User:R niemeyer

R. Niemeyer: Writing 101 UMW

A SANE is a registered nurse, their degree ranging from diploma to a doctorate, who undergoes 40 classroom hours of specific training to become properly qualified to care for victims of sexual assault. “Classroom content consists of: the dynamics of sexual victimization; coordinated multidisciplinary response and the roles of each agency; the forensic examination for victims and suspects; examiner objectivity, reducing re-traumatization; common injuries related to the site and instrument of penetration; standard evidence collection and additional potential evidence; the use of the colposcope and photographic equipment; importance of the detailed medical forensic history and documentation; treatment options; 911 transfer for possible emergent findings and referral for follow-up; crisis intervention; jurisdictional laws related to sexual offenses; and testimony.” After the 40 hours is complete the SANE then observes between 5 and 10 pelvic examinations, and then is observed performing between 5 and 10 pelvic examinations.

SANE programs were first established in Memphis, Minneapolis, and Amarillo from 1976-1979. In 1992 the first meeting for SANE’s was held by the Sexual Assault Resource Service in Minneapolis which formed the International Association of Forensic Nursing (IAFN). SANE programs were created to provide proper service to patients who weren’t receiving suitable attention in the emergency room. “They have helped relieve the overcrowding and optimize productivity in the ED, offer rape victim’s timely, compassionate care, and facilitate coordination among the sexual assault response team (SART) members.” They also aim to “provide prompt and compassionate care, preserve the dignity of victims, reduce psychological trauma, and enhance evidence collection for better investigations and prosecution. The SANE will record the attack, gather proof of the attack, and offer the patient both physical and emotional treatment.

Receiving SANE Certification (SANE-A) includes: “Passing a written examination, developed by the IAFN certification board and the Center for Nursing Education and Testing, a license as an R.N. in the United States or its Territories or a license as a first-level general nurse in the jurisdiction of current practice; a minimum of two years of practice as an R.N. in the US or as a first-level general nurse in the country of licensure; successful completion of an adult/adolescent SANE education program that includes either (a) a minimum of 40 continuing education contact hours of classroom instruction, or (b) 3 semester hours (or the equivalent) of academic credit in an accredited school of nursing, and sufficient supervised clinical practice until determined competent in SANE practice. The IAFN website provides a state-by-state list of nurses holding a SANE-A certification."

Different SANE programs process patients in different ways, but they all have two primary objectives; to show proof and indication of sexual interaction and to substantiate the victim’s story. The different categories of processing are: assessment, plan, implement, and evaluate.

The SANE’s assessment must start within an hour of notification. The examiner must be informed by police about the attack, then inform her team, and explain the forensic and medical procedure to the patient before they can consent. The examiner then records the attack according to the patient. After, the examiner will document any physical discoveries on the patient, and present emotional care and support to the victim.

The plan begins with notifying the Emergency Department if the patient has serious injuries, as well as collecting medical and forensic evidence in the ED. The SANE will consider any needs of the patient (a heated blanket, etc.), and provide the patient with safety.

Implement is performing the examination and collecting and labeling the necessary evidence. The SANE will offer the patient emergency contraception and protection against STD’s, and provide the patient with clinics centered upon emotional support. Evaluate is looking over records to guarantee they support the victims story and illustrate clear evidence of the attack, and having the SANE’s supervisor review it. Then the SANE will collaborate with the crime lab, victim, and police. The SANE program is joined with the Sexual Assault Response Team (SART). SART works towards ending and preventing violence for women, and holding perpetrators responsible when attacks occur. In 2005 the US and Canada had around 800 SART programs and 330 SANE programs linked with them.

There are two types of SART responders; the initial responders and the second responders. The initial responders are “law enforcement who takes the report, the detective who conducts the investigation, the advocate who does crisis intervention and supports the victim through the examination, and the healthcare provider who conducts the medical-forensic examination. These primary providers compose the SART that conducts the multidisciplinary team interview (MDTI) of the victim." The MDTI requires the patient to explain the incident once to all providers. The SANE will ask questions related to the medical-forensic part of the interview (injuries, pain, places of penetration, etc.), the detective’s questions will relate to the crime scene and the attacker, and the advocate will provide comfort and support throughout the interview.

Second responders will communicate with the victim after a number of days, if necessary. The social worker assesses the victim’s mental and emotional state and will provide her with emotional support and therapy, along with counselors and mental health providers to ensure recovery. The lab technician will examine the evidence, which allows the prosecutor to build a case. Once an attack is reported by the victim, certain steps are followed: the SART team gives the “victim reports to law enforcement; detective determines if there is an indication of a sexual assault examination; if so, the detective calls the triage operator; operators call the on-call SANE; SANE talks to detective who briefs SANE and arranges a time for the examination, which should be started within 45 to 60 minutes of the call; SANE calls the advocate specific to the jurisdiction from which the victim is coming and an expected arrival time, age, and other patient characteristics are noted; victim, SANE, detective, and advocate arrive and begin the MDTI, followed by the examination; victim treatment, risk reduction and health-promoting education; referrals; and victim discharge."

When a person is incapacitated the Department of Justice suggests for every SANE program to have “internal policies based on applicable jurisdictional statues governing consent for treatment of vulnerable adult patients. In cases of adolescents, the jurisdictional statues governing consent and access to the exam should be followed”. The policy should include rules for four types: “Minor children, organic brain or mental health related incompetence; competence that is expected to resume within hours to a few days, but is acutely lacking; and acutely mentally altered and not expected to become competent for many days or longer”.

For the patient to be able to consent to an exam, three things are required: the patient has the capability to make a choice, she/he is thoroughly provided with information that presents all of her options, and she/he is able to make her decision without any outside influences. The policy is meant to be designed well enough to protect the patient’s emotional state and protect the nurse against legal matters.