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Richardson JE, Houston-Kolnik J, Ramos S, Oxner D, Presler-Jur P. Health Information Technology Documentation and Referrals for Intimate Partner Violence and Sexual Assault. Appl Clin Inform 2024; 15:852-859. [PMID: 39106951 PMCID: PMC11483172 DOI: 10.1055/a-2381-3487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 07/21/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Hospital settings provide a unique opportunity to screen for intimate partner violence (IPV) and sexual assault (SA) yet often lack health information technology (IT) solutions for generating reliable and valid medicolegal documentation via forensic reports. OBJECTIVES The objective of the project was to evaluate a pilot, technology "tool" for documenting cases of IPV and SA that could support forensic nurse examiners and related stakeholders in generating high-quality documentation and coordinating victim support services. METHODS The tool was a digital health intervention implemented for use among forensic nurse examiners, law enforcement, victim support organizations, and more within four counties of California. We conducted a mixed-methods pilot study that captured data around the adoption, use, and impact of having access to the newly implemented tool. RESULTS The tool successfully went live in all four pilot counties at different time points with different proportions of use by county and form type: exams, referrals, addenda, risk assessments, and other. Participants were motivated to use the tool out of a perceived need for data handling functionalities that went beyond traditional manual (paper) means. Key functionalities included body mapping, data quality controls within validated forms, attaching addenda to already existing case reports, and the means to distribute data to external recipients. Further study and development are needed on functions to incorporate into body maps and forms and understanding the information needs of law enforcement and victim support organizations. CONCLUSION Our evaluation demonstrated the feasibility and acceptability of a health IT tool to support forensic nurse documentation of IPV and SA and direct information to multiple legal and support-related stakeholders. Areas of future development include integrating IPV- and SA-related data standards for digitized forms, enhancements to the body mapping feature, and understanding the needs of those who receive digital data from forensic nurse examiners within the tool.
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Affiliation(s)
- Joshua E. Richardson
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Jaclyn Houston-Kolnik
- Health Practice Area, RTI International, Research Triangle Park, North Carolina, United States
| | - Stefany Ramos
- Health Practice Area, RTI International, Research Triangle Park, North Carolina, United States
| | - Devin Oxner
- Health Practice Area, RTI International, Research Triangle Park, North Carolina, United States
| | - Paige Presler-Jur
- Health Practice Area, RTI International, Research Triangle Park, North Carolina, United States
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2
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Magdaleno C, Cera J, Struwe L, Blanchard E. The Development and Implementation of a Forensic Education Module for Nebraska Critical Access Providers: A Pilot Study. JOURNAL OF FORENSIC NURSING 2024; 20:E43-E49. [PMID: 38165743 DOI: 10.1097/jfn.0000000000000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
BACKGROUND Sexual assault, intimate partner violence, and human trafficking are traumatic events for individuals and communities. As healthcare shortages increase, critical access hospitals must manage resources to ensure comprehensive forensic care effectively. Current literature indicates a lack of forensic healthcare education for providers within critical access hospitals. This forensic education module for critical access healthcare providers aimed to (a) increase forensic examination competencies, (b) improve forensic interviewing skills, (c) increase provider self-efficacy, and (d) show knowledge retention. METHODS This mixed-methods pilot study utilized a convenience sample of 45 healthcare providers in Nebraska critical access hospitals who presented for the forensic education module training. Repeated measures analysis of variance and paired t tests assessed the aims of this study. Structured surveys gathered qualitative data on three themes. RESULTS Implementation of the forensic education module showed a statistically significant increase in forensic interviewing skills, nonstatistically significant changes in general self-efficacy, and sustainability of knowledge and self-efficacy over 6 weeks. Analysis also showed a clinically significant increase in provider self-efficacy over 6 weeks. Structured questionnaire responses showed participants valued the content to address their perceived barriers to providing care. CONCLUSIONS This study validates the need for increased education in Nebraska's rural and medically underserved areas to ensure access to forensic care and provision of services. This pilot study shows the potential for forensic education interventions to increase provider competencies and improve provider self-efficacy, with evidence of retention of knowledge and skills.
