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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Self-Disclosure in the Nurse-Patient Relationship

“How much of ourselves should we share with our patients?”

Illustration by Jennifer Rodgers for AJN

The ‘therapeutic use of self.’

Early nursing theorists wrote about how the “therapeutic use of self” helps us to forge close working relationships with our patients. Today we talk about authenticity, and it’s been noted that “the essence of nursing care comes from bringing our authentic selves to the nurse-patient relationship.”

We each develop a nursing “style,” weaving our own identities into the way we relate to patients and families. But where do the parts of ourselves that are very much “us” but not immediately evident to others come into the picture?

“Would a single mother hesitate to share her story of adopting a child without
a male partner? Would a widower refrain from correcting the assumption that
his spouse is still alive?. . . . I am compelled by the belief that sharing truth in either
scenario would enhance the authenticity of the relationship. Nevertheless, I remain
reluctant to correct my patients’ misperceptions of my family life.”

To disclose or not to disclose?

In this month’s Reflections column, “A Lie by Omission?“, nurse practitioner Charles Yingling takes a thoughtful look at what we choose to share with our patients, and what […]

2019-01-18T09:31:02-05:00January 18th, 2019|Nursing, nursing stories, patient engagement|0 Comments
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True Grit: A Core Nursing Attribute?

‘Seeing things through.’

In the popular movie named after the attribute, a young girl searches for a man with “true grit”—someone with courage, fortitude, and determination to see things through. She needed someone to find her father’s murderer and believed only someone with true grit would be able to persevere against the odds.

The concept of grit is a good one to describe attributes that a good nurse should possess. How often do we get through challenging days—with short staff and patient crises, for example—just by sheer grit, by having the willpower to soldier on and do what needs to be done?

Helping nursing students develop grit.

In this month’s issue of AJN, Linda Koharchik reflects on the need for grit in nursing and believes nursing faculty can help students develop it. In her article “Helping Students to be Gritty,” she cites several sources that describe ways for clinical instructors to help students. One way is to assign challenging patients or situations, so students can benefit from the instructor’s guidance in handling particularly difficult circumstances.

I agree. As a nursing student, I gained most of my clinical experience in a large municipal hospital that was often underequipped, with basic supplies sometimes hard to come by. We learned to problem-solve and improvise […]

2019-01-16T15:57:20-05:00January 16th, 2019|Nursing, nursing students, students|2 Comments
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Hidden in Plain Sight: What Nurses Need to Know About Food Insecurity

Are any of the people you see in your office or clinic “food insecure?” How about the college friends of your children? Or perhaps your own coworker?

Food insecurity is all around us.

The United States Department of Agriculture describes food insecurity as the lack of “consistent, dependable access to adequate food for active, healthy living.” Recent data indicate that food insecurity affects about 13% of U.S. households. In some states, the rate approaches 20%. Certain populations are particularly vulnerable: 27% of veterans who served in Iraq or Afghanistan and as many as 37% of college students are food insecure.

Twice monthly, the Muslim Food Pantry in Flint, MI, distributes free food to anyone who needs it. The pantry is run by volunteers and offers food, bottled water, and hygiene products to those with limited or no food or clean water—the latter a result of the Flint […]

2019-01-14T11:45:33-05:00January 14th, 2019|Nursing, Public health|0 Comments
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What’s a Preceptor’s Duty When a New Nurse Doesn’t Fit the Unit?

Challenges and joys.

square peg, round hole

Precepting new graduate nurses is challenging but also exhilarating. To guide a new nurse to a point of safe, confident, independent patient care requires a different level of critical thinking and relational skills. How do I delegate tasks and responsibility to my preceptee safely? How do I teach in a way that connects well with my preceptee’s learning style? How do I reassure the patient and family that they are safe in the care of these new hands under my watch?

Despite the challenges, it is inspiring to play an integral role in someone’s growth. I experience pride and joy watching my preceptees evolve from nervous trainees to skilled and compassionate novice nurses.

While I am always seeking to build up the new graduate nurse I’m precepting, the ultimate goal is always patient safety. There are rare times when new nurses have not not found the ‘right fit’ in our unit. We are a pediatric ICU unit in a level one trauma hospital. We care for very sick patients, are very fast-paced, and rarely have lulls in our census.

When a preceptee struggles.

I recently had a preceptee who struggled with the basics in caring for even our most stable patients. […]

2019-01-09T12:17:49-05:00January 9th, 2019|Nursing|4 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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