A Nurse's Role in the Care of Sexual Assault Victims

Keith Carlson, RN, BSN, NC-BC - 03/13/19

The collection of forensic evidence following sexual assault is a crucial aspect of a victim’s post-assault interaction with the healthcare system, including extremely important medicolegal aspects of the case. Sexual Assault Nurse Examiners (SANE), Forensic Nurse Examiners (FNEs), and other skilled care providers are the healthcare professionals who generally perform such sensitive and crucial assessments.

Assessing Trauma

In the wake of an overwhelming trauma like sexual assault, having evidence collected from his or her body can be retraumatizing for the victim. At the same time, the healthcare professional collecting the evidence must follow their state’s specific medical and legal guidelines for correct specimen collection, storage, and documentation.

Sexual assault victims can be of any age, sexual orientation, sex, economic class, religion, or cultural background, and such individuals require kind, compassionate, professional, and highly skilled care that will not cause additional trauma while amassing the necessary evidence for an investigation and potential prosecution of the perpetrator.

Victims of assault suffer both physical and psychoemotional trauma. A nonjudgmental approach that addresses the victim and their loved ones with the utmost sensitivity is essential. For those who are adolescent or younger, an additional layer of trauma and violation must be impeccably approached. All staff involved in this sensitive process should view the victim’s loved ones as secondary victims of the crime as their trauma can also be significant. We must also understand that some victims will be blamed by family and friends, thus compassion is essential.

Sexual assault victims may also blame themselves for what happened to them, and such feelings may color victims’ ability to make prudent decisions. Guiding and supporting the patient could not be more important at such a time. 

The Trauma-Informed Approach 

The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued its key principles of a trauma-informed approach (Substance Abuse and Mental Health Services Administration, 2018. Retrieved from https://www.samhsa.gov/nctic/trauma-interventions) These guidelines urge adherence to the outlined principles that can be utilized in most any setting. Those principles are:

  1. Safety
  2. Trustworthiness and Transparency
  3. Peer Support
  4. Collaboration and Mutuality
  5. Empowerment, Voice and Choice
  6. Cultural, Historical, and Gender Issues

Using these principles coupled with high-level training in sexual assault evidence collection, a skilled provider can ease victims’ fears about the examination, minimize discomfort and secondary trauma, as well as collect important evidence according to state and local guidelines.

Evidence Collection 

Sexual assault evidence collection kits may differ slightly between states and localities.  These kits may be utilized for collection of oral, vaginal, anal, and other samples needed for the processing of DNA and other evidence. The swabbing of orifices is central to evidence collection due to the potential for the recovery of DNA samples that can lead to positive identification of the perpetrator.

Blood, hair, and fingernail clippings are obtained from the victim, and if she or he is still wearing clothing from the time of the attack, it is carefully removed in order to catch any of the perpetrator’s hair that may have attached to the victim’s clothing or body. Undergarments and other clothing are often collected as prescribed by the situation and local or state guidelines. Toxicology may be an important aspect of specimen collection, especially if drugging of the victim is suspected or known to have occurred.

Proper collection of samples also involves proper documentation, identification, packaging, storage, and shipping, when necessary. An unbroken chain of custody is equally crucial, and this necessitates the ongoing assurance of the integrity of evidence for admissible use in court.

Risk and Prevention 

Risk factors for violence perpetrated by intimate partners have been correlated with young age, lower socioeconomic status, mental illness, the abuse of alcohol or illicit drugs, societal acceptance of violence, weak or absent social supports, among others. (World Health Organization/London School of Hygiene and Tropical Medicine (2010). Preventing intimate partner and sexual violence against women: taking action and generating evidence. Geneva, World Health Organization).      

Prevention may focus on younger age groups, especially the prevention of all forms of violence against children and intimate partners. This may include education on the impact of alcohol and illicit drugs on families and communities, increasing women’s access to education, and changing laws that discriminate against women.

The Nurse’s Crucial Role

Without proper training and understanding, nurses and other personnel can potentially damage sensitive evidence if protocol and procedures are not followed to the letter. And as stated above, guidelines can differ between states and localities.

Whether a nurse is trained as a Sexual Assault Nurse Examiner (SANE) or serves in another capacity (emergency nursing or triage, for example), understanding the importance of evidence collection in sexual assault cases is crucial. With thorough education and training, general nursing staff can assist trained personnel in treating and supporting victims, and preparing for crucial evidence collection.

Sexual assault and its treatment and prosecution are sadly part and parcel of 21st-century life and healthcare. Thus, a highly educated nursing workforce is central to the delivery of high-quality, evidence-based, compassionate, and thorough sexual assault evidence collection and patient care.