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Affiliation(s)
- Catherine Magdaleno
- Author Affiliation: College of Nursing, Omaha Division, University of Nebraska Medical Center
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3
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Chen LH, Wei LC. Comprehensive Care Strategies in Forensic Nursing: Integrating Perpetrator Rehabilitation Into Sexual Assault Management. JOURNAL OF FORENSIC NURSING 2024; 20:E20. [PMID: 38441486 DOI: 10.1097/jfn.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
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4
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Kosa SD, Coelho M, Friedman-Burley J, Lebel N, Kelly CE, Macdonald S, Du Mont J. Bridging Gaps in Collaboration Between Community Organizations and Hospital-Based Violence Treatment Centers Serving Transgender Sexual Assault Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:1811-1829. [PMID: 37970834 DOI: 10.1177/08862605231211922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
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.
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Affiliation(s)
- Sarah Daisy Kosa
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Madelaine Coelho
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Joseph Friedman-Burley
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Nicholas Lebel
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Carolyn Emma Kelly
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Sheila Macdonald
- Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada
| | - Janice Du Mont
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, ON, Canada
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5
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Gary JC, Charles L, Mitchell S. Sexual Assault Nurse Examiner Education Needs in Texas. JOURNAL OF FORENSIC NURSING 2023; 19:E45-E52. [PMID: 36994994 DOI: 10.1097/jfn.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
ABSTRACT Background: As with many areas of the nation, Texas lacks a robust sexual assault nurse examiner (SANE) workforce. A program in Texas offers courses to educate and expand SANE skills to better provide trauma-informed care to vulnerable populations. Methods: A survey to stakeholders of a SANE educational program, as part of a planned program evaluation, elicited not only barriers to providing care but also specific program needs to better expand access to sexual assault and domestic violence medical forensic examinations in Texas. Results: In January 2022, a total of 40 stakeholders, all registered nurses in the state of Texas, provided vital information on their current program. Analysis of written survey responses provided themes regarding barriers to providing SANE care and suggestions for expanded education. Discussion: The survey provided valuable feedback and comments on the perceptions of the current SANE program. Written responses offered direction for additional learning desires of SANEs associated with the program as well as areas for the program to expand to meet the needs of the learners. This stakeholder guidance has implications beyond this one SANE education program to enhance and expand other programs based on learner needs.
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Affiliation(s)
- Jodie C Gary
- Author Affiliations: School of Nursing, Texas A&M University
| | - Laurie Charles
- Center for Excellence in Forensic Nursing, School of Nursing, Texas A&M University
| | - Stacey Mitchell
- Center for Excellence in Forensic Nursing, School of Nursing, Texas A&M University
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6
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Hollender M, Almirol E, Meyer M, Bearden H, Stanford KA. Sexual Assault Nurse Examiners Lead to Improved Uptake of Services: A Cross-Sectional Study. West J Emerg Med 2023; 24:974-982. [PMID: 37788040 PMCID: PMC10527845 DOI: 10.5811/westjem.59514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 10/04/2023] Open
Abstract
Introduction: Sexual Assault Nurse Examiners (SANE), who are trained to provide comprehensive and compassionate specialty care to sexual assault survivors, are increasingly used in the emergency department (ED), but there is little published literature to support their benefit. In this study we aimed to compare services offered and received by sexual assault survivors in the ED when care was provided by a SANE vs those with traditional care teams, hypothesizing that SANE utilization will be associated with improved uptake of recommended services. Methods: This was a retrospective review examining all patient encounters in which a sexual assault was disclosed in a large, urban, adult ED between June 1, 2019-June 30, 2022. We extracted timeline information from the ED encounter, demographic information, resources offered to and accepted by the patient, clinical care data, and continuity of care data from the medical record. We used unadjusted and adjusted analyses to compare patient demographics and services offered and accepted between SANE and non-SANE encounters. Results: We included a total of 182 encounters in the analysis, of which 130 (71.4%) involved SANEs. Demographics were similar between groups, except there was a larger proportion of cisgender men in the non-SANE group (14.0% vs 5.5%), and the timing of visits differed, with non-SANE visits more common during the overnight shift. All recommended testing, prophylaxis, and resources were offered more frequently during SANE visits, and all but one were more frequently accepted by patients during SANE visits, although not all comparisons reached statistical significance. Conclusion: Patients who received care from a SANE were more often offered recommended services and resources and more frequently accepted them. Making SANE care available at all times to these vulnerable patients would both improve patient outcomes and allow hospitals to meet required quality metrics. States should consider expanding legislation to encourage and fund SANE coverage for all hospitals to support access to vital resources in the ED for survivors of sexual assault.
