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Forensic Evidence Collection for Nurses in Texas

Contact Hours: 2

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Contact Hours: 2

This online independent study activity is credited for 2 contact hours at completion.

Course Purpose

The purpose of this course is to provide an overview of emergency room nurse requirements for forensic nursing and evidence collection according to Texas’s state and federal guidelines.

Contact Hour Designation

This online independent study activity is credited for 2 contact hours.

Overview

Forensic science is a specialty that focuses on recognizing, identifying, and evaluating evidence collected in criminal investigations. Texas’s Senate Bill 1191 requires that all nurses working in the emergency department receive basic education on collecting forensic evidence of a sexual assault. This online learning activity provides an overview of emergency room nurse requirements for forensic nursing and evidence collection according to Texas’s state and federal guidelines.

Objectives

Upon completion of the independent study, the learner will be able to:

  • Define forensic science
  • Review the standards of forensic nursing practice
  • Understand the Texas Evidence Collection Protocol
  • Review the types of sexual assault forensic exams
  • Understand the distinct types and forensic evidence and the importance of maintaining the chain of custody of evidence.

Policy Statement

This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.

Disclosures Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.

Fast Facts: Forensic Evidence Collection for Nurses in Texas

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Definitions
American Nurses Association (ANA)An organization created to advance and protect the profession of nursing.
AssessmentInvolves collecting data and information relative to the patient’s situation, health, or death.
DiagnosisIncludes analyzing the assessment data to determine actual or potential diagnoses, problems, and issues.
EvaluationThe making of a judgment about the amount, number, or value of something.
Eye Movement Desensitization and Reprocessing (EMDR)A psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories.
Forensic nurseA Registered or Advanced Practice Nurse who has received specific education and training to care for patients have health concerns that are associated with victimization or violence.
Forensic ScienceA specialty that focuses on recognizing, identifying, and evaluating evidence collected in criminal investigations.
ImplementationThe process of putting a decision or plan into effect.
International Association of Forensic Nurses (IAFN)An international membership organization comprised of forensic nurses who work around the world, and other health professionals who support the work of forensic nursing.
OutcomesSomething that follows as a result or consequence.
Planning The process of making plans for something.
sexual assault Any type of sexual activity or contact that is not consent to.
Sexual Assault Nurse Examiners (SANE)forensic nurses who provide care to victims of sexual assault.
Victim A person harmed, injured, or killed because of a crime, accident, or other even or action.
Introduction

Forensic science is a specialty that focuses on recognizing, identifying, and evaluating evidence collected in criminal investigations.1 It has three main areas; biology (crime against people and involves the collection of body hair, fluids, and fibers), chemistry (involves the identification or analysis of chemical compounds like drugs, glass, etc.), and drugs/toxicology (includes criminal and non-criminal deaths and crimes associated with drug abuse).1

A person who is a victim of sexual assault in Texas has a legal right to a forensic exam if the assault is reported within 120 hours of occurance.2 Professional caregivers trained in forensic nursing are required to collect the evidence effectively, while maintaining compassion for the victim.2

Nurses that are certified in forensic sciences are referred to as Sexual Assault Nurse Examiners (SANE).2 Because there is a shortage of certified SANE nurses, Texas’s Senate Bill 1191 requires that all nurses working in the emergency department receive basic education on collecting forensic evidence of a sexual assault.2 But remember, the basic training is not the same as what certified nurses receive.2

Forensic nursing skills is not only needed by nurses specializing in forensic sciences; it is a must-have skill for all nurses.1 A nurse working in the emergency room (ER) might encounter cases of child abuse, rape, drug abuse, domestic abuse, and more that require assessing the patient and determining their medical care needs.1 The nurses’ evidence collection in such cases can make or break a case.1

Since nurses are the first healthcare professionals to meet the patient in the ER, they need to be sensitive to the victim and collect important evidence before it is lost.1 Forensic evidence’s importance has been greatly elevated over the last 15 years in courts and, thus, requires a greater demand for forensic nurses and collection of evidence.1 If every nurse in the ER has basic training in evidence collection, then the victim can be examined locally and will not have to be transferred to another location equipped with certified forensic nurses.2 This course will cover forensic evidence collection according to Texas’s state and federal guidelines.

