Research| Volume 48, ISSUE 6, P709-718, November 2022

Download started.


Pathway to Healing and Recovery: Alleviation of Survivor Worries in Sexual Assault Nurse Examiner-Led Sexual Assault Telehealth Examinations

Published:August 12, 2022DOI:



      The purpose of this study is to understand the pre-examination worries of individuals who experience sexual assault, and whether those worries were experienced or resolved during a telehealth-enabled, sexual assault nurse examiner-led sexual assault examination.


      Patient surveys were administered to understand pre-examination worries, whether those worries were ultimately experienced during the consultation, and patient perceptions of care quality, telehealth consultation, and whether the examination helped individuals feel better. Data analysis was conducted using descriptive statistics and binomial proportion tests.


      Surveys were collected from 74 adolescents and adults who obtained sexual assault care at 6 rural and 2 suburban hospitals. Study findings showed individuals overcome substantial worries to access care, with 66% having at least 1 worry and 41% endorsing 3 or more pre-examination worries. Most participants felt believed (83%) and did not feel judged (88%) or blamed (85%) during their examination. Analysis of pre-examination worries and worry resolution during the examination showed 88% to 100% resolution of worries related to being believed, judged, blamed or lacking control. Participants highly rated the quality of care received (92%) and 84% stated the examination helped them feel better, suggesting a sexual assault nurse examiner-led examination is an important step toward recovery and healing.


      These findings have implications for emergency department support for sexual assault nurse examiner-led care and public health messaging to demystify sexual assault care, allay fears, and highlight care benefits.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Criminal victimization, 2017. Morgan R, Truman J.
        (Published 2019. Accessed March 28, 2022.)
        • Campbell R.
        • Javorka M.
        • Gregory K.
        • Vollinger L.
        • Ma W.
        The right to say no: why adult sexual assault patients decline medical forensic exams and sexual assault kit evidence collection.
        J Forensic Nurs. 2021; 17: 3-13
        • Nielson M.H.
        • Strong L.
        • Stewart J.G.
        Does sexual assault nurse examiner (SANE) training affect attitudes of emergency department nurses toward sexual assault survivors?.
        J Forensic Nurs. 2015; 11: 137-143
      2. Federal Bureau of Investigation, National Incident-Based Reporting System, 2012-2016 (2017). The criminal justice system: statistics. RAINN; 2022. Accessed March 28, 2022.

