Does Sexual Assault Nurse Examiner (SANE) Training Affect Attitudes of Emergency Department Nurses Toward Sexual Assault Survivors?

Lessons in Sexual Assault and Violence: A Scoping Review of Undergraduate Nursing Education

BACKGROUND

More than half of women and one third of men have experienced sexual violence in their lifetime. Nurses must be able to screen and treat patients who have experienced sexual assault, yet they may lack the knowledge and identification skills based on their exposure to content in their undergraduate nursing programs. This study examined the current state of the science regarding sexual assault and violence education in undergraduate nursing curricula.

METHOD

This scoping review was guided by Levac's five-step framework. Databases were searched using the key terms "nursing education" and "sexual assault education."

RESULTS

A total of 501 articles were identified; eight articles were included in the review. Themes of knowledge, confidence, and educational preparedness emerged.

CONCLUSION

Despite the importance and prevalence of sexual assault, limited educational content is provided in undergraduate nursing schools. Results urge implementing educational didactic, simulation, and clinical placement opportunities to improve nursing students' knowledge. [J Nurs Educ. 2024;63(10):665-670.].

Bridging Gaps in Collaboration Between Community Organizations and Hospital-Based Violence Treatment Centers Serving Transgender Sexual Assault Survivors

Community and healthcare organizations have not historically collaborated effectively, leaving gaps in the continuum of care for survivors of sexual assault. These gaps are particularly acutely felt by transgender (trans) survivors, who experience additional barriers to care and face higher rates of sexual assault. To bridge these gaps and enhance the provision of comprehensive support for trans people, we developed an intersectoral network of trans-positive community and hospital-based organizations in Ontario, Canada. As part of a baseline evaluation of the network, we conducted a social network analysis to determine the extent and nature of collaboration between members within and across these two sectors. Using a validated social network analysis tool (PARTNER survey), data were collected from June 22 to July 22, 2021. The extent of collaboration was examined by relationship type: intrasectoral (same sector) and intersectoral (different sectors). The nature of collaboration was examined using relational scores (value: power, level of involvement, potential resource contribution; trust: reliability, mission congruence, openness to discussion). Fifty-four community organizations (65.9% of 82 invited) and 24 hospital-based violence treatment centers (64.9% of 37 invited) responded. The majority of collaborations were within, rather than across, the two sectors: of all 378 collaborations described, 70.9% (n = 268) were intrasectoral collaborations and 29.1% (n = 110) were intersectoral collaborations. Intersectoral relationships were characterized by lower scores for level of involvement, trust, reliability, and mission congruence than intrasectoral relationships, but higher scores for power. These findings were shared in a virtual consultation session of key stakeholders, in which some participants expressed "surprise" and concern for the lack of collaboration and character of relationships across sectors. Recommendations to increase intersectoral collaboration, which included intersectoral program planning and service design and supporting increased opportunities for intersectoral training and knowledge exchange, are presented.

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

AIM/OBJECTIVE

The 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.

BACKGROUND

Nationally, 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.

DESIGN

A descriptive longitudinal study with repeated measures was conducted.

METHOD

A 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.

RESULTS

Initially, 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.

CONCLUSION

Lack 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.

Characteristics of acute sexual assault care in New England emergency departments

Objective

Interventions such as written protocols and sexual assault nurse examiner programs improve outcomes for patients who have experienced acute sexual assault. How widely and in what ways such interventions have been implemented is largely unknown. We sought to characterize the current state of acute sexual assault care in New England.

Methods

We conducted a cross-sectional survey of individuals acute with knowledge of emergency department (ED) operations in relation to sexual assault care at New England adult EDs. Our primary outcomes included the availability and coverage of dedicated and non-dedicated sexual assault forensic examiners in EDs. Secondary outcomes included frequency of and reasons for patient transfer; treatment before transfer; availability of written sexual assault protocols; characteristics and scope of practice of dedicated and non-dedicated sexual assault forensic examiners (SAFEs), provision of care in SAFEs' absence; availability, coverage, and characteristics of victim advocacy and follow-up resources; and barriers to and facilitators of care.