Forensic Nursing Practices

The current forensic nursing practices use the quality-care model as its framework, which the International Association of Forensic Nurses (IAFN) developed.3

In collaboration with the American Nurses Association (ANA), the International Association of Forensic Nurses (IAFN) assembled a group of forensic nursing experts to revise the previous edition of the handbook, “Forensic Nursing: Scope and Standards of Practice,” to focus on those patients that are affected by violence and trauma, including individuals, families, communities, or populations.

The standards of forensic nursing practice include 3:

Assessment

Assessment involves collecting data and information relative to the patient’s situation, health, or death.4 Collecting data is a systematic and ongoing process to provide nursing care and identify the implications of the findings.4 The data includes demographics, social determinants of health, health disparities, and physical, functional, psychosocial, emotional, cognitive, sexual, cultural, age-related, environmental, spiritual/transpersonal, clinical-forensic, and economic assessments.4

Multiple assessment parameters are recognized by the World Health Organization (WHO), such as 4:

  • Recognizing the impact of your personal attitudes, values, and beliefs on the assessment process.
  • Integrating global and environmental factors.
  • Identifying barriers to communication based on psychosocial, literacy, financial, and cultural considerations.
  • Assessing the impact of family dynamics on the patient’s health and wellness.

Diagnosis

Diagnosis includes analyzing the assessment data to determine actual or potential diagnoses, problems, and issues.4 These barriers to safety include but are not limited to interpersonal, systematic, cultural, or environmental circumstances.4 It is the responsibility of forensic nurses to recognize normal and abnormal behavior, development, and physical variations of the patient.4 For this, nurses can use assessment data, technology, standardized classification tools, and clinical findings.4

Nurses that specialize in forensic sciences use complex data and information obtained during the medical–forensic history, examination, diagnostic procedures, and review of medical–forensic documents in identifying diagnoses.4

Outcomes Identification

After diagnosis, a nurse must identify the expected outcomes for a patient and develop a personalized plan according to the situation.4 Nurses are responsible for engaging the patient, the interprofessional team, and other healthcare professionals to identify the expected outcomes.4

Nurses use clinical expertise and evidence-based practice to identify health risks and issues.4 Moreover, the formulated expected outcomes derived from assessments, patient preferences, and diagnoses need to be culturally sensitive and appropriate.4 A timeframe is also generated for attaining the expected outcomes.4

The expected outcomes should 4:

  • Be modified based on the patient’s status and situation.
  • Should incorporate cost and clinical effectiveness.
  • Align with the expected outcomes of other members of the interprofessional team.

Planning

Next, the forensic nurse is tasked to develop a plan that describes actions to attain expected, measurable outcomes in partnership with the patient, family, interprofessional team, and other healthcare professionals.4 Nurses are responsible for using appropriate interventions that minimize unwanted treatment and suffering.4

Nurses can use evidence-based strategies in the plan for identified diagnoses, problems, and issues, such as 4:

  • Promotion and restoration of health
  • Prevention of illness, injury, disease, and death
  • Facilitation of healing
  • Alleviation of suffering
  • Appropriate supportive care

Forensic nurses contribute to the development, evaluation, and continuous improvement of organizational systems that support the planning process.4

Implementation

Next, the forensic nurse implements the identified plan.4 The nurse partners with the patient and family members to implement the plan safely, effectively, timely, and at the patient’s developmental level.4

At this stage, nurses need to demonstrate caring behaviors to develop therapeutic relationships with the patient.4 They also integrate critical thinking and technology solutions in implementing the nursing process to collect, measure, record, retrieve, trend, and analyze data and

information to enhance nursing practice and patient outcomes.4

As a part of the implementation process, nurses need to4:

  • Coordinate care delivery and organize components of the plan
  • Employ strategies to promote health and a safe environment

Evaluation

Lastly, the forensic nurse evaluates progress toward the attainment of goals and outcomes.4 For this to occur, the nurse conducts a holistic, systematic, ongoing, and criterion-based evaluation of the goals and outcomes in relation to the structure, processes, and timeline prescribed in the plan.4

