Forensic Nursing: Part 2. Inside Forensic Nursing

Laura A. Stokowski, RN, MS

Disclosures

Medscape Nurses 

In This Article

Sexual Assault Nurse Examiner

The medical care portal for many sexual assault victims is the hospital emergency department.[7] Long waits, lack of privacy, unskilled examiners, insensitivity, and improper collection or loss of evidence are factors in the continued victimization, instead of the healing, of sexual assault survivors. Turning to forensic nursing and the sexual assault nurse examiner (SANE) role has dramatically improved this situation. Under the SANE model of care, sexual assault victims consistently receive prompt, compassionate, culturally sensitive and developmentally appropriate services from nurses knowledgeable about victimization issues and expert in assessment and evidence collection that will support future legal proceedings. The SANE also attends to the assault victim's related medical needs, including prevention of pregnancy and sexually transmitted disease, and the evaluation and treatment of minor injuries.

The SANE is the only forensic nursing role to be validated through research to any degree. Research shows that SANEs collect forensic evidence more accurately than non-SANE trained nurses or physician colleagues.[8] Better forensic evidence collection and documentation leads to more successful sexual assault prosecution.[9] More consistent post-rape medical care is provided with the SANE model than with the standard care model.[9] Perhaps more important, however, is the SANE's unique contribution to the victim's early psychological recovery, a result of the SANE's expertise in victimization and trauma issues.[9]

Forensic Assessment and Consultation Team

Inova Fairfax Hospital in Falls Church, Virginia, is home to a 14-nurse sexual assault and domestic violence response team known as the Forensic Assessment and Consultation Team (FACT). Led by clinical manager Suzanne Brown, MS, RN, an adult and pediatric SANE and certified forensic nurse (CFN), FACT nurses are on call 24 hours a day to provide assessment and care for patients in Fairfax County, Virginia. Sexual assault evidentiary examinations of both victims and suspects are conducted at the request of law enforcement or child protective service officials.

Exams are conducted in a completely private exam room designed to make patients as comfortable as possible. The FACT exam room is outfitted with all of the technology and tools needed for comprehensive examination, evidence collection, and computer documentation, including the binocular colposcope that illuminates, magnifies, and documents even the most microscopic genital injuries during the forensic gynecologic exam. Depressing a foot pedal sends digital images directly to the computer, where they become part of the official report. An adjacent child-friendly waiting area is well-used; a shocking 60% of FACT's sexual assault patients are under the age of 16 years. For domestic violence patients, FACT's domestic violence response nurses take portable equipment to other area hospitals or to police departments to conduct examinations.

Brown's nurse examiners conduct more than 600 forensic exams yearly, and a percentage of their time is also spent in court. To meet this demand, Brown holds an in-house intensive training program in forensic nursing. She finds that nurses from diverse clinical backgrounds can be successful FACT nurses. "We have nurses from women's health, obstetrics and gynecology, mental health, and even endoscopy. They don't necessarily have to have an ED background. With the right training, they develop a sophisticated understanding of the importance of high-quality medicolegal evidence."

FACT is a regional program, serving adult and child clients from an area that covers 20 jurisdictions. Regional programs are popular because they allow the nurse examiners to see more clients and perform more examinations, helping them to develop and maintain competence. It is also cost-effective, particularly for rural and remote areas that do not see enough cases yearly to maintain their own nurse examiner programs.

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