2. SANE NURSES AND HOSPITALCONSIDERATIONS

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. The Medical Forensic Exam

10. 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?

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

13. 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.

14. 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).

15. 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.

16. 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.