Nurses also focus on patient-centeredness, effectiveness, efficiency, safety, timeliness, and equitability of the strategies in relation to the attainment of goals.4 Nurses are also required to document the result of evaluations and create, revise, or develop protocols based on them.4

Texas Evidence Collection Protocol

The Texas Evidence Collection Protocol (TECP) was developed to offer guidance to health care professionals in Texas who conduct forensic medical assessments for individuals of sexual victimization or those suspected of committing sexual offenses.5

The document is meant to serve as a reference and as part of a multidisciplinary approach to optimize the provision of consistent health care and minimize additional trauma to the patient.5 All facilities and communities must follow the TCEP requirements or create their own forensic requirements, provided they adhere to the protocol.5

The key points of TECP include5:

  • Sexual assault should be treated as trauma, whether physical injuries are present or not. Health care providers can help reduce the neurobiological response to trauma by providing trauma-informed care that restores patient safety, security, and control.
  • Treat emergent medical conditions before, or concurrently with, addressing forensic issues such as evidence collection.
  • Specialized assessment and close patient monitoring should be provided in case of non-fatal strangulation as it is a life-threatening event.
  • Patients have the right to decline any part of the assessment process, examination, and evidence collection even after they have signed informed consent and authorization forms.
  • Nurses are required to use open-ended or clarifying questions that allow patients to relay the events and avoid “why” questions as trauma impacts memory.
  • Nurses need to maintain the confidentiality of forensic medical information and documentation in all patient interactions.
  • Per Texas Code of Criminal Procedure §56.045, health care professionals must offer access to a sexual assault advocate during the medical forensic examination if that service is available. The advocate should be separate from the healthcare, law enforcement, and judicial personnel.
  • Mandatory reporting is required for suspected abuse of children, the elderly, or a person with a disability, regardless of the wishes of the patient, their families, or friends.
  • Child victims and patients who are the suspected perpetrators should always be seen by a forensic expert.
  • Nurses need to follow certain protocols during the evidence collection process. They need to avoid contamination of potential evidentiary items and seal the evidence. After the evidence has been collected and sealed, it can only be opened by crime laboratory personnel.
  • Role confusion can occur when caring for suspected perpetrators and survivors of trauma. Practitioners should be diligent about staying within their own professional practice guidelines.
  • Department of Defense (DoD) policy outlines services for military members who have been sexually assaulted. Such survivors receive information about their reporting options from a person knowledgeable of the DoD policy to ensure their rights are not violated.
  • Policies should be developed regarding the process for obtaining photographs, the method used to identify the patient in the photographs, and documentation that the photographs exist in the permanent medical record for each patient.

The sexual assault evidence collection kit (SAEK) does not have to be used for a sexual assault examination to occur. SAEKs should be used only when indicated.

Types Of Sexual Assault Forensic Exams

The Texas Evidence Collection Protocol (TECP) also outlines the type of sexual assault forensic exams based on the victim’s age.

Prepubertal Child

In the TCEP, the pediatric population is referred to as the prepubescent population.5 According to the Department of Justice, “A child’s stage of pubertal development is determined by assessing secondary sexual characteristics rather than chronological age. Although the onset and timeline of the pubertal process is unique to each child, the stages are identifiable and predictable.”5

Mandatory reporting requirements apply to this group, and the evidence collection process needs to be conducted within 120 hours of the assault.5

Adolescent

An adolescent is defined as a child under the age of 18 who has reached puberty.5 While the physical developmental level of these patients is similar to that of an adult and must be considered when performing the exam; these patients should otherwise be treated as adolescents rather than children.5 An adolescent can consent to an exam without a parent or guardian’s permission.5 Moreover, mandatory reporting requirements apply to this group.5

Adult

An adult is simply defined as a person who is not a child.5 Anyone 18 years or older has the option of reporting or not reporting the offense to law enforcement.5 Adult patients can also request a non-report exam, which means evidence is collected with or without law enforcement involvement.5 The non-report exam evidence will also not be processed until the patient reports the crime to law enforcement.5 The evidence can be collected up to 120 hours after the sexual assault.5

