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UCHealth Sexual Assault Nurse Examiners offer specialized training

COLORADO SPRINGS, Colo. (KRDO) - The Sexual Assault Nurse Examiners (SANE) team at UCHealth's Memorial Hospital is conducting comprehensive training this week for nurses from across Colorado to learn more about how to care for patients who have been assaulted.

UCHealth defines a Sexual Assault Nurse Examiner (SANE) as a Registered Nurse who has been trained in the comprehensive care of the sexually assaulted patient, has the ability to conduct a medical/forensic examination with or without evidence collection, and is capable of testifying as an expert witness in a legal proceeding. The SANE may care for the adult/adolescent population, the pediatric population, or both.

As a nationally-known program, UCHealth Memorial’s SANE team hosts training roughly every other month. The team has also hosts nurses from across the country and toured clinicians from other countries. 

UCHealth says Memorial has one of the nation’s few full-time comprehensive forensic nurse examiner programs, providing expert medical care to patients who encounter violence.

That includes:

  • Intimate partner violence
  • Elder abuse
  • Strangulation
  • Sexual assault
  • Child sexual assault
  • Human trafficking.

Memorial's SANE team also provides expert witness testimony in criminal cases.

According to UCHealth, last year alone, the SANE nursing team at Memorial saw more than 2,600 patients in the Emergency Department.

KRDO Newschannel 13's Mallory Anderson sat down with a UCHealth Forensic Nurse Examiner to learn more about the program and why it's important to the community.

Why is it important to be specially trained as a SANE nurse beyond the typical training medical professionals undergo?

Kim Nash, Forensic Nurse Examiner: Patients who experience sexual violence, whether we know they experience sexual violence or we suspect that they did, they have health consequences related to that violence. Many people think of law enforcement as what's needed in those situations, and they forget about the short and long-term health consequences. So clinicians, whether they're doctors or nurses, physician assistants, those health care clinicians responding to this patient population, they need to have specialized education and training to appropriately identify what those health needs may be.

How often do you host these trainings, and who do you offer them to?

Nash: At UCHealth Memorial, we have a grant through the Department of Criminal Justice here in Colorado that allows us to provide this specialized clinical training opportunity about every other month. We don't just offer this clinical opportunity to UCHealth employees or clinicians. This is something that's open to any physician or any nurse in the state of Colorado.

Is this program common in hospital systems?

Nash: It's really important that people understand whether it's here in your own community of Colorado Springs or in other communities across the state, or the nation, not every hospital system supports this type of specialty nursing. So for a hospital or a community that does support it, they show a real commitment to the community understanding that this is not just a criminal justice need and a community safety need, but it is about that patient, their family, their friends, their circle of their community because the consequences of sexual violence are far-reaching and they definitely go beyond the criminal justice system.

What goes into this training?

Nash: The International Association of Forensic Nursing puts forth guidelines for standardized education. Physicians or nurses or clinicians can take a standard 40-hour course that addresses the adolescent adult patient or a 40-hour course that addresses the pediatric patient. Here in Colorado, with UCHealth Memorial and the grant through the criminal the Department of Criminal Justice, we support a unique 64-hour course that combines adult, adolescent, and the pediatric population. So once you take your didactic education, which can be a live class or an online class, then we suggest a clinical experience like the one that's happening here today, where nurses are trained by experienced forensic nurses using live gynecological teaching associates, meaning live mock patients, to learn the skills needed to conduct the full comprehensive medical forensic exam.

So this is a pretty intense training?

Nash: Our goals here for the two-day or 16-hour clinical skills lab is to teach the needed skills like pelvic exams, evidence collection, addressing potential pregnancy or sexually transmitted infection concerns. But it's also about building confidence. Confidence because these clinicians, we want them to be able to go back to their communities and offer these services. If they don't, patients in their communities will be accessing health care who isn't trained. So there are doctors and nurses that are unfortunately put in the position of conducting a medical forensic exam when they haven't had any formal training in education. That's not only unfair to the patient and the community, but it's unfair to that clinician who's being asked to do that in unfair circumstances. We know that on average there's about 8 to 900 forensic nursing or SANE programs across the nation, which sounds like a lot until you consider how many hospitals there are. There are between 5 to 6,000 hospitals within the U.S., which means that the majority of hospitals don't have the specialized community of nurses or other clinicians to conduct these exams.

