The Identification and Management of Military Sexual Trauma in Veterans: Ask the Question!

Military sexual trauma (MST) is a serious and pervasive problem in the US military and results in the occurrence of physical, psychological, and psychosocial negative health consequences in female and male veterans. The prevalence of MST is increasing, and more veterans are seeking health care outside of the Veteran Affairs Medical Centers (VHA). Consequently, nurse practitioners as non-VHA health care providers may treat this population in the community. Insufficient knowledge precludes the ability to identify and manage MST. This article provides NPs with information for accurately identifying and managing military sexual trauma in the military and veteran population.     

Perinatal Care for Individuals With a History of Sexual Trauma

Many women and individuals assigned female at birth experience sexual assault or abuse in their lives leading to sexual trauma. In this article, we review the effects of sexual trauma and resulting chronic stress on the body and during the perinatal period. Maternal, fetal, and neonatal health implications are discussed. Routine screening for sexual assault and violence can assist with early identification and intervention. A variety of modalities and methods for managing the effects of sexual trauma have been identified, including pharmacologic treatment, psychotherapy, complementary and alternative medicine, and shared decision-making. Further research regarding different treatments is essential to find additional tools to aid clinicians providing care to this vulnerable population. When nurses care for individuals with a history of sexual trauma, incorporating trauma-informed care can help prevent retraumatization and promote a healthy perinatal experience.     

Sexual Assault Nurse Examiner (SANE) Program Goals and Patient Care Practices

PURPOSE: To examine Sexual Assault Nurse Examiners (SANE) programs' goals and guiding philosophies and how they influence patient care practices for sexual assault victims. DESIGN: Data were collected from a national random sample of SANE to examine whether programs differed significantly in their goals and patient care practices. METHODS: Iterative cluster analysis was used to identify types of programs distinct in their stated goals. FINDINGS: Three types of emphasis in SANE programs were identified: (a) prosecution of cases as a primary goal; (b) attending to patients' emotional needs, supporting feminist values, empowering patients, and changing the community response to rape; and (c) least importance on prosecution of cases and average importance on the other goals. Programs that were more focused on prosecution goals provided less comprehensive patient services. CONCLUSIONS: Programs focused on prosecution as a primary goal were less likely to provide comprehensive services, especially those involving patient education. Such information is important for patients because their health concerns (e.g., pregnancy, STIs) have long-term implications for their well-being. Historical and structural differences among SANE programs might explain these different patient care practices. Researchers should examine the underlying processes in SANE programs that shape both their goals and patient care approaches.     

Assailants' Sexual Dysfunction During Rape: Prevalence and Relationship to Genital Trauma in Female Victims

Background: Partial or complete failure to maintain an erection sufficient for coitus is known to occur in a proportion of sexual assailants during the rape episode. Objective: The purpose of this study was to determine whether the presence of coercion, physical violence, and genital injury associated with sexual assaults is influenced by the assailant's erectile impotence. Methods: This prospective, observational study evaluated consecutive female patients presenting to a free-standing urban sexual assault clinic during a 3-year study period. Sexual assault victims presenting directly to four downtown emergency departments (EDs) are routinely referred to the clinic for evaluation after triage and initial assessment. The clinic is associated with a university-affiliated emergency medicine residency program and is staffed by forensic nurses trained to perform medical-legal examinations. The primary outcome was to compare the frequency of anogenital findings documented in women whose assailant experienced no erectile dysfunction vs. those victims who reported erectile impotence in the assailant. Results: During the study period, 569 sexual assault victims were eligible to participate in the study; 47 (8.3%) reported that their assailants had experienced erectile impotence. Except for assailant age, the two victim groups were comparable in terms of marital status, alcohol and drug use, known assailant, and time to physical examination. In attacks where erectile dysfunction occurred, there was a higher incidence of physical coercion (60% vs. 32% without physical coercion, p < 0.001) and subsequent non-genital trauma (72% vs. 46%, respectively, p < 0.001). Thirty-two women (68%) had documented anogenital trauma despite the assailant having erectile dysfunction. There was no significant difference in the overall pattern of anogenital injury between the two groups (χ² = 9.1, p = 0.036). Conclusion: Erectile impotence occurred in up to 8% of sexual assailants during the rape episode. Despite this erectile dysfunction, the majority of sexual assault victims sustained anogenital trauma. In the attacks with erectile impotence, there was a higher incidence of intra-rape violence and subsequent non-genital injuries.     

