NurseWeek | HealthWeek Safe and Sane Forensic nurses gather evidence to aid sexual assault survivors

Safe and SANE
Forensic nurses gather evidence
to aid sexual assault survivors

By Mary Elizabeth Hopkins
June 26, 2000

After a woman is attacked, a sexual assault nurse examiner carefully collects forensic evidence that can be used in court – if the case makes it that far – and can offer survivors referrals to other agencies.

Photo: Artville


	You've read the article. Now tell us what you think. Related sites For More Information To find out how to become a Sexual Assault Nurse Examiner or Sexual Assault Response Team nurse, contact: Carmen Henesy, RN, a SANE nurse in San Francisco and the Northern California regional representative for the International Association of Forensic Nurses at rnsane@prodigy.net Diane Faugno, RN, secretary-treasurer of IAFN, (760) 739-3444 Jeannie Stephenson, RN, (213) 742-5519 Malinda Waddell, MN, FNP, RN, director of forensic nurse specialists in Long Beach, Calif., (562) 430-6220, fnsmalinda@juno.com International Association of Forensic Nurses, East Holley Avenue, P.O. Box 56, Pitman, N.J. 08071, (856) 256-2425 fax: (856) 589-7463 http://www.forensic nurse.org or iafn@ajj.com An online course, "Introduction to Forensic Nursing Concepts FS207," will begin Aug. 14. Sherry Arndt, MPA, RN, is the instructor. For a course description and information, visit the course.

At the Parkland Health & Hospital System ER in Dallas in the 1980s, then-paramedic Vangie Barefoot, RN, brought in a sexual assault survivor to the waiting room. Injured people, arrested for other crimes and brought in by police, were shackled to the rails. Sitting beside them, the sobbing survivor had to wait for hours, too agitated to flip through magazines in the waiting area. No one paid attention to her tears.

In those days, codes, emergencies and children with colds and sniffles took priority in the triage system, Barefoot said.

"A sexual assault was not life-threatening, and it was difficult for male doctors to deal with. It’s such an uncomfortable thing. The longer they put it off, the more likely the survivor would be to fall asleep or go home."

Legal adjunct
Now the director of nursing at Taylor Care Center, Barefoot is in her fifth year as a Sexual Assault Nurse Examiner at Johns Community Hospital in Taylor. She gathers forensic evidence to be used in court – if the case makes it that far.

"The beauty of having SANE nurses is they’ve tried to make a standardized method of data collection, and the nurses are dedicated to it," said Karen Bachar, MA, research specialist at the Arizona Rape Prevention Education and Evaluation Project in Tucson.

"The ER doctors didn’t always get good forensic evidence," said Carmen Henesy, RN, a SANE nurse in San Francisco and the Northern California regional representative for the International Association of Forensic Nurses, based in New Jersey.

In all cases where the perpetrator was known, the court or judge convicted the person based on the evidence Barefoot collected. About 40 percent of perpetrators disappear without a trace, she said.

Many plead guilty outside of court, Barefoot said. They usually receive 20 years in prison, of which they must serve 80 percent, rather than the 25 years to life they’d get if convicted in court.

In this specialty, the nurse doesn’t serve as the patient advocate because doing so might cause a conflict of interest in court, said Jeannie Stephenson, RN, director of the sexual assault team at California Hospital Medical Center in Los Angeles.

If the survivor requests one, an advocate offers support and comfort while the SANE nurse carefully collects evidence during the next four hours or so in a quiet, well-appointed room outside the ER or in a reserved ER cubicle.

The SANE nurse can offer referrals to other county agencies and follow-up advocacy care.

"I haven’t met five people in my lifetime who’ve heard of SANE nurses," Barefoot said.

Tough, good work
Despite the painful circumstances, Barefoot enjoys her position.

"It’s really hard. I don’t enjoy or relish that someone has been sexually assaulted, but I derive great pride in the fact that someone was there for the survivor," she said.

Funding, training and terminology for SANE nurses vary by state and region. In California, they’re part of a Sexual Assault Response Team. There, a survivor must meet with the district attorney as a first step, said Detective T. J. Clark, a member of the sex crimes unit in the Los Angeles Police Department. Then, Clark said, a patrol officer drives the survivor to California Hospital Medical Center, where a response team nurse is waiting.

In Central Texas, SANE nurses are in short supply. To get the training, they have to take about a week off work, Barefoot said. Some hospitals offer sponsorships. And the training must be in Texas, whereas in other states it doesn’t matter where SANE nurses receive their credentials.

In California, SART nurses are more plentiful, but the overall nursing shortage affects them, Stephenson said. "Part of the problem is that it’s an intense specialty," she said.

Furthermore, without adequate staffing, burnout can lead to attrition. "Your energy level just wanes if there’s no one to back you up," Barefoot said.

Wherever they work, SANE and SART nurses tailor the exam to survivors’ needs.

"One woman just really wanted to bathe, so I did the pelvic part of the exam first, and let her shower. She had that right," Barefoot said. "The whole goal is to stop the survivor from being a victim and turn them into someone who’ll survive."