Sexual Assault Nurse Examiner's Confidence to Care for Black, Indigenous, and Transgender Survivors: Development and Preliminary Content Validity of Practice Vignettes

Introduction: This paper developed and used practice vignettes to understand sexual assault nurse examiners' perceptions of self-confidence to provide care for Black, Indigenous, and transgender sexual violence survivors. Sexual assault nurse examiners are uniquely positioned to provide patient-centered postsexual violence health care but not all sexual assault nurse examiners receive culturally specific and identity-affirming training. Black/African American, Indigenous, and/or transgender people disproportionately experience sexual violence but may receive poorer health care after sexual violence compared with white cisgender people. Understanding sexual assault nurse examiner confidence to provide this care is paramount to improving sexual assault nurse examiner training and patient outcomes.

Methods: In collaboration with a nurse advisory board, researchers developed and validated 3 case vignettes that manipulated the race or gender of the patient. A fourth previously validated vignette that assessed sexual assault nurse examiner care for a transgender patient also was administered. Sexual assault nurse examiners then answered questions about their confidence to provide (1) a patient-centered safety plan, (2) patient-centered referrals, and (3) care without personal biases influencing care. The current study used a cross-sectional online self-report survey with 4 sexual assault nurse examiner patient vignettes randomized across a convenience sample of 70 sexual assault nurse examiners recruited from a midwestern state.

Results: On average, sexual assault nurse examiners rated the vignettes as realistic. Sexual assault nurse examiners reported lower confidence to develop a patient-centered safety plan, provide care without allowing personal biases to influence that care, and provide patient-centered referrals for Black, Indigenous, and/or transgender survivors compared with white cisgender survivors.

Discussion: Training and mentorship programs could improve sexual assault nurse examiner confidence to provide trauma- and violence-informed care for Black, Indigenous, and transgender survivors, and vignettes could be used to measure changes in confidence owing to training.