The Working Relationship Between Emergency Room Nurses and Medical Rape Victim Advocates: A Qualitative Examination of Nurses' Perceptions of the Influence of Nurse Training and Experience on Nurse-Advocate Interactions

Nurses and medical advocates respond to sexual assault survivors seeking hospital services. Ideally, both providers work collaboratively. However, this does not always happen. Extant research on the nurse-advocate relationship focuses on Sexual Assault Nurse Examiners (SANEs). This study examines how ER nurses perceive their training and experience influence the working relationships between emergency room (ER) nurses (not exclusively SANEs) and medical advocates. Key findings indicate nurses perceive increased training improves (a) role understanding, (b) trust, (c) respect, (d) rapport, and (e) appreciation. Less training was associated with poorer role understanding and trust.

Rape Crisis Victim Advocacy: A Systematic Review

While rape crisis center (RCC) advocacy is generally regarded as valuable, there are no prior systematic reviews of the advocacy literature. This review examined RCC advocacy service provision, perceptions and impact of advocacy, and challenges and facilitators to effective service provision. Databases related to health and social sciences were searched including Academic Search Complete, PsychINFO, PubMed, CINAHL, ProQuest, Science Direct, OAlster, WorldCat, and MEDLINE. Empirical articles written in English that examined RCC advocacy service provision and/or impact in the US were included. The researchers reviewed abstracts and titles, and then full texts. Forty-five articles met criteria, were summarized, and double checked. Findings demonstrate advocacy is multi-faceted, beneficial, and challenging. Advocates work directly with survivors and interact with other responders on behalf of survivors. Specifically, advocates provide emotional support, safety plan, support survivors in making decisions, and assist them in navigating other systems. While advocates are generally regarded positively by survivors and responders, some responders have concerns about advocates. In addition, advocates sometimes report victim-blaming and being ill-equipped to meet survivors' needs. Finally, advocates face specific challenges in their work with survivors and responders. Future research using diverse methodological approaches is needed to understand advocacy utilization and reach; survivors' perceptions of advocacy; marginalized survivors' experiences; connections between specific services, implementation, and outcomes; and effective strategies for advocates' interactions with other responders. Additional resources to help advocates serve all survivors effectively and equitably; to support evaluator-practitioner partnerships; and to share unpublished data on advocacy may help contribute to improvements in advocacy practice.

Voice of the Victims: Accounts of Secondary Victimization With the Court System Among Homicide Co-victims

The treatment homicide co-victims receive from the criminal justice system often leaves them aggrieved and feeling alienated. A neglected but important area of investigation is the courtroom workgroup's handling of murder cases. This exploratory study examines the nature and extent to which varying secondary victimization experiences are common among co-victims as the murder cases are processed through the court system. The sample consists of 27 co-victims connected to 24 separate cases where the murders occurred in a major metropolitan area in the southeastern United States. Drawing upon focus group data, Nvivo 10 was employed to identify themes that illustrate common secondary victimization experiences among co-victims along with positive and mixed reactions to court processes and personnel. The findings indicate that court requirements to provide notifications are infrequently met and attorney's practice to supply information about case progress and counseling to family members regarding plea-bargaining and sentencing decisions are greatly restrictive. When information is offered, it is often perceived as highly technical and when assistance is provided, it is frequently limited or intermittent. Despite the prevalence of negative experiences, there also were reports of positive interactions with the district attorney and victim advocates. The study concludes by identifying ways in which the courtroom workgroup can uphold the rights afforded to co-victims while at the same time meeting the duties and responsibilities of the workgroup.

Domestic Violence Offender Treatment and Multidisciplinary Treatment Teams: The Role of "Treatment" Victim Advocates

In Colorado, "treatment victim advocates" (TVAs) serve alongside providers and probation/parole officers on "multidisciplinary treatment teams" (MTTs) to oversee domestic violence offender's treatment. Although this model provides an opportunity for victim safety concerns to be heard, the utility of using victim advocates as advisors regarding interventions for domestic violence offenders has yet to be studied. Using survey data and narrative responses from TVAs ( N = 37), the current study examines the challenges and opportunities TVAs face while serving on MTTs. Results suggest that, overall, TVAs are successful in communicating with other members of the MTT, are confident that their perspectives are valued in the offender decision-making process, and are able to provide a wide variety of services and referrals to the victims with whom they are engaged. Implications and recommendations for the Colorado model as well as correctional professionals managing domestic violence offenders internationally are presented and discussed.

"Catching flies with honey": the management of conflict in Sexual Assault Response Teams

Sexual Assault Response Teams (SARTs) are models of service delivery characterized by coordination between rape crisis, health care, and criminal justice sectors. Expanding on research documenting the extent and nature of conflict in SARTs, this study qualitatively explores the strategies used to manage conflict and variations in the use of strategies between professions. Analysis of interviews with SART members (n = 24) revealed five types of strategies: (a) preventative strategies sought to prevent conflict and build capacity for resolving conflict, (b) problem-solving strategies identified and responded directly to conflicts, (c) forcing strategies involved one person attempting to force a perspective or solution on others, (d) unobtrusive strategies covertly worked toward change, and (e) resigned strategies limited direct responses to conflict to protect the coordination. Rape crisis advocates talked the most about conflict management strategies and were almost exclusively responsible for unobtrusive and resignation strategies.

