Sexual Assault Nurse Examiner (SANE) Programs : Alternative Systems for Service Delivery for Sexual Assault Victims

To determine the effects of actual waiting time, perception of waiting time, information delivery, and expressive quality on patient satisfaction. During a 12-month study period, a questionnaire was administered by telephone to a random sample of patients who had presented to a suburban community hospital emergency department during the preceding 2 to 4 weeks. Respondents were asked several questions concerning waiting times (ie, time from triage until examination by the emergency physician and time from triage until discharge from the ED), information delivery (eg, explanations of procedures and delays), expressive quality (eg, courteousness, friendliness), and overall patient satisfaction. There were 1,631 respondents. The perception that waiting times were less than expected was associated with a positive overall satisfaction rating for the ED encounter (P < .001). Satisfaction with information delivery and with ED staff expressive quality were also positively associated with overall satisfaction during the ED encounter (P < .001). Actual waiting times were not predictive of overall patient satisfaction (P = NS). Perceptions regarding waiting time, information delivery, and expressive quality predict overall patient satisfaction, but actual waiting times do not. Providing information, projecting expressive quality, and managing waiting time perceptions and expectations may be a more effective strategy to achieve improved patient satisfaction in the ED than decreasing actual waiting time.

This research examined how contact with the legal, medical, and mental health systems affects rape survivors' psychological well-being. Although community services may be beneficial for some victims, there is increasing evidence that they can add trauma, rather than alleviate distress (termed secondary victimization). This study examined how secondary victimization affects rape survivors' posttraumatic stress (PTS) symptoms. Adaptive and snowball sampling were used to recruit a sample of 102 rape survivors. Victims of nonstranger rape who received minimal assistance from either the legal or medical system, and encountered victim-blaming behaviors from system personnel, had significantly elevated levels of PTS. This high-risk group of rape survivors had PTS levels significantly higher than all other victims in this study, including those who did not seek community assistance postrape. However, for these high-risk rape survivors, receiving sustained mental health services after these negative experiences was associated with a significant decrease in PTS.

This research examined how the legal, medical, and mental health systems respond to the needs of rape victims. A national random sample of rape victim advocates (N = 168) participated in a phone interview that assessed the resources available to victims in their communities, as well as the specific experiences of the most recent rape victim with which they had completed work. Results from hierarchical and iterative cluster analysis revealed three patterns in victims' experiences with the legal, medical, and mental health systems. One group of victims had relatively positive experiences with all three systems, a second group had beneficial outcomes with only the medical systems, and the final group had difficult encounters with all three systems. Multinominal logistic regression was then used to evaluate an ecological model predicting cluster membership. Community-level factors as well as features of the assault and characteristics of the victims predicted unique variance in victims' outcomes with the legal, medical, and mental health systems. These findings provide empirical support for a basic tenet of ecological theory: environmental structures and practices influence individual outcomes. Implications for ecological theory and interventions to improve the community response to rape victims' needs are discussed.