Empowering Nurses to Lead: Enhancing Confidence in Trauma-Informed Discharge Readiness Assessment
Year: 2026
Type: dissertation
Abstract: Background: Sexual assault is a pervasive, ongoing public health problem that affects all genders, races, ages, sexual orientation, and socio-economic statuses. (Rape, Abuse & Incest National Network , n.d.). Sexual assault includes a broad spectrum of sexual acts, attempted or completed, that ranges from sexual touch to rape that are committed without a person’s freely given consent. These acts can be committed through force, threat of force, and/or verbal coercion lifetime (The American College of Obstetricians and Gynecologists , 2019). Because the trauma experienced by survivors of sexual assault can have lasting and devastating effects on their mental, social, physical, and emotional wellbeing, it is imperative to use a trauma-informed approach when developing a plan of care for this vulnerable population (Ashworth et al., 2023). Incorporating trauma-informed care into every aspect of the care encounter provides sexual assault survivors the opportunity to regain control that may have been lost during the present or past traumatic experience. In the Greater Tucson area, Sexual Assault Nurse Examiners (SANEs), independently contracted through the Southern Arizona Center Against Sexual Assault (SACASA), provide trauma-informed forensic care to survivors of sexual assault. Because documentation from the SANE is included within the medical forensic examination kit and, therefore, separate from the survivors’ emergency department medical record, the SANE completes his or her own discharge process. This process is completed prior to referring the survivor back to the main emergency department. While these nurses are highly skilled in addressing both clinical and emotional trauma, no formal process currently exists to assess discharge readiness using a structured tool. Instead, discharge decisions are made based solely on the SANE’s clinical judgment, which may result in unmet psychosocial needs of the victim, inadequate preparation for transition, or missed opportunities for connection to post-assault resources. The implementation of the RN-Readiness for Hospital Discharge Scale (RN-RHDS), enhanced to include five trauma-informed nurse perception statements, offered an opportunity to equip SANEs with a standardized, survivor-centered assessment tool. Because nurses work closely with the patient, it is paramount that they are provided resources to not only drive forward the discharge process but also empower them to use their clinical judgement to address gaps in patient care.Purpose: The purpose of this project was to explore if the Registered Nurse- Readiness for Hospital Discharge Scale, enhanced with the addition of five nurse perception statements can improve nurse confidence in assessing the discharge readiness of sexual assault survivors. Methods: This project incorporated a quasi-experimental, one group pre- and post- test design to evaluate the impact of a trauma-informed discharge readiness assessment tool on nurse confidence with the discharge process for victims of sexual assault. A convenience sample of registered nurses that are independently contracted with the Southern Arizona Center Against Sexual Assault (SACASA) was recruited to participate. Participants were required to watch an educational presentation of the RN-RHDS, its benefits, and how to use it within the discharge workflow. Nurse confidence was evaluated using brief, self-developed pre- and post- surveys. Each participant was asked to create a unique, four-digit identifier that was used for both the pre- and two post- implementation surveys. Participants were required to use the same identifier for each survey so that responses to each survey could be compared. Results: Quantitatively, mean scores increased across all domains following implementation of the enhanced RN-RHDS; however, none of the paired comparisons reached statistical significance. These findings suggest a positive directional trend following implementation of the discharge readiness assessment tool. Qualitative responses indicated that SANEs frequently encountered challenges securing housing resources, experienced inconsistent adherence to established plans of care by emergency department staff and expressed concerns regarding survivors’ ability to maintain prescribed medication regimens. One participant specifically noted the need for a more streamlined discharge process. Conclusions: The findings of this study suggest that incorporating a standardized, survivor-centered discharge readiness assessment tool may enhance the quality and consistency of discharge planning, support nurse decision-making, and promote holistic, trauma-informed care for survivors of sexual assault. Providing nurses with structured tools that support clinical decision-making can empower them to take a more active role in discharge planning, strengthening their ability to practice to the full extent of their scope while advocating for safe and effective transitions of care.
Author: Saxton, Jennifer Rose
Language: English
Subfield: Gender Studies
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W7162170464