Military Adult

The Department of Defense policy outlines services for military members who have been sexually assaulted.5 Military members include individuals who are affiliated with the military, such as active duty, reserves, guard on Title 10 status, Army and Air Force federal civilian employees, and family members of a service member.5

Military adults have two reporting choices, restricted (confidential) and unrestricted.5 A restricted report does not trigger an investigation and does not include the victim’s name or any identifying information.5

Elderly

Elderly are individuals aged sixty-five or above.5 Mandatory reporting requirements also apply to this group.5 Evidence needs to be collected by a certified sexual assault examiner (SANE).5 They may consent to an exam without a conservator’s permission (if applicable).2

Suspect

Exams of suspected perpetrators of sexual assault should be conducted by someone who has specialized training.2

Any patient that belongs to vulnerable populations, such as minors (under 18), elderly (over 65), and dependent adults, are subjected to mandatory reporting requirements.2 If any of these populations report a sexual assault, nurses are required to make a mandatory report to the Texas Department of Family and Protective Services or to law enforcement if there is an immediate threat.2

Forensic Medical Assessment

Patients who report sexual assault or are suspected of acute sexual assault should have an Emergency Severity Index (ESI) Triage Level 2.5 The patient should be assessed as soon as possible and triaged for life or limb-threatening injuries or psychiatric emergencies; these take precedence over forensic evidence collection.5 When the patient is stable, forensic medical assessment is offered.5

First, the patient and family are taken to a secluded area where information regarding safety, bleeding, and pain is collected.5 Patients are also instructed not to use the restroom, wash, change clothes, smoke, eat or drink until evaluated by a forensic health care professional.5

If the patient requests, nurses must call for a sexual assault advocate for a hospital accompaniment.5 Nurses also must contact forensic health care professionals and notify them of the patient’s arrival.5 The patient should be informed about the expected arrival and wait times.5

The medical assessment may take place before or concurrently with the forensic sexual assault assessment, depending on facility policy. The assessment is divided into the following steps.5

Obtaining History

The evidence collection process starts with obtaining a history.1 This allows for formulating a diagnosis and treatment plan and provides a procedure to determine the type of evidence that must be collected.1 If a child is being questioned, talk at the child’s vocabulary level and use quotations if possible.5 If an adolescent or adult is being examined, the examiner should ask them to relay what happened before the assault, and everything up to when they arrived at the facility.2

The examiner is responsible for documenting the following items 5:All evidence must be documented appropriately using verbal descriptors, diagrams, and photographs, as applicable.2 When documenting, it is essential to use the patient’s own words for accuracy and avoid passive tense or judgmental wordings.2

Evidence Collection and Packaging

Following are the key points to keep in mind when collecting and packaging evidence 5:

  • Ensure you have the patient’s consent before a forensic medical assessment. Moreover, ensure ongoing agreement is obtained.
  • Examiners are instructed to wear powder-free gloves when collecting and packing evidence and changing them frequently and between each swab collection. Consider wearing gloves when handling any kit contents. Inspect for integrity prior to using SAEK.
  • Underwear goes in SAEK, while all other clothing is packed separately in paper bags.
  • Do not cough or sneeze over evidence.
  • Use a prepackaged DFSA specimen kit to collect urine specimens, if indicated.
  • Wet evidence should be air-dried prior to packaging, if possible. If air drying is not possible, wet evidence should be refrigerated as soon as possible. Consider contacting law enforcement, which has authority to take specimens for drying.
  • Examiners should never use saliva to seal envelopes; instead, self-adhesive labels or tapes should be used.
  • Seal and label all evidence collected with the date and time of collection and the examiner’s initials.
Chain Of Custody

The chain of custody provides accurate information about who collected and transported the physical evidence.2 Therefore, a chain of custody must be maintained and documented throughout the entire patient assessment and evidence collection process.5

The collected evidence should be labeled with the patient’s name, date of birth, unique identifier number, examiner’s initials, date, and time.5

Chain-of-custody documentation must include5:

Swab And Evidence Collection

When collecting physical evidence, concentrating evidence on two swabs from each site is best practice.5 Examiners need to explain the process to the patient and the reason for collection.5 When taking swab evidence, examiners need to keep the following things in mind5:

  • Moisten swabs with sterile water directly prior to evidence collection.
  • Swabs can be packaged directly into swab boxes.
  • Maintain strict practices to prevent cross-contamination of evidence.

