Term Paper on "Competency Evaluation in Sexual Assault Nursing"

Term Paper 15 pages (4861 words) Sources: 1+

[EXCERPT] . . . .

Competency Evaluation in Sexual Assault Nursing

The report of the U.S. Department of Justice Office of Violence Against Women entitled: "A National Protocol for Sexual Assault Medical Forensic Examinations: Adults and Adolescents" relates that: "Sexual assault can result in physical trauma and significant mental anguish and suffering for victims. Victims may be reluctant, however, to report the assault to law enforcement and to seek medical attention for a variety of reasons." (2004) This is because victims fear their assailants and worry that they may not be believed and they also feel embarrassed and lack easily accessible services. The U.S. Department of Justice Office of Violence Against Women reports the development of a protocol based on national, local and tribal experts input throughout the United States, which included representative of law enforcement, prosecutors, advocates, medical personnel, forensic experts as well as others.

Protocol Goals

The protocol is stated to have the goals as follows: (1) to supplement the many excellent protocols that have been developed by individual states, tribes and local jurisdictions and those at the national level. This protocol is considered to be a guideline rather than a list of requirements; (2) to provide guidance to jurisdictions on responding to victims that are adults or adolescents; (3) to support the use of coordinated community responses to sexual violence; (4) Address the needs of victims while promoting the response of the criminal justice system. This includes stabilization, treatment and engagement of victims as "essential partners in the criminal investigation"; and (5) to promote high-quality, sensitive, and supportive exams for all victims, with no regards to their jurisdiction or geographical location of the provision of service. (the U.S. Department of Justice, 2004)

II. Operational Issues

Under the section entitled 'Operational Issues' specifically addressed is the role of 'Sexual Assault Forensic Examiners' which are the health care professionals who conduct the examination stating that "It is critical that all examiners, regardless of their discipline, are committed to providing compassionate and quality care for patients disclosing sexual assault, collecting evidence competently, and testifying in court as needed." (the U.S. Department of Justice, 2004) Recommendations for building the capacity of examiners performing these exams in jurisdictions include: (1) Encourage the development of specific examiner knowledge, skills and attitudes; and (2) Encourage advanced education and supervised clinical practice of examiners, as well as certification for nurses who are examiners." (the U.S. Department of Justice, 2004) There are specifications that facilities are obligated to meet and recommendations for jurisdictions in terms of the building of capacity of the health care facilities for responding to sexual assault cases however, the information most important to the nurse includes aspects of proper methods and procedures in terms of evidence documentation. Generally, the jurisdictions will have standardized sexual assault collection kits or will purchase kits that are premade through vendors. Despite the variations, critical components of the kits include: (1) a kit container; (2) Instruction sheet or checklist; (3) Forms; and (4) Materials for collection and preservation of evidence required by the crime forensics laboratory. (the U.S. Department of Justice, 2004)

III. Type of Evidence Collected

Evidence that may be collected however, this is not an exhaustive list includes: (1) Clothing; (2) Foreign materials on the body; (3) Hair (including head and pubic hair samples and combings); (4) Oral and anogenital swabs and smears; (5) Body swabs; and (6) a blood or saliva sample for DNA analysis and comparison. (U.S. Department of Justice, 2004) Other necessary knowledge for the nurse according to the U.S. Department of Justice includes considerations of timing when collecting evidence. The rule-of-thumb is that data should be collected within 72 hours after the assault because evidence collected "...beyond that point is conceivable." (the U.S. Department of Justice, 2004) Because this is so, the cutoff or limitation has been lengthened to between five days and one week in some jurisdictions. As the technologies of DNA advance the time limits are being noted by the U.S. Department of Justice to be extended even further and as well this is attributed to the stability of DNA as evidence. The U.S. Department of Justice notes that there are cases being solved presently that when the evidence was collected over two years ago the evidence was considered in too small of samples to be usable in forensic testing.

