ENA Connection - September 2016

ENA
National Awards

Demystifying Treatment and Legal
Options After Sexual Assault
UPMC Video Honored by ENA

Ateam of nurses from the University of Pittsburgh Medical Center will accept ENA’s Media Award at Emergency Nursing 2016 in September for the video “After a Sexual Assault.” The creative motivation for the team was entirely altruistic.

With grant money from the Beckwith Family Foundation, the nurses embraced an opportunity to improve patient education after a sexual assault. “After an incident, patients are in crisis mode and have lost a great deal of autonomy,” said Lisa Simonian, DNP, CRNP. “Just the thought of a forensic exam is understandably terrifying, and this can prevent us from collecting the evidence we need. We were hoping to defuse that anxiety.” Following the best practices of facilities that have presented sensitive information to patients via a video while waiting for the sexual assault nurse examiner to arrive, UPMC hired a video production company and set out on its first multimedia voyage.

Patient education was the primary goal, but the team soon realized that the video was a service to colleagues as well. “The methodology for the sexual assault examination has changed so much in the past 20 years since I was a baby nurse,” Simonian said. “At that time, there was a lot of horror and fear because we didn’t do the exam on a daily basis. Now the SANE is a respected professional who does this on a daily basis, and ED nurses can breathe a sigh of relief.”

Casting Call

The nurses had to not only develop on-camera personas but ensure an accurate representation in the portrayal of patients.

A male actor appeared as a patient in one of the first encounters with a nurse. “We specifically wanted a diverse cast,” said Valerie Krasneski-Schreiber, MS, RN, CEN, SANE-A. “Sexual assault affects all races and genders. It was important to us that no patient felt like an outsider.” To comply with the federal Prison Rape Elimination Act, some correctional facilities approached UPMC about a memorandum of understanding and legally formalized the service agreement under which the hospital provides SANEs for examinations of victims in the facilities.

“This has made a huge difference in terms of our male population,” Simonian said.

Promoting Patient Choice

Regardless of demographics, a key theme in the video is the patient’s right to make choices throughout the sexual assault exam and legal process.

For instance, patients often resist the exam, yet it’s vital for any police report. “Nobody likes to go to the gynecologist,” Simonian said. “If you’ve just lost the ability to say yes or no to sexual activity and somebody at the hospital wants to examine you, it can almost feel like a second assault.” An equally daunting notion is that of giving a report to police officers. “It’s uncomfortable to recount your story to a nurse after a sexual assault, but it’s another matter entirely having to share the incident with uniformed officers, male or female,” said Debra Shane, MSN, RN, SANE-A. “Talking to law enforcement can be intimidating, and our patients are in a very fragile state, especially after having a sexual assault exam and kit collection. Sometimes we negotiate immediate evidence collection but give the patients an extra day before meeting with law enforcement.” Krasneski-Schreiber said the video affords patients the time to process the next steps. “We want patients to know they have choices and a say in how we do things. People don’t always realize that when they come to the ED.”