The Joint Commission Expands Sexual Assault Definition
By Gary Evans
The Joint Commission (TJC) has revised its definition of a sexual abuse/assault of healthcare workers, clarifying and expanding it to include social media and related technology. The original definition was developed more than a decade ago, before the ubiquitous presence of social media and related technology.
“Review of literature regarding cybercrimes, as well as review of events shared with TJC indicated that the definition required enhancement,” says Suzanne Gavigan, MSN, CRNP, CPPS, assistant director of quality and patient safety at TJC. “The new standard will be evaluated via the Sentinel Event policy. If a healthcare organization has an event that meets the criteria, it should perform an internal review. Healthcare organizations are then encouraged to share their review with The Joint Commission.”
Generally triggered by the death or serious harm of a patient, sentinel events call for comprehensive investigations that include a root cause analysis to determine why the issue happened and tactics for future prevention. The new definition goes into effect Jan. 1, 2023, for all TJC accreditation and certification programs, except the Health Care Staffing Services and Integrated Care Certification programs.
According to TJC, the new definition:
- updates and aligns sexual assault criteria with external entities;
- presents a shared model among stakeholders;
- provides clear and concise guidance for identifying such events.
The revised definition of sexual abuse/assault includes “non-consensual sexual contact of any type with any individual. This includes — but is not limited to — unwanted touching of any kind, especially of the breasts, buttocks, perianal area.”1
These are the key descriptions of what constitutes sexual abuse/assault under the new TJC definition.
- All types of sexual assault or battery such as rape, sodomy, and coerced nudity (partial or complete);
- Forced observation of masturbation and/or sexually explicit images, including pornography, texts, or social media;
- Taking sexually explicit photographs and/or audio/video recordings of an individual. This also includes maintaining and/or distributing these recordings (i.e., posting on social media). This includes, but is not limited to, nudity, fondling, and/or intercourse involving an individual.
Generally, sexual contact is non-consensual in the following situations:
- When the individual lacks the cognitive or legal ability to consent, even if he or she appears to want the contact to occur;
- When the individual does not want the contact.
“Other examples of non-consensual sexual contact may include, but are not limited to, situations where an individual is sedated, temporarily unconscious, or is in a coma,” TJC stated. “An individual’s current consent to engage in sexual activity is not valid if it is obtained from an individual lacking the capacity to consent, or consent is obtained through intimidation, coercion, or fear, whether it is expressed by the individual or suspected by staff.”
Any forced or coerced sex is considered abuse, regardless of a pre-existing or current sexual relationship.
“Organizations are required to conduct an investigation and protect an individual(s) from non-consensual sexual relations anytime the organization has reason to suspect that the individual(s) does not wish to engage in sexual activity or may not have the cognitive or legal ability to consent,” TJC noted.
Much like incidents of violence, sexual abuse and assaults likely are underreported in healthcare. However, sexual harassment and abuse of nurses has been widely revealed by the #MeToo movement.2 In research that excluded patients, looking only at sexual advances by colleagues or superiors in healthcare, 40% of the harassed women described disturbing coercive advances, bribery, or threats.3,4
“A healthcare organization should follow its internal policy for management of any allegation against staff,” Gavigan says.
Other nursing researchers report a spectrum that “includes offensive jokes, showing of sexual body parts, touching body parts of nurses, and showing of sexual materials. There are many unreported incidents in which nurses have experienced rape, offers for sexual involvement, and other types of harassment at the workplace. Findings of various studies on sexual violence in healthcare settings reveal that female nurses are more prone to sexual violence because their gentleness, caring attitude, and compassionate nature are wrongly perceived by some as sexual signals.”5
There may be a fine line between sexual assault and assault in general, as nurses face a barrage of dangerous patient behavior. According to a Press Ganey report, 5,217 nurses were assaulted in the second quarter of 2022. The findings are based on the organization’s analysis of 483 U.S. facilities in its National Database of Nursing Quality Indicators.
A request for additional, more specific information was not granted as this report was filed, but the company released this information in a news statement: “More than two nursing personnel were assaulted every hour in Q2 2022. That equates to roughly 57 assaults per day, 1,739 assaults per month, and 5,217 assaults per quarter.”6
Details of the attacks include:
- Psychiatric units, EDs, and pediatric units reported the highest number of assaults;
- Obstetrics and NICUs reported the lowest number of nurse assaults;
- Most assailants are patients, followed by family members, co-workers, visitors, and intruders;
- Most assailants are men, although women are more likely to commit assaults in pediatric and rehab units;
- Psych units and rehab units report the largest percentage of assaults resulting in moderate or severe injuries.
The current TJC definition of sexual abuse/assault, which expired Dec. 31, includes “non-consensual sexual contact, including oral, vaginal, or anal penetration.” One or more the following must be present to determine if the incident is a sentinel event:
- Any staff witnessing sexual contact;
- The perpetrator’s admission the sexual contact occurred on the organization’s premises;
- Sufficient clinical evidence to support allegations of non-consensual contact.
“However, sex abuse or assault often occurs without the presence of others, is seldom admitted to, and takes many forms that may not result in clinical evidence to prove an occurrence (for example, unwanted intimate touching),” TJC explained in changing to the new definition.
- The Joint Commission. Revision to Sentinel Event Policy definition of sexual abuse/assault. Oct. 19, 2022.
- Evans G. #MeToo in medicine? Sexual harassment in healthcare. Hospital Employee Health. March 1, 2018.
- Jagsi R, Griffith KA, Jones R, et al. Sexual harassment and discrimination experiences of academic medical faculty. JAMA 2016;315:2120-2121.
- Jagsi R. Sexual harassment in medicine - #MeToo. N Engl J Med 2018;378:209-211.
- Ross S, Naumann P, Hinds-Jackson DV, Stokes L. Sexual harassment in nursing: Ethical considerations and recommendations. Online J Issues Nurs 2019;24:1.
- Press Ganey. On average, two nurses are assaulted every hour, new Press Ganey analysis finds. Sept. 8, 2022.
The Joint Commission has revised its definition of a sexual abuse/assault of healthcare workers, clarifying and expanding it to include social media and related technology. The original definition was developed more than a decade ago, before the ubiquitous presence of social media and related technology.
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