Before implementation of SANE programs, rape victims who came to an emergency department for care often had to wait for many hours in a very busy, public waiting area. During this time, they were often not allowed to eat, drink or use the rest room due to concerns about destroying evidence. In addition, their significant emotional needs were overlooked. Nursing research into the victim’s psychological response to rape helped pave the way for the growth of SANE programs, which began expanding rapidly in the late 1990s.
Crozer-Keystone’s first SANE program was established in 2005 at Delaware County Memorial Hospital when several Emergency Department nurses volunteered for a week of intensive specialized training. During these sessions, nurses learn to assess, document and collect forensic evidence, conduct a limited medical exam, and provide the victim with emotional support and crisis intervention. Today, SANE programs have been established at all four CKHS hospitals, and SANE nurses are on call 24/7 to respond to the needs of victims of sexual assault.
According to the SANE Development and Operation Guide, the basis of a SANE program is the belief that sexual assault victims have the right to immediate, compassionate and comprehensive medical-legal evaluation and treatment by a specially trained professional who has the experience to anticipate their needs during this time of crisis.
This month, we spotlight the nurse at each hospital who was the first to champion the SANE program. Please click on the link of the nurse's name to read about her contributions.
Tara Scherf, RN, BSN
When the DCMH Emergency Department was looking for nurses to volunteer for SANE training in 2005, Tara Scherf, RN, BSN, was the first to respond. With several years of experience as an ED nurse, she was interested in opportunities for growth, and as a SANE nurse for the past four years, she has found her work very rewarding.
“This is a population of patients who are traumatized and don’t know what to expect when they come to the ER for care,” Scherf says. “They have no idea that they could be here from two to four hours just for the exam, which involves a head to toe assessment, documentation that includes taking photos of every injury and taking narrative from the victim, as well as a speculum exam which can trigger flashbacks when the victim has been traumatized. Having SANE nurses who are specially trained and dedicated to providing this service compassionately helps victims feel a little more at ease and a little less re-traumatized. We walk them through it step by step.”
Last year, SANE nurses cared for 32 sexual assault victims at DCMH.
Scherf notes that SANE nurses take call above and beyond their regular work schedules with a commitment to come to the ED within an hour of the victim’s arrival to help facilitate their care and contact law enforcement on their behalf. “We have a collaborative relationship with the police department and the Women Against Rape (WAR) advocacy group which also benefits our patients,” she says. “We help them through the whole legal process, including testifying in court.”
Scherf and her SANE colleagues at DCMH have set a goal to become certified within the next year.
SANE Nurses at DCMH
Michele Connell, RN, BSN, CEN
Ellen Favazza, RN, BS
Shannon Hanshaw, RN
Kathy Keenan, RN, PHRN
Kristen Kolody, RN, BSN
Jim Plank, RN
Tara Scherf, RN, BSN
Regina Schultz, RN
Shanta Stevens, RN
Brigid Straube, RN, BSN
Ginny Tanner, RN-C, BSHA
Theresa Sardella, RN, BSN
During 10 years as an Emergency Department nurse, Theresa Sardella, RN, BSN, SANE, observed that many ED nurses were reluctant to take the sexual assault cases “due to discomfort with the process, time involved with the forensic exam, and sometimes even bias.”
In the past, ED nurses usually had to care for four or five other patients in addition to the sexual assault victim, so they didn’t have adequate time to spend with the victim, according to Sardella. “In situations like that, the victim is almost re-victimized because they’re not getting the attention or care they need,” she explains. “Now, the SANE nurse’s assignment is one-to-one. The nurse’s sole attention is on the victim throughout the entire process of the exam and collection of evidence. You don’t leave the patient’s side until everything is finished, and they are reassured by that.
Sardella also notes that SANE nurses act as advocates. “We do evidence collection with great sensitivity to the needs of the victim providing emotional support, while at the same time, carefully securing DNA evidence with the legalities in mind,” she says. “The SANE nurse also remains as a legal advocate for the victim, following through with them all the way to court, including testifying on their behalf. We’re there every step of the way for comfort and support from beginning to end.”
Nurses bring an invaluable benefit to their collaboration with law enforcement on behalf of sexual assault victims, according to Sardella. “The SANE nurse interviews the victim prior to collecting evidence, working with the detectives, to secure as much information as possible regarding the assault. By nature, nurses have the ability to talk to patients and elicit more information, because patients are generally more comfortable talking to us than a detective, and they often give us critical information,” she says.
SANE nurses also serve as educators at the high school and collegiate levels regarding date violence and date rape. “We provide education on safe practices,” Sardella says, “all with the hope of prevention and early reporting if a violation occurs.”