Results

We approached all 186 distinct adult EDs in New England to recruit participants; 92 (49.5%) individuals participated, most commonly physician medical directors (n = 34, 44.1%). Two thirds of participants reported they at times have access to a dedicated (n = 52, 65%, 95% confidence interval [CI], 54.5%-75.5%) or non-dedicated (n = 50, 64.1%; 95% CI, 53.5%-74.7%) SAFE, but fewer reported always having this access (n = 9, 17.3%; 95% CI, 7%-27.6%; n = 13, 26%; 95% CI, 13.8%-38.2%). We describe in detail findings related to our secondary outcomes.

Conclusions

Although SAFEs are recognized as a strategy to provide high-quality acute sexual assault care, their availability and coverage is limited.

Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department

Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors' mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors' future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.

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

INTRODUCTION

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.

PURPOSE

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.

METHODS

Guided by the Consolidated Framework for Implementation Research, this developmental evaluation involved semistructured qualitative interviews with 15 ED nurses from 13 EDs.

RESULTS

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.

DISCUSSION

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.

Emergency Department Nurses' Perceptions of Patient Substance Use, Impact on Sexual Assault Care, and Access to Follow-up Behavioral Health Resources

INTRODUCTION

Patients may present to the emergency department for sexual assault care under the influence of drugs or alcohol. However, many emergency nurses are not prepared to meet their unique needs or aware of follow-up behavioral health resources. The purpose of this study was to (1) summarize current resources provided to patients and processes for referral to behavioral health services after sexual assault care, (2) explore emergency nurses' attitudes and behaviors toward patient substance use, and (3) explore nurses' perceptions of adjunct mobile health interventions for follow-up behavioral health care and describe anticipated barriers to use.

METHODS

Fifteen emergency nurses participated in semi-structured qualitative interviews.

RESULTS

Participants had mixed perceptions of patient intoxication during sexual assault care. They felt that conversations about substance use may be more appropriate after the ED visit. Participants recognized the opportunity to connect ED patients with substance use treatment or prevention resources but perceived that there are few local service providers. Most participants were not referring patients with substance use issues to behavioral health services after sexual assault care and said that their emergency departments did not have processes for referral to these services. Acceptability of mobile health for follow-up behavioral health care was high, but participants had concerns for patient privacy and internet access. Participants gave recommendations to improve referral practices and patient engagement with mobile health interventions.

DISCUSSION

This study highlights the need for emergency nurses to consider patient intoxication during sexual assault care and opportunities to connect patients with resources post-assault.

Pathway to Healing and Recovery: Alleviation of Survivor Worries in Sexual Assault Nurse Examiner-Led Sexual Assault Telehealth Examinations

INTRODUCTION

The purpose of this study is to understand the pre-examination worries of individuals who experience sexual assault, and whether those worries were experienced or resolved during a telehealth-enabled, sexual assault nurse examiner-led sexual assault examination.

METHODS

Patient surveys were administered to understand pre-examination worries, whether those worries were ultimately experienced during the consultation, and patient perceptions of care quality, telehealth consultation, and whether the examination helped individuals feel better. Data analysis was conducted using descriptive statistics and binomial proportion tests.

RESULTS

Surveys were collected from 74 adolescents and adults who obtained sexual assault care at 6 rural and 2 suburban hospitals. Study findings showed individuals overcome substantial worries to access care, with 66% having at least 1 worry and 41% endorsing 3 or more pre-examination worries. Most participants felt believed (83%) and did not feel judged (88%) or blamed (85%) during their examination. Analysis of pre-examination worries and worry resolution during the examination showed 88% to 100% resolution of worries related to being believed, judged, blamed or lacking control. Participants highly rated the quality of care received (92%) and 84% stated the examination helped them feel better, suggesting a sexual assault nurse examiner-led examination is an important step toward recovery and healing.