Listed below are the recommended collection procedures for each forensic medical assessment.

Table 1: Evidence Collection Method2,5

ItemsCollection procedure
Oral swabsPut on new gloves and use two swabs to swab inside the patient’s mouth around the gum lines. Place the two swabs into a swab box. Close both ends of the box and label it. Place the labeled box in the oral swab envelope. Label and seal the envelope with the examiner’s initials. Place the envelope in the SAEK.
DNA buccal swabsPut on new gloves and use two swabs to swab the inner cheeks of the patient’s mouth. Place the two swabs into a swab box. Close both ends of the box and label it. Place the labeled box in the patient’s known DNA envelope. Label and seal the envelope with the examiner’s initials. Place the envelope in the SAEK.
Clipped or pulled head hair standardsUse lightly moistened swabs for matted head hair or clip them. Reference samples should be collected only by cutting.
Head hair combings and combPut on new gloves and open a small paper included in the SAEK over the patient’s lap. Use a comb provided in the SAEK, comb the patient’s hair over the paper. Allow patients to comb their own hair if they choose. Bindle the comb into the paper and place it in the envelope. Bundling is the process of folding paper into thirds lengthwise then into thirds widthwise, and finally pocketing edges to prevent content slippage. Label and seal with examiner’s initials. Place the envelope in the SAEK. If the patient has hair extensions, collect samples of hair extensions as evidence and notate the presence of hair extensions. If the patient is aware, also document if the extensions are synthetic or human hair.
ClothingPut on new gloves and place a clean sheet on the floor. Take the large changing paper out of the SAEK and spread it out on top of the clean sheet. Make the patient stand in the middle of the changing paper and provide privacy to remove their clothing. Have the patient place individual items in separate areas on the changing paper. The changing paper should be labeled, and each piece of clothing should be inspected. You can also photograph stained or damaged clothing. Label each item of clothing with the patient’s name, date seen, and examiner’s initials.
Dried secretion/debrisSwab sites where foreign DNA may be present. Wear gloves during the assessment. Document site and source on SAEK envelope, swab box, and forensic medical record, using the patient’s own words.
Fingernail swabsPut on new gloves and moisten two small swabs to use under the patient’s fingernails: one set of two swabs for left-hand nails and one set of two swabs for right-hand nails). Do not scrape with a wooden stick, as it can cause injuries.
Vulva swabsSwab the vulva with two swabs total (simultaneously). Swab the inner labia majora and labia minora. Avoid the urinary meatus. Swabs should not come in contact with a prepubertal female hymen, as it can cause extreme pain in prepubertal females.
Vaginal swabsShould not be collected in prepubertal females (have not reached menarche), except under sedation with physician direction and supervision or by the physician directly.
Penile swabsPatients can swab their own penis. Or pre-moisten two swabs and swab the head of the penis, staying away from the urethral meatus. Use the same two swabs to swab under the foreskin and the shaft of the penis.
Scrotal swabsUse two pre-moisten swabs to swab the scrotum.
Anal swabsUse two pre-moisten swabs to swab around the external anus.
Retained objects in vagina or rectumCollection of retained objects in prepubertal females should be done under sedation by a physician, protocol, or direct supervision. The collected retained object should be air-dried. Once dry, place in an additional evidence envelope.

Documentation

During documentation, examiners must use facility-approved forensic medical assessment documentation forms.5 They also should be mindful of the terms and use words such as “reported” or “stated” rather than “alleged.”5Examiners are responsible for documenting a patient’s pertinent medical and surgical history, and medications.5 The original documentation copy stays in the facility, while one copy is placed in SAEK.5 Moreover, ensure there is a copy of the documentation for law enforcement.5 Seal documentation in SAEK and ensure the complete appropriate chain-of-custody documentation when transferring evidence.5

Types Of Forensic Evidence

Forensic science includes the analysis of varied materials that can identify a suspect.6 From the validity of tape-recorded messages to collecting diverse types of evidence, forensic science encompasses different fields.6

The following are types of forensic evidence that should be collected.

