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MOTIVATION TO STAY SANE REMEMBER THE PAST, CLAIM THE FUTURE

MOTIVATION TO STAY SANE REMEMBER THE PAST, CLAIM THE FUTURE. OBJECTIVES. Identify qualities necessary to be an effective SANE Identify methods for self-improvement Use of tools for tracking improvement. CAUTION!.

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MOTIVATION TO STAY SANE REMEMBER THE PAST, CLAIM THE FUTURE

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  1. MOTIVATION TO STAY SANEREMEMBER THE PAST, CLAIM THE FUTURE

  2. OBJECTIVES • Identify qualities necessary to be an effective SANE • Identify methods for self-improvement • Use of tools for tracking improvement

  3. CAUTION! This presentation is intended for discussion and not to malign anyone present or absent NOR to imply the presenter has all the answers to material presented.Remember, there is always more than one way to do things right!

  4. Assumptions for SANE Proficiency: • Ability to effectively collect and document history • Ability to document physical finding • Ability to communicate with LE, Prosecution and / or Defense • Ability to work with the SANE Team and / or Sexual Assault Response Team (SART) members • Ability to work within the organizational structure

  5. Considerations during selection process: • Strong documentation skills • Strong observation skills • Leadership / Initiative • Communication Style • Ability to accept constructive criticism • Ability to work with other disciplines • Ability to work as part of the team

  6. Recent Publication Conclusions: Follow-up examinations by specialists affected the interpretation of trauma and detection of STIs in ~23% of pediatric patients undergoing sexual abuse assessments. “The experience level of the initial examiner was associated with a change in likelihood of trauma; a decrease in likelihood of trauma on the second examination was about twice as likely if the initial examiner had performed <100 examinations when compared to those who had conducted ≥100 examinations. Interpretation of trauma likelihood changed in 86% (69 of 80) of patients with unknown findings.” 2 reviewers of the initial examinations were SANEs and had >500 exams. These 2 reviewers had a 94.7% concordance rate. Gavril, Amy R., Kellogg, N. D., and Prakash, N. (2012). Value of Follow-up Examinations of Children and Adolescents Evaluated for Sexual Abuse and Assault. Pediatrics, 2012;129:282-289 [Online serial]. Originally published January 30, 2012

  7. 7 y/o pt: “He stuck his tu-tu inside my tu-tu. He told me he would give me $5 if I would take off my closed and he lied. He is my step-brother and he is 14 years old. He took his tu-tu out of his pants nad stuck it in here (pt points to her vaginal area), he said this is how babies are made. I was moving because it hurt. He told me not to tell anyone. He does this to Lexi, too. She told me he does it a lot.” 15 y/o pt: “See forensic interview” 12 y/o pt: “It’s been going on for a year. The last time was in January or December. My step-dad’s only private part touched mine. His private also touched my mouth – inside my mouth.” She indicates on Body Surface Diagram the male penis in female sexual organ and female mouth. “His fingers touched me there, too.” She indicates her genitals with her hand. Non-certified SANE with 3 years of experience & 79 exams OR CA-CP SANE with 16 years of experience & 700 exams OR CA-CP SANE with 11 years of experience & 500 exams Quick Quiz on Patient History

  8. Labia Majora: no trauma noted Labia Minora: a condaloma 2mm X 2mm Hymen: full thickness tear at 10:00 o’clock Vagina: no trauma noted Cervix: not visualized Perineum: no trauma noted Anus: discolored healing 1 cm tear at 9:00 and a 1 cm healingtear @ 11:00 Impressions From Exam: sexual assault by history and exam Non-certified SANE with 3 years of experience & 79 exams CA-CP SANE with 16 years of experience & 700 exams CA-CP SANE with 11 years of experience & 500 exams Quick Quiz on Physical Findings

  9. Who sees + findings: Non-certified SANE with 3 years of experience & 79 exams CA-CP SANE with 16 years of experience & 700 exams CA-CP SANE with 11 years of experience & 500 exams Quick Quiz on Physical Findings

  10. Means of Tracking Improvement • Case review • QA review with: • Advocates • Law Enforcement • Prosecution • Periodically performing exams together / observing exam performance

  11. Self Improvement • Look for articles related to sexual assault exams • Review findings with more experienced members of the team • Case Review participation • Number of exams performed related to questions, e.g., SANE with 50 exams experience asking same questions as when first began performing exams

  12. Claiming the Future • Nursing remains at the top of the list of respected professions • Nurses do ownership of their practice and develop methods of accountability which has led and will lead to ever greater benefits to all.

  13. Remembering our past: • Nurses were the “Handmaidens” of the physician • As late as the 1970’s in Texas nurses were expected to stand when a physician entered the room • Nurses from Florence Nightingale on have used scientific evidence to improve our CARE giving and patient outcomes

  14. The difference between genius and stupidity is genius has its limits.Albert Einstein

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