INTERNATIONAL ASSOCIATION OF

INTERNATIONAL ASSOCIATION OF Forensic Nurses ' Leadership.Care.Expertise. CERTIFICATION RENEWAL Sexual Assault Nurse Examiner— Adult/Adolescent ...
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INTERNATIONAL ASSOCIATION OF

Forensic Nurses

'

Leadership.Care.Expertise.

CERTIFICATION RENEWAL

Sexual Assault Nurse Examiner— Adult/Adolescent (SANE-A®) and Pediatric (SANE-P®) CERTIFICATION RENEWAL HANDBOOK 2014

TABLE OF CONTENTS INTRODUCTION………………………………………………………………………….……………...………………………………………5

RENEWAL INFORMATION.……………………..……………………………………………………………………………………………7 Purpose and Rationale Duration of Certification Expiration Date Responsibility for Renewal Eligibility Requirements RENEWAL METHODS.…....…………………………………………………………………………………………......................... 9 Renewal Options By Exam By Continuing Education Contact Hours Application/Submission Options Electronically (preferred) Online – must pay by credit card Email Via Paper (processing fee) Fax Mail HOW TO RENEW BY CONTINUING EDUCATION……………………………………………………………………………….. 10 Deadlines and Fee Schedule Refund Policy Continuing Education Requirements Category A Category B Documentation of Continuing Education Incomplete Renewal Applications SANE-A Test Content Outline SANE-A Reference List SANE-P Test Content Outline SANE-P Reference List

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AFTER SUBMITTING YOUR APPLICATION…………………………………………………………………………………………..21 Audit Process Notification of Certification Renewal Status Use of the Credentials Nondiscrimination Policy Appeals Process Disciplinary and Complaints Policy

CONTACT INFORMATION………..…………………………..………………………………………………..…………………………23

SEXUAL ASSAULT NURSE EXAMINER CERTIFICATION RENEWAL APPLICATION………………………………….25

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INTERNATIONAL ASSOCIATION OF FORENSIC NURSES

©2014 International Association of Forensic Nurses

INTRODUCTION Congratulations on your decision to seek renewal of the credential of Sexual Assault Nurse Examiner – Adult/Adolescent (SANE-A®) and/or Sexual Assault Nurse Examiner – Pediatric (SANE-P®).1 A nurse who earns one or both of these credentials demonstrates the highest standards of forensic nursing for sexual assault nurse examiners. You are a member of a select group. By meeting the requirements to maintain the SANE-A and/or SANE-P credential, you exhibit an ongoing professional commitment to provide quality patient care through continuous SANErelated education and practice. The International Association of Forensic Nurses (Association), through the Commission for Forensic Nursing Certification (CFNC), is honored to help you maintain certification in this challenging and dynamic nursing specialty. The mission of the CFNC is to ensure that the Association’s certification program is psychometrically sound, technically accurate, and legally defensible. The Association established the CFNC to promote the highest standards of forensic nursing practice through the development, implementation, coordination, and evaluation of all aspects of the certification and certification renewal processes. As the independent and autonomous governing body for the SANE-A and SANE-P certification examination programs, the CFNC has the sole authority for establishing policies regarding certification eligibility, development and scoring of the examinations, administration of the examinations, certification renewal requirements, and operations of the certification programs. This handbook explains the process for renewing the SANE-A and/or SANE-P certification, including: •

Eligibility requirements for renewal;



Methods of renewal;



Guidelines for completing the application; and



What to expect after you submit your application.

Please review this handbook carefully before you submit your application. A complete application enables the Certification Renewal/Audit Committee to process your application in an expeditious manner. You are responsible for ensuring that you meet the eligibility requirements before you submit your application.

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The International Association of Forensic Nurses holds the registered trademarks for the SANE-A® and SANE-P® designations. For readability, the registration marks appear in the text of this document only upon initial mention.

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Should you have any questions, please contact:

CFNC c/o International Association of Forensic Nurses 6755 Business Parkway, Suite 303 Elkridge, MD 21075 p 410.626.7805 f 410.626.7804 email [email protected] website www.ForensicNurses.org

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©2014 International Association of Forensic Nurses

RENEWAL INFORMATION Purpose and Rationale The CFNC supports the ongoing professional development of its certificants. The purpose of a mandatory renewal process is to provide you with an opportunity to demonstrate, reinforce, and expand your knowledge and skills. Renewal also encourages, acknowledges, and ensures that certificants participate in ongoing professional development activities and continued learning that is specific to sexual assault forensic nursing. The CFNC certification renewal requirements mandate continuing education and professional activities that enhance ongoing professional development, recognize learning opportunities, and provide a process to attain and document professional development achievements. You may accomplish professional development either by obtaining the required number of continuing education contact hours or by achieving a passing score on the certification examination.

Duration of Certification Certification as a Sexual Assault Nurse Examiner – Adult/Adolescent (SANE-A) or Pediatric (SANE- P) is valid for a period of three (3) years. The scope of issues that face sexual assault nurse examiners has compelled the CFNC to conclude that new practices, research, and information are introduced in the field with frequency. Requiring that professional development activities be conducted at least every three (3) years ensures that you will remain up-to-date with both current best practices and emerging knowledge.

Expiration Date Regardless of the month in which you obtain your certification, your certification expires on December 31 of the third year of certification. For example, if you achieved certification in May of 2011, your certification expires on December 31, 2014. Similarly, if you achieved certification in October of 2011, your certification expires on December 31, 2014.

Responsibility for Renewal •

Each certificant is responsible for his or her certification renewal.



Each certificant is responsible for notifying the Association of any changes to his or her mailing and email addresses.



The Association is not responsible for notices that fail to reach a certificant.

As a courtesy, the Association sends renewal notices to each certificant’s last known email address approximately three (3) to six (6) months before the certification renewal application deadline. Following the initial renewal notice, the Association sends an email reminder.

