There’s a lack of sexual assault care nationwide, and rural areas are hit especially hard.
But despite a shortage of Sexual Assault Nurse Examiners, or SANEs, there isn't enough infrastructure or resources to support nurses interested in these programs, according to a recent study out of the University of Texas at Arlington.
Researchers wanted to understand what barriers were preventing nurses from completing the requirements for a SANE program, especially in rural areas.
Registered nurses can go through additional training to become a SANE — a nurse who can meet the specific health care needs of patients who experienced sexual assault or abuse.
The program is designed to teach registered nurses about trauma-informed care and how to collect forensic evidence.
“In addition to the educational component, you have to complete a clinical skills workshop or a preceptorship,” said Morgan PettyJohn, researcher and assistant professor in UTA’s School of Social Work. “Basically, where you are being closely mentored and walked through the hands-on parts of the exams. Then, from that point, you go into supervised practice back in your local communities.
The study found many providers run into issues when trying to complete their training. And those issues can be uniquely challenging for nurses in rural communities.
“They deal with a lot of barriers related to infrastructure,” PettyJohn said. “There's typically not well-established SANE programs nearby. As a byproduct of that, there is also not a lot of mentorship that they can receive from more experienced SANEs.”
PettyJohn said rural nurses can also have an issue with low case volume due to sparse populations and survivors not wanting to come forward because of stigma.
The study emphasizes that SANEs are proven to improve survivor outcomes of survivors. Jenifer Markowitz, a consultant with Forensic Healthcare Consulting who contributed to the study, said SANEs and other forensic nurses respond to several types of violence that can affect people’s health like intimate partner violence and elder abuse and neglect.
“Any time we have patients who are not evaluated or under-evaluated… the impact for both their short and long-term health can be significant,” Markowitz said.
When providers treat an injury without addressing the underlying violence or abuse, Markowitz said it can mean patients don’t get the tools and resources they need to make decisions for themselves and their families.
There are also some unique injuries that require more specialized knowledge to assess, such as strangulation.
The study identified some solutions to support nurses who are interested in SANE training, including “financial and logistical support not only through the training process, but also through the transition to post-training practice.”
The training is typically in addition to a full-time nursing schedule and often requires nurses to work in an on-call capacity. PettyJohn said many of the nurses they spoke with highlighted the importance of employer support.
“Talking about, ‘My employer understands the importance of having a sane on our staff, and they're very supportive of that,’” she said. “So they allow the flex time to study at home one day a week to work on the educational modules. Or ‘they allow me to change my schedule around during the week so that I can go do practice hours at a local SANE provider in the next county.’”
Researchers also found nurses benefitted from logistical support, such as a person who can help connect them with local SANE programs or different agencies.
The study focused on nurses in Michigan, but PettyJohn said the findings can be utilized to support nurses in states like Texas, where most counties have no SANEs.
“Texas is such a large and rural dominant state,” she said. “There’s only about 88 out of Texas's 254 counties that have an active SANE program. And, of course, those tend to be clustered and concentrated around the major cities."
The researchers noted noted survivors are better supported when when sexual assault is recognized as a health care issue by the various stakeholders involved – like lawmakers and law enforcement.
Markowitz said the study highlights just one part of the health care industry that needs to grow to support survivors of sexual assault and abuse.
“This country has seen a real explosion in the last 15 to 20 years of clinicians who are able to respond to victims of sexual violence,” she said. “But the reality is…we still need even more forensic nurses because truly all patients who have experienced violence can use the services of a forensic nurse because violence is a health care issue."
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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