Medical Advocates’ Care for Sexual Assault Survivors: Emergency Room Nurses’ Perspectives

“Consistent with best practices in qualitative methodology, participants were sampled until the team determined theoretical saturation — redundancy of major patterns and themes without novel insights — was achieved (Morrow, 2007).”

“Prior work by Campbell and colleagues suggests nurses can provide reliable information about survivors ’ experiences (Campbell, 2006; Campbell et al., 2005, 2022).”

“SANE training involves explicit instruction on the role of medical advocates (Campbell et al., 2005), and may, therefore, impact how nurses perceive advocates ’ practices.”

“For some survivors, contact after services may be unwanted and triggering (Campbell et al., 2019).”

“They suggest supporting survivors ’ decisions (Patterson & Campbell, 2010; Patterson & Tringali, 2015) and providing emotional support and connection to follow-up care are helpful (Maier, 2012), while struggling to connect with survivors or being too quiet is unhelpful (Downing & Mackin, 2012).”

“Advocates often lack diversity, particularly related to race/ethnicity and age (Bach et al., 2021).”

“Advocates are also trained to provide this information in easy-to-understand language and to talk through the decision-making process with survivors (Wasco et al., 2004).”

“In addition, the medical advocate helps ensure the survivor receives the available medical options they desire during care (Greeson & Campbell, 2011).”

“For example, research has found advocates sometimes struggle with being empathetic and compassionate for all survivors (Kolb, 2011), which may translate to gaps in service delivery.”

“These fi ndings are concerning, as medical advocates ’ primary role is to support survivors in whatever decisions they make regarding their bodies and care (Greeson & Campbell, 2011).”

“A recent systematic review of rape victim advocacy concluded that most empirical research on rape victim advocacy has been conducted by studying advocates (Wegrzyn et al., 2023).”

“They suggest supporting survivors ’ decisions (Patterson & Campbell, 2010; Patterson & Tringali, 2015) and providing emotional support and connection to follow-up care are helpful (Maier, 2012), while struggling to connect with survivors or being too quiet is unhelpful (Downing & Mackin, 2012).”

“However, SANEs have also noted that, occasionally, advocacy services may not be well received if the advocate is too quiet or struggles to connect with the survivor (Downing & Mackin, 2012).”

“However, to date, this literature has only relied on the perspectives of SANEs, although non-SANEs also respond to survivors (Delgadillo, 2017).”

“For example, nurses have reported advocates may interrupt them or ask too many questions throughout the medical process, which can delay and/or disrupt patient care (Hoffman et al., 2023; Patterson, 2014).”

“Further, research on multidisciplinary collaboration suggests valuing one another ’ s work is important to effective collaboration (Greeson et al., 2019; Hoffman et al., 2023).”

“Others may be nurses with little or no specialized training in caring for survivors (Adams & Hulton, 2016).”

“Prior work by Campbell and colleagues suggests nurses can provide reliable information about survivors ’ experiences (Campbell, 2006; Campbell et al., 2005, 2022).”

“If the survivor consents to advo-cacy services, the nurse and medical advocate should work as a team to support the survivor and address their needs holistically (Wegrzyn et al., 2021).”

“An advocate may re-explain options to survivors multiple times, even after information has been provided by medical staff (Hoffman et al., 2023; Shaw & Campbell, 2011).”

“Recent research demonstrates that non-SANEs have less trust in advocates and understanding of their roles (Zinter et al., 2023).”