Monday, January 11, 2010

Health, Healing and Caring Nurses: A Reflection of SANE

from Joanne Maclaren, BSN, RN

If you have a few minutes, I think the above piece by a SANE nurse is an insightful look into the job they do and the challenges they face doing it. The author makes several important points that are also applicable for F2F Advocates.

A few excerpts:

The medicalization of the body is one example of how power and control is exerted by the medical discourse (Van der Riet, 1997). Being aware of such power inequities, the forensic nurse must create a space for the patient to feel believed and understood, to feel safe, and to help to them bring some control back into their life (Braen, Martin, Warfield, & Engelberg, 1985; DiVasto, 1985; Hennebry, 1995). The SANE can achieve this through adopting a caring, patient-centered approach when providing care. Examples of this include offering possible options for care, addressing the immediate concerns patients have, and offering them choice continually throughout the physical examination and care process. This further reinforces and validates the person as a whole and strives to not objectify the person by focusing solely on the physical injuries and aspects of care.

I approach each individual knowing there may be similarities in the experience, yet contextually each case is very different and the individual nuances of each patient need to be valued. Approaching care in this manner helps to maintain the patient’s autonomy and helps them to re-claim their sense of control over their own body and serves to guide the direction of care. Care becomes participatory versus being directive which is vital to begin to help restore the woman’s sense of health and healing.

As forensic nurses, we must also strive to stay aware of incongruent societal expectations of how women should act or behave pre- and post-sexual assault and reinforce for our patients that there is no right or wrong way to be. Pre-assault, prevailing societal expectations may define what we believe to be appropriate or acceptable behavior. Women who are sexually assaulted internalize what is considered “acceptable” and look for where they fell short of this and “caused” their own victimization. Classically, women tell themselves “If only I hadn’t walked in the dark alone…or didn’t drink so much…or dressed more appropriately” and so on. They believe they were a target for such violence due to the fact that they did not conform to socially acceptable behavior or actions. The SANE must help women who have been sexually assaulted understand they are not to blame for the violence which occurred against them and must help to inform patients’ understanding of health, illness and well-being (Holmes & Gastaldo, 2002). Post-assault we must also be aware of the power of language and how language can further increase the vulnerability of our patients as a result of how we document the crimes against them and through the use of labels, such as ‘victim’ when describing them.

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