From Forensics to Advocacy: What it’s Like to be a SANE (Sexual Assault Nurse Examiner)

From Forensics to Advocacy: What it’s Like to be a SANE (Sexual Assault Nurse Examiner)

When people experience sexual assault, they may sustain more than just physical injuries; trauma also affects short- and long-term mental health. The medical treatment needed may require a provider to examine parts of the body that were recently violated, which can cause more distress. When reporting an assault, survivors often lack the information they need about how to proceed.

Sexual assault nurse examiners (SANEs) are trained to help survivors across this spectrum of patient care. From providing evidence-based treatment to performing assessments to collect forensic evidence that can be used in a criminal trial, these nurses play a critical role in supporting survivors at the beginning of their recovery process.

What Is the Role of a Sexual Assault Nurse Examiner?

When a sexual assault survivor comes to a SANE-certified hospital or community health center, a sexual assault nurse examiner is the first point of care, according to Kim Day, forensic nursing director for the International Association of Forensic Nurses (IAFN). SANEs ask the patient if they would like a forensic exam, which can be completed even if the patient decides to not report their assault to law enforcement.

“Just going through the process with someone and providing holistic patient-centered care for that patient during a traumatic time in their life can really impact the way they leave the hospital,” Day said.

Forensic exams are meant to document trauma from the assault and collect evidence that could be used in a criminal trial. This includes taking a medical history; documenting scratches, bruises, abrasions, and other injuries on a body map diagram; taking photos of injuries; collecting DNA swabs to be processed; and observing the patient’s behavior. In cases where toxicology information is relevant, SANEs will also perform those tests on a patient.

In addition to performing a forensic exam, the main duty of a SANE is to provide holistic nursing care for the patient. Survivors of assault may need access to testing for pregnancy, as well as prophylactic antibiotics to prevent the contraction of diseases. Depending on the patient’s needs, SANEs also provide referrals to see other specialists, such as a licensed professional counselor, who can help them in their recovery process.

The SANE in Court: It’s Not Like “Law and Order”

Beyond working in the clinical setting, SANEs are qualified to testify in court if a patient’s case goes to trial. The specialized training SANEs receive prepares them to effectively answer questions regarding evidence discovered during a forensic exam. However, while SANEs can play a critical role in the trial process, the legal aspect of the job is not the main focus, Day said.

“If the nurse goes into this work thinking that they’re going to get the bad guy and put him behind bars, they will fail at this… because that is not what we do,” she said. “The work we do is nursing. We take care of the patients.”

This is a key factor to consider when choosing to become a SANE. Nearly 80 percent of sexual assaults are not reported to law enforcement, according to a Justice Department analysis of violent crime in 2016 (PDF, 669 KB). While performing a forensic exam and being prepared to provide evidence in court is a requirement of the job, the emotional and medical needs of a patient come first.

SANEs are trained to work within a multidisciplinary team, also known as a Sexual Assault Response Team (SART), which includes survivor advocates, members of law enforcement, and mental health providers. Together, these professionals coordinate the response to survivors of sexual assault.

What Is a Sexual Assault Response Team?

SANEs and other trained health care providers: When an individual decides they would like to have a sexual assault forensic exam (SAFE), health care providers like Nurse Practitioners (NPs) or SANEs address the initial physical and psychological needs the patient might have as a result of their assault.

Survivor advocates: Individuals who need access to information and emotional support can work with an advocate to navigate their path to recovery. A survivor may reach out to an advocate via a crisis center, or one may be brought in to support someone who has decided to seek treatment at a hospital or report their assault to the police.

Law enforcement: In cases where an individual decides to report their assault, police officers and detectives are responsible for taking statements, coordinating with the hospital to receive the results of the forensic exam, and investigating the alleged assault.

Prosecutors: In cases where the survivor has chosen to report their assault and enough evidence is present, prosecutors are tasked with making the decision on whether to bring the case to court.

Therapists and counselors: In the aftermath of an assault, whether a case goes to trial or not, survivors need additional support to continue their recovery process. Mental health professionals trained in working with sexual assault survivors may provide care at any step in the recovery process, from coping with the immediate aftermath of an attack to navigating long-lasting trauma.

Why Is Access to SANE Care Important?

According to the Centers For Disease Control and Prevention (CDC), one in three women and one in four men have experienced sexual violence involving physical contact during their lifetimes. The effects of experiencing an assault can be both physical and psychological, necessitating specialized care that embodies the concept of cura personalis, or care for the entire person. This holistic attention to the entire individual is the expertise of clinicians like nurses.

SANE education programs are designed to train nurses to address survivors’ specific needs. After completion of this training, SANEs become uniquely qualified to treat this vulnerable patient group. This means that they can provide trauma-informed care to minimize the harm of invasive exams that may trigger a patient. In doing so, they can also equip their patients with forensic evidence that can be used if they decide to report their assault.

