Equipping Nurses to Support Survivors of Sexual Assault and Intimate Partner Violence

Sexual Assault and Intimate Partner Violence: Awareness and Prevention

Sexual assault remains a prevalent issue in the United States and around the world. In a survey by the CDC, 53% of women and 29% of men in the US reported experiencing contact sexual violence. 

The overlap of sexual assault and intimate partner violence is well documented. According to the Rape, Abuse & Incest National Network (RAINN), approximately 33% of sexual assaults are perpetrated by a current or former intimate partner, and 40-45% of individuals in abusive relationships experience sexual assault by their partner.

Two recent Doctor of Nursing Practice student projects at the School of Nursing empower nurses to support those who have been subjected to sexual assault and intimate partner violence, demonstrating the life-saving potential of nurse-led interventions.

Reducing Wait Times for Sexual Assault Survivors

DNP student Lucy Frank, MSN, APRN, PMHNP-BC, SANE, is conducting a quality improvement project that assesses wait times for patients seeking Sexual Assault Evidence Kits (SAEKs). Her project was inspired by her work as a Sexual Assault Nurse Examiner (SANE) at the Duke University Emergency Department.

“SANE nurses receive enhanced training not only on collecting the forensic SAEK, performing appropriate documentation, and providing evidence testimony as a fact or expert witness in court, but also on making medical recommendations for imaging and medication administration because of their exam,” said Frank. “They also provide connection to safety resources, social work, law enforcement for reports, and crisis centers when necessary.”

“Studies show a SANE nurse at the bedside heightens conviction rates, enhances trauma-informed care, and connects patients with more resources,” Frank added.

An absence of full-time SANE nurses results in long wait times for patients, Frank explained, which can impede the delivery of care, since much of the exam is time sensitive.

“HIV prophylaxis in acute risk populations is efficacious when started 72 hours after an assault,” said Frank. “Also, in drug-facilitated sexual assault (DFSA), many drugs used during an assault to alter the survivor’s consciousness are out of their system within 24 hours, making it untestable if they are out of this window.”

As many emergency departments nationwide struggle to meet standards advocating for round-the-clock access to kits, Frank is working closely with her department’s SANE program to address wait times and deliver optimal patient care.

“Any time lapse represents degradation of forensic evidence, lack of opportunities for HIV prevention, and concerns for missed injuries or opportunities to connect patients with crisis resources,” Frank said. “This can literally save lives."

Preventing Fatalities Due to Intimate Partner Violence

After previously working as a SANE nurse herself, Chantal Howard, DNP, RN, CEN, NEA-BC, graduated from the School of Nursing’s DNP program in 2024 and now sits on Frank’s DNP committee. Dr. Howard's own DNP project, which earned the Outstanding DNP Scholarly Project Award, focused on initiating a Lethality Assessment Program in the Duke University Emergency Department, enabling nurses to screen patients with signs of intimate partner violence to assess the risk of homicide.

Dr. Howard’s DNP project was inspired by her experience serving on the Domestic Fatality Review Team in Wake County, created in 2013 at the direction of the state legislature to gather findings and work to prevent future domestic violence fatalities.

Instituting the Lethality Assessment Program

Through her work in Wake County, Dr. Howard became familiar with the Lethality Assessment Program (LAP), a screening questionnaire developed by Duke alumna Dr. Jacquelyn Campbell that is administered to patients to determine the risk that they will be killed or seriously injured by an intimate partner.

While LAP is currently utilized in several states, it is typically delivered by law enforcement—officers responding to a 911 call, for example—who then initiate a warm handoff with a local crisis center. 

“When I learned of this program, I thought: if the police can do this, why aren't we doing this in the hospitals?” said Dr. Howard. “If we educate nurses on the signs or red flags of intimate partner violence, they can perform these screenings and connect the patients with potentially life-saving resources.”

In collaboration with the Durham Crisis Response Center, Dr. Howard trained 143 nurses to recognize the signs of intimate partner violence and deliver the LAP screening.

By December 2024, 36 patients had been screened, with 33 scoring as high risk for being killed or seriously injured. Of these 33 patients, 22 accepted handoffs and spoke with the Durham Crisis Response Team, resulting in 51 delivered services including counseling, safety planning, emergency shelter, and domestic violence protective orders or other legal measures.

“Not everybody is ready for the handoff or to leave the relationship, but the screening can still serve as an educational tool,” said Dr. Howard. “If the perpetrator has choked the patient, has a gun, and is constantly jealous—and then loses their job on top of that—the patient can think back to the questionnaire and understand that they are now at high risk of being killed.”

Dr. Rosa Gonzalez-Guarda, PhD, MPH, RN, FAAN, Associate Professor and Assistant Dean of the PhD Program, spoke to the unique contributions and lasting impact of Dr. Howard’s work.

“Chantal’s project was not just an academic exercise, but a longstanding commitment to saving lives. Her implementation of the lethality assessment program was novel in its application in an emergency department, a setting where women experiencing intimate partner violence are more likely to seek care, but are rarely screened for danger,” said Dr. Gonzalez-Guarda.

“Her project demonstrates the effectiveness of training nurses to implement the lethality assessment protocol and its potential impact in improving outcomes for survivors of intimate partner violence as well as their families and communities,” Dr. Gonzalez-Guarda added.