Responding to the September 9 article “The importance of forensic nursing”
Patient interviews can be healing in and of themselves as well as providing legal documentation for the client/victim. Based on the placebo effect, findings show that a warm respectful interview with health care personnel can begin the healing process, allowing the client to release stress and negative emotions. This is especially important for the client who has been subjected to violence. A healing therapeutic relationship triggers the body’s natural healing mechanisms for both emotional and physical healing. (For more on the placebo effect see http://www.fda.gov/fdac/features/2000/100_heal.html or http://www.bcx.net/hypnosis/placebo.htm)
The therapeutic approach to a patient that optimizes the confidence of the patient and reassures her that she will be helped and respected is paramount. As a hypnotherapist and red cross first responder I am trained to begin interaction with a patient (conscious or unconscious) by gently laying a hand on the patient’s (uninjured) hand or forearm and saying clearly and gently, “My name is ………., I’m trained in …… and I’m going to help you.” This simple statement can relieve the patient of fear and anxiety and begins the process of building trust and rapport. Patients who are recovering from surgery and still under the effects of anesthesia can benefit greatly from hearing, “ Every thing went just fine. You’ll recover very quickly and easily.” Since the power of suggestion is heightened both in a state of anxiety or semi-consciousness it is very important that the patient hear positive suggestions for health and recovery.
Respect and support can also be communicated through touch and eye contact. Throughout the interview gazing warmly at the patient, giving her proper attention adds the healing relationship. One should avoid glancing at clocks or allowing the eyes to dart away while the patient is talking. If the client becomes emotional gently squeezing her hand, patting a forearm or shoulder or even offering a box of tissue encourages release and not only fosters a trusting relationship but often reduces the patient’s need for extended catharsis.
While performing the physical exam one can avoid triggering the patient emotionally by preparing him for your touch. A simple phrase like, “This is my touch” or “I’m going to need to touch your face now.” is effective. Introducing the touch to injured or sensitive areas by first touching a non-sensitive area (i.e. touching the thigh, saying, “Here’s my touch” before contact with the perineum) is also important. Keeping touch firm, gentle, and brief helps communicate respect and confidence as well.
One should avoid correcting the patient even if the information she shares is known or suspected to be false. A patient in this vulnerable state may shut down or become defensive if she feels she is being contradicted. The same holds true for using statements intended to encourage when they contradict the patient’s present state or words. Such statements as, “You’re okay!’”, “Don’t cry.”, or “You’re just upset.” can feel like abandonment or even attack to a victim in the midst of catharsis. Allowing the patient to feel and express deep feelings, however briefly is part of the healing process. More effective and supportive statements are, “Are you okay?”, “Go ahead and let it out.”, or “I’m sure you’re upset.” as such statements do not imply judgment or contradiction.
The healing power of patient-healthcare professional interaction is often underestimated and frequently more harm than good is done by ignoring such simple attention to communication details. Even if you are the only professional the victim encounters who gives her confidence, respect and warmth those few moments of interaction can make the difference between quick recovery and a long painful ordeal. Regardless of the legal outcome the healing triggered by such a positive therapeutic relationship will make a great deal of difference in each life you touch.
Forensic Nursing Chronicles 