At the clinic we see approximately 160 new women and 15 new men per year. We offer emergency contraception, screening and treatment for sexually transmitted infections and emotional support, counselling and psychology. We do not offer forensic testing, however we do try to facilitate this by linking patients in with various agencies. We operate an 'open' referral system, so people can self refer, and like all GUM services we are not restricted by geographical boundaries. We try to encourage people to book an appointment at set clinics. Each week there are 3 female and one male clinic. Patients usually attend a few weeks post assault for a sexual health screen, two weeks after this for results, then at three months for blood tests for HIV, hepatitis B & C and syphilis. Patients may attend more frequently e.g. if they are seeing the health advisers or psychologists to address their mental health needs, or if they have other problems. 

I was lucky enough to be selected for the Edith Cavell Scholarship late last year, which is funded by the Charitable Foundation of the Royal London Hospital. This year the scholarship was an exchange visit to Winchester, Virginia in the USA.  An American nurse came to the Royal London in September in 2002.

I applied for the scholarship to look at the way integrated care pathways (ICPs) were used in the USA as we are currently developing these in the sexual assault service and the genito-urinary medicine service. I was also interested in the way Sexual Assault Nurse Examiners (SANEs) work.

The scholarship provided me with a wonderful opportunity to visit another country and see their health system in action.  I spent four weeks in April with health care professionals at Valley Health System (VHS) in Winchester, Virginia, USA.  Winchester in a town of approximately 30,000 people and is based in Northern Virginia, about 2 hours east of Washington DC.  During my month there I was able to meet up with a variety of nurses and other professionals. This enabled me to get an overview of the way their health system works, and to exchange information regarding treatments and practice with them. I was also able to collate various pieces of written information, which I have started to share with my colleagues at the Royal London.

I gave a number of presentations about the NHS, the Royal London Hospital and the sexual assault service. It was interesting to be able to share with my American colleagues the benefits and challenges of a private and a public healthcare system, such as the NHS. The most difficult aspect for me to understand was the way this 'private' health care system works, having spent most of my life relying on or working for the NHS.

Valley Health System is linked with Shenandoah University and I had the chance to participate in a number of lectures at the nurse education department, some of which were inter-disciplinary.  Basic nurse education in Virginia is such that a two-year course leads to the registered nurse qualification, some nurses go on the complete a further two years to gain their Bachelor of Science in Nursing or BSN. With their basic registration nurses are able to work in various specialties, including paediatrics and mental health.

For me, one of the highlights of the exchange was a course held in Richmond, Virginia. The 5-day course was for nurses who wanted to become Sexual Assault Nurse Examiners (SANE) They care for the victim, collect evidence and appear as a witness in the courtroom.  It is a growing specialty in the USA. There were nurses there from a variety of states, with a mixture of laws and practice, so any concerns I had about differences soon disappeared. The course consisted of 50 hours of didactic training, followed by a practical element, which involves spending time in court, shadowing a person practising as a forensic examiner, completing a number of patient examinations and time with the police. I have a year to complete this section but with differences between the USA and UK systems I will have to make a few adaptations.

The nurses who run the course have links with an organisation called the International Association of Forensic Nurses. They have developed standards for forensic nursing and they have recently held the first certification exam for forensic nursing. I am not aware of any plans to bring the certification exam to the UK. 

On the practical side I was able to spend some time with the SANE and her colleague in the Emergency Room (ER) at Winchester Medical Center. When a person reports an assault the police take them to the Emergency Room. A physician sees them then they are seen by a SANE.  The SANE then takes a statement then documents and collects evidence based on it. S/he will also administer any medications and give the patient verbal and written information about other services, e.g. counselling. The notes that the SANEs make are kept separately from the hospital notes; access to them is limited.

The forensic nurse examiners in Winchester also saw children but they had received additional training in child abuse by completing a second course, also run by the nurses in Richmond. And, of course, their basic training qualifies them to work with children.

The second part of the scholarship is a month away from work to write up the findings.  During this month I shall be preparing presentations for various colleagues within and outside my clinical group, and I shall be working with my colleagues in I&I to develop the integrated care pathway (ICP).  I will also spend time completing as much of the SANE course as I can, with some adaptations appropriate to the UK. 

Before I left for Virginia I had been in contact with a nurse in a large sexual assault referral centre in Manchester. I believe she is the only other UK nurse that has done a similar course in the US. She is currently examining complainants of sexual assault, but she is not yet expressing opinions in court. We intend to meet up soon to discuss the way forward for nursing in this field. This is particularly relevant to my practice as the ELSAS is in discussion with the Metropolitan Police Service to develop a service that offers forensic testing and after care for those who have been sexually assaulted.

Overall the exchange/scholarship has enabled me to see a different health care system in action, to learn about the strengths and weaknesses of both systems and to make a step on the ladder of a whole new field of nursing. It has also given me the opportunity to network and make new friends and acquaintances, with whom I shall remain in contact. For me it was an incredibly positive experience, one that I would highly recommend. So, for those of you wondering about whether to apply for this or another scholarship - go for it!

Acknowlegements

Finally, I would like to give thanks to the many people who helped me during the last few months both in the USA and in the UK including The Charitable Foundation of The Royal London Hospital.

References

1. Horn CK et al.  Historical disclosure of rape by women attending genitourinary medicine clinics. International Journal of STDs and AIDS: 1999;  10: 47-8.

2. Coxell A et al. Lifetime prevalence, characteristics and associated problems of non – consensual sex in men :cross sectional survey BMJ, 1999: 318; 846-50.

3. Petrak JA , Skinner CJ, Claydon EL. The prevalence of sexual assault in a genitourinary medicine clinic : service implications Genitourinary medicine, 1995: 71;98-102

6. Daunton C. Ed. Edith Cavell, her life and her art. Richmond, Surrey First Impressions, 1990.

7. Lynch V. Forensic Nursing in the emergency department: A new role for the 1990's. Critical Care Nursing Quarterly,  1991:14.3; 69-86.