Sexual Assault Response Team: overcoming obstacles to program development

Preservation of forensic traces by Nursing in emergency services: a scoping review

OBJECTIVE

to map the scientific production on the preservation of forensic traces by Nursing professionals working in emergency services.

METHOD

a scoping review, with searches for studies carried out in six databases, in the gray literature available in Google Scholar and in the references of the studies selected. For analysis, the data reduction method was adopted.

RESULTS

26 studies were included, organized into five categories: 1) Nursing professionals' knowledge on the preservation of forensic traces; 2) Procedures performed by Nursing to preserve traces in the victim's body; 3) Procedures performed by Nursing to preserve traces in the victim's belongings/objects; 4) Procedures performed by Nursing to document traces; and 5) Actions to maintain the chain of custody performed by Nursing.

CONCLUSION

the studies showed situations in which the emergency nurse may act in the preservation of forensic traces present in the victim's body and in objects, as well as in the registration of traces, verifying the role of Nursing to ensure integrity of the chain of custody, especially in situations of aggression, firearm injury, sexual violence, child abuse and assistance to trauma victims.

Preservación de los rastros forenses que realizan los enfermeros en los servicios de emergencias: revisión de alcance

Resumen Objetivo: mapear la producción científica sobre la preservación de rastros forenses por profesionales de enfermería que trabajan en los servicios de emergencias. Método: revisión de alcance, con búsqueda de los estudios realizados en seis bases de datos, en la literatura gris disponible en Google Scholar y en las referencias de los estudios seleccionados. Para el análisis, se adoptó el método de reducción de datos. Resultados: se incluyeron 26 estudios organizados en cinco categorías: 1) Conocimiento de los profesionales de enfermería sobre la preservación de rastros forenses; 2) Procedimientos que realizan los enfermeros para preservar rastros en el cuerpo de la víctima; 3) Procedimientos que realizan los enfermeros para preservar rastros en las pertenencias/objetos de la víctima; 4) Procedimientos que realiza el personal de enfermería para documentar los rastros; y 5) Acciones que llevan a cabo los enfermeros para mantener la cadena de custodia. Conclusión: los estudios demostraron que hay situaciones en las cuales el enfermero de emergencias puede actuar para preservar los rastros forenses presentes en el cuerpo de la víctima y en los objetos, así como también registrar los rastros, lo que comprueba la actuación del enfermero para garantizar la integridad de la cadena de custodia, particularmente en situaciones de agresión, heridas con arma de fuego, violencia sexual, abuso infantil y asistencia a víctimas de trauma.

Preservation of forensic traces by Nursing in emergency services: a scoping review

Objective:

to map the scientific production on the preservation of forensic traces by Nursing professionals working in emergency services.

Method:

a scoping review, with searches for studies carried out in six databases, in the gray literature available in Google Scholar and in the references of the studies selected. For analysis, the data reduction method was adopted.

Results:

26 studies were included, organized into five categories: 1) Nursing professionals’ knowledge on the preservation of forensic traces; 2) Procedures performed by Nursing to preserve traces in the victim’s body; 3) Procedures performed by Nursing to preserve traces in the victim’s belongings/objects; 4) Procedures performed by Nursing to document traces; and 5) Actions to maintain the chain of custody performed by Nursing.

Conclusion:

the studies showed situations in which the emergency nurse may act in the preservation of forensic traces present in the victim’s body and in objects, as well as in the registration of traces, verifying the role of Nursing to ensure integrity of the chain of custody, especially in situations of aggression, firearm injury, sexual violence, child abuse and assistance to trauma victims.

Sexual assault response teams (SARTs): an empirical review of their effectiveness and challenges to successful implementation

Historically, the response of the legal, medical, and mental health/advocacy systems to sexual assault has been inadequate and uncoordinated. To address this problem, communities have developed coordinated sexual assault response teams (SARTs) to address these problems. SARTs are community-level interventions that seek to build positive relationships and increase collaboration among sexual assault responders. SARTs hope to improve both the community response to sexual assault victims and the processing of sexual assault cases through the criminal justice system. This article has three aims: to summarize the historical development of SARTs in the United States, to review the empirical literature on SARTs' effectiveness at improving multidisciplinary relationships, legal outcomes, and victims' help-seeking experiences; and to review the empirical literature on the challenges SARTs face, which may hamper their effectiveness. Findings suggest that SARTs are a promising practice, but face many challenges; further methodologically rigorous research is needed to more fully understand these interventions. Implications for policy, practice, and future research are discussed.