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Affiliation(s)
| | - Ellen Almirol
- Chicago Center for HIV Elimination, Chicago, Illinois
| | - Makenna Meyer
- Chicago Center for HIV Elimination, Chicago, Illinois
| | - Heather Bearden
- University of Chicago, Section of Emergency Medicine, Chicago, Illinois
| | - Kimberly A Stanford
- Chicago Center for HIV Elimination, Chicago, Illinois
- University of Chicago, Section of Emergency Medicine, Chicago, Illinois
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7
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Ashworth H, Lewis-O'Connor A, Grossman S, Brown T, Elisseou S, Stoklosa H. Trauma-informed care (TIC) best practices for improving patient care in the emergency department. Int J Emerg Med 2023; 16:38. [PMID: 37208640 DOI: 10.1186/s12245-023-00509-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023] Open
Abstract
A patient's current or previous experience of trauma may have an impact on their health and affect their ability to engage in health care. Every year, millions of patients who have experienced physically or emotionally traumatic experiences present to emergency departments (ED) for care. Often, the experience of being in the ED itself can exacerbate patient distress and invoke physiological dysregulation. The physiological reactions that lead to fight, flight, or freeze responses can make providing care to these patients complex and can even lead to harmful encounters for providers. There is a need to improve the care provided to the vast number of patients in the ED and create a safer environment for patients and healthcare workers. One solution to this complex challenge is understanding and integrating trauma-informed care (TIC) into emergency services. The federal Substance Abuse and Mental Health Service Administration's (SAMHSA) six guiding principles of TIC offer a universal precaution framework that ensures quality care for all patients, providers, and staff in EDs. While there is growing evidence that TIC quantitatively and qualitatively improves ED care, there is a lack of practical, emergency medicine-specific guidance on how to best operationalize TIC. In this article, using a case example, we outline how emergency medicine providers can integrate TIC into their practice.
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Affiliation(s)
- Henry Ashworth
- Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA, USA.
| | | | - Samara Grossman
- Department of Psychiatry, Boston Public Health Commission, Boston, MA, USA
| | - Taylor Brown
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sadie Elisseou
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Hanni Stoklosa
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- HEAL Trafficking, Los Angeles, CA, USA
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Hullenaar KL, Rivara FP, Wang J, Zatzick DF. Exploring Collaborative Care Effects on the Mental and Physical Health of Patients With and Without Violent Victimization Histories. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6865-6887. [PMID: 36458828 DOI: 10.1177/08862605221138655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Collaborative care is a multicomponent intervention delivered by frontline social work, nursing, and physician providers to address patients' physical, emotional, and social needs. We argued that collaborative care may particularly benefit patients with a violent victimization history because it practices three principles of trauma-informed care: patient-provider collaboration, preventing repeat trauma in clinical and community settings, and delivering comprehensive mental and physical healthcare. We conducted an exploratory secondary data analysis of a collaborative care randomized clinical trial involving patients who presented with traumatic physical injury at a Level I trauma center in Washington state between 2006 and 2009. We used random-effect linear regression models to estimate how histories of multiple violent traumas moderated the effects of the collaborative care intervention on Short Form-36 Mental Component Summary (MCS) and Physical Component Summary (PCS) T-scores over time. Collaborative care significantly improved follow-up MCS scores among patients who experienced three to four types of violent victimization in their lifetime. Additionally, intervention effects on MCS scores at the 3- and 6-month follow-up were clinically stronger for patients who reported three to four types of violent victimization (3-month = 7.5, 95% confidence level [CI] = 5.1 to 18.7; 6-month = 11.9, 95% CI = 5.1 to 18.7) than those without a history of violent victimization (3-month = 0.8, 95% CI = -5.1, 6.6; 6-month = 5.6, -2.4 to 13.5). We did not find that intervention effects on PCS scores differed between these groups at any wave. Collaborative care may be a promising approach to delivering trauma-informed mental healthcare to patients with histories of multiple types of violent victimization.