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Eligibility Requirements To be eligible to renew the SANE-A and/or SANE-P certification, each certificant must: 1. Hold current certification in the renewing specialty (i.e., SANE-A or SANE-P); AND 2. Hold an active, unrestricted license as a registered nurse (RN) in the United States or a US territory OR Hold an active, unrestricted license as a first-level general nurse (or the equivalent) in the country/jurisdiction of practice;2 AND 3. Have practiced as a sexual assault nurse examiner and/or have provided clinical instruction for sexual assault nurse examiners for a minimum of 300 hours within the past three (3) years;3 AND 4. Obtain either the required continuing education contact hours OR Achieve a passing score on the certification examination.

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Applicants who do not have a US RN license must have completed a post-secondary nursing education program that includes classroom instruction and clinical practice in medical, surgical, obstetric, pediatric, and psychiatric nursing. To confirm eligibility, these applicants may be asked to provide a transcript from their nursing education program. 3

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“Practice” includes providing patient care, being on-call, teaching/precepting, consulting, and participating in peer review. INTERNATIONAL ASSOCIATION OF FORENSIC NURSES

©2014 International Association of Forensic Nurses

RENEWAL METHODS Renewal Options Each certificant has two (2) options for renewal: 1. Achieve a passing score on the certification examination prior to the certification expiration date of December 31; OR 2. Obtain the required amount of continuing education contact hours between the date of certification and the standard application deadline date of August 31 of the expiration year. By Exam Since the examination is updated periodically, renewal by examination ensures that you have continued to build your knowledge and skills since achieving initial certification. Should you choose to renew by examination, you must take and achieve a passing score on the examination before your certification expires on December 31. You may take the examination in either testing window (Spring or Fall) in the year in which your certification expires. To renew by taking the certification examination, the candidate must: •

Review the SANE Certification Examination Handbook available at www.ForensicNurses.org and complete the application following the instructions included for applying, remitting payment for, and scheduling the examination; and



Take the examination on the scheduled date and achieve a passing score.

By Continuing Education Contact Hours After obtaining initial certification, you may accrue and use continuing education contact hours for certification renewal. You must obtain the continuing education contact hours between the date of initial certification and the date that you submit your application. If choosing the continuing education option, the candidate must: •

Meet the Certification Renewal Requirements; and



Submit the Certification Renewal Application with the appropriate fee(s); and



Submit the completed Continuing Education Log(s). Supporting documentation of attendance at each activity is not required, unless the application is selected for audit.

All applications, associated forms, and fee(s) must be received by September 15 of the expiration year. If a candidate files an application after September 1, the application must be received by September 15, and a late fee must be included. No applications will be accepted after September 15. You are encouraged to retain a copy of the completed application and associated forms. ©2014 International Association of Forensic Nurses

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Application/Submission Options The applications for the examination or for renewal by continuing education are available online at www.ForensicNurses.org through the “Certification” tab and the “Examinations and Renewals” option on the left navigation menu. You may submit an application either: •

Electronically—processing is free Online—preferred, but available only if you pay by credit card Email—print the application, complete, scan, and email OR



Via Paper—processing fee is $20 Fax—print the application, complete, and fax Mail— print the application, complete, and mail

After submitting your application and fee, you will receive an email confirming payment. Application fees are nontransferable from one applicant to another.

HOW TO RENEW BY CONTINUING EDUCATION Renewal by meeting continuing education requirements ensures that you have participated in professional development activities that are directly related to the body of knowledge for sexual assault nurse examiners as defined by the respective examination content outlines. All continuing education events submitted must relate to the appropriate test content outline (e.g., SANE-A test content outline for SANE-A renewal and SANE-P test content outline for SANE-P renewal) (see pages 15-16 & 18-19). The CFNC is not able to provide approval of courses prior to attendance.

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©2014 International Association of Forensic Nurses

Deadlines and Fee Schedule IAFN Member Application Fee

Non-Member Application Fee

$200

$325

$225

$350

$300

$425

June 30, 2014: early filing discount ends

July 1 – August 31, 2014: standard filing fee applies

September 1 – 15, 2014: $75 late filing fee is included

Refund Policy All application fees are nonrefundable and nontransferable to another applicant. The application fee minus a processing fee of $100 will be refunded only if you fail to meet the eligibility requirements. If your personal check is returned for insufficient funds, you will be required to pay a $45 returned-check fee. Following a returned check, any fees must be remitted by money order, certified check, or credit card.

Continuing Education Requirements SANE-A® and/or SANE-P® certification renewal requires a total of 45 hours of continuing education activities. These hours may be completed in Category A, or a combination of Categories A and B. Should you choose to renew by obtaining continuing education, you must complete all educational activities before submitting the renewal application and must meet each of the following criteria: •

Complete a total of forty-five (45) hours of continuing education contact hours within the three (3) -year certification period; and



Ensure that at least thirty (30) of the forty-five (45) continuing education contact hours fall under Category A (see page 12 for definitions); and



Ensure that at least six (6) of the thirty (30) continuing education contact hours under Category A are from an accredited/approved nursing education provider, meaning that nursing continuing education credits have been awarded. Certificants outside the United States shall have the alternative requirement that at least six (6) of the thirty (30) Category A continuing education contact hours have been hosted/provided by a nursing organization or an employer of nurses.

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Category A A minimum of thirty (30) contact hours of continuing nursing education is required under Category A. Category A includes attendance at: •

Workshops



Conferences



Conventions



Seminars

All continuing education contact hours under Category A must meet the following criteria: •

Educational content is specific to the test content outline or educational guidelines (i.e., for SANE-A renewal—content must be specific to the SANE-A test content outline or educational guidelines; for SANE-P renewal—content must be specific to the SANE-P test content outline or educational guidelines);



Candidates may attend basic educational courses on topics such as general forensics if the content reflects the test content outline for which the candidate seeks renewal;



Candidates may attend initial SANE-A and/or SANE-P training courses. Because these courses are considered basic preparation, however, the candidate may use only 50% of the continuing education contact hours for certification renewal purposes;



At least six (6) of the thirty (30) Category A hours must be from an accredited/approved nursing continuing education provider. Certificants outside the United States shall have the alternative requirement that at least six (6) of the thirty (30) Category A continuing education contact hours have been hosted/provided by a nursing organization or an employer of nurses;

The following courses are examples and not an exhaustive list of what is NOT acceptable for SANE certification renewal purposes:

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o

Basic Cardiac Life Support (BCLS)

o

Advanced Cardiac Life Support (ACLS)

o

Pediatric Advanced Life Support (PALS)

o

Advanced Burn Life Support (ABLS)

o

Advanced Life Support in Obstetrics (ALSO)

o

Neonatal Resuscitation Program (NRP)

o

SANE-A and/or SANE-P certification preparation/review courses

o

Certification review or training courses, such as those for Certified Emergency Nursing (CEN) or Trauma Nurse Core Curriculum (TNCC)

INTERNATIONAL ASSOCIATION OF FORENSIC NURSES

©2014 International Association of Forensic Nurses

Category B No more than fifteen (15) hours of activities in Category B may be used for certification renewal. Category B includes: •

completion or instruction of academic courses



publication of an article or chapter in a book, journal, or newsletter



presentation of SANE nursing content to professional or community groups



precepting other SANE nurses

The following information describes how activities in Category B can be used for renewal: •







Academic Credit Courses: Courses that are offered by an accredited educational institution may be used if the content applies to the test content outline for the examination for which the candidate seeks renewal. To use the course for certification renewal, the candidate must obtain a grade of “C” or better. o

one academic semester hour = 15 hours toward renewal

o

one academic quarter hour = 12.5 hours toward renewal

Professional Publications: Publication of content reflecting a topic on the test content outline for which the candidate seeks renewal. The content must be published in a recognized professional journal or newsletter or by a recognized publishing company. The format may be an article, book, book chapter, or research paper. o

authorship or co-authorship of a book = 15 hours toward renewal

o

authorship or co-authorship of a book chapter, article or research paper = five (5) hours toward renewal

SANE Nursing Presentations: Presentation of a program reflecting a topic on the test content outline for which the candidate seeks renewal to professionals and/or the community. Each presentation may be used only once during a renewal period and must be a minimum of thirty (30) minutes in length. o

each 30 minutes of presentation time = 1.5 hours toward renewal

o

each 60 minutes of presentation time = three (3) hours toward renewal

SANE Poster Presentations: Each poster presentation reflecting a topic on the test content outline for which the candidate seeks renewal may be used only once during the renewal period. Poster presentations are given credit as follows: o



poster development/presentation = two (2) hours toward renewal

SANE Nursing Preceptorship: Participation as a preceptor for sexual assault nurse examiners. This is typically a one-on-one relationship with specific, mutually determined goals. The total hours can be accumulated through multiple ©2014 International Association of Forensic Nurses

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preceptorships. To use the precepting experience for renewal, a candidate must have precepted for at least forty-five (45) hours. Credit is given as follows: o

each 45 hours as a preceptor = five (5) hours toward renewal

Documentation of Continuing Education To document your continuing education hours, you must use the Continuing Education Verification Log(s). List continuing education activities in chronological order, starting with the date of your initial certification (or most recent renewal) to the present. Continuing education hours must be obtained within the three- (3-) year certification period. Continuing education hours that you received before your initial certification are not accepted. Continuing education hours obtained after August 31 will not be applied to the current renewal cycle. If renewing both the SANE-A and SANE-P certifications, you are required to submit a separate application and a Continuing Education Log for each certification.

Incomplete Renewal Applications Renewal applications must be complete before they are processed and approved. Renewal applications are considered incomplete if any of the required information is missing and/or illegible, or the appropriate fee is not included. The Association’s staff will notify candidates at least once via email and once via telephone if the renewal application is incomplete and will detail what must be done within a specified time frame to complete the application. The notices will include a deadline for response. If the certificant does not respond within fourteen (14) days, he or she will be notified that the renewal application will not be processed. Any resubmission of the application after the final notification is sent will be subject to an additional processing fee.

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©2014 International Association of Forensic Nurses

SANE-A® Test Content Outline

1. a. b. c.

p. q.

Assessment of the Sexual Assault Patient 40% Identify the patient’s immediate psychological response to sexual assault. Identify the risk factors and symptoms of peritraumatic and/or posttraumatic stress disorder. Identify urgent/emergent medical problems that require medical treatment prior to and/or during the SANE examination. Obtain and document a pertinent health history. Obtain and document the reported sexual assault/abuse history. Perform a head-to-toe physical assessment. Adapt examination techniques based on the patient’s specific need. Distinguish trauma from disease process and/or normal variations in anatomy. Assess orifices involved in the sexual assault for trauma. Assess the patient for indicators of drug-facilitated sexual assault. Identify, implement, and document deviations to usual examination procedures. Assess and promote safety of the patient during and after the SANE evaluation. Assess the patient’s level of physical, psychological ad cognitive development. Assess the patient for the risk of infection with the human immunodeficiency virus and provide information and/or treatment for prophylaxis. Assess the patient’s hepatitis B immunization status and provide information and/or treatment for prophylaxis. Assess the patient for pregnancy and counsel the patient about emergency contraception options. Assess the patient’s immunization status and offer or refer the patient the immunization if indicated.

2. a. b. c. d. e. f. g.

Evidence Collection and Documentation 16% Use a systematic method of forensic evidence collection that protects the integrity of the evidence. Take measures to maintain/protect the chain of custody of the evidence. Consider issues of timing in collection of forensic evidence and laboratory specimens. Collect and record biological and trace evidence from involved orifices and other body areas of contact. Collect standard samples (e.g., blood, hair, buccal cells) for DNA. Collect and document clothing and its present condition. Use written descriptions and body diagrams to document findings.

d. e. f. g. h. i. j. k. l. m. n. o.

3. Management of the Sexual Assault Patient 23% a. Throughout the examination, provide information, education and support while soliciting feedback from the patient. b. Provide the patient with the opportunity for developmentally appropriate control and consent. c. Provide crisis intervention and anticipatory guidance to the patient and family members/caregivers. d. Facilitate communication when there is a language or other communication barrier. e. Offer or provide for testing, prophylaxis and treatment of sexually transmitted infections. f. Counsel the patient regarding safe sex precautions to prevent sexually transmitted infection transmission. g. Educate the patient about actions and side effects of prophylactic medications. h. Consult with or refer to other healthcare providers regarding medical problems identified. i. Refer the patient for followup counseling, support and/or advocacy services. j. Provide followup for the patient regarding photodocumentation, wound care, laboratory results, etc.