DISCUSSION

These findings have implications for emergency department support for sexual assault nurse examiner-led care and public health messaging to demystify sexual assault care, allay fears, and highlight care benefits.

Sexual Assault Nurse Examiner Training: A Review of Literature and Implication for Nursing Education and Service to Rural Communities

Sexual assault nurse examiners (SANEs) play a critical role in providing quality care to patients who have experienced sexual violence. Recent national legislative initiatives have been launched both to better explore state-specific needs in regard to training SANE nurses as well as pilot programs that will establish evidence-based methods of expanding SANE training to remote, rural, and underserved communities.A scoping literature review was conducted to identify best practices in SANE training as well as implications for delivering this education to rural and underserved communities. This review analyzed the scientific strengths and weaknesses of existing research, provided an overview of findings within the literature, and identified areas where further research could be directed to inform local, state, and national strategy on SANE education.Blended learning programs that pair online education with simulated clinical experiences are promising alternatives to the traditional classroom experience; however, more research is needed to know how to enhance retention and engagement of nurses utilizing these methods to obtain preliminary SANE training.

Educational Needs of U.S. Emergency Nurses Related to Forensic Nursing Processes

BACKGROUND

Forensic nursing is a specialty deployed in patient care areas, including emergency departments, intensive care units, labor and delivery suites, and psychiatric units treating persons who have suffered trauma from a violent or criminal act. The recognition of violence-related injuries in patients presenting to health care facilities is critical to an appropriate care trajectory. These patients require specialized resources beyond the treatment of physical injuries to include psychosocial and legal care that supports patient recovery and pursuit of criminal justice.

OBJECTIVE

The purpose of this study is to obtain a broad view of current forensic knowledge and training for emergency nurses working in U.S. emergency departments and to identify gaps in nursing skills and practice such that appropriate education can be developed for this nursing specialty.

METHODS

The study was conducted using a quantitative exploratory, descriptive approach via an emailed cross-sectional survey sent to a convenience sample of U.S. emergency nurses.

RESULTS

A total of 43,775 emails were sent out to members of the Emergency Nurses Association. Of that group, 2,493 recipients opened the email, and 1,824 completed the survey, resulting in a total response rate of 4% and a 73% response rate from those who opened the email. Few respondents self-reported competence in the care of patients who experienced child abuse (13.1%), elder abuse (12.4%), interpersonal violence (17.6%), sexual assault (19.2%), human trafficking (7.4%), developmental challenges (7.2%), strangulation (12.5%), or who were suspected of committing a violent crime (11.4%).

CONCLUSIONS

There is a compelling need to expand forensic education to advance knowledge and skill acquisition in emergency nursing practice and provide staff with additional resources that support a holistic trauma-informed approach to patient care.

Promoting Professional Quality of Life and Resiliency in Sexual Assault Nurse Examiners

BACKGROUND

Sexual assault nurse examiners (SANEs) have received specialized education and clinical training in providing forensic care for sexual assault and abuse victims. SANEs provide compassionate and competent care that promotes emotional recovery for their patients; however, caring for this population puts SANEs at risk for secondary traumatic stress, professional burnout, and compassion fatigue. The research regarding SANEs indicates that there may be multiple personal and organizational factors that affect their development of negative outcomes related to professional quality of life.

PURPOSE

This study explored challenges SANEs experience in their work and what resources are utilized to promote their resiliency and professional quality of life.

METHODS

SANEs were recruited to complete an anonymous online survey through the International Association of Forensic Nurses community; 69 SANEs completed the survey. Eight of the SANEs also participated in follow-up focus groups.

RESULTS

The participants reported many gratifying aspects of their work. They also described challenges related to personal, professional, organizational, and community factors. Many of the reported negative effects align with secondary traumatic stress and professional burnout. The SANEs identified multiple ways to support their resiliency in the context of this difficult work.

