Posts Tagged ‘Sexual Assault Nurse Examiner’

Are Staff Nurses Prepared to Care for Domestic Violence Victims?

December 25, 2008

As nurses, we advocate for our patients and we attempt to provide them with the best care possible based on theory, evidence-based practice, and research. Nurses advocate for women who are abused and attempt to counsel them on their value and who they are as a person. Nurses attempt to help heal victim’s wounds and find resources for them to continue on with life, preferably a healthy, happy, and safe life. The problem comes in when nurses are unprepared to collect evidence in the ER or office when a domestic violence victim seeks our help. The victim does not often get a second chance and so as nurses we can’t afford to miss anything, and we need to get everything right the first time for these women. How many times have we seen the perpetrator get off free because of lack of evidence? In many large city hospitals forensic nurses are trained and on staff 24/7 to provide care and collect evidence when domestic violence victims are brought in. My question is what happens to the victims that seek care in a small town hospital? Many of these hospitals see domestic violence victims infrequantly and don’t have adequately trained staff to care for them when they do seek help. As a former ER nurse I have been in situations caring for rape victims. We had a kit available but read through it step by step and prayed we performed the exam correctly. I believe a nurse with knowledge of an advanced health assessment can be a great help to victims in being able to detect abnormal findings and reporting them in full detail. This is a great start, but what else can nurses in small hospitals do to make sure domestic violence victims receive care a forensic nurse can give without the forensic nurse qualifications?

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Sexual Assault: Forensic Nursing in the ER, comment

November 15, 2007

RE: The post from August 9, 2005 and titled:
Sexual Assault: Forensic Nursing in the ER, in Forensic Nursing Chronicles

Fortunately in this case, the nurse (and /or physician) had the insight to do a rape kit and take the child seriously. All too frequently we hear about children who have been repeatedly sexually abused by a relative or a family friend, only to find out that their parent or caretaker didn’t take them seriously. These sexual acts, from molestation to penetration can have serious consequences to the child later in life.
I believe events such as the one in this case occur more frequently than most people think.
The program Dateline: To Catch a Predator, has multiple stories of men showing up at the home of a young teenage girl that they were in contact with on the Internet, only to find Dateline there instead. These men are from all walks of life. Previous sex offenders, people on Parole, religious leaders, just to name a few.
This is a widespread problem, not just an isolated case here and there. I’m glad there is a push in the medical community to be more aware of and recognize child abuse, but this is just a small part of it.


Sexual assault nurse examiners – comment

October 24, 2007

We have a SANE program at our hospital. The course is very extensive, 40 hours didactic, followed by clinical hours, including riding with the police department. The didactic component addresses the physical and emotional assessment, legal ramifications, counseling, and protocol. We have practioners and nurses on the team. Each team member is committed to 12 hours on call each week. There is a special room at the hospital dedicated to rape victims. The nurse undergoing this training must be committed to the program. Not only is she viewed as the first caregiver; she also is a voice for the client in the courtroom.


Women from many different cultures

October 18, 2007
The forensics nurse is called upon to take care of many women from many different cultures. Rape and abuse happen every day. Women of all ages, from all cultures are victims. Providing culturally competent care in forensics nursing happens at many levels.
To begin with, the provider must understand her own feelings about different cultures, and acknowledge that one’s life experiences reflect the way in which one reacts to the world. Did the provider grow up in a tightly knit, excusive community? Was she exposed to many cultures prior to working in the health care setting? What messages did she hear as she was growing up?
The second step is to look at her own feelings working with cultures different from her own. Does she find it difficult and awkward, or does she approach each encounter as a learning experience? Stepping outside the box helps. The culture that condemns female circumcision needs to understand that other cultures may condemn the male infant circumcision. Also, try to visualize what it would be like to seek care and not be able to speak the language or understand the customs.
The third step is knowledge. The provider who learns about different cultures on many different levels is open to new information and ways of doing things. Ask questions. Are there certain personal or religious beliefs the client observes? Are there healers from different cultures who can do an inservice?
The fourth step is understanding basic human rights. Look into your client’s eyes, use touch and acknowledge that she is above all a woman of the human race. With the basic human right comes the right for privacy. Although it may seem easier to use the support person for an interpreter, this can be disempowering for the client. Have a good working knowledge of how to contact the interpreter and explain that the interpreter is specially trained. Some cultures require a female attendant. Know how to access this before the situation happens. If the partner seems reluctant to leave, have a plan worked out for a fellow nurse or medical secretary to find a reason to have him or her leave the room.
Lastly, ask the client if there is anything you could have done different. Reflect on the situation and learn from each case. Share information with your colleagues (maintaining confidentiality).