III. Evidence Integrity & Chain of Custody Requirements in Forensic Science

Evidence integrity is addressed in the U.S. Department of Justice report which states that proper collection, preservation and maintenance of the 'chain of custody' of the evidence is critically important to subsequent use of the evidence to prosecute offenders in criminal proceedings. Chain of custody is the process of documentation of the evidence at every step, and accounting for every minute of the evidence's location from the time of collection until the evidence is submitted in the courtroom during the trial prosecuting the offender. A break in the 'chain of custody' results in the evidence being inadmissible which means that the evidence has lost its integrity and the court will not consider the evidence after integrity is lost. Recommendations provided by the U.S. Department of Justice include the following for health care providers and other responders in maintaining the integrity of the evidence collected in connection to a sexual assault case: (1) Follow jurisdictional policies for drying, packaging, labeling, and sealing the evidence; (2) Follow jurisdictional policies for documenting exam findings, the medical forensic history, and the patient's demeanor/statements, and packaging, labeling, and sealing such documentation; (3) Follow jurisdictional policies for consistent evidence management and distribution. A duly authorized agent should transfer evidence from the exam site to the appropriate crime lab or other designated storage site (e.g., a law enforcement property facility); (4) Make sure storage procedures maximize evidence preservation. Ensure that storage areas are kept secure and at the proper temperature for the evidence. Also, make sure jurisdictional policies are in place to address the secure storage of evidence in cases in which patients are undecided about reporting; and (5) Maintain the chain of custody of evidence. All those involved in handling, documenting, transferring, and storing evidence should be educated regarding the specifics of their roles in properly preserving evidence and maintaining the chain of custody. (the U.S. Department of Justice, 2004)

V. Examination Process

The examination process is also addressed in the U.S. Department of Justice report which states in relation to initial contact with the patient that many patients initially present "at a designated exam facility, but most who receive immediate medical care initially contact a law enforcement or advocacy agency for help." (2004) in cases where 911 is called the initially assistance to victims is often in the form of emergency medical services (EMS) or police officer personnel. Recommendations of the U.S. Department of Justice for initial contact with victims includes: (1) Build consensus among involved agencies regarding procedures for a coordinated initial response when a recent sexual assault is disclosed or reported, and educate responders on procedures. Encourage victims to interact with advocates as soon after disclosure as possible; (2) Recognize essential elements of initial response. In particular, encourage victims to seek medical care and have evidence collected. In the case of life-threatening or serious injuries, obtain emergency medical assistance according to jurisdictional policy. Any life-threatening wounds should be treated and victims' immediate safety needs should be addressed before evidence is collected; and (3) if victims decide to seek medical care and/or have evidence collected, follow jurisdictional policies for preserving evidence, collecting a urine sample if needed, and transporting victims to the exam site. (the U.S. Department of Justice, 2004) the U.S. Department of Justice makes recommendations for 'triage and intake' which include the following for facilitation of triage and intake that addresses the needs of patients: (1) Consider sexual assault patients a priority. Use private locations in the exam facility for the primary patient consultation and initial law enforcement interviews, offer a waiting area for family members and friends, and provide childcare if possible; (2) Respond to acute injury, trauma care, and safety needs of patients before collecting evidence. Patients should not wash, change clothes, urinate, defecate, smoke, drink, or eat until initially evaluated by examiners, unless necessary for treating acute medical needs; (3) Alert examiners to the need for their services at the exam site; (4) Contact victim advocates so they can offer services to the patient, if not already done; (5) Assess and respond to safety concerns, such as threats to the patient or staff, upon arrival of patients at the exam site; and (6) Assess patients' needs for immediate medical or mental health intervention. Seek informed consent from patients before providing treatment, according to facility policy.

VI. Documentation of Sexual Assault

Documentation of sexual assault by health care personnel makes a requirement of separate documentation of the medical record by examiners and all other involved clinicians. Recommendations for documentation by health care providers are stated by the U.S. Department of Justice to include: (1) Ensuring that all appropriate documentation is completed. The forensic… READ MORE

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