Table 2: Types of Forensic Evidence6

TypeDescription
Blood stainsBloodstain patterns help in determining the “what and how” of the assault event. Examiners analyze the size, shape, and distribution patterns of blood stains. There are two types of bloodstain patterns; passive (circular drops) and splatter (because of force).
DNADNA profiling is a gold standard in forensic science but is not sufficient to solely convict an individual of a crime. However, biological evidence collected from the crime scene can be compared to DNA databases available. DNA profile includes blood, semen, saliva, urine, feces, hair, teeth, bone, tissue, and cells.
DentistryTeeth are resistant to damage caused by a fire, explosion, or crash, and thus are particularly important in forensics. Forensic dentistry can be used for identification and profiling, analysis of facial injuries, and analysis and identification of bite marks in sexual assaults, homicide, and other crimes.
EntomologyForensic entomology is the study of anthropoids, i.e., insects associated with crimes. It is primarily used for the detection of death but is also helpful in the detection of drugs/poisons. It also helps in determining the location of the assault or incident and the time of infliction of different wounds.
Lip printsLip prints, also known as cheiloscopy, is forensic evidence that identifies humans based on lip prints. Lip prints are invariable, permanent, and enable classification. Lip prints must be collected 24 hours after death to prevent errors.
FingerprintsEvery individual has a distinct fingerprint and variation in their ridge folds, turns, and twists. It can be used to identify the suspects present at the scene of the crime. Examiners can manually collect fingerprints with fingerprint powder and sticky tape or use digital scanners.
DrugsDrug evidence is collected to determine the illegal substances present outside and inside the body. Forensic drug evidence collection is also important to analyze and determine if the evidence is legally admissible in court.
AutopsiesAutopsy refers to the postmortem examination of a body after death. Autopsy is of three types: forensic, clinical, and anatomical. Forensic autopsy is performed to identify the deceased, the manner and cause of death. An examiner or medico-legal expert needs to be informed about all circumstances related to the death, the body position, body photographs, state of clothing, the blood patterns, and the decomposition state of the body. All findings are used to determine the time of death.

Preserving Evidence

Preservation of evidence is an important part of forensic science. From the time the evidence is collected to the time it is presented in court, all evidence must be identified, inventoried, and secured to preserve its integrity.Nurses and examiners must understand the rules governing chain of custody to ensure the evidence collected at the crime scene is the same as presented in court.7

Effective evidence preservation includes appropriate packaging with correct and consistent information on labeling and procedural documentation for all items.7

The following are the key points of the rules governing the chain of custody and preservation of evidence:

  • The chain of custody form must contain information about the evidence collected and must remain with the evidence until it is released to law enforcement.8
  • The patient’s identifying information with the date, time, Law Enforcement involved, including the case number must be included.8
  • Each person who has had contact with or possession of a piece of evidence must be identified on the chain of custody form from the time it is collected and then released to Law Enforcement.8
  • Any error in the chain of custody documentation or if it is incomplete, inaccurate, or omitted, will cause the evidence to be inadmissible in a court of law.8
  • Transit time between the collection and storage of evidence should be minimized.5
  • Liquid and wet evidence should not be in the SAEK and should be stored in a timely manner to avoid degradation.5
  • Biological evidence should be air-dried before packaging to minimize degradation. Packaging in paper is preferred; however, some laboratories allow packaging in plastic if the sample is thoroughly dried.7
  • Only a law enforcement official or authorized agent should be allowed to transfer evidence from the collection site to the designated site.5
  • To maintain the individuality of a sample, a nurse should never simultaneously collect evidence from more than one patient, since cross-contamination could occur and jeopardize any criminal case.2
Interventions For Sexual Assault Victims

Sexual assault is a highly common trauma that occurs in up to 10% of the population.9 In the aftermath of sexual assault, 30–50% of rape victims develop posttraumatic stress disorder.9 This can affect the victim’s social, interpersonal, and occupational functioning.9 Thus, it is important that effective interventions are developed or made aware of.9

