Victims of sexual assault require specialized medical care when they report to hospital emergency departments including physical examination, evidence collection, and emotional support. Sexual Assault Nurse Examiners (SANEs) are medical professionals trained to complete the examination and evidence collection in a prompt and sensitive manner. In fact, where SANE programs exist, emergency room waiting times are shorter, evidence collection improves, and revictimization from untrained staff is reduced. Unfortunately, SANEs are not widely available, particularly in rural areas. This lack of trained examiners employed at local hospitals creates a gap in access to proper care, often resulting in long waits as hospitals try to locate an examiner, treatment from untrained staff, or a referral to another hospital. The purpose of this study was to determine SANE's perceptions of the barriers contributing to their low representation in one Midwestern rural community. In-depth semi-structured interviews were completed with six Sexual Assault Nurse Examiners.

Findings of this study suggested that Sexual Assault Nurse Examiners working in rural areas experience many of the same difficulties that Sexual Assault Nurse Examiners in urban areas experience in addition to their own unique challenges. Difficulties that rural and urban SANEs have in common include frustrations with on-call systems, difficulties with scheduling, difficulties maintaining competency and proficiency in SANE skills, and experiences of vicarious trauma. SANEs working in rural areas face unique challenges related to patient privacy as well as their own challenges related to competency. This study suggested for example, that rural SANE programs face additional challenges keeping SANEs proficient in their skills because of the low rates of sexual assault survivors seeking SANE services in rural areas. Policy recommendations and avenues for future research are also discussed.


Laura Harrison

Committee Member

Annelies Hagemeister

Committee Member

Maria Bevecqua

Date of Degree




Document Type



Master of Science (MS)


Social and Behavioral Sciences

Creative Commons License

Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License



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