        • Campbell R.
        • Patterson D.
        • Bybee D.
        Prosecution of adult sexual assault cases: a longitudinal analysis of the impact of a sexual assault nurse examiner program.
        Violence Against Women. 2012; 18: 223-244
        • Kjærulff M.L.B.
        • Bonde U.
        • Astrup B.S.
        The significance of the forensic clinical examination on the judicial assessment of rape complaints–developments and trends.
        Forensic Sci Int. 2019; 297: 90-99
        • Amstadter A.B.
        • McCauley J.L.
        • Ruggiero K.J.
        • Resnick H.S.
        • Kilpatrick D.G.
        Service utilization and help seeking in a national sample of female rape victims.
        Psychiatr Serv. 2008; 59: 1450-1457
        • Campbell R.
        • Wasco S.M.
        • Ahrens C.E.
        • Sefl T.
        • Barnes H.E.
        Preventing the “second rape” rape survivors’ experiences with community service providers.
        J Interpers Violence. 2001; 16: 1239-1259
        • Resnick H.S.
        • Holmes M.M.
        • Kilpatrick D.G.
        • et al.
        Predictors of post-rape medical care in a national sample of women.
        Am J Prev Med. 2000; 19: 214-219
        • Ullman S.E.
        • Lorenz K.
        African American sexual assault survivors and mental health help-seeking: a mixed methods study.
        Violence Against Women. 2020; 26: 1941-1965
        • Zinzow H.M.
        • Resnick H.S.
        • Barr S.C.
        • Danielson C.K.
        • Kilpatrick D.G.
        Receipt of post-rape medical care in a national sample of female victims.
        Am J Prev Med. 2012; 43: 183-187
        • Peterson C.
        • DeGue S.
        • Florence C.
        • Lokey C.
        Lifetime economic burden of rape in the United States.
        Am J Prev Med. 2017; 52: 691-701
        • Miyamoto S.
        • Thiede E.
        • Dorn L.
        • Perkins D.F.
        • Bittner C.
        • Scanlon D.
        The Sexual Assault Forensic Examination Telehealth (SAFE-T) Center: a comprehensive, nurse-led telehealth model to address disparities in sexual assault care.
        J Rural Health. 2021; 37: 92-102
        • Miyamoto S.
        • Thiede E.
        • Wright E.N.
        • et al.
        The implementation of the sexual assault forensic examination telehealth Center: a program evaluation.
        J Forensic Nurs. 2021; 17: E24-E33
      3. IRB Member - Biomedical Focus. Citi Program. Published 2018.
        (Accessed July 28, 2022)
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • et al.
        The REDCap consortium: building an international community of software platform partners.
        J Biomed Inform. 2019; 95103208
        • Campbell R.
        • Greeson M.R.
        • Fehler-Cabral G.
        With care and compassion: adolescent sexual assault victims’ experiences in sexual assault nurse examiner programs.
        J Forensic Nurs. 2013; 9: 68-75
        • Fehler-Cabral G.
        • Campbell R.
        • Patterson D.
        Adult sexual assault survivors’ experiences with sexual assault nurse examiners (SANEs).
        J Interpers Violence. 2011; 26: 3618-3639
        • Kim Y.
        • Dykema J.
        • Stevenson J.
        • Black P.
        • Moberg D.P.
        Straightlining: overview of measurement, comparison of indicators, and effects in mail–web mixed-mode surveys.
        Soc Sci Comput Rev. 2019; 37: 214-233
        • Peugh J.L.
        • Enders C.K.
        Missing data in educational research: a review of reporting practices and suggestions for improvement.
        Rev Educ Res. 2004; 74: 525-556
        • Lee K.J.
        • Tilling K.M.
        • Cornish R.P.
        • et al.
        Framework for the treatment and reporting of missing data in observational studies: the Treatment and Reporting of Missing data in Observational Studies framework.
        J Clin Epidemiol. 2021; 134: 79-88
        • Little R.J.
        A test of missing completely at random for multivariate data with missing values.
        J Am Stat Assoc. 1988; 83: 1198-1202
        • Du Mont J.
        • Macdonald S.
        • White M.
        • et al.
        Client satisfaction with nursing-led sexual assault and domestic violence services in Ontario.
        J Forensic Nurs. 2014; 10: 122-134
        • Lechner M.
        • Bell K.
        • Short N.A.
        • et al.
        Perceived care quality among women receiving sexual assault nurse examiner care: results from a 1-week postexamination survey in a large multisite prospective study.
        J Emerg Nurs. 2021; 47: 449-458
        • Campbell R.
        • Patterson D.
        • Lichty L.F.
        The effectiveness of sexual assault nurse examiner (SANE) programs: a review of psychological, medical, legal, and community outcomes.
        Trauma Violence Abuse. 2005; 6: 313-329
        • Nugent-Borakove M.E.
        • Fanflik P.
        • Troutman D.
        • Johnson N.
        • Burgress A.
        • O’Connor A.
        Testing the Efficacy of the SANE/SART Programs.
        American Prosecutors Research Institute website, Published 2006 (Accessed March 28, 2022.
        • Ullman S.E.
        Correlates of social reactions to victims’ disclosures of sexual assault and intimate partner violence: a systematic review.
        Trauma Violence Abuse. 2021; 15248380211016013
        • Campbell R.
        • Bybee D.
        • Townsend S.M.
        • Shaw J.
        • Karim N.
        • Markowitz J.
        The impact of sexual assault nurse examiner programs on criminal justice case outcomes: a multisite replication study.
        Violence Against Women. 2014; 20: 607-625
        • Campbell R.
        • Fehler-Cabral G.
        Why police “couldn’t or wouldn’t” submit sexual assault kits for forensic DNA testing: a focal concerns theory analysis of untested rape kits.
        Law Soc Rev. 2018; 52: 73-105


      Sheridan Miyamoto is Associate Professor and Director of the SAFE-T Center, Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA. Twitter: @SWMiyamoto. ORCID identifier:


      Elizabeth Thiede is Doctoral Student, Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA. ORCID identifier:


      Cameron Richardson is Assistant Research Professor, Clearinghouse for Military Family Readiness, The Pennsylvania State University, University Park, PA. ORCID identifier:


      Elizabeth N. Wright is Post-Doctoral Scholar, Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA. ORCID identifier:


      Cynthia Bittner is Assistant Director of the SAFE-T Center, Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA.