When you find yourself in the role of Sexual Assault Nurse Examiner: Information that will help you and your patient

It is mid-way through your shift and the triage nurse tells you a patient reporting a sexual assault has just arrived for care. Your first inkling is to appear very occupied with your other patients—it has been a very long time since you have even had the chance to look at a Sexual Assault Evidence Collection Kit. Doesn’t it take hours to properly complete the kit? Isn’t the paperwork overwhelming? What if the case goes to court and I need to testify?

First of all, consider the age of the patient, the length of time since the assault, and the immediate needs of the patient. The patient’s priority is crucial and should be addressed in a timely manner.

Laws vary by state. The timeframes for evidence collection after an assault also vary. It is important for you to have some basic knowledge of the laws, statutes and kit collection recommendations in your jurisdiction. You should also be familiar with your resources. If medical advocates from the local Rape Crisis Center are available to respond, allow the patient the benefit of that source of support, while allowing you to concentrate on the steps of evidence collection and the necessary documentation. The patient will have support through the process and beyond. Medical Advocates are familiar with the resources in the area and provide an invaluable service in safety planning with the patient. Creating a safe discharge plan can be challenging. Utilize your resources to the benefit of the patient.

The kit box should be intact before being opened for use. Once you open a kit “you own it,” so it should remain in your possession at all times until secured with the enclosed evidence seals upon completion. Each kit box includes a set of instructions, so let the patient know that in order to ensure proper evidence collection you may need to refer to the instructions as you go.

Let the patient know what you can offer him/her and answer any questions they may have regarding the exam. Consider the requirements for the patient to be able to consent to have evidence collected. Does the patient have to report to police? Does the patient have the option to have evidence collected, sent to the crime lab and stored, giving the patient additional time to report to police? In some states, evidence can be collected up to 120 hours (five days) post-assault. Check on the protocols for your state. If the patient does not want evidence collected, they should be given a medical exam and offered the appropriate prophylactic medications. The assault can be documented using the appropriate forms according to your state protocol. Listen to the patient’s report of the assault; that history will guide your evidence collection.

Remember, even if no evidence is found it does not mean a sexual assault did not happen.

In a drug-facilitated sexual assault, the patient may have little recall of the event; know few details of the assault; may have awoken in a strange place; or recalls drinking one or two drinks but was markedly more intoxicated than would be expected. Consider collecting a sample for Comprehensive Toxicology Screening if it is indicated and available at your crime lab. In some states, the sample is collected, maintained at an appropriate temperature and analyzed if requested by law enforcement. That information should be shared with the patient. If the patient is unable to provide details of the assault, as in a suspected drug-facilitated sexual assault, consider collecting all other steps of the kit box in addition to toxicology samples.

When you have completed the exam, inform the patient of the findings.

The patient should also be offered prophylaxes according to the history of the assault and your facility protocols.

Safety planning is a crucial step in preparing for a patient’s departure, and both the nurse and medical advocate from the rape crisis center should collaborate on the needs of the patient prior to his/her discharge from the facility. Knowing your resources are key in providing quality care to the patient. Sexual assault survivors should be heard, respected, and empowered.

Familiarize yourself with your kit before you need to use one. Both you and your patient will benefit from your preparation.