Can Telenursing Help Victims of Sexual Assault?


Hours after Stacey and her then-boyfriend were held up at gunpoint in their Florida hotel room, and she was brutally raped by the attacker, first responders took them to a local hospital. On vacation and far from home, she was in a state of shock.

But Stacey, who asked that her last name be withheld, was quickly seen by a Sexual Assault Nurse Examiner (SANE), a certified forensic nursing specialist who works with victims of sexual assault.

The SANE nurse remained for the duration of her hospital stay, collected all the forensic evidence needed for the rape kit, and comforted Stacey. A month later, her attacker was picked up following the carjacking of two young females, and the combination of the DNA from Stacey's rape kit and other evidence was enough to send him to prison for life.

If the attack against Stacey had occurred in a city or town where no SANE nurse was available, her story would in fact have been much grimmer.

“I don't think I would have made it,” recalls Stacey, now 40 and living in Massachusetts, almost 15 years after the attack.

The first SANE program was started in the 1970s in Memphis by nurses who realized that sexual assault victims were getting neither compassionate care nor help in preserving and collecting the forensic evidence needed to prosecute their assailants.

There are now 778 programs across the country, funded by various methods—some have state subsidies, others are reimbursed by fees, and others get funded from victim compensation fees—with each program hosting approximately one to 20 nurses, according to the Maryland-based International Association of Forensic Nurses.

Underserved Communities

Still, this is not enough to serve all the patients who need help across the nation—particularly those living in rural communities or in areas underserved by hospitals, said Kim Day, the SAFE Technical Assistance project director at the nurses' association.

“We have one SANE program for every ten hospitals,” said Day, “And there are [places] that have no SANE coverage at all—and this can be significant for survivors that live in those areas.”

But the gap in services may soon be closed—thanks to the remote video technology known as telemedicine.

Next month, a national Telenursing Center, operated by the Massachusetts SANE program, will begin operating as a 24/7 facility for underserved populations.

The program is funded by a $3.3 million Department of Justice grant, channeled through the federal Office for Victims of Crime (OVC), to the Massachusetts Department of Health, awarded in 2013.

The center, based at Newton-Wellesley Hospital, will be staffed by nurses from the Massachusetts SANE program, which has been operating across the state since the 1990s.

Kristie Holden, the Massachusetts SANE Southeast Regional Coordinator , who will also be working on the pilot project, believes the telenursing system will help leverage the crucial services provided by SANE nurses.

“Before SANE, no one knew how to care for [rape victims],” said Holden. “No one knew how to do evidence collection; people would read directions off the box.”

A SANE nurse receives 40 hours of additional training, stays with the patient from the beginning of her hospital visit to the end—which could last hours—and is responsible for collecting all the forensic evidence for the rape kit before it is transferred to law enforcement.

“The expansion and availability of SANE nurses is the best thing that has happened in the field over the last decade,” said Scott Berkowitz, president and founder of the Rape, Abuse & Incest National Network (RAINN), the nation's largest anti-sexual violence organization, based in Washington, D.C.

It makes it a lot easier for victims, and improves the quality of evidence if there is a criminal case.”

Reporting Sexual Assaults

Studies have shown that the percentage of victims reporting their crime has increased after working with a SANE nurse, in addition to higher and more successful prosecution rates. Seventy-two percent of sexual assaults were reported by victims to the police when there was a SANE nursing program in the community, as opposed to 50 percent when there was no presence.

The conviction rate was 69 percent, compared to 57 percent if a SANE nursing program was in the community.

Under the telenursing program, trained SANE nurses will work with on-site nurses through a video conferencing station. Telemedicine has increasingly become a tool for experienced doctors and nurses to assist colleagues in less populated areas.

Sitting in his or her remote station in Massachusetts, a SANE nurse will be able to guide the local examiner in collecting the forensic evidence needed for the sexual assault kits, as well as in providing emotional and therapeutic support. The center will be staffed with 25 nurses around the clock.

Two pilot sites—located at the Marine Corps Air Ground Combat Center in 29 Palms, CA, and the Naval Air Station in Jacksonville, FL—are scheduled to begin operating when the national center is launched. Organizers explain military personnel are regarded as among the largest under-served populations.

Sites are also being considered in rural, tribal and correctional communities.

“We identified these particular areas because their communities didn't have trained examiners ready, and these communities face numerous challenges with sexual assault,” said Kris Rose, Deputy Director of OVC, who spearheaded the project for the federal government.

It often took hours to transfer sexual assault victims in the military to SANE installations located off the base, and the lengthy time sometimes led to victims changing their minds about going through with the process, Rose said.

Having the ability to actually collect sexual assault kits on site can make a difference for prosecution in military sexual assault cases, she added.

Rape Kit Backlog

Still, with an estimated national backlog of over 400,000 untested rape kits and news reports showing cities—from Memphis to Detroit— warehousing thousands of untested kits, the question arises: Is it a good idea to add in these new kits to the mix, particularly in areas that are under resourced to begin with?

How are correctional, tribal and rural communities going to be able to process the kits and work with local crime labs, law enforcement and prosecutors to bring these cases swiftly to court?

“The participating partners have to develop a relationship and there has to be a plan to test these kits and investigate these cases,” responds OVC Deputy Director Rose. “Not to do that would be irresponsible.”

She maintained that the Massachusetts Department of Health, which is overseeing the partner selection process, would not provide funding to communities that don't have all these pieces in place.

However, Stacey, the sexual assault survivor, who had a successful prosecution, says that even just the prospect of immediate medical and psychological care can make a big difference.

“Not everyone chooses prosecution,” she said. “What mattered to me, right after my assault, was that someone was there who provided a sense of calm—and that someone was going to help me catch the bad guy. “

Cara Tabachnick is managing editor of The Crime Report. She welcomes comments from readers.

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