The past 10-20 years have witnessed significant reform in sexual assault law and the protection of women and children. Over the past 10 years, our awareness of magnitude and the trauma of sexual assault victimization has increased considerably.
Unfortunately in transitional medical settings such as hospital EDs, rape victims still encounter a time-consuming, cumbersome succession of examiners, some with only a few hours of orientation and little experience. Many doctors and nurses are not sufficiently trained to do the medicolegal exam and are unwilling or unable to provide expert witness testimony if the case goes to court.
The purpose of this research is 1) to review the development and implementation of sexual assault nurse examiner(SANE) programs and sexual assault response team(SART) across the United States, 2) explore a medical forensic response model for sexual assault victims in Korea, and 3) develop the standard of the sexual assault exam components and ation.
There are two primary goals of forensic examination; to provide the victim with the best medical care possible and to collect forensic evidence in order to identify and prosecute the offender. To best accomplish these goals, it is recommended that medical forensic examiner function as a member of sexual assault response team, especially sexual assault nurse examiner.
The SANE is a specially trained, certified, registered nurse who has forensic training and clinical education to help victims of sexual assault. These nurses offer victims compassionate care and are responsible for collecting evidence that could potentially lead to arrest, prosecution, and conviction of the assailants. SANEs often work as a part of a SART-a multidisciplinary team that provides specialized immediate response to recent victims of sexual assault. This team is most often comprised of SANEs, law enforcement officers, prosecutors, victim advocates, and forensic laboratory specialists. Team members work collaboratively to better meet the needs of the sexual assault survivor, as well as to maximize reporting and prosecution of the crime. Their goal is to reconcile patient care with medicolegal investigation. All members of the team will not be present at the time of the exam, but rather they may only become involved if his or her skills are needed to respond to elements of given assault.
To keep pace with fast growing modern society, nursing health care system is becoming more diversified. In the accordance with the high quality health services that are required, and by the development of technology and improvement of nursing knowledge. it is sub-divisioned, specialized and becoming scientific. Furthermore as medical environment, society structure, and community needs changed, people started to become accepted that nurse specialists are required in certain specified department. This means that nurses can't meet the request of the demands how we face increasing crimes in spite of 13 specialized active regions.
Therefore filed of nursing, especially in pathological physiology we certainly need to accept forensic nursing requests and develop.
Almost everyday emergency department nurses look after trauma patients. When the patient arrives, even though preserving evidence untouched is important in confused situation, medical teams have to strive as harder as they can to save the lives of patients. In this circumstances, one of the most necessary and important works of nurses is collecting forensic evidences and keeping them safe. Therefore Lynch(1995) asserted that medical workers should consider both medical and forensic requests. Because blindness of nurses can leave question mark over forensic cases that could be related in the future. Smialek(1983) said that evidence that proves case's exact reconstruction, confirmation of the crime and verification of innocence gets destroyed during injury care. The joint Commission on Accreditation of Health Caere Organizations, JCAHO suggested the importance of nurses' roles in finding forensic evidences and managing them. Machielse(2008) also said that as emergency departent nurses first meets the patients, talks to the family, and handles the podential evidences, they should be the one who should collect forensic evidences. And also trauma team should make early assessments and during mediating life threatening injury, one of the others should take pictures of the damage or specific injury marks.
Based on this concepts, forensic nursing started in early 1970s at medical examiner in Canada as nurses attended in autopsy. In 1986, the University of Texas in Arlington first established the degree of forensic nursing and after that it has been developing as years go by. But in our country education of forensic nursing is only available in Kyungpook National University Department of forensic medicine school of medicine in the course of Master Degree. This was the start but the history is short and not only the general publics but also nurses don't know much about forensic parts of a nurse. And advanced research is limited to sexual violence and child abuse.
In fact, in domestic case, the reason why people don't try to secure a proof is that people are lack of forensic knowledge and it was at a high rate in Park's study. Further also in Jo(2012)'s study, emergency nurses don't know the importance roles of forensic nursing and lack of knowledge. Like this, even though nurses's roles in collecting forensic evidences, preserving and recording them is significant there were only study cases about lack of knowledge but not yet they studied actually performed roles of forensic nursing.
On this we surveyed nurses who worked over 6 months about cognition of the roles of forensic nursing and levels of performances and figured out correlations between perception and performances. Based on this results to propose the education of forensic nursing for emergency nurses and the needs for forensic nurses we started research and here are the conclusions.
