Sexual Assault Exam: Utilizing Simulation to Increase Nursing Confidence

Abstract

<p>Poster presentation</p> <p>Session D presented Friday, September 15, 2017</p> <p>Purpose: It was recognized that emergency department (ED) nurses were undertaking an examination of patients who have been sexually assaulted, but had not received formal training. ED nurses were unfamiliar with the exam process and were concerned of incorrectly collecting forensic evidence. Staff would wait until a sexual assault nurse examiner (SANE) became on call to complete the exam, therefore delaying throughput. The purpose of this staff development was to enhance the emergency nurse's knowledge and skills in caring for sexually assaulted patients. Simulation was identified as a way to build the nurses' confidence with performing a forensic examination.</p> <p>Design: A four-hour staff development training that consisted of a simulation-based learning experience. Multiple training sessions (n=12) were available to provide a small group/facilitator ratio. The facilitators consisted of the ED nurse educator, SANE coordinator, and a SANE-trained nurse. The nurse educator collaborated with the simulation staff to provide this training.</p> <p>Setting: The setting is a 640-bed, non-profit hospital that is across 2 facilities. The EDs see 80,000 patients a year. The training was held at the simulation center.</p> <p>Participants/Subjects: All ED nurses participated in this training, (n=71). The participants' years of nursing experience consisted of less than one year to 44 years. There were 60 females and 11 males. 31 of the participants had performed a sexual assault forensic exam. 21 have performed an exam in the past year.</p> <p>Methods: The training consisted of didactic content, simulation, and a debriefing. The didactic content was provided by the SANE coordinator who reviewed the process and summarize the collection kit. For the simulation, the participants were separated into three groups with one facilitator. Low-fidelity manikins were provided with moulage injuries. The participants were given a case study, and guided through the assessment, identification of injuries, and collection of evidence. Debriefing consisted of reviewing chain-of custody, discussions, and answering questions. Discussions consisted of maintaining a non-judgmental demeanor, providing compassionate care, collaboration with physicians during the pelvic exam, collaboration with the patient advocates, and the patient's right to anonymous reporting. An evaluation of the training consisted of demographic questions, achievement of objectives, overall experience with the class, quality of the instruction, and general comments. This was measured by a rating of excellent, good, fair, or poor.</p> <p>Results/Outcomes: Overall 65 out of the 71 participants rated the training as excellent. When asked to rate your confidence that this simulation helped develop the skills to perform a sexual assault exam, 48 rated it excellent, 22 good, and 1 fair. General comments included feeling more comfortable with performing an exam; an increased confidence; and a greater understanding of the process, collection of evidence, and documentation.</p> <p>Implications: Providing a simulated-based training can increase the skills of nursing care for patients who has been sexually assaulted. The success of this course has encourage a continuation to provide training for all new nurses. One of the managers went on to address the open times that a SANE nurse was not on-call. Staff are rotated through the role of the taking these patients during that 12-hour shift.</p>