Monday, November 8, 2010

SANE A - The Male Perspective

By Peter Eisert, BS, RN, SANE-A, SANE-P

Human beings rarely allow their face to truly express what is deep in their soul. It is something we typically guard against. When you see the emotional pain, confusion, fright, shock, and sadness occurring simultaneously on the face of a patient that was raped, it sticks with you.

It has been three years since this image was etched into my memory, but when I close my eyes I can see her face as if I just met her yesterday. When my pager goes off and I begin my drive to the emergency department, the glimpse of her damaged soul invades my consciousness. I am glad it does, as it was at that moment that I really knew that I wanted to be a sexual assault nurse examiner (SANE).

The decision to join a sexual assault forensic examiner (SAFE) team is not an easy one. Beyond the personal evaluation of time, commitment, education, personal experiences, and vicarious trauma that we each need to consider, some nurses have other considerations to ponder and overcome to become a SANE. One group of nurses, are men.

When the thought of joining the SAFE team first entered my mind, I decided I needed to learn more about the role. My first step was searching the internet and I discovered no academic sites discussing men as SANEs. Instead, I found blogs that described men caring for sexual assault victims as “gross” or with comments such as, “if I was just raped I wouldn’t let a man touch me.” I then asked some of my nursing colleagues their thoughts and received mixed feedback about men in this role.

I was not ready to give up all hope about the possibility of being a SANE. I decided to do a literature review. My search yielded no results for the men in this career. Fortunately, I found dozens of articles and other references that discussed SANEs. In a single article, the author mentioned men being on their SANE team. I also found a paragraph addressing male SANEs in Virginia Lynch’s Forensic Nursing textbook (2006). I was elated to find these and set out to contact the authors.

After several weeks, I was able to correspond with these two men and we discussed their role as sexual assault nurses. Their words were encouraging. They both had been providing forensic nursing care for years with extremely rare instances where the patient refused them solely on their gender. They both had felt some resistance early on, but that quickly dissipated. With this encouraging news, I made the decision to apply to the SAFE team and became the first male SANE in our institution.

Since joining the team three years ago, I have yet to have a patient, pediatric or adult, decline my services once I have met with them. There were a few cases early on that patients did ask for a female nurse. These were due to the staff’s introduction of me. For example, “the male forensic nurse is on call today, is that okay?” This question undermines my ability to connect with the patient and results in a “no” response. If the staff feels it necessary to let the patient know that I am male, I ask them to say, “Pete is our forensic nurse today and he will be caring for you.” This still conveys to the patient I am a man, but allows me the opportunity to connect with them.

The forensic exam is all about our patients and I do give them opportunity to decline my services and opt for one of my female colleagues. So far, not one patient has taken the offer.

When I meet my patient, I immediately begin to return the power and control that they lost in the assault. I am acutely aware of my body language. I try to sit eye level or even lower than them. If the only chair in the room would position me higher than my patient, I ask to switch places with the advocate or friend of the patient, or I sit on the floor. As the exam transitions from patient history to physical/forensic exam, I remind the patient that we can stop at any time for any reason and I have a female healthcare provider in the room with me. As I perform the exam, I ask the patient if I can touch them, especially when examining intimate areas of their body. I also feel it is very important to keep them covered as much as possible to maintain their dignity and privacy.

One area that I personally struggle with is therapeutic touch. I am not a “touchy-feely” kind of guy, but when caring for my patients and their families in my regular job, I am not afraid to hold their hand, put an arm around them, or give a hug. These moments are spontaneous and not always predictable. I understand that the patients I work with in the SANE role have been touched when there was no invitation and I don’t want to re-traumatize them with a spontaneous touch.

Becoming a SANE has affected my life many ways. I have felt an excitement about nursing that I have not experienced in years. The combination of forensic and nursing science is fascinating to me and I have read more research since joining the team, than I have in first ten years of my career. This has led me to participate in research and conduct evidence based practice projects that will hopefully improve outcomes for patients who are victims of violence.

While my overall experience as a SANE has been wonderful, I do look at the world from a new perspective. When I watch the children in my neighborhood walk up the street from the bus stop, I now think to myself that 1 in 5 of the girls will be victims of an attempted or completed rape and 1 in 3 will be an abusive relationship. When this runs through my mind, I long for the days of ignorant bliss. These thoughts, however, have motivated me to actively speak on the subject of sexual and interpersonal violence.

My experience as a SANE has taught me that what is often more important to these patients is the genuine care and concern for them, not the nurse’s gender. Whether you are a “female” or “male” nurse, each SANE has the ability to positively impact the patients whom we see, helping them transition from victim to survivor.

ReferencesLedray, LE. (2006). Sexual Assault. In Virginia Lynch (Ed.), Forensic Nursing (pp. 279-291). St. Louis, MO: Elsevier Mosby.

Peter J. Eisert started his healthcare career as a medic in the U.S. Army. After serving, he attended Penn State University and earned his Bachelor’s Degree in Nursing. Pete has worked in the Neonatal ICU for more than fourteen years. He also is a member of York Hospital’s Forensic Nurse Examiner Team and is SANE-A and SANE-P certified.

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