Perceptions of Nurse Practitioners as Clinical Leaders in the Military

Health care systems need leaders to address complex challenges. This presents an opportunity for nurse practitioners (NPs). The United States Army is already using NPs as leaders. This study addresses the following 2 research questions: What are Army primary care clinicians’ perceptions of NPs as clinical leaders? and Are there differences in these perceptions? In this study, we used a survey that captured clinicians’ perceptions of NP leadership. Overall, respondents favored NPs as clinical leaders. Over 65% agreed that NPs were qualified as leaders within the Army. This study suggests clinicians perceive NPs as qualified and effective leaders at high levels throughout primary care.     

Combating Compassion Fatigue With Mindfulness Practice in Military Nurse Practitioners

Like their civilian counterparts, military clinicians are at risk for compassion fatigue. Studies have shown a relationship between mindfulness interventions and reduction of compassion fatigue and its components of burnout and secondary traumatic stress. A pilot feasibility study using a mindfulness-based stress reduction program via a mobile application was completed with a group of nurse practitioners in the military. Seventy-five percent of the participants showed improvement in burnout and stress levels and 100% improvement in mindfulness attention. Mindfulness training maybe one way to mitigate symptoms of compassion fatigue for nurse practitioners in the military.     

Organizational characteristics of Sexual Assault Nurse Examiner programs: results from the national survey project

A random sample of representatives from Sexual Assault Nurse Examiner (SANE) programs throughout the United States were contacted to participate in in-depth telephone interviews about program operations and services for sexual assault patients. Programs that had been in operation 5 years or less at the time of this study are compared to older programs to examine trends.     

军队中小医院创伤外科护士工作压力源的分析与应对

目的针对我科护士工作中的压力源进行问卷调查和分析,并据此提出合理的建议和意见,减轻压力,提高护理质量。方法采用随机抽样方法,对我科68名护士进行问卷调查并分析。结果在护士工作压力源5个条目35项压力源中,有10项给护士带来重度水平压力。主要有护理工作的社会地位低,工资及其它的福利待遇低,工作分工不明确,工作量太大,上班的护士数量少,非护理性的工作太多,无用的书面工作太多,缺乏病人教育的有关知识,护理管理者的理解与支持不够,护理管理者的批评过多。结论创伤外科护士承受着多种工作压力源,各级领导应采取行之有效的措施减轻护士的压力,提高护理质量。     

Current Sexual Trauma Among High-Risk Teen Mothers

PROBLEM:  The highest rate of reported intimate partner violence (IPV) is among women 15–45 years old ( Hart & Jamieson, 2001 ) with 20% of pregnant teens reporting abuse ( Campbell, 1999 ); however, little research on IPV and American Indian teen mothers has been done.
METHOD:  The purpose of this paper is to describe the degree of IPV and current sexual trauma among a group of Northern Plains adolescents being served by an American Indian teen mother program.
FINDINGS:  The relationship of trauma, substance abuse, and trauma symptoms are described. IPV was reported by 61% of the participants, with 37.5% reporting IPV during pregnancy and 22.5% reporting current sexual trauma.
CONCLUSIONS:  Development and testing of interventions for American Indian teen mothers, specifically related to trauma, are needed in addition to primary mental health services by agencies caring for this population.     

Transcatheter Aortic Valve Replacement: Clinical Update for Nurse Practitioners

Aortic stenosis is one of the most prevalent types of valvular heart disease in the United States, and nurse practitioners in multiple practice settings can play a vital role in the care of these patients. Early identification and treatment are key to improved patient outcomes. Treatment options have advanced over the last decade and include a less invasive procedure called transcatheter aortic valve replacement. The purpose of this article is to improve nurse practitioner’s knowledge of aortic stenosis, discuss treatment options with a focus on transcatheter aortic valve replacement, and provide their patients with an improved quality and longevity of life.     

