Shifting Sexual Assault Forensic Examiners Orientation From Prosecutorial to Patient-Centered: The Role of Training

Abstract

Sexual assault forensic examiners (SAFEs) have a complex role that entails providing health care and medical forensic evidence collection. The literature indicates that there are two orientations that guide SAFEs in this role. A patient-centered orientation emphasizes attending to emotional needs, offering options, and respecting survivors' decisions, which has been linked to positive emotional outcomes. A prosecutorial orientation places emphasis on evidence collection and has been associated with providing fewer comprehensive services. SAFE training may play a pivotal role in guiding new SAFEs to adopt a patient-centered orientation. However, there is a paucity of research examining how training can bolster the adoption of this orientation. Thus, the current qualitative study explored if and how a national blended SAFE training influenced participants' adoption of a patient-centered orientation. Semistructured qualitative interviews were conducted with 64 health care professionals who participated in a national SAFE training. Utilizing analytic induction, the results suggest that the majority of participants entered the training with a prosecutorial orientation but shifted to a patient-centered orientation. Multiple elements of the training influenced this shift including (a) content that dispelled misconceptions of survivors; (b) providing explanations of how attending to survivors' well-being can lead to positive outcomes;

Ready for Anything

“…Such relationships have been shown to help prelicensure nursing students navigate unfamiliar situations and achieve personal goals (Andersen & Watkins, 2018). Although SANE trainees are necessarily already licensed, the entry into specialty practice may seem nearly as fraught as early career practice because of the added pressures of the need to support criminal prosecution and preventing patient retraumatization (Cole, 2018; Patterson et al, 2017). For SANE trainees, peer support provides opportunities to review aspects of practice, process secondary or vicarious traumas, and engage in mutual collaboration and learning.…”

“…SANE training involves acquainting trainees with the myriad of potential effects of violence and abuse relevant to the collection and preservation of forensic evidence; however, the psycho-neuro-emotional and cultural ramifications for both the patient and the SANE may be overlooked (Patterson et al, 2017). For the SANE, this can lead to increases in compassion fatigue, burnout, and secondary traumatic stress (Flarity et al, 2016).…”

“…For the SANE, this can lead to increases in compassion fatigue, burnout, and secondary traumatic stress (Flarity et al, 2016). Where students in prelicensure and advanced practice education are often encouraged to consider how they interact with patients in an environment of care, SANE trainees may instead be encouraged to focus on the legal and criminal justice ramifications of their practice—programs with this focus are described as “high prosecution” (Patterson et al, 2017). As Campbell and colleagues note, the “…conceptualization of nursing practice as a caring profession rooted in a holistic understanding of patients' lives is theoretically antithetical to the adversarial culture of the legal system” (Campbell et al, 2011, p. 17).…”

“…Nurses may therefore be unschooled in providing trauma-informed care and unaccustomed to managing trauma sequelae in patient care. The situation may be compounded in SANE training, where time-limited educational programs focus on evidence collection and other basics of practice (Patterson et al, 2017). As a result, SANEs may feel unequipped to engage in trauma-informed care when interacting with patients who likely have the greatest need.…”

The Link Between the SAMFE and Police Perceptions of Victim Credibility

“…3See Patterson et al (2020) for a discussion of prosecutorial versus patient-centered SANE professional orientations.…”