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Affiliation(s)
| | | | - Jin Wang
- University of Washington, Seattle, USA
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9
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Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
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Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
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10
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Burns CJ, Borah L, Terrell SM, James LN, Erkkinen E, Owens L. Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:401-409. [PMID: 36538661 DOI: 10.1097/acm.0000000000005046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals. METHOD The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review. RESULTS Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]). CONCLUSIONS Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.
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Affiliation(s)
- Courtney Julia Burns
- C.J. Burns is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3216-5921
| | - Luca Borah
- L. Borah is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8975-1051
| | - Stephanie M Terrell
- S.M. Terrell is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-7776-4621
| | - LaTeesa N James
- L.N. James is a health sciences informationist, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-5955-2876
| | - Elizabeth Erkkinen
- E. Erkkinen is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3522-7286
| | - Lauren Owens
- L. Owens is assistant professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; ORCID https://orcid.org/0000-0002-8277-2826
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11
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Chalmers K, Parameswaran R, Dussault N, Farnan J, Oyola S, Carter K. Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:3244-3278. [PMID: 35658735 DOI: 10.1177/08862605221104522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Kristen Chalmers
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
| | - Ramya Parameswaran
- 166668University of California San Francisco Health, San Francisco, CA, USA
| | - Nicole Dussault
- Duke University Medical Center, 169103Duke University, Durham, NC, USA
| | - Jeanne Farnan
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
- Department of Medicine, 2462University of Chicago, Chicago, Il, USA
| | - Sonia Oyola
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
- Department of Family Medicine, 2462University of Chicago, Chicago, Il, USA
| | - Keme Carter
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
- Department of Medicine, 2462University of Chicago, Chicago, Il, USA
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12
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Chalmers KD, Parameswaran R, Dussault NE, Farnan JM, Oyola S, Carter K. Patient Advocates' Perspectives on the Care of Sexual Assault Survivors in Chicago-Area Emergency Departments. Violence Against Women 2023; 29:370-387. [PMID: 35978273 DOI: 10.1177/10778012221097140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Emergency departments (EDs) providing care and forensic examinations for sexual assault (SA) survivors are often supported by SA patient advocates. This study explored advocates' perspectives regarding problems and potential solutions in SA patient care through a focus group with 12 advocates. Thematic analysis identified two major themes: provider-patient interactions and ED-hospital systems. Challenging aspects of provider-patient interactions included (a) provider attitudes and (b) disempowering behaviors. Within ED-hospital systems, themes included time constraints, efficiencies, and hospital preparation. Advocates surveyed were optimistic about an increased presence of SA nurse examiners and enhanced protocols and provider training to improve survivors' experiences.
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Affiliation(s)
- Kristen D Chalmers
- 12246University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | | | | | - Jeanne M Farnan
- 12246University of Chicago Pritzker School of Medicine, Chicago, IL, USA.,University of Chicago Medicine, Chicago, IL, USA
| | - Sonia Oyola
- 12246University of Chicago Pritzker School of Medicine, Chicago, IL, USA.,University of Chicago Medicine, Chicago, IL, USA
| | - Keme Carter
- 12246University of Chicago Pritzker School of Medicine, Chicago, IL, USA.,University of Chicago Medicine, Chicago, IL, USA
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13
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Salcedo J, Cleland K, Bartz D, Thompson I. Society of Family Planning Clinical Recommendation: Emergency contraception. Contraception 2023; 121:109958. [PMID: 36693445 DOI: 10.1016/j.contraception.2023.109958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG (such as Plan B One-Step, My Way, Take Action), and oral ulipristal acetate (UPA) (ella). These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPA at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPA use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.
