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DNP Project · 2023

Development of an Evidence-Based Protocol: Trauma-Informed Pelvic Exams in the Emergency Department

Ashley Tuttle, DNP, APRN, CNM, FNE · Doctor of Nursing Practice in Midwifery, University of Kansas School of Nursing

The protocol behind the Pelvic Exam Tool started as this doctoral project. Its aim was an evidence-based, trauma-informed protocol for patients having a pelvic exam in the emergency department, with preferred language and scripting and recommended exam techniques.

  • Help clinicians perform trauma-informed pelvic exams
  • Improve clinician confidence with trauma-informed exams
  • Increase patient satisfaction
Download the full paper (PDF, 1.2 MB)Use the Pelvic Exam Tool

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Development of an Evidence-Based Protocol: Trauma-Informed Pelvic Exams in the Emergency Department

Ashley Tuttle, DNP, APRN, CNM, FNE

Doctor of Nursing Practice in Midwifery · University of Kansas School of Nursing · 2023

What the literature showed

The patient’s perspective

Women with a history of sexual violence reported more distress and pain during pelvic exams. Young women having their first exam asked for rapport, orientation, and continuous feedback.

Trauma-informed care

Using SAMHSA’s Four Rs and shared decision-making improved patients’ experience of the exam.

Stirrup-free exams

In a randomized trial of 197 women, exams without stirrups lowered patients’ sense of vulnerability.

Presentations

This work has been presented at national and regional conferences.

  1. Supporting Patient Autonomy in Pelvic Examinations: A Trauma-Informed Framework for Midwifery Care

    Podium presentation · American College of Nurse-Midwives (ACNM) Annual Meeting

  2. Development of an Evidence-Based Protocol: Trauma-Informed Pelvic Exams in the Emergency Department

    Podium presentation · International Association of Forensic Nurses Annual Conference

  3. Development of an Evidence-Based Protocol: Trauma-Informed Pelvic Exams in the Emergency Department

    Podium presentation · St. Luke’s Health System Annual Clinical Forensic Conference

  4. Trauma-Informed Pelvic Exams

    Podium presentation · International Association of Forensic Nurses Annual Conference

Selected project references

  • Ades V, Wu SX, Rabinowitz E, et al. An integrated, trauma-informed care model for female survivors of sexual violence. Obstet Gynecol. 2019;133(4):803–809.
  • AGREE Next Steps Consortium. The AGREE II Instrument. 2013. www.agreetrust.org
  • Chor J, Stulberg DB, Tillman S. Shared decision-making framework for pelvic examinations in asymptomatic, nonpregnant patients. Obstet Gynecol. 2019;133(4):810–814.
  • Cuevas KM, Balbo J, Duval K, Beverly EA. Neurobiology of sexual assault and osteopathic considerations for trauma-informed care and practice. J Am Osteopath Assoc. 2018;118(2):e2–e10.
  • Grol R, Wensing M, Eccles M, Davis D. Improving Patient Care: The Implementation of Change in Health Care. 2nd ed. Wiley Blackwell; 2013.
  • Scott KM, Kessler RC, Stein DJ, eds. Trauma and Posttraumatic Stress Disorder in the World Mental Health Surveys. Cambridge University Press; 2017.
  • Seehusen DA, Johnson DR, Earwood JS, et al. Improving women’s experience during speculum examinations at routine gynaecological visits: randomised clinical trial. BMJ. 2006;333(7560):171.
  • Smith SG, Zhang X, Basile KC, et al. The National Intimate Partner and Sexual Violence Survey: 2015 Data Brief—Updated Release. Centers for Disease Control and Prevention; 2018.
  • Weitlauf JC, Finney JW, Ruzek JI, et al. Distress and pain during pelvic examinations: effect of sexual violence. Obstet Gynecol. 2008;112(6):1342–1350.

The full reference list is in the paper. More sources are on the References page.