A community-based approach to sexual assault

The community-based Athens-Clarke County Sexual Assault Nurse Examiners (ACC-SANE) program was developed to respond to the needs of sexual assault victims. Although this type of SANE model allows for a strong nurse-managed program, there are frustrations and pitfalls that differ from most hospital-based programs. At this time, the majority (71%) of SANE programs are based in hospitals, and few (15%) function in outpatient/community facilities. In the ACC-SANE program, many community agencies interact to provide a seamless approach to postassault health care, counseling, and criminal prosecution. SANE nurses are well equipped to provide forensic examinations in a caring, out-of-hospital environment. The program is housed in a remodeled cottage that rests on property owned by the Athens-Clarke County government and that is adjacent to the local police department. ACC-SANE is governed by a nonprofit board of directors. This management model has allowed the original organizing groups to remain active in the development of the program. As these agencies continue in the governance of the program, they remain committed to the success of ACC-SANE. The impact of program growth and published program guidelines is examined.     

Acute severe pain is a common consequence of sexual assault

Sexual assault (SA) is common, but the epidemiology of acute pain after SA has not previously been reported. We evaluated the severity and distribution of pain symptoms in the early aftermath of SA among women receiving Sexual Assault Nurse Examiner (SANE) care, and the treatment of pain by SANE nurses. Severe pain (≥7 on a 0-10 numeric rating scale) was reported by 53/83 women sexual assault survivors (64% [95% CI, 53-74%]) at the time of SANE evaluation and 43/83 women (52% [95% CI, 41-63%]) 1 week later. Pain in 4 or more body regions was reported by 44/83 women (53% [95% CI, 42-64%]) at the time of initial evaluation and 49/83 women (59% [95% CI, 48-70%]) at 1 week follow-up. Among survivors with severe pain at the time of initial postassault evaluation, only 7/53 (13% [95% CI, 6-26%]) received any pain medication at the time of initial SANE treatment. These findings suggest that pain is common in SA survivors in the early postassault period, but rarely treated. PERSPECTIVE: Acute pain is common after sexual assault. Practice guidelines for SANE nurses and others who provide care to sexual assault survivors in the early aftermath of assault should include specific recommendations for pain evaluation and treatment. Prospective longitudinal studies of pain outcomes among sexual assault survivors are needed.     

The introduction and inspiration to a sexual assault nurse examiner in forensic nursing

A number of regulations concerning women and children have been introduced recently in Taiwan, and those regulations have improved the safety for women and children. But there remain problems as far as evidence gathering for medical and forensic purposes is concerned, giving rise to continuing difficulties in enforcing the regulations. Sexual assault nurse examiners (SANEs) perform one of several recognized forensic nursing roles. The position of SANE was developed to improve medical care for persons who have been sexually assaulted. The SANE education program combines the roles of nursing/medicine, law enforcement, prosecution, and advocacy to provide services involving both compassion and comprehensive medical-legal evaluation by a specially trained professional who has the experience to anticipate their needs during this time of crisis. This paper introduces SANEs in forensic nursing, discusses the way forensic nursing is conducted and introduces Taiwan's SANE training program for sexual assault victims.     

Sexual assault nurse examiner program characteristics, barriers, and lessons learned

Sexual Assault Nurse Examiner (SANE) programs have been developed throughout the United States to better meet the needs of sexual assault survivors. This study builds upon three previously published national surveys of SANE programs, with a random sample of 243 SANE programs surveyed. Results are discussed along with implications for SANE program practice.     

Community cooperatives combat sexual assault and domestic violence

The effectiveness of the SANE program is borne out by the following testimonies: "The emotional support required by these victims is best rendered by a SANE. This frees the ED nurse to care for other patients, while sexual assault victims receive a high level of care," says Nancy Donel, RN manager at St. Thomas Hospital ED. "The DOVE program benefits not only the emergency physician, but the EMS system as well. It gives us a resource and a specifically identified program with well-trained, qualified providers. Through their training and knowledge, SANEs not only help victims, but also increase the number of legal convictions that take assailants off the streets. This improves the health and safety of the communities in which we live and serve," says Michael Mackan, MD, of the Summa Health System.     

Negotiating the challenges of multidisciplinary responses to sexual assault victims: sexual assault nurse examiner and victim advocacy programs

The purpose of this study was to examine Sexual Assault Nurse Examiner (SANE) programs' relationships with victim advocacy organizations. A national telephone survey was conducted of randomly selected SANE programs, all of which served adults, and some of which also served adolescents and children. Nearly one-third of 231 participants reported that SANEs in their program had experienced conflicts related to roles and boundaries with victim advocacy organizations at some point during the program's history. The most frequently mentioned conflicts involved professional autonomy, control, or turf issues. Future researchers should address personnel, organizational, and structural factors that facilitate collaborative relationships between SANE and victim advocacy organizations.     