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Affiliation(s)
- Jennifer Salcedo
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, United States.
| | - Kelly Cleland
- American Society for Emergency Contraception, Lawrenceville, NJ, United States
| | - Deborah Bartz
- Department of Obstetrics and Gynecology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States
| | - Ivana Thompson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
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14
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Prusky MA, Solomon CJE, Tracy KP, Shah SC, Rodriguez J, Balata M, York SL, Rumoro DP. Training to Enhance the Knowledge and Comfort Level of Emergency Physicians Providing Care for Survivors of Sexual Assault. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:e9-e12. [PMID: 36849432 DOI: 10.1097/ceh.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Although sexual assault (SA) is a substantial public health problem, emergency physicians do not universally undergo continuing education on caring for survivors of SA. The goal of this intervention was to develop a training course that improves physician understanding of trauma-sensitive care in the emergency department and equips physicians with knowledge of the specialized care required to treat SA survivors. METHODS Thirty-nine attending emergency physicians underwent a 4-hour training on trauma-sensitive care for survivors of SA and completed prequestionnaires and postquestionnaires to assess training efficacy in improving knowledge base and comfort level providing care. The training consisted of didactic portions focused on the neurobiology of trauma, communication skills, and forensic evidence collection techniques and a simulation portion with standardized patients to practice evidence collection and a trauma-sensitive anogenital examination. RESULTS Physicians demonstrated significantly improved performance (P < .05) on 12 of 18 knowledge-based questions. Physicians also showed significant improvement (P < .001) on 11 of 11 Likert scale questions that assessed comfort level communicating with survivors and using trauma-sensitive techniques during medical and forensic examinations. CONCLUSION Physicians who received the training course demonstrated a significantly improved knowledge base and comfort level treating survivors of SA. Considering the prevalence of sexual violence, it is imperative that physicians are appropriately educated on trauma-sensitive care.
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Allison MK, Curran G, Walsh WA, Dworkin ER, Zielinski MJ. Factors Affecting Telemedicine Implementation in Emergency Departments and Nurses' Perceptions of Virtual Sexual Assault Nurse Examiner Consultation for Sexual Assault Survivors. JOURNAL OF FORENSIC NURSING 2023; 19:41-49. [PMID: 36812373 PMCID: PMC9971634 DOI: 10.1097/jfn.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- M. Kathryn Allison
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Geoffrey Curran
- Center for Health Services Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Central Arkansas Veterans Healthcare System, USA
| | | | | | - Melissa J. Zielinski
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Vogt EL, Jiang C, Jenkins Q, Millette MJ, Caldwell MT, Mehari KS, Marsh EE. Trends in US Emergency Department Use After Sexual Assault, 2006-2019. JAMA Netw Open 2022; 5:e2236273. [PMID: 36264580 PMCID: PMC9585426 DOI: 10.1001/jamanetworkopen.2022.36273] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/08/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Adult sexual assault (SA) survivors experience numerous emergent health problems, yet few seek emergency medical care. Quantifying the number and types of survivors presenting to US emergency departments (EDs) after SA can inform health care delivery strategies to reduce survivor morbidity and mortality. Objective To quantify ED use and factors that influenced seeking ED care for adult SA from 2006 through 2019. Design, Setting, and Participants This cross-sectional study used SA data from the Nationwide Emergency Department Sample from 2006 through 2019, which includes more than 35.8 million observations of US ED visits from 989 hospitals, a 20% stratified sample of hospital-based EDs. The study also used the Federal Bureau of Investigation's Uniform Crime Reporting Program, which includes annual crime data from more than 18 000 law enforcement agencies representing more than 300 million US inhabitants. The study sample included any adult aged 18 to 65 years with an ED visit in the Nationwide Emergency Department Sample coded as SA. The data were analyzed between January 2020 and June 2022. Main Outcomes and Measures Annual SA-related ED visits, subsequent hospital admissions, and associated patient-related factors (age, sex, race and ethnicity, income quartile, and insurance) were analyzed using descriptive statistics. Results Data were from 120 to 143 million weighted ED visits reported annually from 2006 through 2019. Sexual assault-related ED visits increased more than 1533.0% from 3607 in 2006 to 55 296 in 2019. Concurrently, admission rates for these visits declined from 12.6% to 4.3%. Female, younger, and lower-income individuals were more likely to present to the ED after SA. Older and Medicaid-insured patients were more likely to be admitted. Overall, the rate of ED visits for SA outpaced law enforcement reporting. Conclusions and Relevance This cross-sectional study found that US adult SA ED visits increased from 2006 through 2019 and highlighted the populations who access emergency care most frequently and who more likely need inpatient care. These data can inform policies and the programming needed to support this vulnerable population.
