Nurses: Do your part to heal victims of violence
How you treat victims of violence can have a long-term effect on their healing process, says Meg Kaufman, MD, executive director of Zero Tolerance for Violence in Dallas, TX. "Because ED nurses are taking people who have been traumatized into treatment immediately, that is a window of opportunity," she emphasizes.
Humane and compassionate conduct of medical duties may be a turning point in the patient's recovery, Kaufman explains. "This begins the task of restoring faith in humanity as a source of good, as well as the source of the evil he or she has experienced," she stresses. "Appropriate, humane, speedy treatment decreases the incidence of long-term disability."
The way patients are handled immediately after violence is key, Kaufman explains. "What you do makes a big difference at this point, and the literature supports that." Appropriate immediate intervention lessens the likelihood of long-term disorders such as post-traumatic stress disorder, depression, anxiety disorders, substance abuse, and counterphobic behavior.1,2
Here are some ways to meet the emotional needs of victims of violence:
Encourage sensitive treatment by staff. "Nursing staff should be leaders in encouraging staff to be humane and compassionate to victims of violence," says Kaufman.
Respect patient's personal space. Victims of violence may be retraumatized if their personal space is violated. "If somebody has just been attacked, they will be very sensitive to that. Touching a victim may elicit a grossly exaggerated startle response," says Kaufman. "Instead of walking up to the patient and putting in an IV, ask the patient's permission before handling them."
Be more verbal. Take care to explain details about procedures. "Careful explanation of the patient's physical condition and what to expect in the ensuing hours or days may help," says Kaufman. "Even physical pain is experienced as less intense and frightening if it is understood that it is a temporary state and may be expected to decrease within a reasonably predictable time."
Small interventions can have a major impact, stresses Kaufman. "Simple explanations about the time course of wound healing and post-trauma reactions show the patient there is hope for recovery from his or her current overwhelmed state," she says.
Suspend moral judgments. Even if you have opinions about a patient's actions, suspend judgment, urges Kaufman. "If a patient got shot by a drug dealer in the wrong part of town, you may wonder what he was doing there in the first place, but suspend your judgment for the moment," she says. "Keep in mind you don't have the whole story, and patients will sense it if you are judging them."
Be aware of your tone. Even if patients cannot absorb what you tell them, the tone of your voice may sink in. "Trauma patients may be using their imprinting memory, which is an early-childhood mental process which is not very verbal," Kaufman explains. "They may not be able to integrate at higher cognitive levels of functioning, but they can feel whether they are in good hands or not by listening to the way you speak to them."
Express concern for the victim. "Being kindly, comforting, straightforward, and clear instead of remote and silent or intimidating and overpowering, can help the victim along on the road to recovery," says Kaufman.
Ensure patient's safety. Know reporting requirements and community resources for victims of violence. "Legally protected groups with special reporting requirements in all states include the disabled, minors, and the elderly," says Kaufman. "The patient's safety needs should be anticipated even if the victim does not require assistance or does not seem to be in danger."
References
1. Yehuda R, McFarlane AC. Am J Psychiatry 1995; 152:1705-1713.
2. Rothbaum BO, Foa EB, Riggs DS, et al. J Traumatic Stress 1992;5:455-475.
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