Pushing the Boundaries: The Impact of the Role of the Clinical Nurse /Midwife Specialist (CN/MS) Sexual Assault Forensic Examination (SAFE) in Ireland

Abstract

Introduction: Landmark research of Magee et al. (2002) (n=3,120) found that in Ireland , 4 in 10 women (42%) and almost 3 in 10 men (28%) experienced sexual assault or abuse in their lifetime. Subsequently, a National Review of Sexual Assault Treatment Services found sexual assault remains one of the most underreported and under recorded violent crimes in Ireland (O’Shea 2006). Key recommendations included expansion of existing services and introduction of a pilot programme in forensic nursing in Ireland, where nurses would undergo a higher diploma and apply for accreditation as CN/MS (SAFE). Short description of practice change implemented: Expansion of Sexual Assault Treatment Units (SATU) from four to six units in Cork, Dublin, Letterkenny, Waterford, adding Galway, Mullingar (2009). Successful implementation of nurse training following pilot programme CN/MS (SAFE). Aim and theory of change: Patients attending SATU may be physically and /or psychologically traumatised making difficult, life changing decisions. SATUs need to be appropriately staffed and available around the clock to provide prompt medical /supportive care and collect forensic evidence. As a nationally agreed service with defined multiagency guidelines (National SATU Guidelines 2014) and choice of care pathways, the CN/MS (SAFE) can consolidate the initial healthcare response to the under-reported crime of rape/sexual assault by utilising specialistic clinical nursing/midwifery knowledge and critical thinking skills to provide optimum patient care. This change also addresses the issue of recruitment/retention of doctors to carry out forensic examinations (O’Shea 2006). Targeted population and stakeholders: All male /female patients age 14 or older who present to SATU following recent rape/sexual assault. The optimisation of the role of nurses /midwives as Forensic Clinical Examiners realises advantages to Patients, SATU services, Nursing/Midwifery, the wider Inter-disciplinary Team, Inter-disciplinary working ,Criminal Justice System. Timeline: 3 groups of CN/CM (SAFE) graduated 2010-16 developing, assimilating, integrating a broad in-depth knowledge base in this speciality through a structured academic and clinical framework. Highlights: Innovations, Impact, Outcomes CN/MS (SAFE) has transformed the care/services for patients significantly advancing and extending the breadth /depth of SATU services namely: availability of trained staff on a 24 hr basis streamlined response times, accessibility, efficiency of healthcare/forensic service delivery (see Table 1) implementation of patient focused care initiatives including increased patient care pathways influential in driving quality improvement in SATUs nationally participation in patient, staff, community education / risk reduction programmes contribute to development, evaluation and implementation of national strategies Table 1 table of case numbers from 2009 to present day will not load! Sustainability: Some CN/MS (SAFE) have advanced skills in both the academic and practice arena and the enhancement and expansion of this nursing/midwifery role to Registered Advance Nurse Practitioner (RANP (SAFE) would support national policy direction promoting quality patient care. Realisation of the RANP (SAFE) would also ‘assist sustainability, the long range thinking’ (Markowitz 2009) for this unique and extremely challenging area of healthcare practice. Transferability: Transferable skills to other health related services e.g. sexual health, paediatric sexual assault forensic examination etc. Scope for other jurisdictions internationally to adopt and develop the Irish model of CN/MS (SAFE) training and role into their own programmes of care. Discussions & Key findings: CN/CM (SAFE) are attached to a SATU strategically located nationally so that the patient has no more than a three hour drive to the nearest SATU. SATU availability helps to minimise patient distress and ensures timely collection of forensic evidence (O’Shea 2006). The CN/CM (SAFE) initiative is unique to Ireland. It demonstrates international leadership, supported at Government level and by the many different disciplines /agencies involved including An Garda Siochana, the Rape Crisis Centres. Since 2009, Forensic Clinical Examiners in Ireland are either Medical Doctors or CN/MSs (SAFE). Conclusions: To date, CN/MS (SAFE) in the realms of rape / sexual assault in Ireland have forged a path through a previously unknown clinical area. Working as Forensic Clinical Examiners, the CN/MS (SAFE) use a consistent, standardised, patient focused approach with the interdisciplinary team to improve outcomes and reduce the long term sequelae for each patient regardless of the circumstances of the incident or a person’s engagement, or not with the criminal justice system. Expansion of SATU services in Ireland and availability of CN/MS (SAFE) has greatly improved accessibility for patients following rape /sexual assault.