Victim confidentiality on Sexual Assault Response Teams (SART)

The purpose of this study is to examine how professionals and paraprofessionals involved with a Sexual Assault Response Team (SART) understand and navigate different professional statutory requirements for victim confidentiality. Telephone surveys are conducted with 78 professionals: medical (27.8%), criminal justice (44.3%), and victim advocacy (27.8%). The majority of participants (58.2%) disagree with the statement that maintaining victim confidentiality posed a challenge to coordination on SART, 10.1% were neutral, and 31.7% agreed with the statement. Significantly more victim advocates than criminal justice and medical professionals perceive that maintaining victim confidentiality posed a challenge to coordination on SART. Consensus on how best to conceptualize victim confidentiality within SART has not been attained. Findings show that not all criminal justice and medical professionals understood the statutory provision of privilege to communications between rape crisis victim advocates and victims. Implications for practice and research are discussed.

Negotiating the challenges of multidisciplinary responses to sexual assault victims: sexual assault nurse examiner and victim advocacy programs

The purpose of this study was to examine Sexual Assault Nurse Examiner (SANE) programs' relationships with victim advocacy organizations. A national telephone survey was conducted of randomly selected SANE programs, all of which served adults, and some of which also served adolescents and children. Nearly one-third of 231 participants reported that SANEs in their program had experienced conflicts related to roles and boundaries with victim advocacy organizations at some point during the program's history. The most frequently mentioned conflicts involved professional autonomy, control, or turf issues. Future researchers should address personnel, organizational, and structural factors that facilitate collaborative relationships between SANE and victim advocacy organizations.

The effectiveness of sexual assault nurse examiner (SANE) programs: a review of psychological, medical, legal, and community outcomes

In sexual assault nurse examiner (SANE) programs, specially trained forensic nurses provide 24-hour-a-day, first-response medical care and crisis intervention to rape survivors in either hospitals or clinic settings. This article reviews the empirical literature regarding the effectiveness of SANE programs in five domains:(a) promoting the psychological recovery of survivors, (b) providing comprehensive and consistent post-rape medical care (e.g., emergency contraception, sexually transmitted disease [STD] prophylaxis), (c) documenting the forensic evidence of the crime completely and accurately, (d) improving the prosecution of sexual assault cases by providing better forensics and expert testimony, and (e) creating community change by bringing multiple service providers together to provide comprehensive care to rape survivors. Preliminary evidence suggests that SANE programs are effective in all domains, but such conclusions are tentative because most published studies have not included adequate methodological controls to rigorously test the effectiveness of SANE programs. Implications for practice and future research are discussed.

Forensic nursing in the context of sexual assault: comparing the opinions and practices of nurse examiners and nurses

This population-based study compared nurses who had participated in a sexual assault nurse examiner training program (SANEs) to nurses who had not participated in the program (nonSANEs) on their opinions and practices in relation to the collection of forensic evidence. Self-administered surveys were distributed to all SANEs and non-SANEs employed in sexual assault care centres in Ontario (N = 317). We found that SANEs were more likely to indicate that certain samples, items, or questions should not be taken and/or asked as a regular part of the forensic examination. They were less likely to perceive the presence of physical injuries and semen and/or sperm as being "extremely important" to a positive legal outcome. Finally, more SANEs reported experiencing dilemmas with respect to their dual roles as caregivers and evidence collectors. These findings are discussed in relation to the more expansive and comprehensive experience and education of SANEs versus nonSANEs. Implications for care offered to victims of sexual assault are discussed.

Using a SANE interdisciplinary approach to care of sexual assault victims

BACKGROUND

Many hospitals have recognized the need to develop policies and procedures for female sexual assault victims' prompt access to emergency medical care and for collecting law enforcement evidence. At Lehigh Valley Hospital (Allentown, Penn), care in the emergency department (ED) for sexual assault victims was covered by oncall obstetricians and gynecologists. Although many aspects of rape management were in place, a busy ED with varying levels of physician response and exposure to the process of rape management contributed to a lack of standardized, objective, timely, and compassionate medical management of sexual assault victims. DEVELOPING THE PROGRAM: The Sexual Assault Nurse Examiner (SANE) interdisciplinary approach to care of sexual assault victims was implemented in May 1998. Community education and awareness projects emphasized prevention of sexual assault and domestic violence, as well as minimization of trauma for victims by promoting services that provide a supportive, caring, and healing environment.

RESULTS

Comparing a baseline group of 130 sexual assault victims with 39 patients who were evaluated after the SANE approach was implemented indicated increased clinical interaction and significant improvements in quality indicators, such as completeness of evaluation and information gathered relevant to medical-legal issues.

DISCUSSION

Law enforcement staff developed a more collaborative relationship with SANE examiners through the interdisciplinary team approach. Collaborative relationships were initiated with several other hospitals in the hospital's integrated delivery system to help offset some of the program's training, continuing education, and on-call costs and to allow for joint outcomes collection. The SANE program became a core ED service in July 1999.