SANE NURSES AND HOSPITALCONSIDERATIONS

Definition of SANE A Registered Nurse (RN) or Advanced-Practice Nurse (APN) who has completed specialized education and clinical preparation in the medical forensic care of the patient who has experienced sexual assault or abuse Training includes: 40 hour classroom training AND 40+ hours of clinical training Competency to perform a medical-forensic examination Ability to provide testimony as an expert witness in the court of law Adult/Adolescent vs. Pediatric/Adolescent Certified SANE-A/SANE-P vs. SANE Introduce Alisha from Skokie Hospital

Role of SANE Use nursing process to assess, diagnose and treat patient Patient’s health after assault is the first concern Document medical and assault history Assess patient for physical injuries Offer treatment for STI’s, HIV and pregnancy Provide emotional support, education, and referrals Crisis intervention if needed Other functions: Perform evidence collection and forensic component of the exam Serve as scientific experts that can provide factual and expert witness testimony if needed

Role of SANE cont’d It is NOT the responsibility of the SANE to: Investigate Act as the victim advocate Determine if a sexual assault occurred Label someone as a victim Limit ourselves to evidence collection only Let others guide our practice as a nurse and healthcare provider

SANE ER Nurse Specialized training in patient- centered care (80+ hours) Should be knowledgeable in legislative changes Perform multiple exams per year Provided with advanced training opportunities 1:1 patient care Functions independently when performing the exam Little to no training on how to work with a victim of sexual assault May be unaware of legislative changes Perform fewer exams No advanced training unless being provided by ER May be asked to care for other patients Requires physician involvement in the exam

Benefits of SANE (Ledray, 2001 & Campbell, Bybee, Ford, & Patterson, 2008) Improve patient care Improve evidence collection and documentation Reduce the risk of re-traumatizing Increase reporting the crime to law enforcement Increase prosecution rates and conviction Create community change by providing an area-wide response and structure for care Bring services together Increase collaborative relationships between disciplines Without SANE services: Wait up to 4-12 hours prior to being seen in the average emergency department Not seen as acute in the emergency department Wait in the general waiting room, usually with a law enforcement officer, creating a feeling of shame and embarassment Not allowed to eat, drink, urinate and other necessary needs for hours prior to the examination Emotional needs overlooked due to lack of training and sensitivity of healthcare staff leading to possible re-traumatization No safety assessment performed by healthcare staff May encounter multiple examiners leading to several disclosures of the assault and a lack of rapport and trust building Healthcare staff are not trained to conduct the medical-forensic examination leading to poor patient care, documentation and evidence collection Healthcare staff reluctant to perform the examination due to lack of training, the exam’s time consuming nature and they do not want to testify

Tips to Improve Law Enforcement and Health Care Provider Interactions COMMUNICATION!!!! Understand roles and responsibilities Respect differences Acknowledge difficult situation Recognize different levels of expertise Know current legislation Victim-centered/patient-centered care and services Just briefly talk about these topics like you would speaking with a SART. Focus on the victim-centered/patient-centered care and services as this is included in their protocols/guidelines moving forward

The Medical Forensic Exam

Choices Consent for medical forensic exam, evidence collection and photographic evidence Reporting decision and evidence analysis Each step of the medical forensic examination Each step of evidence collection Treatment and/or testing for STIs, including HIV and pregnancy Consent for drug facilitated sexual assault testing Presence of an advocate throughout the exam 35 choices alone on this screen How many informed choices have you had to make today?

Questions Jaclyn Rodriguez BSN, BS, RN, SANE-A SANE Coordinator Office of the Illinois Attorney General 100 W. Randolph Street, 13th Floor Chicago, IL 60601 O: 312-814-6267 | C: 312-519-2133 | F: 312-814- 7015

1. If sexual assault occurred within the past 7 days, encourage the victim to have a sexual assault medical forensic examination. Explain to the victim the purpose of the exam, its importance to her/his health as well as to the investigation, and the importance of having the examination conducted promptly because evidence will dissipate over time. Inform the victim that the emergency services and forensic services (examination and treatment) of sexual assault survivors is at no cost to the victim. 2. It is the victim’s decision about whether or not to submit to a sexual assault medical forensic examination. 3. Offer or arrange transportation for a sexual assault medical forensic examination. 4. Encourage a victim who has declined to undergo a medical forensic examination to seek medical attention.

The sexual assault medical forensic examination is commonly done by a nurse and/or physician; if available, the exam is conducted by a sexual assault nurse examiner (SANE).

The Sexual Assault Evidence Collection Kit is a prepackaged set of materials and forms for use in the collection of evidence relating to a sexual assault. The standardized evidence collection kit for the State of Illinois shall be the Illinois State Police Sexual Assault Evidence Collection Kit, used to preserve evidence found on the victim’s person.

If a drug facilitated sexual assault is suspected, obtaining the first urine after the assault occurred is critical. However, urine collection should be offered up to 120 hours (5 days) after the assault. Obtaining a blood sample may also provide important information. It is the victim’s decision to decide about whether or not s/he wants to provide urine or blood samples for toxicology. The sexual assault evidence collection kit does not contain materials for a urine sample. Medical personnel will use hospital testing materials when the victim consents to a urine test.