For the Love of Health
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For the Love of Health
Trauma Informed Care with Forensic Nurse Examiners Amy Stier and Sarah Peluso
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In 2023, ChristianaCare's Emergency Departments treated more than 2,000 patients who were victims of violent crimes. In situations like those, a special team of nurses called Forensic Nurse Examiners provide comprehensive, trauma- informed care.
In this episode of For the Love of Health, ChristianaCare Forensic Nurse Examiner Coordinator Amy Stier and her colleague, fellow Forensic Nurse Examiner Sarah Peluso explain the vital role Forensic Nurse Examiners (FNEs) play across the country and how ChristianaCare is setting the gold standard in the field.
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We are able to provide these victims one-on-one compassionate care in a private area.
Speaker 2You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. And now here are your hosts.
Speaker 3Hello everyone, I'm Megan McGerman.
Speaker 2And I'm Jason Tokarski. Welcome to another episode of For the Love of Health brought to you by ChristianaCare.
Speaker 3In 2023, christianacare's emergency department treated more than 2,000 patients who were victims of violent crimes. In situations like those, a special team of nurses, called Forensic Nurse Examiners, provide comprehensive care.
Speaker 2ChristianaCare's internationally known Forens forensic nurse examiners are available 24 hours a day, seven days a week. Joining us today to talk more about their work are Christiana Care forensic nurse examiner coordinator, amy Steyer, and her colleague, fellow forensic nurse examiner, sarah Peluso.
Speaker 3Amy and Sarah. Thank you both so much for your time today. Thank you for having us. Thank you Explain the role of a forensic nurse examiner in a hospital setting.
Speaker 4Forensic nurses look a little bit different at every hospital, but here at Christiana Care our forensic nurses are also emergency department nurses, but we have additional training in caring for adult or pediatric victims of any kind of violence, and that care includes obtaining a proper history. Doing a safety assessment on the patient includes obtaining a proper history, doing a safety assessment on the patient, identifying and documenting injuries, identifying and collecting potential evidence, along with photographs and written documentation as well.
Speaker 3So you mentioned it can be different at different hospitals. So what does the national landscape look like for this role?
Speaker 4There is a shortage of forensic nurses throughout our entire country. When you look at our tri-state area, out of those 200 hospitals, 80% of them do not have a forensic nurse or have a forensic nurse that is only on call, Especially in rural areas throughout our country. Some patients have to drive hours to find a hospital that has a SANE nurse or a forensic nurse available to provide that exam. And you mentioned what was the other kind of nurse. A forensic nurse is a nurse that takes care of patients of a wide variety. A SANE nurse just simply means a sexual assault nurse examiner, so they only do sexual assault exams and there's a mixture of forensic nurses and S sane nurses throughout our country.
Speaker 2So you've said that this is a very unique program, and especially from the perspective of you're there 24-7, 365. You're always in Christiana Carey's emergency department. Why is that important? Why is it so important to have that coverage available for the victims of sexual assault and violence?
Speaker 1Well, because victims of crimes don't just present during banker's hours, they present 24 hours a day. In alliance with the Emergency Nurses Association and the International Association of Forensic Nurses, christiana Care supports and knows the importance of having a specially trained forensic nurse that's able to respond to those victims of crimes that present. With a trauma patient for instance, life-saving medical intervention would supersede any sort of detailed injury documentation or preservation of evidence. But it still doesn't mean that it's not important and it doesn't mean that it can't affect the patient in the future. Christiana Care supports us in allowing that role to be at the bedside, to have the forensic nurse focus solely on that detailed injury documentation and evidence preservation. We do have patients that present that do not have life-threatening injuries but have still experienced unimaginable trauma, for instance our sexual assault patients. Those types of patients we approach a little differently. We're able to greet them at triage, promptly, bring them back to a quiet, isolated area, away from the busyness of the emergency department, and provide that one-on-one trauma-informed care for them.