IMPLICATIONS

The nature of this work puts SANEs at risk for developing adverse symptoms related to professional quality of life. SANEs need better support and resources to cope with the demands of their work. Findings of this study will be used to design SANE Well, a support application to promote SANE wellness and resiliency.

Building a Capacity of Sexual Assault Nurse Examiners in an Underserved U.S.-Mexico Border Region

Sexual assault nurse examiners (SANEs) conduct medical forensic examinations for persons who have been sexually assaulted. Positive psychological effects, high prosecution rates, and increased victim self-efficacy to seek resources for recovery were reported among sexual assault victims who received forensic care from SANEs. However, such endeavors may be very challenging to achieve because of the severe shortage of certified SANEs. This article will describe how one institution located in a medically underserved U.S.-Mexico border town built a SANE program to increase the capacity of SANEs in the region through 3-year grant funding. The lessons learned, challenges faced during implementation, and sustainability plans including integrating SANEs into the local medicolegal system to seek justice for sexual assault victims are critically addressed in this article.

Can artificial intelligence achieve human-level performance? A pilot study of childhood sexual abuse detection in self-figure drawings

Childhood sexual abuse (CSA) is a worldwide phenomenon that has negative long-term consequences for the victims and their families, and inflicts a considerable economic toll on society. One of the main difficulties in treating CSA is victims' reluctance to disclose their abuse, and the failure of professionals to detect it when there is no forensic evidence (Bottoms et al., 2014; McElvaney, 2013). Estimated disclosure rates for child sexual abuse based on retrospective adult reports range from 23 % to 45 % (e.g., Bottoms et al., 2014). This study reports the four stages in the development of a Convolutional Neural Network (CNN) system designed to detect abuse in self-figure drawings: (1) A preliminary study to build a Gender CNN; (2) Expert-level performance evaluation, (3) validation of the CSA CNN, (4) testing of the CSA CNN model. The findings indicate that the Gender CNN achieved 88 % detection accuracy and outperformed the CSA CNN by 19 percentage points. The CSA CNN achieved 72 % accuracy on the test set with 80 % precision and 79 % recall for the abuse class prediction. However, human experts outperformed the CSA CNN by 16 percentage points, probably due to the complexity of the task. These preliminary results suggest that CNN, when further developed, can contribute to the detection of child sexual abuse.

Shifting Sexual Assault Forensic Examiners Orientation From Prosecutorial to Patient-Centered: The Role of Training

Sexual assault forensic examiners (SAFEs) have a complex role that entails providing health care and medical forensic evidence collection. The literature indicates that there are two orientations that guide SAFEs in this role. A patient-centered orientation emphasizes attending to emotional needs, offering options, and respecting survivors' decisions, which has been linked to positive emotional outcomes. A prosecutorial orientation places emphasis on evidence collection and has been associated with providing fewer comprehensive services. SAFE training may play a pivotal role in guiding new SAFEs to adopt a patient-centered orientation. However, there is a paucity of research examining how training can bolster the adoption of this orientation. Thus, the current qualitative study explored if and how a national blended SAFE training influenced participants' adoption of a patient-centered orientation. Semistructured qualitative interviews were conducted with 64 health care professionals who participated in a national SAFE training. Utilizing analytic induction, the results suggest that the majority of participants entered the training with a prosecutorial orientation but shifted to a patient-centered orientation. Multiple elements of the training influenced this shift including (a) content that dispelled misconceptions of survivors; (b) providing explanations of how attending to survivors' well-being can lead to positive outcomes; (c) earlier placement of patient-centered content to allow instructors to explain how patient-centered care can be applied to each component of the SAFE role including the medical forensic exam; and (d) continual emphasis on patient-centered care.

Gaps in Sexual Assault Health Care Among Homeless Young Adults

INTRODUCTION

Young adults experiencing homelessness are at increased risk for sexual assault. Receiving a post-sexual assault examination has important implications for HIV and unintended pregnancy prevention; yet, utilization is not well understood. In a population at elevated risk for HIV, unintended pregnancy, and sexual violence, identifying barriers and facilitators to post-sexual assault examination is imperative.

