organizations in developing skill-building experiences for new or less-experienced sexual assault nurse examiners.

Rural Location and Relative Location: Adding Community Context to the Study of Sexual Assault Survivor Time Until Presentation for Medical Care.

Despite a strong empirical base linking community context and proximity to resources to individual health care access, studies examining predictors of sexual assault survivor time until presentation for medical care have not yet examined these relationships. This study addresses this gap. The data included retrospective records on a sample of 1,630 female survivors who reported their sexual assault to law enforcement and were subsequently seen by a sexual assault nurse examiner (SANE) in one of eight Alaskan communities between the years 1996 and 2006. Logistic regression models were used to determine whether delays in presentation (presentation 12 hr or more after assault) differed for women presenting in unique communities (rural location), and between those whose assault and exam occurred in different communities versus occurring in the same community (relative location). Although rural location did not seem to have a unique impact on time until presentation, differing locations (i.e., relative location) of assaults and exams increased the likelihood of delays in presentation. Non-American Indian/Alaska Native race/ethnicity and knowing one's assailant(s) also increased the likelihood of delays. These results indicate that in addition to a need for further research, there is a need for more appropriate and reliable sexual assault medical services across communities, and that survivors assaulted by known assailants should be targeted in efforts to reduce time until presentation.