Michell Spoden — Rape is not only a physical/sexual assault but it inflicts deep psychological wounds on the victims who often find themselves facing severe and long-lasting psychological impact following the assault. Most rape victims have special therapeutic and adjustment needs. Hence the need for specially trained caregivers. Today, this need is being fulfilled at a number of places in the role of a SANE Nurse. The Journal of Humanitarian Affairs did an interview with Alison Rerko, a 42-year-old SANE Nurse at the Cleveland Clinic’s Fairview Hospital, to learn about the work of a SANE Nurse as a caregiver for rape victims.
Michell: Alison, first let me ask, what is a SANE nurse?
Alison: Sexual Assault Nurse Examiner (SANE) is a Registered Nurse that has specialized training in working with patients that have an acute or chronic history of violence, abuse, and sexual assault, in addition to their nursing education. The SANE nurse is responsible for assisting the patient in documenting their abuse in order to facilitate medical intervention. The SANE nurse is also educated in photo documentation and evidence collection. Photo documentation and evidence collection are options in patient care. The training involves 40 hours of classroom training and then up to 100 hours of clinical experience. SANE trained RN’s are asked to practice a minimum of two years prior to sitting and taking the certification exam that is sponsored by the International Association Forensic Nurses (IAFN).
Michell: Why do they have SANE Nurses today? Do they serve in hospitals or clinics or both?
Alison: SANE programs are also known by other names. Some of the names are Forensic Nursing Programs, Sexual Assault Forensic Examiners (SAFE) programs, Sexual Assault Response Team (SART) programs; whatever it is called, they function very similarly. The primary focus is to provide specialized nursing care to facilitate healing for improved health and welfare of the patient. Many of these programs function within the hospital setting. Some programs are “free standing”, meaning they are not directly tied to a specific hospital. Whether it is a free standing program or in a hospital setting, the primary focus is always the health and welfare of the patient experiencing violence.
Michell: How long have you worked as a SANE Nurse?
Alison: I have worked as a SANE nurse since 2002. I am Board Certified as an Adult/Adolescent and as a Pediatric SANE. Both certifications require specialized training and clinical competencies. I was the first SANE nurse at Fairview Hospital and was fortunate enough to work with a great Nurse Managers, Medical Director, and Emergency Room staff, and hospital President who saw value in the specialty of SANE nursing and supported the creation of the SANE Program at Fairview Hospital. The program initiated January 1, 2004. Do you tend to all ages and genders? Fairview Hospital is one of the few hospital programs that do specialize in working with children and adults. Violence knows no barriers; it does not differentiate between races, sex, socio-economic status, or age. Special populations such as the elderly and the young are often times victimized as are women; however, many men are also victims of sexual violence, domestic violence, and physical violence. Fairview Hospital works with any patient of any age that arrives with a complaint of violence. The SANE nurses are very aware that violence impacts the health of the patient, but also the family or their significant others. As a result of this understanding, we work with not only patients but also their loved ones if given the opportunity.
Michell: And are you a survivor? And do you think it makes a difference when working with rape victims?
Alison: I am not a survivor of sexual assault; however, because violence is so prevalent in our society that I have had close family members and friends who have been victimized by abuse. I am impacted daily by violence through the care of patients and through collaborations with other medical professionals and community members.
I think SANE nursing makes a positive impact on the lives of our patients. For me, personally, I am humbled daily by my patients. I learn something new from each patient that I encounter. I know that each person experiences sexual violence differently, and reacts differently. No two patients have had the same experience. I have learned courage from my encounters with patients. I have seen what it means to be courageous first hand. The courage that patients must muster up to come and talk to a complete stranger about the most intimate and embarrassing details of their experience with violence. The courage needed to wake up every day and move forward, whatever that journey may look like. For some patients, it is moving forward in the legal and judicial arenas; and for others, it is simply learning a new way of living and coping. I want my patients to feel that they are in a safe, non-judgmental environment and hope that they perceive their care as being compassionately delivered.
Michell: Is it better to have same sex nurses for rape victims?
Alison: I believe that a compassionate and caring nurse, regardless of sex, is what is needed for the patient. I want male health care workers to know that a positive male experience is as powerful as a negative male experience. Patients are in crisis and are dependent on healthcare providers to know what to do. I do not believe that a patient’s experience is tainted by the sex of the provider, but rather, by how respectful and caring the provider is.
Michell: What are some of the things that a SANE Nurse should keep in view when caring for a rape victim?
Alison: SANE nurses are encouraged to have a solid background in the nursing field, prior to taking the SANE training. Nurses need to have a developed “sixth sense”. Many patients are not able to articulate what has happened to them because they do not have the vocabulary to explain it, or they simply do not have a clear memory of all that has been experienced. It is essential for the nurse to be solid and confident in her practice in order to read the non-verbal cues that the patient may be demonstrating. SANE RN’s most valuable asset is their ability to listen and observe. SANE RN’s typically work with patient is on a one-on-one basis. This provides the provider with the ability to sit, actively listen, validate and observe the patient. The SANE nurse at all times must be aware of the patient’s ability to cope and function.
