ReachMD

Alone, in an unfamiliar place, surging with every emotion, this is often the experience of patients who seek medical care after sexual assault. Sexual violence is a serious and growing public health concern requiring prompt and compassionate care in emergency departments (EDs). ED nurses play an essential role in not only caring for the patient upon arrival, but also can affect their future decisions on medical care, health, well-being, and even legal proceedings. These situations are challenging for both patients and providers, but there are strategies that can help ED professionals provide quality care.   

However, a lack of specialized training in caring for patients who have experienced sexual assault could be causing some challenges. 

Let’s take a closer look at the care needs of sexual assault patients.   

1. Balance the need to conduct a physical examination to assess and treat their injuries and other medical concerns and collection of forensic evidence without revictimizing or retraumatizing the patient.  

2. Management of potentially unpredictable, intoxicated, and agitated state of being, physically, emotionally, and mentally, to collect patient information and a recount of the sexual assault along with details of the occurrence. Some patients arrive unconscious or comatose and are unable to provide consent. 

3. Accurate and meticulous documentation of the patient visit that can be used in a court of law. 

4. Effective patient education and counseling in a clear and concise manner, including prophylactic treatments for infectious diseases and contraception, identification of unmet patient healthcare inequities, and coordinated continued care.  

THE OPPORTUNITY 
There are three training and educational strategies with positive demonstrated effects to help ED nurses. 

1. Practice Trauma-Informed Care (TIC) Approaches. TIC is an approach that recognizes the impact of trauma and seeks to promote healing and empowerment for survivors. It involves creating a safe and supportive environment, building trust, and providing patient-centered care that is sensitive to the unique needs of each patient. 

2. Become a Sexual Assault Nurse Examiner (SANE) certified. SANE training applies culturally humble, patient-centered care approaches and knowledge of medical and legal implications to the collection of accurate and meticulous critical information and forensic evidence, medical assessment and evaluation, and effective communication on treatment and connecting patients with appropriate resources. They’re also trained to testify in a court of law as an expert and/or factual witness.  

3. Engage with local Sexual Assault Response Teams (SART).  

If the latest finding of a 1533 percent increase in sexual assault ED visits from 2006 to 2019 is any indication, EDs across the nation need ED nurses with this specialized expertise to provide the best care for patients. The demand is great and compounded by the need to collect forensic evidence, document findings, give emotional support, and coordinate care. However, additional education and training on trauma-informed care, obtaining SANE certification, and the use of person-first language can aid in overcoming challenges. Through compassionate and comprehensive care, ED nurses help promote healing and empowerment for sexual assault patients. 

REFERENCES 
“Adult and Adolescent Sexual Assault Patients in the Emergency Care Setting.” 2021. Elkridge: International Association of Forensic Nurses and Emergency Nurses Association. 

Alexander, Kamila A., and Elizabeth Miller. 2022. “Sexual Violence—Another Public Health Emergency.” JAMA Network Open 5 (10): e2236285. https://doi.org/10.1001/jamanetworkopen.2022.36285. 

Chalmers, Kristen, Meredith Hollender, Liam Spurr, Ramya Parameswaran, Nicole Dussault, Jeanne Farnan, Sonia Oyola, and Keme Carter. 2023. “Emergency Department Preparedness to Care for Sexual Assault Survivors: A Nationwide Study.” The Western Journal of Emergency Medicine 24 (3): 629–36. https://doi.org/10.5811/westjem.59257. 

Furbacher, Jacqueline, Callan Fockele, Ben Del Buono, Laura Janneck, Cooper March, Melanie Molina, Herbet C Duber, et al. 2022. “2021 SAEM Consensus Conference Proceedings: Research Priorities for Developing Emergency Department Screening Tools for Social Risks and Needs.” The Western Journal of Emergency Medicine 23 (6): 817–22. https://doi.org/10.5811/westjem.2022.8.57271. 

Vogt, Emily L, Charley Jiang, Quinton Jenkins, Maya J Millette, Martina T Caldwell, Kathleen S Mehari, and Erica E Marsh. 2022. “Trends in US Emergency Department Use After Sexual Assault, 2006-2019.” JAMA Network Open 5 (10): e2236273. https://doi.org/10.1001/jamanetworkopen.2022.36273.