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4. a. b. c. d. e.

Interact Throughout the Judicial Process 11% Testify as a fact witness for the prosecution or defense. Testify as an expert witness for the prosecution or defense. Testify regarding the integrity of the chain of custody of evidence. Respond to subpoenas and court orders. Respond effectively to aggressive/condescending questions when testifying.

5. a. b. c. d.

Professional Practice Issues 10% Ensure that systems are in place to provide for the safety of the SANE during and after the evaluation. Implement principles of confidentiality. Implement principles of informed consent and informed refusal. Evaluate and utilize current evidence-based practice (e.g., research, quality improvement).

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INTERNATIONAL ASSOCIATION OF FORENSIC NURSES

©2014 International Association of Forensic Nurses

SANE-A® Reference List This reference list contains recommended resources to assist you in preparing for the certification examination. This list is not all-inclusive; other references may help you study to meet the competencies, including the Journal of Forensic Nursing and other peer-reviewed journals. American Nurses Association & International Association of Forensic Nurses (2009). Forensic nursing: Scope and standards of practice. Silver Spring, MD: Nursebooks.org. Centers for Disease Control & Prevention. (2005). Antiretroviral postexposure prophylaxis after sexual, injectiondrug use, or other nonoccupational exposure to HIV in the United States. Morbidity & Mortality Weekly Report, 54(RR02), 1-20. (available online at www.cdc.gov). Centers for Disease Control & Prevention. (2010). Sexually transmitted diseases treatment guidelines, 2010. Morbidity & Mortality Weekly Report, 59(RR-12), 1-114. (available online at www.cdc.gov). Centers for Disease Control & Prevention. (2012). Interim guidance for clinicians considering the use of preexposure prophylaxis for the prevention of HIV infection in heterosexually active adults. Morbidity & Mortality Weekly Report, 61(31), 586-589. (available online at www.cdc.gov). Centers for Disease Control & Prevention. (2012). Update to CDC’s sexually transmitted diseases treatment guidelines, 2010: Oral cephalosporins no longer a recommended treatment for gonococcal infections. Morbidity & Mortality Weekly Report, 61(31), 590-594. (available online at www.cdc.gov). Hammer, R. M., Moynihan, B., & Pagliaro, E. M. (2012). Forensic nursing: A handbook for practice (2nd ed.). Sudbury, MA: Jones & Bartlett. International Association of Forensic Nurses. (2013). Sexual assault nurse examiner (SANE) education guidelines. Elkridge, MD: International Association of Forensic Nurses. International Association of Forensic Nurses. (2013). Atlas of sexual violence. T. Henry (Ed.). St. Louis, MO: Mosby. Kaplan, R., Adams, J. A., Starling, S. P., & Giardino, A. P. (2011). Medical response to child sexual abuse: A resource for professionals working with children and families. St. Louis, MO: STM Learning Inc. Ledray, L. E., Burgess, A. W., & Giardino, A. P. (2011). Medical response to adult sexual assault: A resource for clinicians and related professionals. St. Louis, MO: STM Learning Inc. Lynch, V. A., & Duval, J. B. (2011). Forensic nursing science. (2nd ed.). St. Louis, MO: Mosby. Mezey, G. C., & King, M. B., eds. (2000). Male victims of sexual assault. (2nd ed.). New York, NY: Oxford University Press. US Department of Justice, Office on Violence Against Women. (2013). A national protocol for sexual assault medical forensic examinations: Adults/adolescents (2nd ed.). Washington, DC: US Department of Justice, Office on Violence Against Women. (available online at https://www.ncjrs.gov/pdffiles1/ovw/241903.pdf). World Health Organization (WHO). (2003). Guidelines for the management of sexually transmitted infections. Geneva, Switzerland: WHO Press. (available online at http://apps.who.int/iris/bitstream/10665/42782/1/9241546263_eng.pdf). World Health Organization (WHO) & International Labour Organization. (2007). Post-exposure prophylaxis to prevent HIV infection. Geneva, Switzerland: WHO Press. (available online at http://www.who.int/hiv/pub/prophylaxis/guidelines/en/). ©2014 International Association of Forensic Nurses

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SANE-P® Test Content Outline

1. a. b. c.

Assessment of the Sexual Assault/Abuse Patient 46% Identify the patient’s immediate psychological response to child sexual abuse. Identify the risk factors and symptoms of peritraumatic and posttraumatic stress disorder. Identify urgent/emergent problems that require medical treatment prior to and/or during the SANE examination. d. Obtain and document a pertinent health history. e. Obtain and document the reported child sexual assault/abuse history. f. Perform a head-to-toe physical assessment. g. Distinguish trauma from disease processes and/or normal variations in physiology throughout childhood. h. Distinguish trauma from disease processes and/or normal variations in anatomy. i. Adapt examination techniques based on the patient’s specific need. j. Assess orifices involved in the sexual assault for trauma. k. Assess the patient for indicators of drug-facilitated child sexual assault. l. Provide the patient the opportunity for developmentally appropriate control and consent. m. Identify, implement and document deviations to the usually examination procedures. n. Formulate diagnoses based on history and physical assessment. o. Assess and promote the safety of the patient during and after the SANE evaluation. p. Assess the patient’s level of physical, psychological, and cognitive development. q. Assess the patient for the risk for infection with the human immunodeficiency virus and provide information and/or treatment for prophylaxis. r. Assess the patient’s hepatitis B immunization status and provide information regarding immunization if required. s. Assess the patient’s risk for pregnancy and counsel the patient about emergency contraception options. t. Assess the patient’s immunization status and offer or refer the patient for immunization if indicated. 2. a. b. c. d.

Evidence Collection and Documentation 16% Use a systematic method of forensic evidence collection that protects the integrity of the evidence. Take measures to maintain/protect the chain of custody of the evidence. Consider issues of timing in collection of forensic evidence and laboratory specimens. Collect and record biological and trace evidence from involved orifices and other body areas of contact. e. Collect and document clothing and its present condition. f. Document the patient’s genital findings with photography. g. Use written description and body diagrams to document findings.

