- Is there a role for paediatric Sexual Assault Nurse Examiners in the management of child sexual assault in Australia? [Review]
- CAChild Abuse Negl 2016; 59:13-25
- In Australia, paediatricians and Child Protection Specialists provide the medical and forensic examinations of child victims of sexual assault. There are workforce challenges in the recruitment and r…
In Australia, paediatricians and Child Protection Specialists provide the medical and forensic examinations of child victims of sexual assault. There are workforce challenges in the recruitment and retention of doctors to undertake child sexual assault (CSA) work particularly in remote and rural areas. Pediatric Sexual Assault Nurse Examiner (PSANE) programs have existed in the USA and the UK for many years. Using Rapid Evidence Assessment (REA) methodology, a systematic search of the literature was performed to ascertain what is known about SANE programs, to evaluate the evidence for their effectiveness across a number of domains (accessibility, health and legal outcomes and cost effectiveness) and to inform policy on models of care and elements of best practice which may be appropriate for local implementation in Australia. This review showed that despite the limited evidence available and significant gaps in the evidence, SANEs provide a high standard of medical care and are not detrimental to the legal process. By providing recommendations regarding the potential value, effectiveness and feasibility of establishing a PSANE program in Australia, this article may be of interest to other high income countries facing similar workforce challenges in meeting the needs of children with alleged sexual assault.
- Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children. [Review]
- CIClin Infect Dis 2015 Dec 15; 61 Suppl 8:S856-64
- Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for …
Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases (STD) treatment guidelines. New recommendations for STI management among adult and adolescent sexual assault survivors include use of nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pharyngeal and rectal specimens among patients with a history of exposure or suspected extragenital contact after sexual assault; empiric therapy for gonorrhea, chlamydia, and trichomoniasis based on updated treatment regimens; vaccinations for human papillomavirus (HPV) among previously unvaccinated patients aged 9-26 years; and consideration for human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an algorithm to assess the timing and characteristics of the exposure. For child sexual assault (CSA) survivors, recommendations include targeted diagnostic testing with increased use of NAATs when appropriate; routine follow-up visits within 6 months after the last known sexual abuse; and use of HPV vaccination in accordance with national immunization guidelines as a preventive measure in the post-sexual assault care setting. For CSA patients, NAATs are considered to be acceptable for identification of gonococcal and chlamydial infections from urine samples, but are not recommended for extragenital testing due to the potential detection of nongonococcal Neisseria species. Several research questions were identified regarding the prevalence, detection, and management of STI/HIV infections among adult, adolescent, and pediatric sexual assault survivors.
- The seven pillars of quality care in a statewide pediatric sexual assault nurse examiner program. [Journal Article]
- JCJ Child Sex Abus 2013; 22(7):777-95
- This article describes a systematic approach used by a statewide pediatric sexual assault nurse examiner program to ensure the quality of forensic medical examinations it provides in child sexual abu…
This article describes a systematic approach used by a statewide pediatric sexual assault nurse examiner program to ensure the quality of forensic medical examinations it provides in child sexual abuse investigations. Seven strategies for enhancing quality are described: (a) hiring experienced professionals, (b) effective training, (c) comprehensive protocols, (d) ample support for pediatric sexual assault nurses, (e) management oversight, (f) a clinical coordinator to provide ongoing training and technical assistance, and (g) a quality assurance process in which expert child abuse pediatricians review each statewide pediatric sexual assault nurse examination. To show the evolution of quality care over time, the program's experience from 2004 to 2010 is reviewed, and quality assurance data are analyzed.
- Attitudes of adult/adolescent sexual assault nurse examiners and caring for younger patients. [Journal Article]
- JEJ Emerg Nurs 2014; 40(1):39-45
- CONCLUSIONS: This research fills a gap in the forensic and ED nursing literature by providing insights into the attitudes and concerns of SANEs who care for some of the most vulnerable patients. The findings of this study can inform the acute care and evidence collection practices that are used when caring for pediatric patients who have experienced SA.
