Case 1: A Rape Victim
The most challenging patient encounter in my experience was a thirteen-year old rape victim. The resources I used for handling this case were Rape, Abuse & Incest National Network (RAINN), National Sexual Violence Resource Center (NSVRC), Sexual Assault Awareness (SAA) and SafeBAE (Before Anyone Else). The physical, emotional and psychological implications of rape on the victim cannot be overlooked. Gynecological complications related to rape include vaginal infection and bleeding, fibroids, genital irritation, diminished sexual desire, urinary tract infections and chronic pelvic pain (Bates, 2017). Moreover, victims of physical and sexual abuse suffer more adverse effects compared to victims of sexual violence alone.
Regarding evidence-based practice, I applied emerging approaches in trauma therapy. First, cognitive processing therapy is a principal component of the practice, owing to the mental and emotional trauma the victims experience. The skills am acquiring currently are establishing trust and rapport, providing strict patient confidentiality, approaching the client in non-judgmental perspectives, encouraging verbalization and explaining the signs or symptoms the victim may experience in the short-term and long-term (Strunk, 2017).
Several areas exist that I would do differently. In approaching the client from non-judgmental perspectives, I would avoid expression of emotions such as horror, disbelief or disgust that could create a mental-emotional barrier. Also, I would apply words such as reported instead of alleged, declined instead of refused and penetration instead of intercourse.
The management of patient flow and volume was possible via incorporation of a multidisciplinary team. On documentation, the nurse took the vital signs for each client, after which the client proceeded to the clinician’s office for consultation. During consultation, the clinician conducted a physical examination on the client and performed a high-vaginal swab that was sent to the laboratory for microscopic, biochemical and genetic analysis. While one client was being checked for vital signs, another was doing consultation at the clinician’s office while yet another was having her samples being analyzed at the laboratory.
The significance of communication and feedback cannot be overemphasized. During an encounter with the victim, I applied both verbal and non-verbal cues of communication, including maintenance of proper eye contact, observing the client’s postures, gestures and facial expressions, noting the intonation and using the therapeutic conversation (Vrees, 2017). Also, I ensured patient education took place effectively by asking a few questions after the talk to confirm comprehension.
Several options are available for improving on my skills and knowledge. First, attending seminars and workshops of sexual and domestic violence would boost my expertise in handling the victims. Also, practicing under supervision of sexual assault specialists would be resourceful. This information could be communicated to my Preceptor via an email detailing the requirements.
A relevant PowerPoint presentation could be attached to the email. The current feedback from my Preceptor is encouraging; that my progress is commendable. Nonetheless, I need improvement in communicating with rape victims, particularly how to get emotionally involved in the conversation and how to more effectively apply the cognitive processing therapy. I also need exposure to a client with rape trauma syndrome to be competent in managing the syndrome.
References
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