National TeleNursing Center Helps Rural Clinicians Provide Sexual Assault Exams
- Need: Clinicians in rural areas are often unprepared to treat sexual assault victims after an assault.
- Intervention: The National TeleNursing Center (NTC) in Massachusetts uses telemedicine to connect Sexual Assault Nurse Examiners to clinicians in remote areas, offering them guidance through examinations.
- Results: Clinicians report that the help gives them confidence through the examination process. To date, every one of the remote sites' eligible sexual assault patients have consented to receiving help from NTC.
Sexual Assault Nurse Examiner (SANE) is a national model of nursing practice in which nurses receive specialized training to provide trauma-informed care, including forensic evidence collection, for victims of sexual assault. In 1995, the Massachusetts Department of Public Health (DPH) started the MA SANE program, deploying MA SANEs to care for sexual assault patients in 29 hospitals across Massachusetts. It is a challenge in many states, including Massachusetts, to provide SANE services to all hospitals, especially in rural locations.
In 2012, the Massachusetts DPH received funds from the Department of Justice Office for Victims of Crime (OVC) to support the National TeleNursing Center (NTC), the first national 24/7 sexual assault telemedicine resource for clinicians. Through a video conferencing system, NTC links SANEs to clinicians in rural and underserved areas in order to provide help in the examination process of a sexual assault victim following an assault. They also give guidance on how to collect forensic evidence that is used to prosecute the offenders. Their goal is to increase the confidence and competence of rural clinicians in performing a sexual assault examination, as well as to give quality support to the patients.
From NTC’s headquarters at Newton-Wellesley Hospital in Massachusetts, NTC’s 24-hour call schedule is covered by 19 SANE-certified nurses. Upon a remote clinic’s admission of a sexual assault victim, NTC is notified and the nurse on call arrives at Newton-Wellesley Hospital within the hour to provide assistance.
Through a request for proposal process from the Massachusetts DPH, 6 remote or underserved medical sites across the nation were chosen as pilot sites for NTC services. The following are currently in operation:
- Naval Hospital Twentynine Palms, California
- Sutter Lakeside Hospital (CAH), California
- Naval Hospital Camp Pendleton, California
It is anticipated that the following pilot sites will be operational by May, 2016:
- Hopi Health Care Center, Arizona
- Saint Anne's Hospital, Massachusetts
- MetroWest Medical Center, Massachusetts
Twelve national partners have helped to establish and continue the program.
The following are services that have been provided through the National TeleNursing Center at the launch of the new pilot sites:
- NTC staff paid a visit to offer education on their services and conducted an assessment of the facility’s technology capabilities.
- NTC provided a computer with video conferencing capabilities, installation assistance, and continued technical support.
- An information technology liaison was designated to oversee the accurate functioning of the telemedicine system.
- A clinical liaison was designated to serve as coordinator with NTC and to oversee the sexual assault care team.
During an examination:
- NTC nurses offer support and guidance to clinicians on the use of the evidence collection kits. The kits include forms to document a patient’s assault history, their physical exam findings, and provide methods to collect forensic evidence.
- A local rape crisis advocate is available to provide emotional support to the patient.
- The completed kits are then sent to a crime lab for analysis.
Following an examination:
- NTC nurses review documentation, packing of forensic evidence specimens and chain of custody procedures with the clinician.
- A debriefing is offered with the clinician to review the experience. Because these situations can be emotionally taxing and rural clinicians may have less experience in conducting such exams, debriefing is key.
- The rape crisis advocate links patients with aftercare and counseling services if desired.
- Clinicians are offered continued education regarding sexual assault and forensic evidence collection.
A full evaluation of the program’s effectiveness is currently being conducted; however, NTC has already seen some positive results. Clinicians who have used their services say that the support has helped them feel more comfortable with the examination process. Before the clinician can call NTC for help, the patient’s permission is required. So far, 100% of eligible sexual assault victims have consented and been treated with NTC support.
Additional resources explaining the importance of NTC and SANE programs:
- Can Telenursing Help Victims of Sexual Assault?, The Crime Report
Campbell, R., Patterson, D., Lichty, L. F., (October, 2005). The Effectiveness of Sexual Assault Nurse Examiner (SANE) Programs: A Review of Psychological, Medical, Legal, and Community Outcomes. SAGE Journals. 6(4). Article Abstract | Free Full-text
- Clinicians at remote sites have varying levels of experience treating sexual assault victims. Many have either not been trained or have limited opportunities to use their training as victims may be reluctant to come forward. This is especially true in remote or rural communities in which it is difficult to achieve anonymity.
- It is currently a national requirement that any clinician providing telenursing or telemedicine services become licensed in every state in which their services are used. The NTC nurses are currently licensed in MA, CA and AZ. This may be a time-consuming process and delay a nurse’s start with NTC.
- The baseline skill level and training of the remote site clinicians may vary. It is important to have an assessment of their level of experience and training when assisting and/or supporting them.
- Bureaucratic processes have delayed the implementation of NTC services in some locations.
- The national scope of the program presented some challenges. NTC is currently developing a uniform way to provide support and training that meets multiple needs in varying settings.
Start your program with a strong team and continue to build it. Ensure that your staff is high-caliber. Be strict in your acceptance process of SANE nurses. Prerequisites of NTC nurses include 5 years of experience as a practicing SANE nurse, expertise in several areas of practice, and a recommendation from their supervising nurse. The nurses go through an extensive interview process, and, once hired, take training classes and perform clinical practicums several times each year. The nurses are also required to renew their accreditation on a yearly basis.
Through sustainable funding sources, NTC is planning on increasing their pilot sites in selected locations across the nation.
Abuse and violence
Criminal justice system
Sexual and reproductive health
Arizona, California, Massachusetts
February 8, 2016
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.