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Tuesday, July 21, 2009

SANE cases

People. We deal with people everyday. But how often do we deal with the victim of sexual assault? When we do, do we allow our perception of the world to color our views of them? These patients are a breed all their own and require a certain amount of special handling. These assaults can occur on both sides of the gender fence, though they are more reported when the victim is a woman. They can happen to anyone; Black, white, rich, poor, drug addict, prostitute, lawyer, doctor, old or young it is a crime that crosses all social barriers. Rape is a crime of violence and usually less about the sex and more about domination. So how do we deal with these patients who are in a moment of crisis, knowing that how they are handled can effect them for a very long time? I have had no formal training on this but life and quite a few psych classes have taught me a few lessons. Hopefully this can help others to deal with these psychologically complicated patients. If any of you have any thing to add I would greatly welcome any suggestions.

First I always approach my patient slowly and maintain a "safe" personal space distance. I don't want to violate their space any more than they have already had it violated.

I speak with a low even tone. I maintain an open stance and squat to their level so they can see me. I try never to stand over them or to have what appears to be an aggressive posture.

Before I do anything with them, I ask permission. I tell them up front what I would like to do and explain what is going to happen while I am doing it. I will not cross that personal space barrier until they give me permission. This is an attempt to give them back some control over what is happening to them.

I ask minimal questions, just do the basic assesment, treat any obvious inuries and I don't ask specifics regarding the assault unless they relate to the injuries I treat. ie were you struck with a fist or an object? kicked ect. I stay away from rape specific questions. I think that is more the place of the detective and the SANE nurse.

I let them talk. If they choose to talk to me I just let them say whatever they need to say. I assure them that they are safe with me and will continue to be so when they arrive at the ER.

The last thing I do is explain some of the process they will go through in the ER. This gives them an idea of what is next and also people feel more in control if they are informed.

In our area we have what are called SANE nurses. They are forensic nurses, SANE stands for Sexual Assault Nurse Examiner. They examine and collect evidence and help point victims in the right direction for further care. They are invaluable in my mind and I think all ER's should have atleast one.

I hope some of the things I have learned will help you guys deal with your patients. I am hoping to get some training with our department and a local SANE nurse. If it happens I will pass the info we get on. Remember when we are dealing with these patients that no matter what their life circumstance no one deserves to abused this way and they deserve the utmost of care and gentle handling.

8 comments:

Walt Trachim said...

Amen to all of what you said.

SANEs are a wonderful resource - we have them in our hospitals also - but I still hate having to transport victims of sexual assault because the process that they are subjected to is incredibly hard on them.

Our Fire Department's monthly EMS traning session tonight happens to be on domestic violence and sexual assault, and we have a guest speaker from our area's crisis center. I know her - she's an RN who also happens to be a SANE. And I've been to her classes; she does a good job.

I don't expect tonight's class to be any different. I just hope enough people show up to make it worthwhile.

Raindog said...

Good advice on how to speak with anyone who has been a victim.

Liz said...

um has anyone told you lately that you are amazing?

Linda said...

Came over to your blog from "To Old To Work" What a great post, it is heartwarming to see the compassion you have for these victims when they need it the most.
Hope you don't mind my lurking around.

Gertrude said...

Hey Linda! Welcome to my little corner of the world. Lurk as much as you like. Thanks for the kind words.

JS said...

Great post! JS

TheNanny said...

Great post!

I was a victim of sexual assault (which led indirectly to my interest in the medical field which led to me trolling EMS blogs which led to me finding this entry) and I have to say, if people were to follow your advice - not only for SA cases but also some psych patients - it would help out a lot! When I was undergoing my examination at a SPECIALIZED sexual assault hospital, I remember my nurse saying, "Oh wow, there IS a lot of tearing!" into the microphone as she examined me, on a video feed, which I was clearly able to see from where I was lying. Not only did I have to deal with her surprise, I had to see what she was so surpised about in Hi-Def three feet from my face. I was less than thrilled.

Just simple common sense - keeping the patient informed, being sympathetic, and my favorite part of your post, LISTENING if they want to talk - can really help. When ten different people talk to you about your most private area in the span of two hours, you'd kind of like to know what they are planning on doing with this information. The worst is having people walk into your room, confer with other doctors or nurses, and then walk out without acknowledging you.

I wish more people in the medical field could act this way.

Gertrude said...

Nanny,
I am sorry you had to go through such an experience. I thank you for taking the time to comment and share your feelings. I appreciate the time and courage it took for you to leave what you did.