Teaching Empowering Care to Forensic Nurses: Lessons Learned from a National Training

Purpose: Sexual assault survivors often feel traumatized by the post-assault care they receive in traditional hospital emergency departments, which often leave them feeling more depressed, blamed, and reluctant to seek further help. To address this problem, Sexual Assault Forensic Examiner (SAFE) programs were developed to provide comprehensive medical forensic care and crisis intervention by forensic nurses. Research has suggested that SAFEs can have a positive impact on survivors’ emotional wellbeing, because they espouse an empowering care philosophy (e.g., offering and respecting survivors’ choices) (Campbell et. al, 2008). However, healthcare disciplines have long-standing roots in medical or deficit-based models, which can pose challenges with training professionals to implement empowerment into their patient care. The current qualitative study examines how a national blended SAFE training (12-week online didactic component combined with an in-person two-day clinical simulation) fostered students’ knowledge and skills of implementing empowering care.

Method: In-depth semi-structured qualitative interviews were conducted with 64 healthcare professionals who participated in a national SAFE training about their experiences and challenges with applying empowerment theory in their practice with survivors. Data analysis proceeded in two phases. First, two analysts developed open codes that captured key thematic content in the survivors' narratives. In the second phase, we used Erickson's (1986) analytic induction method for data analysis, which is an iterative procedure for developing and testing empirical assertions in qualitative research.

Results: While the online training helped students understand the importance of empowering care, most students indicated that the clinical training played a stronger role in helping them learn how to provide this model of care. The students explained that the hands-on practice and instructor feedback were beneficial because they helped students conceptualize patient care with the patients’ emotional needs in mind. Students reported that the realistic nature of the mock scenarios portrayed by live models was particularly beneficial to learning how to empower survivors. By following the live models’ cues (e.g. allowing or not allowing certain procedures similar to how a patient may react), students were given practice on how to follow the needs of the patient, which is a critical component of empowering care. Furthermore, observing the instructors demonstrate empowering care helped students learn how to avoid re-traumatizing sexual assault patients. Students were asked to describe how they approached their post-training patients. Students identified utilizing many empowering care approaches they learned in the training. However, many students expressed fear of re-traumatizing survivors, and felt less prepared to provide empowering care for underserved population.

Implications: While forensic nurses have been trained traditionally through didactic instruction, the findings highlight the importance of utilizing simulated training to teach empowerment. Post-training, many nurses did not feel confident with providing empowering care, because they did not have trained SAFEs in their institutions to provide feedback and mentoring. Social work has a long-standing history rooted in empowerment theory and thus, social workers would be a viable option to mentor nurses on empowerment practice. The author will elaborate on these implications for social work-nurse mentoring opportunities.