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Affiliation(s)
- Emily L. Vogt
- University of Michigan Medical School, University of Michigan, Ann Arbor
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Charley Jiang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Quinton Jenkins
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- School of Public Health, University of Michigan, Ann Arbor
| | - Maya J. Millette
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
- School of Public Health, University of Michigan, Ann Arbor
| | | | - Kathleen S. Mehari
- Division of Women’s Health, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Erica E. Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
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Chalmers K, Dussault N, Parameswaran R. Encouraging Trauma-Informed Care of Sexual Assault Survivors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1103. [PMID: 34406129 DOI: 10.1097/acm.0000000000004369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Kristen Chalmers
- Medical student, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, and shift supervisor and hotline counselor, Boston Area Rape Crisis Center, Boston, Massachusetts; ; ORCID: https://orcid.org/0000-0002-1570-9448
| | - Nicole Dussault
- Internal medicine resident, Duke University Medical Center, Durham, North Carolina, and former sexual assault patient advocate, Crime Victims Treatment Center, New York City, New York
| | - Ramya Parameswaran
- Internal medicine resident, University of California San Francisco Health, San Francisco, California, and former sexual assault medical advocate, Resilience, Chicago, Illinois;, ORCID: https://orcid.org/0000-0002-8933-2364
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Field-Springer K, Draut H, Babrow F, Sandman M. (Re)claiming Stories in the #MeToo Movement: Righting Epistemic Wrongs of Physical, Mental, and Emotional Harms of Sexual Violence. HEALTH COMMUNICATION 2022; 37:982-991. [PMID: 33541139 DOI: 10.1080/10410236.2021.1880052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sexual violence is a major public health concern, and healthcare providers are in a unique position to offer care and support for survivors. Our study analyzes survivors' stories of sexual violence posted on Twitter in the #MeToo movement between November 29 and December 25, 2017. In analyzing communicative traces that lie within digital data, we read survivors' stories for emotional expressions that create practice. Three themes, informed by survivors of sexual violence reported in our study, included: 1) gaslighting: (re)claiming what I experienced; 2) shame and blame: redefining victimhood and redirecting pain; and 3) bystander: becoming a respectful witness. The practical implications of this piece identify healthcare providers, and in particular OB/GYNs, occupy an important role to create a space where survivors can reclaim their agency, experience, and seek the support they need to heal.
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Affiliation(s)
| | | | - Fran Babrow
- Department of Health, Behavior, and Society, Johns Hopkins University
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Owens L, Terrell S, Low LK, Loder C, Rhizal D, Scheiman L, Seng J. Universal precautions: the case for consistently trauma-informed reproductive healthcare. Am J Obstet Gynecol 2022; 226:671-677. [PMID: 34418349 DOI: 10.1016/j.ajog.2021.08.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/06/2021] [Accepted: 08/12/2021] [Indexed: 11/01/2022]
Abstract
In the United States, about 1 in 5 women have experienced childhood sexual abuse, and a similar proportion experience rape as adults. Childhood sexual abuse and other forms of trauma have serious impacts on our patients' reproductive health. The American College of Obstetricians and Gynecologists recommends universal screening for a history of sexual abuse and universal application of a trauma-informed approach to care. Despite these recommendations, universal screening is far from universally practiced, and trauma-informed care, despite being the standard of care, is far from standard. Given the high prevalence of trauma in the United States, its impact on perinatal outcomes, the sensitive nature of reproductive healthcare, and the likelihood that many patients may not disclose their trauma history, we advocate for trauma-informed reproductive healthcare as the standard of care.
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Abstract
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.
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Nathan S, Moret JD. Sexual Assault Forensic Examiner Recruitment and Retention: Using Simulation to Teach a Trauma-Informed Interview. JOURNAL OF FORENSIC NURSING 2022; 18:54-58. [PMID: 35001071 DOI: 10.1097/jfn.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Traditionally, sexual assault nurse examiner training focuses on examination skills and evidence collection. Gathering history and supporting the patient in a trauma-informed approach are equally important components of postassault care. Simulation is an established tool in healthcare education; however, there is limited research on applying simulation to the training of sexual assault nurse examiners. The Sexual Assault Forensic Examiner Recruitment and Retention program developed and delivered standardized patient-simulated scenarios to teach elements of trauma-informed sexual assault interviews. Simulation allowed trainees the opportunity to practice interviews and receive direct feedback from the standardized patient actor and experienced examiners. Evaluation results showed that learners valued this opportunity, endorsing that it improved their ability to conduct a forensic interview. This innovative program introduced a framework for training new examiners on trauma-informed interview techniques, using standardized patients.