We tried to find out how much emergency nurses think that roles of forensic nursing is needed and the levels of the performances. Compared to perception level, means of performance was low, higher the academic ability was higher the rates of cognition of forensic nurse role was higher. As a result of comparison between perception and performance, there was correlations.
Based on the results above, I am proposing as follows.
First, we need enthusiastic publicity activities for emergency department nurses so that they can improve the recognition level of the forensic nurse's roles. Second, we need to educate forensic nursing to emergency department nurses to preserve evidences in the exact order. Third, we certainly need to allocate some forensic nurses in the emergency room so that nurses who have overworks can focus on what they are doing.
The manual for forensic uation of sexual assault victim is proposed. The sexual assault response team (SART) that organized in major hospitals is a multi- disciplinary team developed to improve services to victims of sexual assault. The team is comprised of advocates from the local victim service center, law enforcement officers, and specially trained health care professionals, such as the forensic nurse. These team members provide a coordinated, efficient, and supportive response to victims. The specially trained forensic examiner or sexual assault nurse examiner (forensic nurse) perform the physical assessment of the sexual assault victim; collect, , and preserve forensic evidence; provide information and referral to the victim of health case matters; the examination in the medical record; and present expert testimony in court. The forensic uation is performed as follows, 1) medical interview; The examiner obtains a pertinent health history and history of the reported criminal act. A private, quiet environment must be provided for the patient. It is important that the victim feel safe and in control of what is happening to him or her. A general history should included the following information; past history of medical illnesses, recent surgery, medications, allergies, history of sexually transmitted diseases, contraception use, last consensual sexual experience, tampon use, or douching, illicit drug use or alcohol ingestion, last menstrual period, and obstetric history. The forensic interview addresses the details of the assault. The following information should be addressed; a brief deion of the incident, number and identity of the attacker(s), time of the attack, location where the assault took place, type of sexual acts that occurred, that is kissing, fondling, vaginal and/or anal penetration, oral penetration, contact with ejaculate, urine, or vaginal secretions, use of weapons, restraints, contraceptives, condoms by the perpetrator, and use of objects to penetrate or coerce the victim. 2) The physical examination; The physical assessment, including pelvic examination, should be performed on sexual assault victims in order to identify and injuries and to collect evidence. The acute care of victims immediately after sexual assault includes the care of nongynecologic and gynecologic injuries as well as injuries inflicted by a weapon. Before treating the body injuries, a thorough deion, including the location, size, color, and pattern of injury, should be made. This is best done by using photo-ation to record each injury. In addition, a body map should be used to th victim's injuries. A ruler or other object, such as a coin, should be placed next to the injury when photographed to discern the actual size of the injury. The prevention of pregnancy and the prevention of sexually transmitted diseases are needed. The second purpose of the physical examination is to collect evidence that may be used to assist the criminal justice system in identifying and prosecuting perpetrators of rape and sexual assault. If evidence is collected at the clinic site, a chain of custody must be established. Medical ation is an im portant forensic component in caring for the victim of a violent crime. 3) Testifying as an expert witness; The task of an expert witness is to help the judge or jury understand special evidence or to determine a fact in issue. This is done by providing qualified, appropriate, unbiased, and neutral opinion, that is scientifically sound, regarding evidence or a fact in issue. The uation of the child who may have been sexually abused is multifaceted, containing components such as obtaining a history; conducting a physical examination; initial diagnostic and forensic testing when deemed necessary; and making appropriate referrals. The medical interview has become a critical component of the diagnostic, legal, and remedial aspects of child sexual abuse. Because specific medical evidence of abuse is often lacking and there are no eyewitnesses, the child's verbal statements describing abuse and the questions used to elicit these statements are being carefully scrutinized. The highest priority for the examiner should be the patient's safety, comfort, and quality care. The second priority is establishing a high quality of communication and coordination with investigative officials. As with any medical history, the interviewer's questions should proceed from general to specific. The interviewer must ensure that the child understands each question and can give consistent answers to similar questions posed in different ways. The purposes of the physical examination of sexually abused child are to 1) the condition of the patient; 2) diagnose and treat injuries and sexually transmitted diseases; 3) collect and preserve evidence; and 4) reassure the patient and address concerns about her or his physical and psychologic well-being. The standard forms of forensic medical report for sexual assault examination and sexual assault suspect examination are suggested. These forms are consisted of general information of patient, patient history, assault history, general physical examination, genital examination, collection of the forensic evidence and ation for present expert testimony in court.