Responding to the Challenges and Barriers Unique to Rural Appalachian Sexual Assault Nurse Examiner Programs

Abstract

The purpose of this article is to explore the opportunities and barriers challenging sexual assault nurse examiners (SANEs) operating in rural and underserved areas. These challenges include the absence of established SANE programs, patient isolation and poverty, inadequate community support, and ensuring program sustainability. While not specific to rural communities, these challenges and barriers are further exacerbated by long-held beliefs and misconceptions that exist in small, close-knit communities. To mitigate these challenges, SANE programs in rural communities are asked to respond with creative and unique solutions. Through strong community partnerships and carefully coordinated efforts, SANE programs can thrive in even the most isolated and economically depressed rural communities.

Sexual Assault Nurse Examiner Education Needs in Texas

“…An inventory of available sexual assault services in Texas affirms the lack of SANE coverage in the state (Kellison et al, 2020; Senate Bill 71, 2019), and the lack of SANE availability is a significant issue across the United States (Lechner et al, 2021). As Texas boasts three of the 10 largest cities as well as the nation’s greatest rural population (Murdock & Cline, 2021), the scarcity is more burdensome for rural areas where unreported sexual assaults may be higher and SANEs’ ability to gain experience and expertise in their own communities may be lower (Sheeran et al, 2022; Thiede & Miyamoto, 2021; Treat et al, 2022). In 2013, Senate Bill 1191 required all Texas healthcare facilities with emergency departments to have educated healthcare professionals to collect medical forensic evidence during the examination of patients who reported sexual assault (Davis et al, 2017).…”

“…However, the statute’s minimum education time requirement for these professionals was set at 2 hours, leaving institutions to set their requirements equally low. Access to SANE training and education nationwide is scarce, further adding to the shortage (Sheeran et al, 2022).…”

“…Responses specifically requested courses that could be offered in the format of virtual workshops. Literature supports blended learning programs that pair online education and simulated clinical experiences to enhance in-person classroom education or training (Sheeran et al, 2022). The CEFN program reduces the cost and increases access to SANE education in Texas.…”

Leveraging Telehealth to Address Sexual Assault Nurse Examiner Access Disparities in Rural Communities

“…Government Accountability Office, 2016). Yet, across the country, persons in rural areas experience reduced access to SANE care (Annan, 2014; Thiede & Miyamoto, 2021; Treat et al, 2022; U.S. Government Accountability Office, 2018).…”

“…provided by forensic nurses (American College of Emergency Physicians, 2020; American College of Obstetricians and Gynecologists, 2019; U.S. Government Accountability Office, 2016). Yet, across the country, persons in rural areas experience reduced access to SANE care (Annan, 2014;Treat et al, 2022;U.S. Government Accountability Office, 2018).…”