METHODS

As part of a large, multisite study to assess youth experiencing homelessness across 7 cities in the U.S, a cross-sectional survey was conducted between June 2016 and July 2017. Data were analyzed in 2019 to determine the prevalence and correlates of sexual violence and examine the correlates of post-sexual assault examination utilization.

RESULTS

Respondents (n=1,405), aged 18-26 years, were mainly youth of color (38% black, 17% Latinx) and identified as cisgender male (59%) and lesbian, gay, bisexual, or queer (29%). HIV risks were high: 23% of participants had engaged in trade sex, 32% had experienced sexual assault as a minor, and 39% had experienced sexual exploitation. Young adults reported high rates of sexual assault (22%) and forced sex (24%). Yet, only 29% of participants who were forced to have sex received a post-sexual assault examination. Latinx young adults were more likely than other races/ethnicities to receive post-assault care. Participants frequently said they did not get a post-sexual assault exam because they did not want to involve the legal system and did not think it was important.

CONCLUSIONS

Interventions are needed to increase use of preventive care after experiencing sexual assault among young adults experiencing homelessness.

Vocational training and sexual assault against women: challenges for graduation in nursing

Abstract Objectives: To understand the meanings of sexual assault against women in the point of view of students, professors and university managers of undergraduate nursing; and to understand how the contents on this subject are approached in undergraduate courses in Nursing in Higher Education Institutions. Method: A qualitative study, with data collection from March to November 2018, through interviews with ten students, ten teachers and seven managers from two private institutions. Data was treated by the modality of thematic content, with a theoretical-analytical reference of 'gender violence' and 'rape culture'. Results: The topic is approached in a fragmented way in different academic contexts, which leads to the reflection of the topic in the training of nurses, extending to their professional performance. Conclusion and implications for practice: The possibilities of incorporating the subject in the teaching-learning scenarios and practices converge to approach the content about the different types of violence in the undergraduate subjects, with educational actions with the population, potentializing the deconstruction of the culture of female subordination. In addition, the study is aligned with the appropriate time in which the reorientation of the curricular guidelines for the health courses is discussed.

Trauma-Informed Care Education in Baccalaureate Nursing Curricula in the United States: Applying the American Association of Colleges of Nursing Essentials

The practice of trauma-informed care (TIC) allows nurses in any setting to identify and intervene with traumatized individuals and to create a continuum of care when forensic nursing services are needed. The purpose of this article is to suggest ways to incorporate TIC content into baccalaureate nursing programs. We begin with an overview of baccalaureate nursing curricula and common types of traumatic experience important for students to understand. We then propose specific strategies for inclusion of TIC content in baccalaureate nursing education, using the American Association of Colleges of Nursing Essentials of Baccalaureate Education for Professional Nursing Practice. With a solid foundation in TIC, baccalaureate-prepared nursing students can provide effective patient care and better support forensic nursing practice. This will increase the capacity of the nursing profession in general to meet the needs of those affected by trauma, violence, and abuse.

Factors Influencing the Filing of Complaints, Their Investigation, and Subsequent Legal Judgment in Cases of Sexual Assault

In Geneva, examination of victims of sexual assault is performed by a gynecologist and a medical examiner. 48% of the victims file a complaint and we wanted to investigate the factors leading to file a complaint, those leading the Prosecutor to go to trial, and those influencing a conviction. Between 2006 and 2012, 676 victims of sexual assault were investigated (averaged age 26 year, mean 22). Information on injuries, perpetrators, and circumstances of the assault was collected and analyzed. The attacker being the ex-spouse or a friend and the presence of semen were factors leading to file a complaint. The assailant being a family member or ex-spouse and the presence of genital/anal lesions were factors influencing the Prosecutor. The presence of nongenital lesions, the assailant being known by the victim, influenced conviction. This study shows that the medical examiner plays a vital role in the investigation of cases of sexual assault.