A study reviewed the impact of early interventions on PTSD and how it is important for the development of treatment directives and clinical decision-making.9 It was hypothesized that early intervention would be safe and efficacious in preventing PTSD and reducing PTSD symptom severity.9

Following are the types of interventions and studies included in the review9:

Table 3: Early Interventions in PTSD9

InterventionInclusion criteriaSetting
Cognitive restructuring, coping skills training and progressive muscular relaxation training vs. progressive muscular relaxation trainingSexual aggression < 3 monthsSeeking treatment at psychological counseling centers
Pre-examination video intervention vs. standard careSexual assault < 72 hoursSeeking forensic examination at an academic medical center
Modified prolonged exposure session vs. standard care  Trauma < 72 hoursPublic hospital emergency department
Newly integrated Eye Movement Desensitization and Reprocessing (EMDR) protocolSexual trauma 24–72 hours ago First time Filed police complaintVia research center, family doctor or regional victim aid associations
Standard EMDR treatment protocol according to Shapiro (2001)Sexual assault 8–12 weeks ago By intimate partner Filed police complaint No previous similar traumaReferral via psychologists of regional victim aid associations
Post-examination video intervention + standard care vs. standard careSexual assault < 72 hoursVia specialized nurse examiners at local hospital
Cognitive processing therapy vs. standard careRape or sexual assault < 1 month Meeting criteria for ASDSeeking treatment at a rape and sexual assault crisis center
Conclusion

Sexual assault is a health care issue and has potential health consequences, including chronic pain, somatic diseases, risk of STDs, behavioral changes, and suicide.5 Thus, it is critical to refer patients for follow-up care, including assessment of injuries from the assault.5 Nurses and other healthcare professionals are responsible for the collection and preservation of evidence, and doing it in an empathetic manner.8

Forensic science is an important field that has been recognized as a specialty in the last 20 years.1 However, some states, such as Texas, are concerned about the standard of care assault victims receive in rural areas where certified SANE nurses are unavailable. Therefore, they have implemented continuing education guidelines that mandate anyone working in an ER as either their home unit, floating, contracted, or other duties that involve functioning in the ER setting to complete continuing education on forensic science.1 All nurses and healthcare professionals should have advanced training in the care and overall assessment of the patient.8 Ongoing education and training are essential due to the ever-changing advances in treatment and technology and can be achieved by attending conferences, reviewing published research studies, and using current guidelines and recommendations.8

References
  1. Org® W, Slate M. Forensic Evidence Collection for Nurses. https://www.rn.org/courses/coursematerial-173.pdf
  2. Forensic Evidence Collection for Texas Nurses: Sexual Assault Survivor Examination Guidelines. Wild Iris Medical Education. Accessed October 4, 2022. https://wildirismedicaleducation.com/courses/tx-forensic-evidence-collection-ce-for-nurses
  3. Forensic Evidence Collection for Sexual Assault Victims (Texas). Nursingce.com. Published 2016. Accessed August 19, 2019. https://www.nursingce.com/ceu-courses/forensic-evidence-collection-for-sexual-assault-victims-texas
  4. International Association of Forensic Nurses, American Nurses Association. Forensic Nursing: Scope and Standards of Practice. 2nd ed. American Nurses Association; 2017.
  5. PROVIDED BY. Accessed October 4, 2022. https://forensic-nursing.tamu.edu/documents/txecp.pdf
  6. Forensic Evidence: Types and Its Admissibility». Published November 10, 2021. https://www.lawaudience.com/forensic-evidence-types-and-its-admissibility/
  7. Module 03: Preserving Evidence. projects.nfstc.org. https://projects.nfstc.org/property_crimes/module03/pro_m03_t18.htm
  8. Kleypas DA, Gossman WG. Evidence Collection. Nih.gov. Published July 30, 2019. https://www.ncbi.nlm.nih.gov/books/NBK441852/
  9. Oosterbaan V, Covers MLV, Bicanic IAE, Huntjens RJC, de Jongh A. Do early interventions prevent PTSD? A systematic review and meta-analysis of the safety and efficacy of early interventions after sexual assault. European Journal of Psychotraumatology. 2019;10(1):1682932. doi:10.1080/20008198.2019.1682932
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