A participatory evaluation project to measure SANE nursing practice and adult sexual assault patients' psychological well-being

This paper describes a collaborative project between a team of researcher-evaluators and a Sexual Assault Nurse Examiner (SANE) program to develop an evaluation survey of SANE nursing practice and patient psychological well-being. Using a participatory evaluation model, we followed a six-step process to plan and conduct an evaluation of adult sexual assault patients treated in one Midwestern SANE program. Our collaborative team developed a logic model of "empowering care," which we defined as providing healthcare, support, and resources; treating survivors with dignity and respect; believing their stories; helping them re-instate control and choice; and respecting patients' decisions. We created a corresponding survey that can be administered to patients following exam procedures and tested it with N = 52 sexual assault victims. Results indicated that nursing practice was consistent with this empowering care philosophy as the overwhelming majority of patients reported positive psychological well-being outcomes. Implications for evaluating forensic nursing practice are discussed.     

Efficacy of a 2-year-old sexual assault nurse examiner program in a Canadian hospital.

INTRODUCTION: The purpose of this study was to describe a sexual assault nurse examiner (SANE) program at a hospital-based sexual assault care center in Ontario, Canada, and assess its efficacy in comparison with physician examiners. METHODS: Data obtained from the hospital records of 515 women who came to a Toronto sexual assault care center were examined. A number of variables relevant to this assessment of services were examined, including client demographics and presenting history, aspects of the sexual assault, and characteristics of the treatment. RESULTS: Average assessment times were shorter for victims seen by SANEs than for victims seen by physicians (approximately 3(1/4) hours versus 4 hours). Physicians had more interruptions (25.1%) than did SANEs (20.0%). Client characteristics and presentation were similar regardless of who provided care, with some exceptions. DISCUSSION: The results of the study support the utility of the SANE model as an efficient program for the assessment and treatment of victims of sexual assault.     

Outcome indicators for sexual assault victims

Measurable indicators create a profile of an organization's function and provide direction. In this study structure, process and outcome indicators for sexual assault victims are assessed and evaluated. The results present a portrait of the function, weaknesses, and benefits of one community SART program. The research findings suggest the need for improved documentation in the acute setting as well as the need for regular case review and case tracking to identify gaps in services.     

Sexual assault services delivered by SANEs

Sexual Assault Nurse Examiner (SANE) programs have become the standard of care for sexual assault victims in many urgent care settings. This study examines SANE clinical nursing practices at one Canadian sexual assault urgent care centre.     

Establishing a sexual assault nurse examiner (SANE) program in the emergency department

Sexual assault cases present complex medical, psychological, social, and legal challenges to emergency practitioners. Sexual Assault Nurse Examiner (SANE) programs were designed to improve and expedite this patient care. The following review describes unique requirements, objectives, and resources when developing a program based in the Emergency Department.     

Sexual assault nurse examiners' perceptions of funding challenges faced by SANE programs: "it stinks"

Even though Sexual Assault Nurse Examiner (SANE) programs began over 30 years ago, and there is currently greater awareness of sexual violence, the question regarding the financial security of SANE prgrams remains a contemporary concern. Data from interviews with 40 SANEs', many of whom were also directors, from programs located in four states indicated that lack of funding continues to present challenges. Most (72%) directors revealed that there are problems with funding. Directors voiced concerns about program sustainability, as well as the ability to provide education in the community and training and continuing education opportunities for SANEs. Even though funding of programs is not the responsibility of SANEs not serving as directors, approximately one-third of regular SANEs were aware of budget cuts or financial struggles faced by their program. These SANEs also expressed concern about the sustainability of programs, the ability to train additional nurses, purchasing their equipment of choice, and lack of compensation. All suggestions for program improvements, directly or indirectly, required more funding.     

Defining the boundaries: how sexual assault nurse examiners (SANEs) balance patient care and law enforcement collaboration

Forensic nursing is multidisciplinary in nature, which can create tensions for practitioners between their responsibilities to patient care and collaborations with law enforcement and prosecutors. Because there are compelling reasons grounded in both nursing theory and legal precedent to maintain separation, there is a pressing need to understand how sexual assault nurse examiner (SANE) programs successfully negotiate these potentially conflicting roles. The purpose of this study was to examine how SANEs define their work with their patients, how they collaborate with law enforcement, and how they negotiate roles differentiation. As part of a mixed methods evaluation of a community-based SANE program, qualitative interviews were conducted with forensic nurses regarding their interactions with patients and members of the legal community. Results indicated that a strong patient care practice had positive indirect effects on victims' participation in the criminal justice system. Implications for forensic nursing practice are discussed.     

