BY: PATTI GLASER-MARTIN AND LISA MALAK
"There is still a stigma attached to being a sexual assault victim," said Jennifer Balthazor, RN, director of St. Vincent Hospital's emergency department in Green Bay, Wis. "You'd think today that would not be true. But it is. People still question if the victim 'should have been THERE,' 'should have done THIS' or 'should have worn THAT.' And it impacts the victim, the victim's family and even the providers who care for the victim in the hospital."
Home to northeastern Wisconsin's only Sexual Assault Nurse Examiner (SANE) program, the hospital sees more than 200 sexual assault victims every year. There would be more, said Balthazor, if it were not for that stigma keeping women, children and men away from the hospital after the trauma of sexual assault.
Nationwide, sexual assault is believed to be woefully underreported. Wisconsin's Brown County, where St. Vincent Hospital is located, has one of the highest reporting levels in the state. Balthazor credits the hospital's SANE program for that. "I truly don't believe the incidence of sexual assault is higher in Green Bay than elsewhere," she said.
"It is our nurses. They do such an amazing job caring for these individuals that victims are not afraid to come in to see us."
SEEING OPPORTUNITY
This was not always the case, Balthazor said. She credits hospital administration for seeing that a difference could be made in the community by training nurses in the SANE specialty. St. Vincent currently has 14 RNs who have taken the Wisconsin Coalition against Sexual Assault's week-long SANE training courses, and the hospital hopes to add four more. SANE nurses are credentialed in both adult (SANE-A) and pediatric (SANE-P) skills.
The SANE program began in 1992 at St. Vincent Hospital and quickly expanded to cover the Green Bay community. More than 20 years later, it is still one of fewer than a dozen such programs in the state. As such, it now provides services for all four of Green Bay's hospitals, reaches north into the Upper Peninsula of Michigan and includes counties to the east, west and south of Brown County.
St. Vincent Hospital and its SANE nurses work closely with local and regional police to encourage victims of sexual assault to come to the hospital. This is important for several reasons. A SANE exam collects evidence of the assault for future prosecution, treats injuries, and provides links to much-needed emotional support networks in the victim's community.
OBSTACLES REMAIN
While a very important service, the SANE program is not without obstacles. Financing is always a concern, said Balthazor, as SANE is not a revenue-generating service. "The high volume of users combined with the high cost of training — average training costs for just one SANE nurse are $5,000" — means such programs are always over budget, she said. "But we are very grateful to have a generous community that donates funds to support our efforts. Local retailers also support the program with shopping days. SANE nurses go to the retailer to purchase clothing for victims, as whatever clothing they were wearing at the time of the assault is kept by police as evidence.
The SANE program also provides Plan B to women who have been raped. While the Ethical and Religious Directives for Catholic Health Care Services allow for this, and the State of Wisconsin requires it, St. Vincent Hospital also needed permission from the Bishop of the Catholic Diocese of Green Bay to do so. "It is a formality," said Balthazor, but a necessary one, as many Catholics do not understand how Plan B works and fear it is an abortifacient.
St. Vincent Hospital SANE annual records show sexual assault victims of ages ranging from 3 months to 91 years, with 55 percent to 57 percent being under the age of 18. Seeing and treating these vulnerable young patients is difficult emotionally for the nurses, said Balthazor. Most sexual assault cases involving children are connected to someone close to the family, and the nurses often have a hard time sending the child home, where there may be potential for a repeat of the situation.
PICTURE BOOK HELPS CHILD VICTIMS
All sexual assault victims are treated with respect and dignity, but child victims need a special approach. The SANE exam can be particularly stressful for a child, and explaining the process to him or her — and family — can be difficult. That is why the SANE picture book was developed as a tool that helps explain openly and honestly what a child will experience during the examination process. The book contains photos depicting the exam, step-by-step.
"The book allows us to sit with the child and parent or parents and walk them through everything that will be happening," said Dana Stueber, SANE-A, SANE-P Team Leader for St. Vincent. "Honesty is vitally important in dealing with children and helps develop a trust that is crucial for the examination and collection of evidence."
Examples of the photos in the book include:
- A nurse talking to the child and her mom
- The child talking to a police officer who looks friendly and non-threatening
- The nurse taking the child to a different room (with her mom), showing pictures of the room
- The nurse putting the child's clothing in a bag
- The nurse doing a head-to-toe assessment, listening to the heart and lungs
- The child playing with toys to help her relax
- The mom on the table, with the child lying back on her
- The child posed in different positions for examining purposes
- The child waving good bye
- The nurse handing the evidence to the police officer
"We found that with more knowledge there is less fear, and this increases the child's trust in the nurse," Steuber said.
They say a picture is worth a thousand words. In the case of children examined by SANE nurses, this picture book is worth so much more. "It simplifies and humanizes the highly technical process and helps put the child more at ease during such an emotional and stressful experience," Steuber said.
Due to the tremendous success of the book, the hospital's SANE nurses are preparing to develop a similar book for individuals with cognitive or other challenges that may make a SANE exam more difficult to perform.
BURN-OUT IS HIGH
With such emotionally challenging cases, it is no wonder this is a high burn-out specialty. "You don't see a lot of good stories coming out of this field," said Balthazor. She recalled the story of a 5-year-old who had a "positive, absolutely positive [for sexual assault confirmation] exam, and yet the jury found the defendant not guilty."
It also can be emotionally draining when SANE nurses move into consulting roles for defense attorneys. In court, the SANE nurse can expect to be closely questioned on the competence of his or her examination and collection processes.
The Wisconsin Coalition of Sexual Assault Nurses is strong and supportive, and its members try to attend court cases where another member is testifying, in order to provide moral and emotional support.
Yet the stress takes its toll. When a nurse dedicates his or her career to caring for individuals facing these difficult scenarios; is experienced in collecting evidence; undergoes grueling cross-examination in the court room; and perhaps sees the alleged perpetrator walk away and very possibly back into the victim's life — "it's hard to feel like you have made a difference," Balthazor said.
PATTI GLASER-MARTIN is director, internal communication and community relations, Eastern Wisconsin Division — Hospital Sisters Health System, Green Bay, Wis.
LISA MALAK is media specialist, Eastern Wisconsin Division — Hospital Sisters Health System, Green Bay, Wis.
ABOUT ST. VINCENT HOSPITAL
St. Vincent Hospital has been delivering health care to Green Bay and its surrounding communities since 1888. The largest hospital in Green Bay, St. Vincent is an affiliate of Hospital Sisters Health System, a 13-hospital health care system based in Springfield, Ill.
Patients from Northeastern Wisconsin and Upper Michigan benefit from a comprehensive range of services that include cancer care, women's services, emergency and trauma care, orthopedics, cardiac care, neurosciences and pediatric services. The hospital's primary purpose is to reveal and embody Christ's healing love for all people through its high quality Franciscan health care ministry. St. Vincent has been named one of the "100 Top Hospitals" nationwide and is accredited by the Joint Commission on Accreditation of Healthcare Organizations.