3. Management of the Sexual Assault Patient 21% a. Throughout the examination, provide information, education and support while soliciting feedback from the patient and family/caregiver. b. Provide crisis intervention and anticipatory guidance to the patient and family/caregiver. c. Facilitate communication when there is a language or other communication barrier. d. Offer or provide for testing, prophylaxis, and treatment of sexually transmitted infections. e. Counsel the patient regarding safe sex precautions to prevent sexually transmitted infection transmission. f. Educate the patient and family/caregiver about actions and side effects of prophylactic medications. g. Consult with or refer to other healthcare providers regarding medical problems identified. h. Refer the patient for followup counseling, support and/or advocacy services. i. Provide followup for the patient regarding photodocumentation, wound care, laboratory results, etc. 18

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4. a. b. c.

Interact Throughout the Judicial Process Testify regarding the integrity of the chain of custody of evidence. Respond appropriately to subpoenas and court orders. Respond effectively to aggressive/condescending questions when testifying.

5. a. b. c. d. e.

Professional Practice Issues 11% Provide for and participate in peer and case review. Ensure that systems are in place to provide for safety of the SANE during and after the evaluation. Implement principles of confidentiality. Implement principled of informed consent and informed refusal. Evaluate and utilize current evidence-based practice (e.g. research, quality improvement data).

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SANE-P® Reference List This reference list contains recommended resources to assist you in preparing for the certification examination. This list is not all-inclusive; other references may help you study to meet the competencies, including the Journal of Forensic Nursing and other peer-reviewed journals. American Nurses Association & International Association of Forensic Nurses. (2009). Forensic nursing: Scope and standards of practice. Silver Spring, MD: Nursebooks.org. American Professional Society on the Abuse of Children. (2011). The APSAC handbook on child maltreatment (3rd ed.). J. E. B. Myers (Ed.). Thousand Oaks, CA: Sage Publications. Centers for Disease Control & Prevention. (2010). Sexually transmitted diseases treatment guidelines, 2010. Morbidity & Mortality Weekly Report, 59(RR-12), 1-114. (available online at www.cdc.gov). Centers for Disease Control & Prevention. (2012). Update to CDC’s sexually transmitted diseases treatment guidelines, 2010: Oral cephalosporins no longer a recommended treatment for gonococcal infections. Morbidity & Mortality Weekly Report, 61(31), 590-594. (available online at www.cdc.gov). Giardino, A. P., & Alexander, R. (2005). Child maltreatment: A clinical guide and photographic reference (3rd ed.). St. Louis, MO: GW Medical Publishing. Giardino, E. R., & Giardino, A. P. (2003). Nursing approach to the evaluation of child maltreatment. St. Louis, MO: GW Medical Publishing. Jenny, C. (2011). Child abuse and neglect: Diagnosis, treatment and evidence. Philadelphia, PA: Saunders. Kaplan, R., Adams, J. A., Starling, S. P., & Giardino, A. P. (2011). Medical response to child sexual abuse: A resource for professionals working with children and families. St. Louis, MO: STM Learning Inc. Lynch, V. A., & Duval, J. B. (2011). Forensic nursing science (2nd ed.). St. Louis, MO: Mosby. US Department of Justice, Office on Violence Against Women. (2013, April). A national protocol for sexual assault medical forensic examinations: Adults/adolescents (2nd ed.). Washington, DC: US Department of Justice, Office on Violence Against Women. (available online at https://www.ncjrs.gov/pdffiles1/ovw/241903.pdf).

9/10/12 Revised—TH 6/19/13 Updated—KM 10/24/13 Updated—KM

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©2014 International Association of Forensic Nurses

AFTER SUBMITTING YOUR APPLICATION Audit Process To maintain the credibility and integrity of the certification process, the CFNC reserves the right to verify any information provided on the renewal application. Requests for verification may be made prior to determination of certification renewal. Certificants are advised to retain all renewal documentation for at least six (6) months after their renewal deadline. To ensure that all renewal requirements are met, the CFNC will audit 10% of the certification renewal applications. Generally, renewal applications will be selected randomly for audit; however, late applications and applications that were initially submitted with missing/incomplete information may trigger an audit. When applications are selected for audit, the Association’s staff will notify the certificants and ask that they submit documentation supporting all activities listed on the Continuing Education Log in both Category A and Category B, as well as verification of their clinical competency, including: •



For listed Category A activities: Documentation of attendance at each activity listed. The documentation must contain the program agenda, identifying the sessions attended, and a certificate of completion or attendance, which states: o

the participant’s name; and

o

date of attendance; and

o

program title; and

o

course location; and

o

program sponsor; and

o

number of continuing education/contact hours received; and

o

the accredited provider name or provider number, if applicable.

For listed Category B activities, copies of the following for each activity are required: o

Academic course – the transcript/grade report (if the candidate is a student) or the syllabus (if the candidate is an instructor).

o

Authorship or co-authorship of a book – the book’s Title Page and the Table of Contents.

o

Authorship of a book chapter – a copy of the book’s Title Page and Table of Contents listing the author’s name.

o

Published journal article – the Table of Contents containing the title of the article and the author’s name.

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o

Presentation – a copy of the course brochure or advertisement showing the candidate’s name as a presenter.

o

Poster presentation – the meeting brochure/syllabus, photograph of the poster, title page of the PowerPoint, or copy of the abstract acceptance letter, each containing the title of the poster presentation and the author’s name.

o

Preceptorship hours – a log with the date, time, and name of the person supervised and a brief description of each activity supervised or a letter from the candidate’s supervisor, verifying this activity.

If any areas of nonadherence are identified during the audit (or any review of an application for renewal), the candidate will be granted fourteen (14) days to submit any required information. If the required information is not provided, the candidate’s certification will expire at the end of the fourteen (14) days or on the normal expiration date (whichever comes last). Should the candidate seek to submit requested materials after the specified deadline, a reasonable processing fee may be imposed. If an application is selected for audit and the certificant does not respond or does not submit the requested documentation, certification will not be renewed.

Notification of Certification Renewal Status You will receive notification of your renewal status by mail directly from the Association. In the event that your application for renewal is at risk of being denied, you will be contacted by email or phone to discuss potential options.