Organizational correlates of secondary traumatic stress and burnout among sexual assault nurse examiners

This study explores correlates of secondary traumatic stress (STS) and burnout among SANE nurses. Cross-sectional interviews were conducted with nurses from a random sample of SANE programs. The interview measured organizational and demographic variables and current levels of STS and burnout. STS and burnout were found to be related but not identical processes. Organizational variables played a significant role in predicting both outcomes. The results have implications for increasing organizational support as a way of lessening the impact of STS and burnout.     

Program and sexual assault survivor characteristics for one SANE program

Sexual Assault Nurse Examiner (SANE) programs address the unique and specific needs of sexual assault survivors. However, relatively little is known about the actual characteristics of existing programs and the characteristics of rape survivors who seek treatment in emergency rooms with SANE programs. This article presents information about one program's development, operation, and clients.     

A community needs assessment for a SANE program using Neuman's model

PURPOSE: To present guidelines for a community needs assessment for a Sexual Assault Nurse Examiner (SANE) program using Neuman's Systems Model. The guidelines provide advanced practice nurses with a holistic, systematic means to conduct an assessment prior to the implementation of a SANE program and facilitate collaborative work with other disciplines and agencies. DATA SOURCES: Selected research-based articles on sexual assault, classic texts and writings on Neuman's Systems Model, and community assessment models and programs. CONCLUSIONS: Sexual assault is a problem faced by almost every community. A thorough community assessment is an important first step in establishing programs that adequately meet a community's needs. Guidelines for conducting such an assessment related to implementation of a SANE program are rare, and guidelines using a nursing model were not found in the literature. IMPLICATIONS FOR PRACTICE: One program that has been successful in meeting community needs is the SANE program. A concise and organized assessment guide can reduce the necessary time and money allocated for a community assessment and can provide a basis for evaluation and research.     

Evaluation of image quality of digital photo documentation of female genital injuries following sexual assault

With the patient's consent, physical injuries sustained in a sexual assault are evaluated and treated by the sexual assault nurse examiner (SANE) and documented on preprinted traumagrams and with photographs. Digital imaging is now available to the SANE for documentation of sexual assault injuries, but studies of the image quality of forensic digital imaging of female genital injuries after sexual assault were not found in the literature. The Photo Documentation Image Quality Scoring System (PDIQSS) was developed to rate the image quality of digital photo documentation of female genital injuries after sexual assault. Three expert observers performed evaluations on 30 separate images at two points in time. An image quality score, the sum of eight integral technical and anatomical attributes on the PDIQSS, was obtained for each image. Individual image quality ratings, defined by rating image quality for each of the data, were also determined. The results demonstrated a high level of image quality and agreement when measured in all dimensions. For the SANE in clinical practice, the results of this study indicate that a high degree of agreement exists between expert observers when using the PDIQSS to rate image quality of individual digital photographs of female genital injuries after sexual assault.     

Responding to sexual assault victims' medical and emotional needs: a national study of the services provided by SANE programs

We measured the consistency with which a national random sample of 110 Sexual Assault Nurse Examiner (SANE) programs provided 17 services to sexual assault victims. SANE programs consistently offered forensic evidence collection, sexually transmitted infection (STI) prophylaxis, information on HIV, information on pregnancy risk, and referrals to community resources. Reasons programs did not routinely offer particular services (e.g., STI cultures, HIV testing/prophylaxis, emergency contraception (EC)) included financial constraints, difficulties balancing medical care with legal prosecution, and affiliations with Catholic hospitals.     

The effectiveness of sexual assault nurse examiner (SANE) programs: a review of psychological, medical, legal, and community outcomes

In sexual assault nurse examiner (SANE) programs, specially trained forensic nurses provide 24-hour-a-day, first-response medical care and crisis intervention to rape survivors in either hospitals or clinic settings. This article reviews the empirical literature regarding the effectiveness of SANE programs in five domains:(a) promoting the psychological recovery of survivors, (b) providing comprehensive and consistent post-rape medical care (e.g., emergency contraception, sexually transmitted disease [STD] prophylaxis), (c) documenting the forensic evidence of the crime completely and accurately, (d) improving the prosecution of sexual assault cases by providing better forensics and expert testimony, and (e) creating community change by bringing multiple service providers together to provide comprehensive care to rape survivors. Preliminary evidence suggests that SANE programs are effective in all domains, but such conclusions are tentative because most published studies have not included adequate methodological controls to rigorously test the effectiveness of SANE programs. Implications for practice and future research are discussed.