Not all hospitals have SANE programs. IAFN’s database of registered SANE programs   indicates that there are currently 962 in the United States. As a result, patients are sometimes required to travel long distances to access SANE care, according to a 2016 report on the availability of forensic examiners (PDF, 191 KB).   This means that the facilities with SANE expertise must be ready to do what they can to help every patient who walks in the door.

Trauma-Informed Care and Practicing Consent

One of the key challenges of completing a sexual assault forensic exam (SAFE) is examining a patient’s physical injuries without retraumatizing them. To help survivors feel comfortable, SANEs ask for consent during each step of the way while providing information on why they are doing each test.

“Consent is not just a piece of paper with a signature on it,” Day said. “It’s a process throughout the exam.”

In practice, the process of asking for consent may resemble the following:

  1. The SANE will inform the patient what body part they will examine and ask permission to do so.
    “I’m going to examine your neck now to see if there are any injuries. Do I have your permission to do so?”
  2. If the patient grants this permission and the SANE notices something that may require a sample collection, the nurse will again ask for permission to collect a specimen and explain why collecting that evidence is appropriate.
    “I notice a scratch that wasn’t mentioned when I documented your health history. There may be DNA or other materials near this wound, so I would like to swab it. Is that OK with you?”

In any instance where the patient does not want a test performed, the SANE is directed to honor the patient’s request. This integration of consent throughout the exam is meant to give the patient a sense of control, a feeling that may have been lost during their assault.

What Are the Requirements to Become a SANE?

Because SANEs work with a patient population that requires specialized care, nurses are required to meet certain expectations in order to take on this role. While some nurses go through training at the local level or through smaller programs, IAFN offers the most recognized certification for SANEs. Nurses can become certified as a SANE-A to care for adults and adolescents or a SANE-P to work in pediatrics. Some nurses elect to pursue both certifications so they can provide care to patients across all age groups.

Steps to SANE Certification
  • Education: To become a certified SANE, a nurse must have the minimum of a registered nursing (RN) license.
  • Experience: Prior to starting the certification process, a nurse must have at least two years of clinical experience working as an RN or at a higher level, such as an NP.
  • Training: As part of the certification process, nurses are expected to complete 300 hours of SANE clinical skills training.
  • Testing: The final requirement to become a certified SANE is to pass a certification examination. IAFN holds exams two times a year.

Information for Further Reading

Citation for this content: [email protected], the online MSN program from the School of Nursing & Health Studies

Texas A&M College of Nursing Announces Center of Excellence in Forensic Nursing

Texas A&M College of Nursing Announces Center of Excellence in Forensic Nursing

Texas A&M University recently announced that the College of Nursing has received approval for its Center of Excellence in Forensic Nursing, transitioning the forensic nursing program into a state- and federally funded center. The new designation will help expand the capabilities and funding resource opportunities, pushing forward the College of Nursing’s initiative to advance forensic nursing education, outreach, and research.

Forensic nursing is a specialty role focused on the intersection of health care, criminal justice, and the legal system. Registered nurses and advanced practice registered nurses can specialize in forensic nursing, allowing them to provide specialized care in the areas of interpersonal violence prevention, intervention, investigation, and post-trauma care. Areas of practice within this specialty include sexual assault, death investigation, corrections, disaster aftermath, risk management, intimate partner violence, child maltreatment, elder mistreatment, and human trafficking.

Nancy Fahrenwald, PhD, RN, PHNA-BC, FAAN, professor and dean of the Texas A&M College of Nursing, tells today.tamu.edu, “The Center of Excellence in Forensic Nursing will accelerate multidisciplinary efforts to devise and implement comprehensive strategies that address interpersonal violence across the life span. We are now in the best position to engage scholars throughout The Texas A&M University System to develop and disseminate new knowledge, positively impacting health and social outcomes for those affected by violence.”

Texas A&M’s new Center of Excellence in Forensic Nursing allows for an expansion of the college’s Master of Science degree and graduate certificate in forensic nursing programs. The Center will also provide interdisciplinary and professional education course trainings available to health care providers, law enforcement agencies, social workers, and others seeking advanced education in treating victims of violence.

To learn more about the newly designated Center of Excellence in Forensic Nursing in the Texas A&M University College of Nursing, visit here.

Penn State Forensic Nurse Researcher Jocelyn Anderson Works to Support Sexual Assault Victims

Penn State Forensic Nurse Researcher Jocelyn Anderson Works to Support Sexual Assault Victims

Jocelyn Anderson, a forensic nurse and researcher at Penn State University, found her calling in the field of forensic nursing after completing her final nursing practicum in a South African intensive care unit (ICU). During her time there, she primarily witnessed two types of violence—physical and gun violence, and sexual assault violence. Oftentimes, the victims of sexual assault would come into the ICU after attempting suicide following their attack.

Forensic nursing has emerged as a discipline to help curb the harmful effects that sexual assault victims face. The International Association of Forensic Nurses defines forensic nursing as the practice of nursing globally when health and legal systems interact. According to the U.S. Bureau of Labor Statistics, the field of forensic nursing is expected to see a 26 percent growth rate over the next decade.

