Nursing

RESPONDING TO RAPE AND SEXUAL ASSAULT

Effective Date: 
Mon, 07/15/1996
Reviewed: 
Fri, 05/15/2015
Revised: 
Thu, 03/30/2017
Policy: 
The Student Health Center provides medical services and psychological services to survivors of sexual assault.
The SHC does not perform forensic examinations and does not collect specimens for prosecution of a crime.
For patients who desire a forensic exam the SHS facilitates contact with the police department which has jurisdiction over the place in which the assault occurred and the police arrange a SANE exam.  
As soon as an assault is identified the patient is offerred an advocate for support.  Advocate contact information is listed in the Sexual Assault Survivor Management reference in the EMR (HC933).
Clinicians are to follow this reference to assure that thorough and comprehensive care is offered.
Medical care includes a complete physical evaluation and care for any injuries as well as emergency contraception, STI screening and treatment.  Medical providers comply with the state mandated requirement to report Violent Injury. Phone numbers for police dispatch, phone numbers for on-campus Sexual Assault Crisis Counselors on campus and Violent injury report forms are found in the Electronic Medical Record under Internal References.
Clinicians and nurses at SHS refer survivors of sexual assault to Counseling and Psychological Services (CAPPS) for psychological assistance and to off campus providers as appropriate.
Procedure: 
  1. Patient discloses that s/he has been sexually assaulted.
  2. Charge nurse determines the clinician most appropriate for visit and arranges clinician schedule to accommodate the visit.  If clinician elicits this information in a visit an attempt is made to revise schedules to allow the clinician and the patient more time for the visit. 
  3. Staff work to limit the number of people from the SHS involved to maintain privacy.
  4. Clinician meets with patient and collects information.  It is critical to identify the time, date, and place of the event.  
  5. Clinician explains the option of a forensic examination.   If the patient desires forensic examination, the clinician calls UCSC non-urgent police line at 459-2231.  UCSC police will need to know the location where the incident occurred.    The police arrange a forensic exam.  The location of the event determines what police department is responsible for taking the report and arranging the forensic examination. For off-campus incidents, UCSC police will link the clinician to the appropriate police department.  Once a jurisdiction has been determined, if it is not on campus, UCSC police must defer management to the police of jurisdiction.
  6. If the patient is going to have a SANE exam, do not examine them.  Do not touch them.  Do not ask a lot of questions.  Facilitate transfer to a location where appropriate exam can take place.
  7. As soon as possible in this process identify someone who can be the patient's advocate.  It is important to have the patient supported by someone who is not a clinician and not police.  A list of state certified sexual assault crisis counselors on and off campus is kept in Internal References.
  8. Assess for acute injuries - do a whole body review. 
  9. Prevent STIs.  There is a web link in the EMR to the CDC STD Guidelines.  These guidelines provide the most up-to-date guidance on prevention of STIs for survivors of sexual assault.
  10. Provide emergency contraception.
  11. Inform the patient that the clinician is required by law to report the incident.  Make clear that the patient may chose to disclose or not disclose any information to the police.  Note the patient preference for talking to police on the Violent Injury Report form.  Give patient the required  pamphlet "Resources and Options:  Sexual Harassment, Sexual Assault, Dating & Domestic Violence, Stalking & Other Prohibited Conduct". (See attached)
  12. The clinician or designee telephones Campus Police and completes and faxes form HC: 433 within 24 hours of the visit.
  13. Patient is given resources for emotional support and a follow up visit with clinician if indicated.
  14. Immediate crisis counseling services are available through CAPs and should be offered to the patient.
Key Points: 

Sexual assault is a serious crime and survivors should receive appropriate information about their right to seek legal action against their assailant.   Survivors who wish to pursue legal action are referred to the police for formal forensic evaluation by a Sexual Assault Nurse Examiner.  THis service is not available at the SHS

Sexual assault survivors need physical examination, prevention of STIs and pregnancy, and emotional support.  The SHS is prepared to provide these services to survivors who choose not to pursue legal action.

Clinicians are responsible for Mandatory reporting of Violent Crime, including sexual assault.  These reports must be submitted within 24 hours of the visit.

REGISTERED NURSE SCOPE OF PRACTICE

Effective Date: 
Sun, 09/15/1996
Reviewed: 
Fri, 08/05/2011
Revised: 
Wed, 05/06/2015
Policy: 

The Registered Nurse (R.N.) functions according to the Registered Nurse Practice Act of the State of California, and must be in possession of a current and valid license in good standing. Under Standardized Procedures the R.N. may perform in an expanded role to provide care and counseling on a variety of health related topics. R.N. job classifications include Clinic Nurse (CN) II and III. Promotion from CN II to CN III is based on years of experience and demonstration of ability to function at higher level of independence and complexity. The CN II and CN III examine and evaluate patients in accordance with algorithms and protocols, which are reviewed as needed.

Procedure: 

The R.N. works closely with the supervising physician to provide care and follow-up for Same Day Clinic patients.

The R.N. utilizes Triage Guidelines to screen and direct patients for appropriate care, provide prescription refills under standing orders, and makes referrals to other agencies or departments.

The R.N. functions according to Standardized Procedures in performing limited exams, ordering particular diagnostic procedures, providing health information regarding common minor health problems, transmitting lab and X-ray orders, providing immunizations,  treating non-genital warts, and allergy immunotherapy injection services.   

Under Standardized  Procedures the R.N. transmits prescriptions related to travel, contraception, Urinary Tract Infections, and Strep throat cultures positive for Group A Beta Hemolytic Strep.

The R.N. cleans and dresses wounds and assists with procedures according to training and standardized procedure.

The R.N. may initiate or assist with provision of emergency care, maintains current BLS certification including AED use, and attends at least annual in-service education on emergency care.

KEY POINTS The R.N. is licensed to practice in the State of California, and abides by the regulations of the Nurse Practice Act. Independent functions that are unique to this facility are codified in Standarized Procedure to which the R.N. adheres.

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