Speaker 3Let's dive a little bit deeper into what sets the Christiana Care program apart. You are one of the only ones in the entire country doing that kind of in-depth care you just described.
Speaker 4So we began in 1997 as sexual assault nurse examiners. On our forensic team we have 25 forensic nurses between the Newark campus and the Wilmington campus. There's lots of forensic nurses throughout our country but not every team has the extensive training that we have. So not only are we sexual assault nurse examiners but we also take care of patients who are victims of intimate partner violence, who are victims of elder abuse or child abuse, victims of any kind of a traumatic injury such as a gunshot wound or a stabbing or a victim of strangulation, and we have that expert training for all of those different patient types where not every forensic nurse has that expert training. Another aspect of what we have accomplished here at Christiana is we have decreased the wait time for a sexual assault victim. Our average wait time every month is less than 10 minutes from when the patient arrives, we're notified and when we are making a face-to-face contact with that patient.
Speaker 3Talk to us more about this specialty training that your team has that sets you apart from other nurses on the units.
Speaker 4We take initially a 40-hour course through the International Association of Forensic Nurses specific to caring for victims of sexual assault. We also have expert training in strangulation and in gunshot wounds ballistics from Dr Smock, who is a nationally recognized expert in strangulation and ballistics. Following that, we have about 125 hours of education specific to the wide variety of patients that we care for.
Speaker 1As well as two to three months of hands-on training or orientation, and we have mandatory education requirements twice yearly.
Speaker 4Well, we recognized that there were patients that were victims of violence. That may not be a sexual assault, but they still have negative health outcomes and they still need a forensic exam and forensic care. So as we recognized more and more populations that we could add, and as the forensic landscape and science changed and supported us receiving that additional training, we added on whatever we could, Whatever additional patients that we can provide care for. We have obtained that training and have trained our team.
Speaker 2The same If you went down the path of seeing that you had that need, that this program needed to have that kind of extra training beyond the same nurse training. There we're looking at a fair number of patients coming into the ED who have this. What does that look like? How many people are we talking about that you're seeing on an average basis in 2023, for example, 2,055 patients between the Newark campus and the Wilmington campus in 2023.
Speaker 4We saw about 330 sexual assault patients, 556 patients of intimate partner violence. We also cared for 186 victims of strangulation.
Speaker 3And is that just Delaware? Are people from Pennsylvania and Maryland coming to see you as well?
Speaker 4We see patients from all over the tri-state region, and that's because between Pennsylvania, new Jersey, maryland and Delaware we are the only location that is available 24 hours a day, seven days a week.
Speaker 1We've kind of made it our mission to never allow a shift to become uncovered. We all work as a team and everybody does their part to make sure, if someone's sick or an emergency happens, that there's someone there, because we value that coverage so much.
Speaker 3And what kind of feedback have you gotten from your patients?
Speaker 4Most of our patients are extremely appreciative. I don't think that immediately after something traumatic that occurred to them, I don't think that they're in the mind frame to be able to say thank you or to really important. And I do the follow-ups every week. So I see the patients two weeks later and I have received such positive feedback from all of the follow-ups and I make sure I share that with those forensic nurses that that patient said that you changed the entire feeling of that visit, that because of us and because we provided that one-on-one care, it made such a difference. One of our patients specifically said that we made her feel safe in such a volatile situation. She felt safe and secure and protected and it was because of the forensic nurses. That feedback is what fuels us and what makes us want to continue doing our job.
Speaker 1Sometimes we're able to follow that full circle as well. Through the justice system. We're able to testify on behalf of the patient, we're able to see them get their protection from abuse or restraining order that they need, and sometimes we have contact with the patient. The patients make contact with us and thank us, and it's able to come full circle. That's exactly why we do what we do.
Speaker 2Tell me more about what you're doing along those lines where it's not just about what you're doing in that moment where you're treating someone in the ED.
