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.
16 hours ago