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A Hidden History of Sexual Violence Can Complicate the Clinical Encounter

Long-term physical and psychological health effects.

illustration by hana cisarova for AJN

According to the Centers for Disease Control and Prevention, in the U.S., “one in three women and one in six men have experienced sexual violence involving physical contact at some point in their lives.” The report notes the high correlation between sexual violence and a range of adverse health effects like respiratory and gastrointestinal disease, chronic pain, and insomnia.

Not surprisingly, the terror of sexual violence is also correlated with post-traumatic stress disorder (PTSD) and its symptoms. These symptoms fall into four broad categories:

  • reexperiencing
  • hyperreactivity
  • avoidance
  • and negative emotions and thoughts about self or the world

Medical environments as triggers.

For survivors of sexual violence, medical environments can feel dehumanizing and present trauma reminders that intensify underlying post-traumatic stress. In addition, such environments can undermine protective routines and carefully delineated personal boundaries. Physical examination, being undressed, or receiving personal care can trigger powerful automatic fight–flight–freeze responses.

These responses may appear as physiological changes such as alterations in breathing and pulse, involuntary movements, or as hypervigilance, fear, anger, dissociation, withdrawal, or anxiety. Interventions like the insertion of a catheter or medications that decrease alertness or require suppositories can register subconsciously as threatening for someone who has survived […]

2019-01-23T15:58:50-05:00January 23rd, 2019|Nursing, patient experience|1 Comment
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To Recruit More Men, Rebrand Nursing as ‘Masculine’? Or Just Stop Oversimplifying the Profession

As a registered nurse for more than 40 years—with experience in pediatrics, public health, and philanthropy—I read a recent article by NPR’s Shankar Vedantam (“Why More Men Don’t Get Into The Field Of Nursing”) with interest. Vedantam essentially argued that more men don’t enter nursing because it’s seen as a “feminine” profession and proposed that we start emphasizing the more “masculine” attributes of the profession.

From youthful contrarianism to a deeper vision of the profession.

When I became a nurse in 1975, my choice was shaped first by my youthful desire to be contrarian: to bend gender norms by being a man in a “woman’s” profession.

When I began practicing nursing, however, I grew in my understanding that a commitment to nursing, particularly in my specialty field of public health, provided me with the means to act every day in concrete ways to further healing and build community. And so I applaud calls like Vedantam’s drawing attention to the need for more men in nursing. The need for diversity (of all kinds) in nursing was highlighted in the 2010 Institute of Medicine’s Future of Nursing report.

The deep-rooted public view of nursing as ‘women’s work.’

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2018-11-14T10:57:09-05:00November 14th, 2018|men in nursing, Nursing|6 Comments
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What Can Nurses Do to Influence Health in Their Communities?

What can I do as just one nurse?

As a nurse, I have often heard my colleagues question their ability to influence health in their communities. At times I have felt this same sentiment. What can I do as just one nurse?

Nurses have a unique perspective of how a community’s physical, social, and economic environment can affect patients’ health. And as we expand our understanding of what creates health, nurses have the opportunity to be a powerful voice when it comes to influencing the health of their communities.

Nightingale as precedent.

Nightingale in Scutari ward during Crimean War/Library of Congress

Nurses working to improve health through environmental modification is not new. The story of Florence Nightingale is well-known. As a nurse, Nightingale recognized changes needed to improve the health of soldiers in a hospital during the Crimean War, when more of the hospitalized soldiers were dying from the spread of infectious disease than from war-related injuries. Through her work with a group of nurses, she was able […]

2018-11-09T08:50:06-05:00November 9th, 2018|Nursing, nursing roles, Public health|3 Comments
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Babies at the Border: Reflections on Nursing on Ellis Island

Immigrants at Ellis Island. Library of Congress.

For the past few years, the nation’s attention has been repeatedly drawn to “the immigration problem” on the southern borders of the United States. This past summer, images of babies screaming for their mothers as families were separated, and photos of teens and young children peering through chain-link fences—with foil blankets crumpled in the background—tugged at heartstrings. With recent fear-mongering about a caravan of refugees making their way through Mexico toward the United States, the issue is once again taking center stage.

A nation of immigrants.

With each image, my thoughts turn to our nation’s long history of regulating immigration. After all, we are a nation of immigrants. Many of our ancestors sought religious freedom, freedom from persecution, or economic opportunity in America. That history is replete with conflicting policies: from the exclusion of Chinese, prejudice against those of Irish and Italian descent, and the deportation of those who were seen as “unfit” physically or mentally to enter the country, to decrees from the president that all immigrants be treated with respect.

A history of working with immigrants ‘in a middle place.’

For over a century, nurses have worked with immigrants in “a middle place”—balancing the needs of newly arrived families with their […]

2018-11-02T10:17:29-04:00November 2nd, 2018|Nursing, nursing history, Public health|0 Comments
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Nurses Concerned About Removal of Key Children’s Health Advocate at EPA

At the end of September, the Environmental Protection Agency (EPA), with no explanation, placed the director of the Office of Children’s Health Protection (OCHP), Dr. Ruth Etzel, on administrative leave. This sidelining of a vocal children’s health advocate as the office was heading into October, Children’s Environmental Health Month, was concerning for all who work in children’s environmental health.

The OCHP’s essential role.

The OCHP was created under an executive order in 1997 as public consciousness was increasing about the special vulnerabilities of children to environmental hazards. It is housed in the Office of the Administrator so as to be able to provide guidance to EPA leadership and ensure that children’s health protection is prioritized throughout the agency’s activities. This is essential because, as many have observed, children are not simply miniature adults—what they eat, drink, and breathe can profoundly affect their physical and mental development, while their hand-to-mouth and on-the-floor activities put them at greater risk for exposures from environmental hazards.

The office provides essential resources for health professionals and the public on environmental health issues such as environmental triggers of asthma and how parents can reduce exposures, reducing exposures to lead, and air quality in schools. The OCHP-produced report, America’s Children […]

2018-10-31T11:54:23-04:00October 31st, 2018|environmental health, health care policy, nursing perspective, Public health|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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