Speaker 1We don't just see patients in the emergency department. We receive consults from all over the hospital and respond to all of the admission floors, the Women and Children's Center, the Pediatric Center, and it doesn't just stop there. We provide education to the providers within the hospital doctors, nurses, any of the caregivers, as well as out in the community, to the Attorney General's office, all of the various law enforcement agencies, schools, universities. Before a patient leaves at discharge, we are always providing safety planning for the patient to ensure they have a safe place to go, making referrals to the domestic violence hotline, whether they need shelter, placement, counseling services, as well as just various law enforcement agencies, the victim advocates, really anything they may need. We attempt to follow through with resources for the patient.
Speaker 4We want to make sure that they have access to all of the different resources that are available, because not every patient realizes there's so many different options and because we see patients from the tri-state region. We have the resources available in New Jersey, in Maryland, in Pennsylvania and, of course, in Delaware, and if we had a patient that came from Virginia or came from Florida, we would find the resources that they need for that state.
Speaker 2So this is more than just treating in the moment. This is continued care beyond to help them through the situation. They've been dealt with. That's correct.
Speaker 1Yes, they're just starting that healing process and that road to recovery when we're discharging them, so it's definitely a continuous process.
Speaker 3Your team was recently recognized with a Compassionate Champion Award by Delaware's Governor Carney for your work in trauma-informed care. Talk to us about the importance of that field of work.
Speaker 4Trauma-informed care is a part of the foundation of forensic nursing. Allowing our patient to be a part of their exam, allowing them to have autonomy is so important. Showing them compassion, providing that safe, inclusive environment, not only for our patients, but for each other as well. We're seeing traumatic things and we need support from each other, and the cohesiveness of our team is what allows us to provide that support to each other. We debrief with each other and that's how I think we get through this and are able to continue helping our patients.
Speaker 3Not only have you been recognized locally, you've also been referred to as the gold standard patient nationally. You've been recognized internationally. Talk to us about that expansive work.
Speaker 4So we've had requests from as far as Malta and the UAE requesting us to provide education to their nurses and their physicians. We've even had nurses come from as far as Australia to shadow our team. She was here for two weeks to learn how we started our program, how we sustain our program, so that she could return back to her country and create a program that is similar to our program, because the International Association of Forensic Nurses recognizes that we have an ideal team here and approach and a wide variety of patients that we're able to care for, and they recommended us and that, I believe, is how the nurses from Australia found us.
Speaker 2Clearly this is a program that has been recognized nationally, internationally, but it might not be something that the average Delawarean or somebody from Pennsylvania has ever heard of, let alone had a need for before. Let's say, somebody does, they're in this situation, it's come up to them. What do you want them to know about your program?
Speaker 1I hope that we don't have to meet anyone, but unfortunately that's just not the reality of the situation. But I would want them to know that we're here 24 hours a day in the emergency department. We're specially trained and we're waiting for a victim at any moment of the day to come in and we're here to provide one onon-one private care, trauma-informed care. We're able to provide these victims one-on-one compassionate care in a private area in the emergency department.
Speaker 4We want to empower our patients and we want to tailor their care to their unique needs, so that we're ensuring that we're treating them the way that they need to be treated best.
Speaker 2What does the future hold for your group? Where do you see forensic examinations, with the way you handle them, that 24-7 care? Where do you want that to go into the future?
Speaker 1I would love to see other health care organizations model Christiana Cares' dedication and support of a forensic nursing program like ours. To be able to adapt that and provide those services to their communities would be an invaluable asset, Amy and.
Speaker 3Sarah. Thank you both so much for your time. Thank you for having us. Thank you.
Speaker 2We'll have more information on Christiana Care's Forensic Nurse Examiner Program in the show notes for this episode.
Speaker 3And don't forget to subscribe to, for the Love of Health, on Apple Podcasts or Spotify and follow Christiana Care on social media.
Speaker 2We'll be back in two weeks with another great conversation.
Speaker 3Until then, thanks for joining us for the love of health.
