Attitudes, Efficacy and Potential Barriers Associated with Expanding the Role of Sexual Assault Nurse Examiners (SANEs) To Care for Younger Children Carol Anne Marchetti PhD, RN, FPMHNP BC, SANE (The presenter has no conflicts to disclose) Learning Objectives 1. Recognize disorders for which children who have experienced sexual assault who are at risk. 2. Describe the role of Adult/Adolescent and Pediatric Sexual Assault Nurse Examiners (SANE) in Massachusetts. 3. Explain the concept of self efficacy and why it is considered to be a robust study variable. 4. Identify components of the The SANE Cross Training Attitudes Instrument. Pediatric Sexual Assault Approximately 70,000 child victims of sexual assault are seen in hospital emergency departments (EDs) in the US each year 1 Often, EDs are the first point of care for children who have experienced sexual assault 2 Saltzman conducted a review of the medical records from 66 EDs and findings indicated that among the children seen in EDs for treatment of sexual assault 30.8% of the were between the ages of 0 9 years, and 34.7% were between the ages of 10 19 years 2 Marchetti 1
Adverse Outcomes of Childhood Maltreatment Somatic reactions Substance abuse Sexually transmitted infections (STIs) Sexual dysfunction Eating disorders Persistent patterns of fear and anxiety Sadness, depression Suicide Social maladjustment Adverse Childhood Experiences (ACE) Study 3 (Felitti et al., 1998) The Massachusetts SANE Program Sexual Assault Nurse Examiners (SANEs) are specially trained and certified nurses who care for patients and collect forensic evidence following a sexual assault (SA). The MA Adult/Adolescent Program serves those 12 years of age and older in 27 designated hospital sites within seven regions throughout MA. In FY2011, the MA SANE program provided direct care to 1,638 child, adolescent, and adult patients. SANE care and services are provided at maximum capacity at current funding levels. The Pediatric SANE Program provides care at Children s Advocacy Centers (CAC) in MA. Marchetti 2
Top 10 Statements You Are Likely to Hear from a SANE 10. You are SAFE and I am glad that you are here; I am here to care only for you. 9. YOU are in charge of this exam; we can complete as few or as many steps in the kit as YOU would like to complete; we can STOP the exam at any time. 8. This assault was NOT your fault. 7. There are NO normal responses to sexual assault; whatever you are experiencing is normal for you. 6. I CANNOT determine if you have been sexually assaulted or raped; however, in addition to collecting physical evidence, I will record what you tell me about the assault and I will document my observations and findings from the examination. Top 10 (continued) 5. You can have evidence collected even if you do NOT report the assault to the police. 4. I will be here throughout the ENTIRE examination; in fact, I cannot leave this room until the kit is sealed. 3. I can provide you with information about MEDICATIONS that are available and designed to PREVENT Sexually Transmitted Infections (STIs), HIV, and pregnancy. 2. I can provide you with information about FOLLOW UP CARE for STI treatment and testing, rape crisis counseling services, and information about victim compensation funding. 1. THANK YOU for allowing me to care for you I am so glad that you came to the ED today. What do we know? Attitudes of Adult/Adolescent Sexual Assault Nurse Examiners and Caring for Younger Patients 4 Focus group including MA SANEs were asked to discuss their attitudes about the potential to cross train to care for younger patients Majority of SANEs endorse cross training Potential barriers identified: Training concerns Financial constraints Concern about opportunity for debriefing and emotional support Marchetti 3
SANE Attitudes Towards Cross Training: Qualitative Study Results 4 Attitudes of Adult/Adolescent Sexual Assault Nurse Examiners and Caring for Younger Patients Qualitative study N=45 A/A MA SANEs Series of 6 focus groups Content Analysis to analyze data Barriers 4 So again the barrier is not only that we would need support but we would [also] need some guidance on how to support the parents because that was a huge drain for me, not the child. The child, that was hard too, but it was the parent that was falling apart. General Attitudes 4 When I first heard about it I thought, No way, I could never, ever do it. Since then, I've come around to thinking that it makes a lot more sense for someone like myself to do this rather than a doctor who knows nothing about sexual assault.... I feel it's definitely something I could do. I just can't imagine taking care of a 5 year old with something like that.... I have two young girls at home. I think it would be too hard for me. Marchetti 4
Proposed Study Aims 4 1. To describe the attitudes, efficacy and potential barriers among SANEs in Massachusetts toward the possibility of cross training to care for younger patients (less than 12 years old). 1. To evaluate the psychometrics of the SANE Cross Training Attitudes Instrument. Self Efficacy 5,6 Bandura s 4 (1977) Social Learning Theory The measure of one's own ability to complete tasks and reach goals Locus of control: Low self efficacy associated with stress, depression, anxiety, and helplessness. High self efficacy related to higher grades; persistence in technical and/or scientific majors in undergrads Widely used for data collection Reliability and validity established A variable in many psychometric instruments Research Questions 1. What are the general attitudes, perceived efficacy and barriers among SANEs with regard to caring for younger patients and using the Massachusetts Pediatric Sexual Assault Evidence Kit (MA Pedi Kit)? 1. How do the SANEs evaluate their efficacy in caring for younger patients? 1. Do differences among the SANEs correlate with differences in attitudes regarding cross training? Marchetti 5
Participants Adult/Adolescent SANEs who are certified in Massachusetts From six of seven of the SANE regions will be invited to participate in the online research study. The Northeast region will be excluded A maximum of 160 SANEs will be included. Participants must be able speak and read English. Recruitment: Email sent via MA SANE listserv Link to sthe SANE Cross Training Attitudes Instrument will be hosted by SurveyMonkey The SANE Cross Training Attitudes Instrument 56 item 5 point Likert scale 1 (strongly disagree) 5 (strongly agree) Demographics Age Degree level Years of experience as a SANE SANE region Whether the SANE nurse has cared for pediatric patients Concepts examined: General Attitudes 10 Items Self Efficacy 17 Items Factors Related to Pediatric Cross Training 15 Items Potential Barriers 14 Items Analysis Data analyses will include: Descriptive statistics for demographic variables; reliability analyses for each construct; Item and total score analyses; and correlation and contingency analyses using Chi Square. Correlations among SANE characteristics and attitudes towards cross training Marchetti 6
Implications Findings from this study will: Inform the MA SANE Program, and others who may be considering expanding SANE services to provide care to younger patients. Inform training plans and protocols among SANE Programs and others who care for children who have experienced sexual assault. References 1. 2. Saltzman National Medicine violence http://www.nationalchildrensalliance.org/ treated Childrens LE, 2007:49;2:210 217 Basile in Alliance. emergency KC, Mahendra CAC departments. statistics: RR, et al. 2011. Accessed National Annals Available of estimates June Emergency at: 1, 2012 of sexual 1. Felitti, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine 1998:14;4:245 258 4. Marchetti, C.A., Fantasia, H. C., & Molchan, L. (2012). Attitudes of adult/adolescent sexual assault nurse examiners and caring for younger patients. Journal of Emergency Nursing. In press. 4. Bandura, A. (1989). Human agency in social cognitive theory. American Psychologist, 44, 1175 1184. Thank you for your attention. Please do not hesitate to contact me for any reason. Carol Anne Marchetti PhD, RN, FPMHNP BC, SANE c.marchetti@neu.edu Marchetti 7