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Forensics and the nursing process

October 16, 2007

Forensics is an integral part of the nursing process. Through forensics, a focused assessment can evolve into a comprehensive assessment. Part of the nursing assessment process is being open to clues given by what is not being said, marks on the body, and a partner who answers questions for the client. A busy practioner in an acute care setting can find that her focused assessment can quickly become a comprehensive, even life saving assessment. To illustrate this point I will pull from a case during my experience in Women’s Health. A client comes into the acute care area of a Women’s Hospital. Her complaint is menstrual cramping with severe pain unrelieved by Ibuprophen. During the interview process, collecting subjective data, the practioner notices that the client’s partner answers the questions for her, and that he does not leave the client’s side. Collecting objective data, the nurse notices unusual bruising along the client’s inner thighs, and upper arms. When the practioner says that she is going to do a pelvic exam and do screening for STDs, the client refuses. This could be a client who is very private with a very protective partner, or the victim of abuse. It is part of the skills gained through learning the nursing process, enhanced by the forensic ability gleaned through years of experience which will guide the practioner to giving her client optimal care.


Sexually Transmitted Diseases: Forensic Nursing in the ER, comment

October 15, 2007

RE: Sexually Transmitted Diseases: Forensic Nursing in the ER
Forensic Nursing Chronicles: August 2005

Having worked in a busy city ER, I have seen case after case of STD’s in young females. They come in for treatment, and are on their way. If rape is reported, (as in the case of LM), it can be challenging at best to get a teenager to report it. In the case of LM she changed her mind in the end and stated that it was consensual.
It is a shame that the man will be going around spreading several STD’s to each unsuspecting female. You would think he would be uncomfortable enough to seek treatment, with four STD’s.
Unfortunately LM will be reminded of the rape every time she has a herpes outbreak.


Sexual Assault Nurse Examiners

September 17, 2007

From the statistics I read about, the majority of sexual assaults are perpetrated by males upon females, and unfortunately many go unreported. I have never understood the reasons how or why this violent part of humanity takes place or other forms of violence for that matter, but that’s how my mind works – I guess its part of my utopian brain. In any event, as a male nursing student I wonder how and if I would be able to help a female sexual assault patient since the likelihood of a male perpetrating her crime is very high. Would I be permitted to help, or would the female patient’s condition be compromised since I am a man? Are most SANEs female for this very reason? Just some questions from a guy nursing student that would like to help these patients if it’s possible.


An Original, Standardized, Emergency Department Sexual Assault Medication Order Sheet

July 17, 2007

I read this article in the Journal of Emergency Nursing. An interdisciplinary group at the Massachusetts General Hospital emergency department created a standardized sexual assault medication order sheet. It follows sexually transmitted disease (STD) and HIV non-occupational exposure recommendations from the Centers for Disease Control and Prevention (CDC) and the Massachusetts Department of Public Health (MDPH). It also includes alternative medications in the case of allergies to the first-line medications and features commentary for clinicians. The team believed that providing excellent standardized care to sexual assault patients was essential and improved the care while decreasing liability for nurses and physicians. Components of the medication order sheet included gonococcal infection, chlamydial infection, trichomoniasis, hepatitis B, pregnancy, tetanus, and HIV medication guidelines. It has been used for 1 year at the time of print of this article. It has received positive feedback that it is easy to use and eliminates confusion in choosing medications. In light of national data that demonstrate that sexual assault victims are not receiving adequate protections from infection and pregnancy it may be worthwhile for other institutions to adopt a similar approach to this national patient care problem.

Finkel: J Emerg Nurs, Volume 31(3).June2005.271-275

Sexual assault nurse examiners – comment

June 12, 2007

I have never heard of the SANE nurses. However, this certainly seems like a great program to have. I think that society still in some ways looks at sexual assault as not a crime. It is! And it is a very violent crime. It affects every aspect of your “self”. The SANE nurse certainly would have a challenging position. I would think they would need more education than just going through nursing school. Some criminal investigation and law classes maybe, as well as what to say to these victims. Maybe, in the future, in order to be a level-1 trauma center ER’s would need to have this program.


Sexual Assault Nurse Examiners

February 22, 2007

SANE nurse’s are sexual assault nurse examiners and provide a very specialized area of forensic nursing. These nurses must have specialized training for competently collecting evidence, while providing both physical and emotional support to the patient. The need for SANE nurses to be readily available in the ED setting is vast. It is not uncommon for a patient to be forced to wait in the ED from four to eight hours for a practioner to exam them. Many ED’s are implementing SANE programs in order to more quickly and efficiently take care of this population of clients. The SANE nurses have a legal obligation to offer the patient post-coital emergency contraception as well as HIV/ Hepatitis/STD testing and treatment. Some of these interventions may be ethically controversial for the nurse, and they should consider this before entering the disciplinary of forensics concerning sexual assault victims.
SANE nurses are extremely beneficial to the patient providing quick and efficient care to the clients. They establish a liaison between the regular staff or hospital and patient. They will serve as a witness in a legal trial concerning the incident or evidence. They also provide assistance to the legal system serving as a liaison between hospital and local authorities. There are currently 280 SANE programs in the US. There is a proven benefit to have these programs available in the community. They also provide a great opportunity to the RN who is seeking a rewarding and challenging career.


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