Originally from a rural community in Minnesota, Anderson had never been exposed to this kind of violence before. She had been introduced to forensic nursing during her training but she wasn’t aware of the opportunities the field had to offer until her time spent in South Africa led her to enroll in a forensic nursing graduate program to help victims recover from sexual assault trauma.

After earning a nursing degree, there are several forensic nursing certificate programs and graduate programs available in the field. After completing these programs, graduates serve as the first line of treatment to victims. Individuals with training in forensic nursing can also become sexual assault nurse examiners (SANEs), which are nurses specializing in domestic violence, child abuse nurses, death investigators, legal nurse consultants, and more.

After completing her graduate degree, Anderson worked at Mercy Medical Center in Baltimore and the University of Pittsburgh Medical Center as a forensic nurse. Her role also involved helping patients who wanted to seek criminal justice for the crimes committed against them. She provided patients with interventions, such as evidence collection and photo documentation, and collaborated with law enforcement officials and attorneys to facilitate prosecuting these sensitive cases.

Anderson tells news.psu.edu, “As the forensic nurse responding in these hospitals, we were responsible for providing both forensic and medical care to those patients after a sexual assault. The physical impacts as well as the mental ones on these patients were the two main aspects we focused on right when they entered through the door.”

The field of forensic and sexual assault nursing is relatively new but it is already proving to help provide better care for victims of sexual assault trauma. Research examining these programs has shown that patients who received care from a specifically trained forensic or sexual assault nurse after an assault were more likely to be given the appropriate care and medication and more likely to have a sexual assault kit collected correctly. Therefore, they are also more likely to have their criminal case moved forward and the traumatic experience will be lessened.

To learn more about Jocelyn Anderson, a forensic nurse and researcher at Penn State University who helps support sexual assaults victims and serves as an advocate for advancements and growth in the field, visit here.

Considering a Career in Forensic Nursing?

Considering a Career in Forensic Nursing?

Forensic nursing involves working with the aftermath of violent situations. Violence is both a health care and a legal issue, so this places forensic nurses in a unique leadership position to connect health care, science, and the legal system. Forensic nurses partner with law enforcement and other agencies to investigate and resolve events such as domestic violence, sexual crimes, child and elder abuse, homicide, and suicide.

What Education and Certifications are Required?

Registered nurses with an associate degree or a BSN and a good foundation of clinical experience can pursue this specialty through a certificate program or an advanced degree (MSN, DNP, PhD) and board certification. Forensic nurses also have their own professional association, the International Association of Forensic Nurses (IAFN), which provides opportunities for networking and professional development as well as education and certification resources. The Commission for Forensic Nursing Certification (CFNC) currently offers two certification options: Sexual Assault Nurse Examiner-Adult/Adolescent (SANE-A) and Sexual Assault Nurse Examiner-Pediatric (SANE-P).

What Do Forensic Nurses Do?

These specialized nurses work in emergency rooms, coroner’s offices, police departments, and even the FBI. They examine the victims of violent crime, collect and analyze evidence, and document injuries. How the nurse treats the patient—the victim of violence or the family left behind—can have a tremendous influence on the ability of that individual, their families, and loved ones to recover post-trauma.

Success Through Adaptability

Forensic nursing requires the ability to cope well with the stressors of working around extreme circumstances. The work involves public health, behavioral health, pediatrics, geriatrics, and even medical legal consulting. The versatility of the highly trained forensic nurse enables them to better care for those citizens who are most vulnerable in our society.

Interested in exploring various career paths for nurses? Visit the DailyNurse nursing specialties directory to learn more.

Forensic Nurse


Explore More Nursing Specialties

BASIC DESCRIPTION

Forensic nurses combine clinical nursing practice in conjunction with knowledge of law enforcement. They provide care to victims and are involved in the investigation of sexual assault, elder and spousal abuse, and unexplained or accidental death. Forensic nursing is high stress because of the nature of the work, and it requires a broad understanding of social, environmental, and psychological influences on behavior. The environments in which forensic nurses work are varied. They work in such settings as correctional institutions, psychiatric facilities, acute care settings, coroner and medical examiners’ offices, and for insurance companies.

EDUCATIONAL REQUIREMENTS

Registered nurse preparation and Bachelor of Science in Nursing are required; often, graduate preparation is required. Certification from Sexual Assault Nurse Examiner (SANE) may also be needed for some practice settings.

CORE COMPETENCIES/SKILLS NEEDED

■ Ability to work in diverse conditions and deal with emotionally charged issues
■ Ability to combine nursing knowledge with investigative and counseling skills
■ Ability to collaborate with experts in other disciplines
■ Be an advocate for victims
■ Coordinate programs in collaboration with medical and law enforcement
■ Be able to deal with death and dying

RELATED WEB SITE AND PROFESSIONAL ORGANIZATION

■ Forensic Nursing Services (http://www.forensicnursing.org)


Register for the Nursing Leaders Virtual Career Fair on December 5th

You have Successfully Subscribed!


Register for the Nursing Leaders Virtual Career Fair on December 5th

You have Successfully Subscribed!