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Affiliation(s)
- Sarah Nathan
- Author Affiliations:University of California, San Francisco School of Nursing
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Moore G, Lutenbacher M, Waynick-Rogers P, Wilbeck J, Raman R, Schorn MN. Bridging Didactic Learning and the Complexity of Practice Through Clinical Immersion: Evaluating the Sexual Assault Nurse Examiner Trainee Experience. JOURNAL OF FORENSIC NURSING 2022; 18:46-53. [PMID: 35045044 DOI: 10.1097/jfn.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this article, we discuss the development and evaluation of the Vanderbilt Nursing Education Program for Sexual Assault Nurse Examiners (VEP-SANE), a 3-day clinical immersion (CI) program, including the lessons learned and the challenges experienced with the completion of two trainee cohorts. To bridge didactic learning and the complexity of practice, the VEP-SANE team designed an innovative, competency-based CI. Fifteen trainees from Cohort 1 and 19 trainees from Cohort 2 met requirements for CI participation. Trainees in Cohort 1 represented the advanced practice registered nurse specialties of emergency, women's health, and pediatrics. For Cohort 2 recruitment, enrollment was expanded to include family and midwifery advanced practice registered nurse specialties. Trainees were required to complete online training modules before CI participation. Online surveys assessed trainee perceptions about levels of knowledge and confidence related to sexual assault nurse examiner competencies (pre/post CI), each CI session, and the overall CI experience. Separate focused discussions were conducted with trainees and faculty after each CI. Both cohorts rated CI sessions as "excellent" or "very good" over 93% of the time. Perceived levels of knowledge and confidence increased from pre-CI to post-CI for both cohorts. Similar CI strengths were identified across trainees and faculty including speakers, high interactivity, safe environment, reality of cases, and surrogate practice. All trainees indicated readiness for preceptorships and interest in a virtual community of practice. Suggestions included more time for laboratory sessions, documenting photos, and interaction with individuals from the lesbian, gay, bisexual and transgender (LGBT) community and presenters. Future efforts focus on CI conversion to a virtual format because of the impact of COVID-19, increased VEP-SANE community of practice interaction, and expanded engagement with practicing sexual assault nurse examiners.
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Affiliation(s)
- Ginny Moore
- Author Affiliations:Vanderbilt University School of Nursing
| | | | | | | | | | - Mavis N Schorn
- Author Affiliations:Vanderbilt University School of Nursing
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Guest H. A concept analysis of trauma-informed care. Nurs Forum 2021; 56:1000-1007. [PMID: 34216387 DOI: 10.1111/nuf.12626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
AIM This concept analysis aims to provide an in-depth analysis of the concept of trauma-informed care and explore the use of this concept in nursing, using Walker and Avant's method. BACKGROUND Trauma-informed care is a priority for nurses caring for patients with previous trauma. Many forms of trauma exist. Various types of trauma may not be apparent without appropriate assessment. Therefore, nurses must approach all patients with the components of trauma-informed care. DESIGN Concept analysis. DATA SOURCE PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO databases were searched for articles in English. The final sample consisted of 23 documents published from 2015 to 2020. REVIEW METHODS Concept analyzed using Walker and Avant's eight-step method. RESULTS Four defining attributes of trauma-informed care were identified as recognition, knowledge, concern, and respect. Definitions, the use of the concept of trauma-informed care, antecedents, consequences, and empirical referents are described. Model, borderline, and contrary cases are discussed. CONCLUSION Many forms of trauma exist. Various types of trauma may not be apparent without appropriate assessment. Therefore, establishing an operational definition of trauma-informed care has implications and significance in victim identification and the provision of trauma-informed care, advocacy, and nursing and interdisciplinary research.
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Affiliation(s)
- Heather Guest
- College of Nursing and Health Sciences, University of Texas, Tyler, Texas, USA.,Nurse Faculty, Traditional Undergraduate Program, Texas Tech University Health Sciences Center School of Nursing, Lubbock, Texas, USA
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