Effective Advocacy in Rural Domains: Applying an Ecological Model to Understanding Advocates' Relationships

Past scholarship has explored the ecological model as it pertains to intimate partner violence from the victim's perspective. Missing from this literature is the application of the ecological model to victim advocates, specifically rural victim advocates. This article explores the microsystem and exosystem levels of the ecological model to understand victim advocates' relationships with their clients and criminal justice personnel. To investigate these relationships, we used a sample of rural advocates located within the Mississippi Delta Region. The findings from the interviews and focus group indicate that the density of rural relationships both help facilitate and create barriers to effective victim advocacy. Social capital specific to the rural domain is being generated by the advocates to benefit themselves and their clients.

Don't ask don't tell: Battered Women living in Sweden encounter with healthcare personnel and their experience of the care given

In recent years there has been increased intimate partner violence (IPV) toward women. Research on the care provided to victims of IPV is limited. The purpose of the study was to gain a deeper understanding of women's lived experience of IPV and their encounters with healthcare professionals, social workers, and the police following IPV. A phenomenological hermeneutic method inspired by the philosophy of Paul Ricoeur was used. The method is based on text interpretation and gives voice to women's lived experience. Twelve women living at a women's shelter in Sweden narrated their IPV experiences. The study revealed that the women experienced retraumatization, uncaring behaviors, and unendurable suffering during their encounter with healthcare professionals. They were disappointed, dismayed, and saddened by the lack of support, care, and empathy. Nurses and other healthcare professionals must understand and detect signs of IPV as well as provide adequate care, as these women are vulnerable. IPV victims need to feel that they can trust healthcare professionals. Lack of trust can lead to less women reporting IPV and seeking help.

Interdisciplinary team communication among forensic nurses and rape victim advocates

Victim advocates and forensic nurses provide integrated care to address the complex legal, medical, and mental health needs of rape survivors. Research suggests that conflict exists between nurses and advocates, but it remains unknown how their communication patterns contribute to or resolve these conflicts. Utilizing a qualitative case study approach, the current study interviewed 24 nurses and advocates from a Midwest organization to better understand team communication patterns when addressing conflicts. The findings suggest that most nurses communicate concerns directly while advocates avoid direct communication. Factors that influenced direct and indirect communication and their implications for practice will be discussed.

The complexity of victim-questioning attitudes by rape victim advocates: exploring some gray areas

Despite efforts to educate and create community awareness, rape myths and victim-blaming attitudes persist in society. This research explores whether advocates express victim-questioning attitudes or questions, negative judgment, or frustration regarding victims' behavior or choices. Data from interviews with 58 advocates reveal that the majority (76%) of advocates never expressed any victim-questioning attitudes during the interview. However, responses from 14 advocates (24%) show that victim-questioning has evolved into a much more complex, subtle form than historical victim blaming or acceptance of rape myths.

Prosecution of adult sexual assault cases: a longitudinal analysis of the impact of a sexual assault nurse examiner program

Most sexual assaults are never reported to law enforcement, and even among reported cases, most will never be successfully prosecuted. This reality has been a long-standing source of frustration for survivors, victim advocates, as well as members of the criminal justice system. To address this problem, communities throughout the United States have implemented multidisciplinary response interventions to improve post-assault care for victims and increase reporting and prosecution rates. One such model is the Sexual Assault Nurse Examiner (SANE) program, whereby specially trained nurses (rather than hospital emergency department [ED] physicians) provide comprehensive psychological, medical, and forensic services for sexual assault victims. The purpose of this study was to examine whether adult sexual assault cases were more likely to be investigated and prosecuted after the implementation of a SANE program within a large Midwestern county. A quasi-experimental design was used to compare criminal justice system case progression pre-SANE to post-SANE. Results from longitudinal multilevel ordinal regression modeling revealed that case progression through the criminal justice system significantly increased pre- to post-SANE: more cases reached the "final" stages of prosecution (i.e., conviction at trial and/or guilty plea bargains) post-SANE. These findings are robust after accounting for changes in operation at the focal county prosecutors' office and seasonal variation in rape reporting. Implications for policy and practice are discussed.

The mental health focus in rape crisis services: tensions and recommendations

In the evolution of rape crisis services, tensions persist between rape crisis service programs and mental health professionals. Changes within these programs and professions have brought the embedded concerns to the surface, but they remain unexamined and unresolved. Recent research on rape trauma and survivors' mental health needs has added to tensions by calling for description and evaluation of rape crisis services and timely psychological treatment for survivors. This article offers a new perspective by discussing the tensions in an open but balanced way so as to promote discussion and solutions. Recommendations and action steps are offered for promoting constructive dialogue and change to improve direct services for survivors.