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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Considerations for clinicians interacting with survivors of trauma

Considerations for clinicians interacting with survivors of trauma
The health care provider controls The patient expresses The health care provider responds
Open and accepting body language
  • Keeps arms uncrossed
  • Keeps hands in view
  • Stays facing the patient
  • Makes eye contact
  • Does not block the door
  • Gives patient full attention (avoids typing or appearing distracted)
  • Asks for permission to make physical contact

Attitude shifts
  • Stigmatization → Normalization
  • Disempowerment → Empowerment
  • Victimization → Resilience
  • Questioning → Believing and validating the patient
  • Biases and assumptions* → Confront biases and empathize

Approach
  • Is nonjudgmental
    • "Risky sex" → "Sex without a condom"
  • Encourages patient agency
    • "I need to" → "Is it okay if I..."
  • "Victim" versus "survivor"
  • Is patient
  • Explains diagnosis, options for treatmentΔ
  • Explains concept of trauma
  • Normalizes the experience
    • "Many people have experienced trauma."
    • "It is normal to feel this way."

Fearful body language
  • Trembling
  • Refuses examination or touch
  • Limited or no eye contact
  • Self-protective posture (huddling, crossing arms, curling)

Negative self-talk
  • "I am ruined/broken/worthless."
  • "I am crazy."
  • "No one will ever love me."
  • "I feel so stupid for reacting this way."
  • "I was the one who had done something wrong."[1]
  • Feelings of powerlessness[1]

Signs of emotional distress[1,2]
  • Crying
  • Difficulty breathing
  • Dissociation
  • Flashbacks
  • Flat affect
  • Anger and/or aggression

Sensitive and attentive
  • Narrates, explains necessary touch: "Inform before you perform"[1]
  • Avoids unnecessary touch
  • Exposes one body part at a time
  • Is sensitive to modesty
  • Is not afraid of silence and hesitation
  • Does not appear shocked, afraid, or disgusted
  • Asks about patient's concerns: "How do you feel about..."

Empowerment language
  • "You are strong; you survived."
  • "It's okay, this can be hard."
  • "It is normal to feel stressed about this."
  • "I'm so glad you are sharing this with me."
  • "I believe you. It took a lot of courage to tell me about this."
  • "It's not your fault. You didn't do anything to deserve this."
  • "You survived something very difficult that was not your fault."
  • "This has had an impact on your life."
  • "I am so sorry that happened."
  • "You are not alone."

De-escalation
  • Gives space for the patients to tell their story; lets them take the lead◊
  • Summarizes periodically: "It sounds like you had very traumatic experiences in childhood..."
  • Uses grounding techniques
  • "I am amazed by your strength to survive and talk about the experience of sexual violence."
  • "Thank you for your courage in sharing this with me."
  • Responds to dissociation and flashbacks

Summary of considerations for physicians when interacting with survivors based on experiences with patients at the EMPOWER Clinic.
* The patient may have been treated badly in the past in health care settings and may be defensive for that reason.
¶ "Victim" can be used in the context of someone who has not yet escaped a traumatic situation and can also be valuable in emphasizing that a trauma was perpetrated by someone else and was not the fault of the person themselves; however, it can be disempowering, and "survivor" may be more appropriate.
Δ Explaining the diagnosis, options for treatment, and associated reasons help the patient feel in control.[3] The health care provider may need to explain these options and rationales repeatedly.
◊ Let the patient take the lead but avoid allowing the patient to tell a long narrative owing to the risk of retraumatizing.
From: Ades V, Wu SX, Rabinowitz E, et al. An Integrated, Trauma-Informed Care Model for Female Survivors of Sexual Violence: The Engage, Motivate, Protect, Organize, Self-Worth, Educate, Respect (EMPOWER) Clinic. Obstet Gynecol 2019; 133:803. DOI: 10.1097/AOG.0000000000003186. Copyright © 2019 the American College of Obstetricians and Gynecologists. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
References:
  1. McGregor K, Jülich S, Glove M Gautam J. Health professionals' responses to disclosure of child sexual abuse history: female child sexual abuse survivors' experiences. J Child Sex Abus 2010; 19:239.
  2. Robohm JS, Buttenheim M. The gynecological care experiences of adult survivors of childhood sexual abuse: a preliminary investigation. Women Health 1997; 24:59.
  3. Raja S, Hasnain M, Hoersch M, et al. Trauma informed care in medicine: current knowledge and future research directions. Fam Community Health 2015; 38:216.
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