Use of the Credentials After achieving certification renewal, you may use the credentials in all correspondence and professional relations. The credential is typically placed after your name, following any academic degrees and licensure (e.g., Mary Smith, RN, SANE-A). If you have earned both the SANE-A and the SANE-P credentials, list them separately (e.g., Mary Smith, RN, SANEA, SANE-P). You may use the credential as long as the certification remains valid.

Nondiscrimination Policy The Association and the CFNC do not discriminate against any applicant or candidate for certification on the basis of race, color, creed, age, gender, national origin, religion, disability, marital status, parental status, ancestry, sexual orientation, military discharge status, or source of income. Applicants/candidates for certification will be judged solely on the criteria determined by the CFNC.

Appeals Process If your application for certification renewal is denied and you believe that a violation of CFNC policy may have contributed, you have the right to appeal. You must submit your appeal in writing to the CFNC c/o the Director of Certification within thirty (30) days of 22

INTERNATIONAL ASSOCIATION OF FORENSIC NURSES

©2014 International Association of Forensic Nurses

your receipt of the determination. Your letter should outline the reason that you believe you are eligible for renewal and comply with the renewal requirements. A reasonable administrative fee may be assessed. If the issue cannot be resolved, the CFNC will review the appeal and render a decision. The applicant will be notified of the CFNC’s decision within two (2) months of the appeal submission. The decision of the CFNC is final.

Disciplinary and Complaints Policy If a certificant fails to meet the renewal criteria specified above, the certification will not be renewed and the candidate must meet the eligibility criteria for initial certification and take the certification examination. The CFNC will deny certification renewal or revoke certification if a certificant engages in any of the following activities: •

Fraud, falsification, or misrepresentation in an initial application or renewal application for certification;



Falsification of any material information requested by the Association/CFNC;



Failure to meet the general eligibility requirements;



Failure to meet established continuing education requirements, including failure to submit the appropriate number and type of continuing education credits (for those who renew by continuing education);



Failure to achieve a passing score on the certification examination (for those who renew by examination);



Any restrictions on the general or registered nursing license, such as revocation, suspension, probation, or other sanctions by a recognized nursing authority;



Misrepresentation of SANE-A and/or SANE-P certification status;



Cheating on any SANE-A and/or SANE-P certification examination;



Failure to provide the documentation requested for an audit; or



Failure to submit the renewal application by the stated deadline.

Actions taken under this policy do not constitute enforcement of the law, although referral to appropriate federal, state, or local government agencies may be made about the conduct of the certificant in appropriate situations.

CONTACT INFORMATION CFNCc/oInternationalAssociationofForensicNurses 6755BusinessParkway,Suite303 Elkridge, MD 21075 p 410.626.7805 f 410.626.7804 email [email protected] website www.ForensicNurses.org Revised 5/31/14—KM ©2014 International Association of Forensic Nurses

CERTIFICATION RENEWAL HANDBOOK 2014

23

NOTES

24

INTERNATIONAL ASSOCIATION OF FORENSIC NURSES

©2014 International Association of Forensic Nurses

SEXUAL ASSAULT NURSE EXAMINER CERTIFICATION RENEWAL APPLICATION Instructions: • Please read the Certification Renewal Handbook before completing this application. • If your application is selected for audit, you will be asked to submit documentation of all activities listed on your Continuing Education Log for Categories A & B and for further validation of your clinical practice hours. • Review the eligibility requirements below. If you meet all the requirements, complete the renewal application legibly and in its entirety, and submit to the Association with the appropriate fee. • If you do not meet all the eligibility requirements below, please consult the Certification Examination Handbook, available at www.ForensicNurses.org through the “Certification” tab.

Renewal by Continuing Education General Eligibility Requirements: A candidate for certification renewal must: •

Hold current certification in the renewing specialty (i.e., SANE-A ® and/or SANE-P ®);



Hold a full and unrestricted license as a registered nurse (RN) in the country/jurisdiction of practice;



Have practiced as a sexual assault nurse examiner (SANE) or provided clinical instruction for SANEs for a minimum of 300 hours in the past three (3) years;



Submit 45 hours of continuing education activity. A minimum of 30 hours of continuing education must be in Category A, six (6) hours of which must be provided by an accredited/approved continuing nursing education provider (except for certificants outside the United States) and be specific to the test content outline for which the candidate seeks renewal. A maximum of fifteen (15) hours is allowed from Category B.

Renewal:

 SANE-A

 SANE-P

Date: ____________________

Applicant Information: Last Name: _____________________________ First Name: _________________________ MI: ____ Address:_____________________________________________________________________________ City/State or Province/Zip or Postal Code: _________________________________________________ Phone Number: ___________________ Email Address: _____________________________________ Certification Information: Have you practiced 300 hrs as a SANE during the past 3 years?

Yes

No

Forensic Nursing Employment Information: (do not submit your résumé) From (month/year): ___________________

To (month/year): ______________________________

Employer Name: ___________________________________________________________________________________ Address: ___________________________________________________________________________ City/State or Province/Zip or Postal Code: _________________________________________________

SEXUAL ASSAULT NURSE EXAMINER CERTIFICATION RENEWAL APPLICATION

Forensic Nursing Employment Information Continued: Position Title: ____________________________________ Supervisor Name: ___________________ Supervisor Phone Number: ________________________ Hours Worked/Week: _________________ Active Nursing License Information: State or Province/Country: _____________________________________________________________ Number: _________________________________ Expiration Date: ___________________________ Validation of Completion of Education Program: Please list the name, address, phone number, and email address of a person who can verify that you completed an education program that is relevant to the certification for which you are applying (an adult/adolescent program if applying for the SANE-A or a pediatric program if applying for the SANEP). If your application is selected for audit, the Association will contact the person listed to verify your attendance. Name: ____________________________________________________________________________ Address: __________________________________________________________________________ City/State or Province/Zip or Postal Code: ________________________________________________ Phone Number: _____________________________________________________________________ Email Address: _____________________________________________________________________ Statement of Understanding: (signature below indicates agreement) I hereby apply for certification renewal offered by the Commission for Forensic Nursing Certification. I attest that I have read and understand the information contained in the Certification Renewal Handbook and the Commission for Forensic Nursing Certification (CFNC) disciplinary and complaints policy on denial, suspension, or revocation of certification, whose terms shall be binding on all applicants for certification renewal and on all nurses who are certified as SANE-A® and/or SANE-P®. I understand that certification renewal depends upon successful completion of specified requirements (including the 300-hour SANE practice requirement during the past three (3) years) and I authorize the Association to disclose, upon request from employers or other parties, my certification or application status. I further understand that the information gathered during the certification renewal process may be used for statistical purposes and for evaluation of the certification program and that information from my certification records shall be held in confidence and shall not be used for any other purpose without my written permission. I understand the CFNC reserves the right to verify any and all information contained in this application. To the best of my knowledge, all information contained herein is true, complete, accurate, and made in good faith.