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.     

Childhood Trauma Experience and the Expression of Problematic Sexual Behavior in Children and Adolescents in State Custody

The present study is designed to identify which types of trauma experiences interact with later development of normal and abnormal sexual behavior in children and adolescents. More specifically, our goal is to determine which types of trauma exposure are related to issues of sexuality, sexually reactive behavior, sexually aggressive behavior, and the combination of both sexually reactive and sexually aggressive behavior. A sample of 5,976 children ages 5 to 18 who were wards of the State of Illinois were studied. All children were assessed with the Child and Adolescent Needs and Strengths (CANS) at entry into care. These data were used to understand the relationship between prior trauma experiences and the expression of problematic sexual behavior. Child sexual abuse was the most common form of maltreatment found in children and adolescents with problematic sexual behaviors. However, other types of trauma experiences, especially exposure to violence, were also related. Sexual abuse and multiple trauma experiences both appear to have an important possible etiological roles in the development of sexually problematic behaviors.     

Performance of Advanced Nurse Practitioners in Minor Trauma Patients

Advanced nurse practitioners (ANPs) manage minor trauma in emergency departments; however, the quality of their care has not been objectively evaluated in comparison to orthopedic senior house officers (SHOs)/junior residents. We reviewed the management of 100 patients by ANPs. SHOs were tested as comparators. ANPs were then re-evaluated after receiving an education program. No difference between ANPs and novice SHOs was observed initially. After an education program, ANPs substantially improved with no statistical difference from experienced SHOs. ANPs provide a comparable standard of care to SHOs for minor trauma once they have completed an education program.     

Health Care Seeking and Engagement After Sexual Assault

Sexual assault (SA), which affects up to 20% of women, is associated with chronic physical and emotional health disorders. Although SA victims/survivors are less likely to seek health care, less is known about the specific barriers and facilitators in health care seeking and engagement. The purpose of this study was to learn the barriers and facilitators from victims/survivors. Data were collected using semistructured interviews. Constructivist coding was used in data analysis. Barriers were reminders of sexual assault, male health care providers, and loss of control with disclosures. Facilitators were health care providers who were empathetic, knowledgeable, and female.     

Shotgun Wounds: Nationwide Trends in Epidemiology,Injury Patterns,and Outcomes from US Trauma Centers

BackgroundShotguns represent a distinct form of ballistic injury because of projectile scatter and variable penetration. Due in part to their rarity, existing literature on shotgun injuries is scarce.ObjectiveThis study defined the epidemiology, injury patterns, and outcomes after shotgun wounds at a national level.MethodsPatients with shotgun injury were identified from the National Trauma Data Bank (2007–2014). Transferred patients and those with missing procedure data were excluded. Demographics, injury data, and outcomes were collected and analyzed. Categorical variables are presented as number (percentage) and continuous variables as median (interquartile range).ResultsShotgun wounds comprised 9% of all firearm injuries. After exclusions, 11,292 patients with shotgun injury were included. The median age was 29 years (21–43) and most were male (n = 9887, 88%). Most injuries occurred in the South (n = 4092, 36%) and among white patients (n = 4945, 44%). The median Injury Severity Score was 9 (3–16). Overall in-hospital mortality was 14% (n = 1341), with 669 patients (7%) dying in the emergency department. Assault was the most common injury intent (n = 6762, 60%), followed by accidental (n = 2081, 19%) and self-inflicted (n = 1954, 17%). The lower and upper extremities were the most commonly affected body regions (n = 4071, 36% and n = 3422, 30%, respectively), while the head was the most severely injured (median Abbreviated Injury Scale score 4 [2–5]).ConclusionsIn the United States, shotgun wounds are an infrequent mechanism of injury. Shotgun wounds as a result of interpersonal violence far outweigh self-inflicted and accidental injuries. White men in their 20s in the southern parts of the country are most commonly affected and thereby delineate the high-risk patient population for injury by this mechanism at a national level.