Establishing Sexual Assault Care Centres in Belgium: health professionals' role in the patient-centred care for victims of sexual violence

BACKGROUND

Having ratified the Convention of Istanbul, the Belgian federal government commits itself to the foundation of Sexual Assault Care Centres (SACC). In the light of researching the feasibility of these centres, this study aimed to evaluate the care for victims of sexual violence (SV) in Belgian hospitals anno 2016 as well as to formulate recommendations for the intended model.

METHODS

Between April and October 2016, a questionnaire was distributed to 159 key health professionals active in 17 different hospitals attached to an AIDS Referral Centre. The survey covered four parts, i.e. the health professionals' profile, their knowledge, attitude and practices, an assessment of the hospital's policy and the caregivers' opinion on the care for victims of SV and on the intended SACCs. Subsequently, a descriptive analysis using 'IBM SPSS Statistics 23' was performed.

RESULTS

A total of 60 key health professionals representing 15 different hospitals completed the questionnaire resulting in a response rate of 38%. The results showed a lack of knowledge and practical experience of caregivers' regarding the care for SV victims. Approximately 30% of responders face personal or professional difficulties upon provision of care to victims of SV. Participants evaluate the current care as good, despite the limited psychosocial support, follow-up, insight for the needs of vulnerable groups and support for family, relatives and health professionals. Yet, the majority of health professionals appraise the SACCs as the best approach for both victims and caregivers.

CONCLUSIONS

By introducing a SACC, the Belgian federal government aims to provide holistic and patient-centred care for victims of SV. Essential in patient-centred health care is an extensive and continuous education, training and supervision of health professionals concerning the care for victims, support for family, relatives and caregivers. At the end and as a result of a participatory process with many professional experts as well as victims, a specific Belgian model, adjusted to the health care system anno 2016 was developed for piloting. The main challenges in establishing SACCs are situated at the institutional and policy level. Collaborating with other institutions and further research are herewith required.

Exploring the Sexual Assault Response Team Perception of Interprofessional Collaboration: Implications for Emergency Department Nurses

There is little research on the dynamics of the sexual assault response team (SART) members' interprofessional collaboration (IPC) practice. The study purposes were to (1) explore the perceptions of IPC among SART members; (2) evaluate the use of Perception of Interprofessional Collaboration Model Questionnaire with the SART; and (3) discuss the implications of the Interprofessional Core Competencies for emergency department nurses and sexual assault nurse examiners. This cross-sectional mixed-methods study (n = 49) was implemented using 4 SART teams in a mid-Atlantic state. There were no statistically significant differences in the subscales within the group level using analysis of variance but offered some valuable insight and content analysis. Emergency department nurses collaborate with different agencies and discipline within their working environment. Understanding the basics of IPC and the perception of IPC within the SART may open doors to further appreciate the dynamics of this team.

The Sexual Assault Nurse Examiner's Interactions Within the Sexual Assault Response Team: A Systematic Review

Many emergency department nurses care for the sexually assaulted victim, when sexual assault nurse examiner (SANE) programs are not available. Therefore, it is important for emergency department nurses to understand the roles of both the SANE and the sexual assault response team (SART). The purpose of this systematic review was to identify the current research on the integration of the SANE among the SART and evaluate the gaps in research of the SANE's role, attitude, behavior, and satisfaction within the collaborative SART. Studies published between 2004 and 2014 using key words were evaluated. A 3-stage search strategy revealed 582 articles. The articles were assessed and categorized according to Level of Evidence definitions. Twelve qualitative and mixed-methods studies were identified. Studies ranged from SART protocols or responses to situational factors to SANE relationships with other SART members. The review reflected the need for more research within the collaborative atmosphere of this multidisciplinary and interagency team that defines the SART, and the individual member's perceptions. Further studies are needed on the SANE's impact on patient outcome and the emergency department nurses role when a SANE or SART program is not available.