The provider must work at the patient’s pace, not their own. The SANE nurse must be ever vigilant in his/her ability to communicate effectively with the patient and the other members of her team, and always advocate for the patient. Many patients have significant health histories that involve past violence related trauma, chronic disease, and mental health issues to list a few. The provider must be aware of the patient’s histories in order to provide appropriate assessment and care. SANE training provides education on types of sexual violence and abuse, provides insight on who is impacted by violence and how to address those issues. Many nurses must learn to become comfortable with sexuality and sexual health and violence-related health issues in order to perform care.
Michell: In your experience, how important is it for families, friends or supporters of the victim to work in close collaboration with the SANE Nurse to speed up recovery process of the rape victim?
Alison: I do not feel qualified to answer this particular question because we do not provide counseling. What I can say is that every patient is different. Every patient’s recovery is specific to that person. I do feel that as a health care provider, it is important to support and educate families, loved ones, and communities to the prevalence of sexual violence, and how we need to realize that it is the offender who is the responsible party, not the patient.
Michell: Have you ever felt that there are excessive expectations of SANE Nurses regarding their helpful role in recovery of rape victims?
Alison: I think that the SANE Nurse puts a lot of pressure on her/himself in their role as immediate provider for the patient. The expectation is always to put the patient first and provide the best care possible. It is the SANE nurse that drives the higher standard of care for this patient population. Many nurses are not taught in nursing school about violence related health care issues, then alone sexual violence. Sexual violence for a long time has been viewed as more of a social issue and not a health care issue. Many nurses are educated to contact the social work department and let them handle the education, referrals, and support. Because of the lack of understanding about violence and its impacts on health, providers may miss the clues that a patient may be living with chronic violence, or has had an acute experience with violence. Sexual violence often times does not leave any physical injury, but the scars from the stress of surviving an event can create havoc to the body systems. Sleep disturbances, digestive disorders, and chronic diseases such as asthma, diabetes, and heart disease may all be exacerbated by violence. This is a profession derived from a passion to care.
Michell: Is dealing with rape victims in itself a traumatic or at least depressive job?
Alison: Any profession that deals with human tragedy is difficult for the caregiver. SANE nurses are only but one of many professions that tackle the issues of humanity. Professionals develop habits, opinions, and daily routines based on their personal experiences. Vicarious trauma is a side effect of the job. How the professional handles the vicarious trauma is what is important. For example, my experiences with patients and their violence has impacted the way I parent. My children tell me all the time that I am too strict or too paranoid. I know that I am very cautious about where my children are, and who they are with, and what they are doing. I also am very open and honest with my children when questions regarding sexuality and sexual health come up in conversation. I want my children to be accurately informed about what is happening. I also encourage my children to know that our house is a safe place and that their friends should feel welcomed and safe too. I know that SANE nursing has made me more understanding of the variety of lifestyles lived by others, and culturally sensitive. I have been able to see the world outside of my bubble. I have been able to see gaps in healthcare and have strived to work with others to close those gaps. I have hopefully taken the tragedies experienced by others and have funneled them positively to create change. I do not find SANE nursing any more depressive than other forms of nursing. I know my limitations. I could not work on a pediatric oncology unit, a burn unit, or for hospice. Emergency and SANE nursing is where my skill sets are best suited.
Michell: Do you have suggestions for those in underdeveloped countries about dealing with rape?
Alison: Sexual violence is universal. It is as prevalent in underdeveloped countries as it is in industrialized countries. My personal, unscientific theory is that the industrialized world must lead by example. As an industrialized nation, we need to acknowledge that violence, abuse, neglect, and sexual violence occur in this country daily, by the second. Once we can get industrialized countries to appreciate this truth and commit it to change, and then can we suggest solutions. We have to create a just global culture, where all people are appreciated and valued. I do know that for me, prevention through education and example are the tools that I will utilize to help facilitate change as best I can.
Michell: Do you think the media, on the whole, is doing enough to cover this topic?
Alison: The media is simply a tool. I believe that because of media in its various forms, it has created an environment that allows for discussions surrounding sexual violence, violence, abuse, and neglect. I believe that in addition to helping foster an open environment, it is also a creating or supporting cultural acceptance of sexual violence and other forms of abuse. The consumer is ultimately responsible for what is displayed or reported in the media and in its varying forms. Consumers drive the media. I would love to see more documentaries, blogs, commercials, and advertising that promote a violence-free world.
Michell: If you would like to put your contact information or any sort of web site that you may have please do so. I know you specifically told me you do outreach and you can also give a brief description of that here if you like.
Alison: My contact is: Alison Rerko RN, SANE-A, SANE-P; 216-476-7278.
Michell: Thank you Alison for your time and your passion to help victims.