Question

Less than a month ago, Jennifer began working as an RN at a regional hospital in a small town in a predominantly rural area. Until she moved to the area with her husband, she lived in a large city several hours away, where she was an RN on the staff of a large metropolitan hospital. Although Jennifer likes the staff at her new job, the difference in pace and protocols at the smaller facility has been an adjustment. On Saturday, Jennifer is working the night shift in the emergency department (ED). It’s a busy night for this usually quiet hospital. The ED waiting area is filled with a variety of patients, including multiple cases of influenza, URIs, and suspected pneumonia. Several victims of motor vehicle accidents have been treated, with another one reportedly on the way by ambulance. Around 3 AM, between patients, Jennifer comes out to check with Brenda, the admitting nurse, to see how many patients are still waiting and assess the complexity of patient complaints. She notices two young women sitting in the farthest corner of the waiting area. One is in obvious distress, while the other appears to be trying to comfort her. Jennifer asks Brenda about the women. “Sounds like a date gone bad,” says Brenda. “Let’s see, her name is Kaitlyn, the one who’s crying. She’s 19, she’s a student at a local college, and that’s her roommate with her. Kaitlyn was at a bar with some college friends, and they were playing pool with some local guys she didn’t know very well. There was a lot of drinking, and the last thing she remembers is getting dropped off outside her dorm by one of the guys she met at the bar. When the roommate came home, she says she found Kaitlyn passed out in the dorm lounge, and when she roused her, Kaitlyn said ‘I think I’ve been raped.’ So her roommate drove her over here, but Kaitlyn isn’t sure she wants to be examined. They got her about 45 minutes ago.” Jennifer is appalled that this patient has been made to wait this long. When she asks Brenda about this, the admitting nurse replies, “Listen, I feel terrible for her, but we’ve got acute cases ahead of her—some being seen now, some waiting. And we’ve got an MVA victim on the way. She’s upset, but she’s not physically harmed, as far as I could see or as far as she could tell me. Our protocol is to triage patients so that most life-threatening cases are seen first.” Jennifer cannot believe what she’s hearing. She insists that Kaitlyn should be seen without further delay. Brenda shrugs and says, “I don’t like to see her wait either, but she’s not likely to press charges in a small town like this, even if it she was raped. There’s really not going to be much we can do.” Jennifer sighs and adds, “What this place really needs is a SANE on staff.”

1. What are your thoughts about the hospital’s protocol, as described by Brenda? Is Jennifer right, or does Brenda have a legitimate point? Is it common for known (or possible) sexual assault victims to wait long periods to be seen in the ED? If so, what is the rationale for that? Is this rationale acceptable?

2. What is Jennifer talking about when she says that a SANE is needed on staff? How could this help with the situation that Jennifer sees as unacceptable at the hospital? Is this level of training unrealistic for a small-town hospital to provide?

Answer 1

1) In this case Jennifer is right because the first priority of the emergency department personnel is to provide appropriate medical care for the life threatening injury of sexually assaulted patient for stabilizing the patient. After appropriate treatment of life threatening injuries the sexual assault nurse examinor will obtain a history , head to foot examination, permome a detailed ano genital exam, collect forensic specimen for evidence and provide treatment appropriate for both developmental amd cultural needs. Repoting to law is mandatory in this case. It is not common to wait for possibe sexually assault client for long time in ED. This patient will be provide as much privacy as possible for registration and waiting until wictims advocate and SANE will be arrived.

2 ) The SANE responsible to obtain physician consultation if the patient have history of LOC, neurological deficit, injuries to head or abdomen, genital trauma, evidence of significant substance use or abuse and bleeding. SANE collect history of the patient, record maintamence, physical examination and evidence collecton, forensic sampling, Small town hospitals staff may act unrealisticly with or with out knowledge, but information provided by Jennifer helps to act them quickly.