PATIENT-CENTERED CARE

It is important for healthcare practitioners to recognize that sexual assault is a traumatic event and, therefore, to provide patient-centered care. When conducting an exam, obtaining the history, and collecting evidence, a trauma-informed approach is essential because violence and abuse can cause psychological distress. Trauma-informed care restores safety, security, and control to patients.

  1. Begin the interview by offering the patient the services of an advocate. Texas law requires that the survivor be offered the support of a certified sexual assault advocate. This person has been trained to support the patient through the exam and future involvement with the criminal justice system. Advocates can also assist patients with access to counseling and reimbursement through the criminal justice system for out-of-pocket costs. A survivor also has the legal right to the presence of an additional support person of their choice (e.g., family member, friend) (Texas A&M, 2019).
  2. Obtain consent. Patients must consent to the evidence collection process. This consent should allow both the collection of evidence and the release of evidence to law enforcement. It is recommended that the consent form also include consent for photographs if they will be taken. Specific statutes address child or nonparental consent as well as for adults with cognitive disabilities (see also “Resources” at the end of this course).
  3. Offer the option of a nonreport exam. Offer adult patients ages 18–64 without a disability the choice to undergo a forensic exam with or without law enforcement involvement. A patient who reports a sexual assault within 120 hours has the right to a forensic examination without making a report to law enforcement. Evidence may be collected and stored, and the patient can decide later whether or not to engage with the criminal justice system.

Survivor Response to Trauma

Individuals respond to trauma in various ways based on their own background, developmental phase, and the type of trauma inflicted. Each survivor’s response to trauma is unique and self-defined. Approximately 30% of posttraumatic stress disorder (PTSD) cases in the United States are attributed to sexual violence. Typically, the physical injuries that survivors sustain during a sexual assault are minor and do not require treatment, but psychological injuries are common and may negatively impact the survivor’s life.

Common symptoms of survivors of sexual assault include:

  • Depression
  • Anxiety
  • Flashbacks or hypersensitivity to reminders of the traumatic event
  • Intrusive thoughts
  • Avoidance of thoughts, people, and places that may trigger memories of the trauma
  • Easily triggered emotions
  • Negative effect on daily life

It is important for persons who have experienced trauma to be made aware of resources to seek help because early intervention may result in less severe symptoms (Meyer, 2019).

Elements of a Trauma-Informed Interview

Trauma can impact a patient’s ability to think, remember, and relay the history of the event in chronological order. The following practices can improve the patient’s ability to recall information accurately. These methods are based on an understanding of the neurobiology of trauma.

  • Build rapport and establish trust with the patient.
  • Acknowledge the patient’s distress.
  • Provide an environment that encourages a feeling of safety both physically and emotionally.
  • Use nonleading, open-ended questions that allow for narrative responses.
  • Minimize interruptions.
  • Focus on what the patient can remember thinking and feeling during the event.
  • Emphasize the patient’s memory of the five senses and emotions during the event.
  • Maintain patience and express empathy and understanding.
  • Expect information to be out of chronological order.
  • Give the patient permission to say “I don’t know” rather than guess.
  • Do not ask the patient “why” questions, and maintain a nonjudgmental attitude.
  • Speak slowly and clearly and allow the patient breaks as needed.
  • Be mindful of the patient’s developmental stage.
    (Lonsway et al., 2019; Texas A&M, 2019)

Language and Cultural Sensitivity

If language interpreters are needed, in-person services through accredited agencies are preferred. Interpreters should utilize trauma-informed care practices. Patients should be given the option to request a different interpreter if they are uncomfortable. Some patients may prefer the anonymity of using a translator on the phone instead of in person (HEALTrafficking.org, 2017).

In addition to addressing the patient’s English-language proficiency, the nurse must respond sensitively to patients in matters of race, ethnicity, gender and gender identity, religion, disability, immigration status, socioeconomic status, sexual orientation, and developmental stage. Any of these factors may influence how a patient experiences the exam.

It is best practice to ask patients about how they identify rather than to make assumptions (IAFN, 2020). Patients should be asked their pronouns (e.g., he, her, they, etc.), and the nurse should replace heteronormative language with gender-neutral terms when caring for patients who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, or queer/questioning). As of 2017, 777,000 adults and 158,000 youth in Texas identified as LGBTQ+ (Mallory et al., 2017).