- Veracity for children in pediatric forensics. [Journal Article]
- JFJ Forensic Nurs 2012; 8(4):155-62
- Child sexual abuse is a heinous crime, and school-age children are the age group most commonly victimized. When occurring within the family, it is particularly difficult and confusing for the child t…
Child sexual abuse is a heinous crime, and school-age children are the age group most commonly victimized. When occurring within the family, it is particularly difficult and confusing for the child to disclose. The role of the sexual assault nurse examiner, and the challenges in applying the ethical concept of veracity when caring for these young victims is examined, using vignettes based on actual situations. It is essential for the forensic nurse to be able to understand and apply theories of childhood development to these cases in order to facilitate communication with the child, while providing assurance that they are believed.
- Pediatric sexual assault nurse examiner care: trace forensic evidence, ano-genital injury, and judicial outcomes. [Journal Article]
- JFJ Forensic Nurs 2012; 8(3):105-11
- CONCLUSIONS: The addition of a P-SANE to the emergency department (ED) provider team improved the quality of care to child/adolescent victims of acute sexual abuse/assault.
- Anogenital injuries in childhood sexual abuse victims treated in a pediatric Forensic Nurse Examiner (FNE) program. [Journal Article]
- JFJ Forensic Nurs 2010; 6(4):188-95
- Medical forensic exams for victims of childhood sexual abuse (CSA) can be a helpful resource for addressing patients' complex medical, psychological, and legal needs. These exams can be performed by …
Medical forensic exams for victims of childhood sexual abuse (CSA) can be a helpful resource for addressing patients' complex medical, psychological, and legal needs. These exams can be performed by physicians or forensic nurses to identify and treat injuries, evaluate the risk for sexually transmitted infections and pregnancy, and collect evidence. In this study, we examined CSA cases treated in a midwestern, community-based forensic nurse examiner (FNE) program to document rates of anogenital injury and identify what factors predict the presence of such injuries (N= 203). Overall, 39% of the cases had anogenital injury. Victims who were examined for suspected vaginal and/or anal assault were significantly more likely to have anogenital injuries, and patients examined within 24 hours of an assault were also significantly more likely to have documented injuries. Patients who were seen for vaginal and/or anal assaults and who had bathed since the assault were significantly less likely to have injury. Nurses who had less experience with pediatric medical forensic exams were somewhat more likely to document anogenital injuries. Findings suggest that clinical pediatric practice would benefit from additional practitioner training in injury detection to avoid false positives.
- Routine pharyngeal cultures may not be useful in pediatric victims of sexual assault. [Journal Article]
- JEJ Emerg Nurs 2000; 26(4):306-11
- CONCLUSIONS: The incidence of positive oral culture results in this sample was zero. This finding supports a more limited approach to standard sexually transmitted disease screening in pediatric sexual assault victims. The elimination of routine oral cultures in pediatric victims without alleged oral contact decreases the examination time, decreases the number of invasive procedures associated with the examination, and decreases the cost of the examination without negatively affecting patient care.
- Sexual assault nurse examiner and sexual assault response team (SANE/SART) program. [Review]
- NCNurs Clin North Am 2000; 35(2):311-9
- Guided by the Center for Advanced Nursing Practice Evidence-Based Practice Model, under the leadership of a Clinical Nurse Specialist for Women's Health, in response to focused community needs assess…
Guided by the Center for Advanced Nursing Practice Evidence-Based Practice Model, under the leadership of a Clinical Nurse Specialist for Women's Health, in response to focused community needs assessment, a SANE/SART program was developed, implemented, and evaluated. The SANE/SART program brings quality improvement across the entire women's health program. Currently, the program scope is expanding to include the pediatric population and is extending into rural communities throughout the state. The model will continue to be the catalyst for future program initiatives and advancing best practice.