Signature:

Date: _________________________

2

SEXUAL ASSAULT NURSE EXAMINER CERTIFICATION RENEWAL APPLICATION Category A Continuing Education Verification Log Complete all requested information. Consult the Category A continuing education section in the Certification Renewal Handbook at page 12, as some courses may only count 50 percent. Note: Do not send verification of attendance UNLESS your application has been selected for audit.

Please use the supplemental pages if you need additional Category A Continuing Education Verification Logs located at the end of this form. Education Activity 1: Conference/Course Title: ___________________________________ Date(s) of Course: __________ Location: ___________________________________ Program Sponsor: _______________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: ______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ 4. _________________________________________________________________________ Education Activity 2: Conference/Course Title: ___________________________________ Date(s) of Course: ___________ Location: ___________________________________ Program Sponsor: ________________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: _______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. ___________________________________________________________________________ 2. ___________________________________________________________________________ 3. ___________________________________________________________________________ 4. ___________________________________________________________________________

3

Please use the supplemental pages located at the end of this form if you need additional Category B Continuing Education Verification Logs. SEXUAL ASSAULT NURSE EXAMINER CERTIFICATION RENEWAL APPLICATION Category B Continuing Education Verification Log Complete all requested information. A maximum of 15 hours of continuing education activities in Category B may be used for certification renewal. To calculate your hours, please consult the Category B continuing education activities in the Certification Renewal Handbook at pages 13 & 14. Category B activities include: SANErelated academic credit courses, professional publications, nursing presentations, poster presentations, and preceptorships. Note: Do not send verification of attendance UNLESS your application has been selected for audit. Before submitting your application, carefully review all your information for accuracy and validity.

Education Activity 1: Activity Type:  Academic Credit Course – select one:  one semester hour  one quarter hour  Professional Publication – select one: authorship/co-authorship of a  book  book chapter,  article, or  research paper  SANE Nursing Presentation – indicate the total number of minutes of your presentation: __________  Poster Presentation – select one:  poster development  poster presentation  SANE Nursing Preceptorship – indicate the total number of hours you precepted other SANEs: ____ Activity Title: ____________________________ Date of Activity: ______________________________ Activity Sponsor: _________________________ Location: ___________________________________ Number of Allowable Continuing Education Hours: _________ (To calculate hours, see Certification Renewal Handbook, pages 13 & 14) Education Activity 2: Activity Type:  Academic Credit Course – select one:  one semester hour  one quarter hour  Professional Publication – select one: authorship/co-authorship of a  book  book chapter,  article, or  research paper  SANE Nursing Presentation – indicate the total number of minutes of your presentation: _________  Poster Presentation – select one:  poster development  poster presentation  SANE Nursing Preceptorship – indicate the total number of hours you precepted other SANEs: ____ Activity Title: ___________________________ Date of Activity: _______________________________ Activity Sponsor: ________________________ Location: ____________________________________ Number of Allowable Continuing Education Hours: _________ (To calculate hours, see Certification Renewal Handbook, pages 13 & 14) Education Activity 3: Activity Type:  Academic Credit Course – select one:  one semester hour  one quarter hour  Professional Publication – select one: authorship/co-authorship of a  book  book chapter,  article, or  research paper  SANE Nursing Presentation – indicate the total number of minutes of your presentation: _________  Poster Presentation – select one:  poster development  poster presentation  SANE Nursing Preceptorship – indicate the total number of hours you precepted other SANEs: ____ Activity Title: ___________________________ Date of Activity: _______________________________ Activity Sponsor: ________________________ Location: ____________________________________ Number of Allowable Continuing Education Hours: _________ (To calculate hours, see Certification Renewal Handbook, pages 13 & 14) 4

SEXUAL ASSAULT NURSE EXAMINER CERTIFICATION RENEWAL APPLICATION

Certification Renewal Fees: Early Filing Discount Fee: (Application received through June 30, 2014)  $200 IAFN Member  ■ $325 Non-Member Standard Filing Fee: (Application received July 1 through August 31, 2014)  $225 IAFN Member  $350 Non-Member Late Filing Fee: (Application received September 1 through September 15, 2013)  $300 IAFN Member  $425 Non-Member

Paper Filing Fee: $20 Not an IAFN member yet? Join TODAY to take advantage of ALL the benefits!  $129 Annual Membership Fee Amount Paid: ________________________ Payment Method (please make checks or money orders payable to “IAFN” in US funds):  Check  Money Order  MasterCard  Visa  American Express  Discover Credit Card Number: __________________________________________________________________ Expiration Date: _______________________ Credit Card Security Code (CVV): __________________ Name on Card: ______________________________________________________________________ Billing Address: ______________________________________________________________________ City/State or Province/Zip or Postal Code: _________________________________________________ Any applicant whose personal check is returned for insufficient funds is required to pay a $45 returned check fee. Remittance of fees thereafter must be by money order or certified check.