When medical professionals leave today, they won't be completely certified as SANE nurses. What happens from here to become truly certified?

Nash: As a SANE nurse here in the U.S., you have to have training and experience. So you need 300 hours of patient experience before you can even sit for certification. Here in Colorado though, you don't need to be certified to conduct the medical exams. However, we do want you to have the didactic or classroom education coupled by this clinical experience. Then, based on the entity that hires you, like the institution or the facility, they'll have their own orientation process. So the hope is that these nurses are leaving here and going back to a program where they're precepted by experienced nurses until they're deemed competent by their facility to see patients on their own.

It sounds like UCHealth Memorial has a pretty extensive program. Is this highly-regarded training?

Nash: I wish that everybody in our community here in Colorado Springs understood how highly regarded this program is. This program has been around since 1995. It started out as a traditional on-call program where nurses were on-call and would be called in when a patient presented. However, years ago we moved the program in-house, meaning that the forensic nurses in Colorado Springs at UCHealth Memorial are fully in-house. They're scheduled as forensic nurses, and that's all they do, is they take care of patients who have been impacted by violence, whether that's sexual assault, child abuse, domestic violence or intimate partner violence, elder abuse, human trafficking, strangulation, gunshot wounds, stabbings, auto versus pedestrian. When I joined the team in 2006, a busy year for us was about 250 sexual assault patients. It may surprise a lot of people to know that last year a forensic nurse in just our community here in Colorado Springs came in contact with over 2,600 patients in one year. Sometimes those patients ended up needing full medical forensic exams. Other times they were consults. But every single time, it was appropriate for a forensic nursing specialist to come in for a consult.

Going to a hospital for sexual assault or intimate partner violence is one of the hardest things that a patient could do. Why would you encourage them to get checked out and trust a SANE nurse?

Nash: Many people in the state of Colorado don't understand that there are reporting options for adult victims or adult survivors of intimate partner or sexual violence. If you are over the age of 18 and you're not an elder and you've been sexually assaulted, there are three reporting options you can choose to report to law enforcement. You can choose to do what's called a 'medical report' where we're not involving law enforcement, but you don't mind if law enforcement has your information like your name and demographic information. Or you can choose to have a full medical forensic exam and remain anonymous where law enforcement doesn't have any identifying information. In all three situations, you get a full comprehensive exam. In all three situations, you can choose to have evidence collected or not with the reporting option. In the medical option, the patient chooses whether they want that evidence to go to the crime lab and be analyzed, or if they prefer to have law enforcement store that evidence. With the anonymous option, you can have law enforcement store that evidence. The rationale behind this is we want patients to come forward for health care regardless of their reporting options and regardless if they want evidence collected. Just because we're not reporting or opening an evidence kit doesn't mean that the health consequences disappear. In addition, after a violent assault or an episode of violence, you may be making a choice that you feel differently about in three days, or next week or next month, or next year. And if you've had the opportunity to come in and receive health care, have evidence collected, and later on, you choose to convert to a report to law enforcement, then at least we've collected some evidence that can then be used from a criminal justice standpoint.

How do you go out of your way to make sure patients feel supported and not shamed during this experience?

Nash: I think the value in doing this job is understanding that you're making a difference. In any area of nursing, it's important to build a rapport. It's important to make sure that your patient has informed consent to any intervention or procedure that we're doing. That's also true for forensic nursing. We want to make sure that we are building rapport, consenting, educating about the options, and then supporting our patients in the decisions that they're making. We also want to provide appropriate interventions, whether those are interventions in our exam room or community resources that we connect our patients to. And we understand the value not just for that patient, but the overall job satisfaction, the resiliency that it builds in you as a clinician to know that you made a positive impact on a patient during a time when they're in great need of resources and positive impacts. That's really rewarding."

For medical professionals interested in learning about free SANE training, click here.

The training comes at a pivotal time as April is Sexual Assault Awareness Month, and Wednesday, April 27 is 'Colorado Denim Day.'

Denim Day is a worldwide event and movement to wear jeans as a visible means of protest against misconceptions that surround sexual assault. Since 2013, the Colorado Coalition Against Sexual Assault (CCASA) says it has hosted Colorado Denim Day in order to raise awareness about sexual assault, show support for survivors, and unite communities across Colorado in taking a stand against sexual violence.

If you or someone you know is in need of help after a sexual assault or other violence from an intimate partner, below is a list of resources:

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Mallory Anderson

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