HOSPITAL SISTERS HEALTH SYSTEM
It can be traumatizing for a victim of an assault to undergo a forensic sexual assault exam, particularly if that victim is a child. Nurse examiners at St. Vincent Hospital in Green Bay, Wis., hope to lessen their young patients' anxiety using a picture book that illustrates what to expect during the exam.
The SANE Story book that the hospital's Sexual Assault Nurse Examiner team created features color photos of each step of the exam process, including a child talking to a nurse examiner, a police officer, a physician and a social worker or advocate; the nurse taking the child's vital signs; the child's caregiver sitting with her as she is examined and the child sitting in some of the poses needed for the exam. All of the photos are of a female child.
Dana Stueber, a team leader for St. Vincent's Sexual Assault Nurse Examiners, explained that the nurse examiners use the book as a tool to establish a bond with their pediatric patients. "Children are already frightened to come to the hospital," Stueber said. "In the case of a SANE exam, we are asking them to let a total stranger look, touch and possibly take pictures of parts of their body that are supposed to be private. It is very important to develop as much trust as possible to help make this exam much less traumatic.
"The book is used to show them what is going to happen first, and then most importantly to do what we have showed them, answering questions on their level of comprehension," she noted.
St. Vincent has 15 nurses trained to conduct sexual assault exams in order to assess victims' conditions and collect evidence of the assault, establishing a chain of custody that makes the exam and physical evidence admissible in court. In fiscal year 2010, St. Vincent's nurse examiner team conducted 206 sexual assault exams, 108 of them on children aged 17 and under.
Stueber said when children are brought into the emergency department after an assault, they normally arrive in the company of a parent, other relative, teacher, guidance counselor, neighbor or other adult.
Stueber said the book calms caregivers too. "We also receive positive feedback from the parents because it helps them to understand what will be happening. They are usually shattered emotionally, and the pictures help make our explanations clearer, helping them to help their child cope."
Stueber said a former SANE program coordinator at St. Vincent created the first SANE Story, a photo album with 8x10 photographs of a SANE nurse and her daughter posing as a caregiver and assault victim. Stueber and her team took fresh photographs last year to reflect some new equipment used in the exam, and they used an internet program to create a hardcover SANE Story.
The nurse examiners also have used the book for older assault victims who are developmentally disabled, including people with Down syndrome. Stueber said statistics show disabled people are four times more likely to be assaulted in their lifetimes than nondisabled people. The St. Vincent team soon will have on hand a SANE Story to use with developmentally disabled patients.
Stueber said that if handled with sensitivity, a sexual assault exam can begin to give a victim a sense of control over their situation. "Our patients can draw strength from the exam, knowing that someone understands what they have been through," she said.
Copies available
The St. Vincent nurse examiner team is making the SANE Story available to members of the Catholic health ministry, for the cost of printing the hardcover book (about $45).