SEND APPLICATION WITH ALL REQUIRED FORMS AND PAYMENT TO: CFNC c/o IAFN 6755 Business Parkway, Suite 303 Elkridge, MD 21075 Phone: 410-626-7805 Fax: 410-626-7804 Email: [email protected]

5

Supplemental Category A Continuing Education Verification Logs

Additional Individual Sessions Attended Use this section if you attended more than 4 sessions at any Education Activity Education Activity # ___ Additional Sessions:

Education Activity # ___ Additional Sessions:

Education Activity # ___ Additional Sessions:

Education Activity # ___ Additional Sessions:

Education Activity # ___ Additional Sessions:

6

Supplemental Category A Continuing Education Verification Logs Education Activity 3: Conference/Course Title: ___________________________________ Date(s) of Course: __________ Location: ___________________________________ Program Sponsor: _______________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: ______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ 4. _________________________________________________________________________ Education Activity 4: Conference/Course Title: ___________________________________ Date(s) of Course: ___________ Location: ___________________________________ Program Sponsor: ________________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: _______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. ___________________________________________________________________________ 2. ___________________________________________________________________________ 3. ___________________________________________________________________________ 4. ___________________________________________________________________________

Education Activity 5: Conference/Course Title: ___________________________________ Date(s) of Course: __________ Location: ___________________________________ Program Sponsor: _______________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: ______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

7

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ 4. _________________________________________________________________________ Education Activity 6: Conference/Course Title: ___________________________________ Date(s) of Course: ___________ Location: ___________________________________ Program Sponsor: ________________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: _______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. ___________________________________________________________________________ 2. ___________________________________________________________________________ 3. ___________________________________________________________________________ 4. ___________________________________________________________________________

Education Activity 7: Conference/Course Title: ___________________________________ Date(s) of Course: __________ Location: ___________________________________ Program Sponsor: _______________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: ______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ 4. _________________________________________________________________________ Education Activity 8: Conference/Course Title: ___________________________________ Date(s) of Course: ___________ Location: ___________________________________ Program Sponsor: ________________________ Was this content provided by an accredited nursing education provider?  Yes

8

 No

Number of hours applicable to certification renewal: _______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. ___________________________________________________________________________ 2. ___________________________________________________________________________ 3. ___________________________________________________________________________ 4. ___________________________________________________________________________

Education Activity 9: Conference/Course Title: ___________________________________ Date(s) of Course: __________ Location: ___________________________________ Program Sponsor: _______________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: ______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ 4. _________________________________________________________________________ Education Activity 10: Conference/Course Title: ___________________________________ Date(s) of Course: ___________ Location: ___________________________________ Program Sponsor: ________________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: _______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. ___________________________________________________________________________ 2. ___________________________________________________________________________ 3. ___________________________________________________________________________ 4. ___________________________________________________________________________

9

Education Activity 11: Conference/Course Title: ___________________________________ Date(s) of Course: __________ Location: ___________________________________ Program Sponsor: _______________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: ______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ 4. _________________________________________________________________________ Education Activity 12: Conference/Course Title: ___________________________________ Date(s) of Course: ___________ Location: ___________________________________ Program Sponsor: ________________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: _______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. ___________________________________________________________________________ 2. ___________________________________________________________________________ 3. ___________________________________________________________________________ 4. ___________________________________________________________________________

Education Activity 13: Conference/Course Title: ___________________________________ Date(s) of Course: __________ Location: ___________________________________ Program Sponsor: _______________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: ______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages):

10

1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ 4. _________________________________________________________________________ Education Activity 14: Conference/Course Title: ___________________________________ Date(s) of Course: ___________ Location: ___________________________________ Program Sponsor: ________________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: _______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. ___________________________________________________________________________ 2. ___________________________________________________________________________ 3. ___________________________________________________________________________ 4. ___________________________________________________________________________

Education Activity 15: Conference/Course Title: ___________________________________ Date(s) of Course: __________ Location: ___________________________________ Program Sponsor: _______________________ Was this content provided by an accredited nursing education provider?  Yes

 No

Number of hours applicable to certification renewal: ______________________________________ Accredited Provider Name or Provider Number, if applicable: __________________________________ Did you attend multiple sessions at this conference/course?  Yes

 No

If yes, please list the titles AND a short description of the individual sessions attended (if more lines are needed, please use the supplemental pages): 1. _________________________________________________________________________ 2. _________________________________________________________________________ 3. _________________________________________________________________________ 4. _________________________________________________________________________

11

Supplemental Category A Continuing Education Verification Logs

Additional Category A Activities:

12

Supplemental Category B Continuing Education Verification Logs Education Activity 4: Activity Type:  Academic Credit Course – select one:  one semester hour  one quarter hour  Professional Publication – select one: authorship/co-authorship of a  book  book chapter,  article, or  research paper  SANE Nursing Presentation – indicate the total number of minutes of your presentation: __________  Poster Presentation – select one:  poster development  poster presentation  SANE Nursing Preceptorship – indicate the total number of hours you precepted other SANEs: ____ Activity Title: ____________________________ Date of Activity: ______________________________ Activity Sponsor: _________________________ Location: ___________________________________ Number of Allowable Continuing Education Hours: _________ (To calculate hours, see Certification Renewal Handbook, pages 13 & 14) Education Activity 5: Activity Type:  Academic Credit Course – select one:  one semester hour  one quarter hour  Professional Publication – select one: authorship/co-authorship of a  book  book chapter,  article, or  research paper  SANE Nursing Presentation – indicate the total number of minutes of your presentation: _________  Poster Presentation – select one:  poster development  poster presentation  SANE Nursing Preceptorship – indicate the total number of hours you precepted other SANEs: ____ Activity Title: ___________________________ Date of Activity: _______________________________ Activity Sponsor: ________________________ Location: ____________________________________ Number of Allowable Continuing Education Hours: _________ (To calculate hours, see Certification Renewal Handbook, pages 13 & 14) Education Activity 6: Activity Type:  Academic Credit Course – select one:  one semester hour  one quarter hour  Professional Publication – select one: authorship/co-authorship of a  book  book chapter,  article, or  research paper  SANE Nursing Presentation – indicate the total number of minutes of your presentation: _________  Poster Presentation – select one:  poster development  poster presentation  SANE Nursing Preceptorship – indicate the total number of hours you precepted other SANEs: ____ Activity Title: ___________________________ Date of Activity: _______________________________ Activity Sponsor: ________________________ Location: ____________________________________ Number of Allowable Continuing Education Hours: _________ (To calculate hours, see Certification Renewal Handbook, pages 13 & 14)

13

Supplemental Category B Continuing Education Verification Logs

Additional Category B Activities:

14

p 410 626 7805

e [email protected]

©2014 International Association of Forensic Nurses

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