Sardella’s involvement in SANE nursing has fueled her interest in forensics. Currently working toward her master’s degree in forensic medicine, she plans to expand her involvement in forensics to include domestic violence, sexual abuse and child abuse. “This is a new and emerging field without limits,” she says. “A forensic nurse can consult at the county level with the district attorney’s office or the medical examiner’s office or respond with detectives to crime scenes. Nurses are considered very valuable to forensics because of our background and experience with families and life and death and dying. Some of the literature says that hospital systems may be required to have forensic nurses on staff in the future because of increasing crime rates. “I’m excited about providing a service to victims that, at this point and time, does not exist as wholly as it should.”
A SANE class will be held at Taylor in late June to train additional staff.
SANE Nurses at Taylor
Joyce Foresman Capuzzi, RN, SANE -A
Alison Colodonato, RN, SANE
Karen Dougherty, BSN, RN, CEN, SANE-A, SANE-P, CFN
When Karen Dougherty, BSN, RN, CEN, SANE-A, SANE-P, CFN, joined Crozer-Chester Medical Center’s Emergency Department last year, she arrived with 10 years of SANE experience. A 30-year emergency nursing veteran, Dougherty singlehandedly established the SANE program at Crozer, obtaining the necessary equipment, writing policies, recruiting nurses for SANE training and arranging the training sessions. In just 10 months, the SANE program was up and running with eight trained nurses to serve the 80+ sexual assault victims who come to CCMC for care each year. In May 2009, Dougherty received the Bertram Speare Spirit of Crozer award for her efforts.
Dougherty, who has SANE certification for both adult and pediatric victims, is dedicated to providing these vulnerable patients with the best of care. “Our SANE nurses take call 24/7 and my phone rings all hours of the day and night,” she says. “That’s okay with me because I’ve made a commitment to the team and I don’t want nurses to conduct SANE exams who aren’t comfortable with it. It’s not good for the victims or for them.”
Dougherty is the only SANE nurse at Crozer currently conducting pediatric exams, which can be particularly tough. “You have to take the time to establish trust by playing and talking with the child. You also have very distraught parents who are also your patients and you have to deal with their emotions at the same time.
“In some cases, a family member is the accused perpetrator,” she continues. “It’s terrible for the child and for the family which often must be split up or the child can’t go home because we must be sure that the child will be safe.”
Dougherty notes that mandatory reporting of sexual assaults is not required in Pennsylvania, but she encourages all victims to be examined by a SANE nurse whether or not they want to notify the police.
“Many college students and young adults aren’t sure whether they want the police involved, but I still want them to have the opportunity to obtain medication for sexually transmitted diseases and pregnancy prophylaxis,” says Dougherty, who is also certified as a forensic nurse examiner. “And just in case they change their mind and decide later that they want to report it, I collect their evidence and hold it for two weeks with their signed consent. That’s very reassuring to patients. They don’t feel pressure to call police right away, but if they change their minds, they know the evidence will be there.”
Moving forward, Dougherty’s vision is to develop the Crozer SANE team into a full forensic nursing team that will handle domestic violence, child abuse and elder abuse as well as sexual assault. “When such victims come into the ED, we will screen them, thoroughly document the abuse or assault, and make sure they have a safe place to go when they leave the ED.”
SANE Nurses at CCMC
Christine Boyle, RN
Danielle Burke, RN, BSN
Barb Coles, RN
Karen Dougherty, BSN, RN
Jen Miller, RN, BSN
Mannan Miller, RN, BSN
Suzie Nestor, RN
Pat Pralle, RN, CEN
Dawn Tierney, RN, BSN
Carol Benecke, RN
“Sexual assault is an experience that will impact the victims for the rest of their lives,” says Carol Benecke, RN, staff nurse in Springfield Hospital’s ED. “I find it gratifying to be able to help them in some way by providing a safe haven, trying to make them feel as comfortable as possible in such a horrible situation by talking and listening to them. I’m not going to judge them or ask questions like, ‘Why did you put yourself in that situation?’ or ‘Why were you drinking?’ I just want to help them feel safe.”
“Some people think you just do the rape kit and you’re finished but there is much more to it than that,” continues Benecke, who previously conducted sexual assault exams as a staff nurse in Taylor’s ED for five years. “It’s important not to rush victims through the exam. I sit and talk to them and try to make them comfortable first. It has to go at their pace, however long that takes. They didn’t have a say in what happened to them, and I think it’s important to give them a say in how the exam goes.”
Some SANE exams are particularly tough, admits Benecke, who recently took the SANE certification exam and is awaiting the results. “Sometimes I finish an exam and go out to my car in tears,” she says. “I once cared for a mentally challenged girl who didn’t understand what had happened or what I was asking her. Her mom was also in the room and she had to rehash everything, which was devastating for her, too. What gets me through is that I know I’m trying to help this person. I’m collecting evidence very carefully so that the monster that did this to her doesn’t do it to anyone else.”
SANE Nurses at Springfield
Joyce Foresman Capuzzi, RN, SANE -A
Alison Colodonato, RN, SANE