More than 11,000 sexual assaults happen in Florida each year, according to the Florida Department of Law Enforcement. In many communities, specially trained nurses respond to document injuries, collect evidence, and begin treatment, either at rape treatment centers or hospital emergency departments.
As a nurse, I want to be there for any patient, but this is a special population, says Sarasota Memorial Hospital emergency department nurse Terri Eartly, RN, BSN, founder of the facilitys sexual assault response program. They need to be understood, and they need to be heard and be able to cry or, sometimes, laugh. And they need to be believed. Society doesnt believe these horrendous things happen, but they do.Terri Eartly, RN, BSN, founder of Sarasota Memorial Hospitals sexual assault response program
Sarasota Memorial treated 72 sexual assault victims in 2006. Through mid-November 2007, 65 victims had obtained care at the hospital, including three males.
That compares to 2,000 sexual assault victims treated annually at the Roxcy Bolton Rape Treatment Center at Jackson Memorial Hospital in Miami. Patients there see a nurse practitioner trained in collecting evidence or the medical director. During the day, full-time nurse practitioners staff the center. In the evening and on weekends, other nurse practitioners rotate call. The center, separate from the emergency department, provides comprehensive services, including counseling and medical care, in a quiet environment.
Maureen Fitzpatrick, ARNP, MSN, holds a full-time research position at the University of Miami and covers the rape center after hours.
Its rewarding to care for individuals who have suffered a severe trauma and help them through the process so they feel physically safe and emotionally safe, Fitzpatrick says. [And we] collect evidence that could lead to the capture and conviction or arrest of the offender.
Sarasota program gets off the ground
Eartly recognized a need for a sexual assault response team and developed Sarasota Memorials program. Sexual assault exams can disrupt ED flow and nurses workloads.
When a sexual assault came in, nurses scattered, because it takes four hours to complete [an exam], says Eartly. She adds, The worst situation is for a nurse to walk into a room and see a victim of sexual assault and not want to be there. That victim will read your face. The empathy has to be there.
Now, when a victim presents in the emergency department, the triage nurse contacts the sexual assault nurse on call. A physician completes a medical screen and by that time, the assault team member has arrived at the hospital and assumes responsibility for the victims care.
Eartly began working on the Sarasota Memorial program three years ago. She based policies and procedures on guidelines from the International Association of Forensic Nurses and the Presidents DNA Initiative, a federal program to improve the use of DNA in the criminal justice system. She gave a presentation to hospital CEO Gwen MacKenzie and was given $3,500 in startup funds. She recruited 20 nurses to receive the training and rotate call. That number has since dwindled to four. The program began in May 2007.
Training consisted of a 40-hour sexual assault examiner course, which includes information about forensic exams, sexually transmitted diseases, anatomy and physiology, and child protection teams. The nurses also spend time at a rape crisis center and at the Florida Department of Law Enforcement crime lab.
Then the nurses must perform 10 pelvic exams under the supervision of a physician. Eartly plans to sit for the sexual assault nurse examiner certification exam in May.
Sarasota Memorials sexual assault
response team nurses receive no call pay and respond at any hour of the day or night. They earn a flat fee for each completed exam. The state had been paying $250. In 2007, Florida increased the reimbursement to $500.
The nurses work closely with the Safe Place and Rape Crisis Center of Sarasota, which provides counseling and a victim advocate, and with law enforcement officials. The nurses collect evidence using a Florida Department of Law Enforcement kit and maintain a chain of custody until handing evidence over to the responsible police officer or sheriffs deputy.
Reporting law rescinded
In 2007, the Florida legislature passed and Gov. Charlie Crist signed into law a provision prohibiting the requirement that victims report the battery to law enforcement in order to have their forensic exams paid for by the state victims compensation fund. Women who initially do not want to prosecute often will change their minds later. At that point, it becomes too late to collect evidence.
Nurses still must report cases involving a stabbing or gunshot wound.
Eartly expects the repeal of the reporting requirement will convince more victims to come forward for medical care. About three-quarters of the patients she sees in the ED say they do not want to tell police.
Fitzpatrick estimates only 10% of assaults are reported to law enforcement. She urges nurses to encourage their patients who have experienced assaults to report them. She says, if the crime is not acknowledged, the victims carry it around with them for the rest of their lives. There is a false sense of security that it doesnt happen as often as it truly does, she says.
Sexual assault exam
The nurse examiner or practitioner begins by taking a history, followed by a head-to-toe assessment, focusing on areas related to the attack. The exam may include using a Woods lamp to check for semen on the persons clothing.
Fitzpatrick performs the pelvic exam and collects evidence. At Sarasota Memorial, the emergency department physician performs the pelvic exam. Eartly has received training to do the exams, but she continues to work collaboratively with the doctors.
The nurses often have to testify in court about their findings.
Victims typically receive a pregnancy test and, if appropriate, emergency contraception. They are offered testing for sexually transmitted diseases and prophylactic treatment.
Rewards and challenges
Sexual assault examiners find their roles demanding, yet rewarding. They never know when they will be called in or what situation they will face. The story is different every single time, Eartly says.
The job requires good listening and clinical assessment skills. It brings together all of the education I have had as a nurse and nurse practitioner and [my] experience, Fitzpatrick says.
Victims come from all walks of life, from all socioeconomic levels. Yet sexual assault remains a topic that makes people uneasy. It also creates an opportunity for nurses to offer compassionate, nonjudgmental care.
It can be emotionally difficult, especially when it is a random attack by an unknown person to the victim, Fitzpatrick says. We see a lot of instances where young women come to Miami or South Florida for vacation or spring break. Thats when they might be given a drug in their drink and the assault happens. You hate to see people taken advantage of.
Eartly usually does not find the exams any more emotionally draining than emergency department cases. If something is upsetting, she knows she can call one of her fellow team members for support.
Its very fulfilling, Eartly says. I find the area fascinating and want to learn as much as I can about it and be the best I can be at it.
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