Minimizing/Preventing Secondary Wounding

Health care providers:

Doctors, nurses, physician’s assistants, sexual assault nurse examiners, dentists, technicians, medical/nursing students, and support staff – work to promote their patients’ health and well being.

When patients experience sexual violence, it affects them physically and emotionally. Some victims may experience physically injury during a sexual attack. Sexually assaulted women, men and children, as well as sexual offenders may be at risk for sexually transmitted infections and (for women) pregnancy. As a result of the sexual violence and/or the discrimination and oppression they may face after being sexually assaulted victims/survivors may experience drug/alcohol dependency, anxiety, and other health and wellness issues that would require the services of a health care provider.

Health care providers may be the first people victims/survivors of sexual violence talk to about their experiences. Health care providers are often the first people who may recognize signs that someone has been/is being sexually abused/assaulted. Health care providers can also help their patients prevent sexual violence and deal with its effect on their lives

Working with victims/survivors of sexual abuse as well as sexual offenders can have an emotional impact on medical professionals. This is referred to Vicarious Trauma. It is also important for health care providers to recognize how they can also cause further trauma to patients who have experienced sexual violence through their failure to address sexual violence or by responding in an insensitive or inappropriate manner. This is referred to secondary wounding. Health care providers may need to invest extra time, resources, training, and services into addressing the needs of patients who have experienced sexual assault/abuse.

Why you are important:

You can…

• Educate and inform: You can educate yourself, your patients, other medical professionals, and the general public about healthy sexuality, relationships and sexual violence. Put educational materials in your office and waiting areas
• Dispel myths: Address any myths or stereotypes you, your patients or coworkers may hold about sexual assault/abuse as well as about victims/survivors of sexual violence
• Watch for signs: You can identify signs and symptoms of sexual violence in your patients and make appropriate reports and referrals
• Identify risk factors: You can notice risk factors that indicate that your patients may be at risk to be sexually assaulted or to commit a sexual offence. Talk with your patients and their families about sexual assault, prevention, and not committing sexual crimes
• Assist with Healing: You can support your patients in dealing with sexual assault trauma and related issues. It is important that your patients feel believed, and not judged by you.
• Prevent Secondary Wounding in Your Medical Practice: Be sensitive to procedures and factors that may trigger victims/survivors and/or cause flashbacks. Explain procedures with patients. Be aware that fears or hesitancy they have may be a result of abuse/assault issues.

What you can do as a…

An individual and a health professional committed to addressing sexual violence:

• Learn about sexual violence, including its impact on health
• Educate yourself regarding doctor’s legal liability and professional responsibilities pertaining to reporting sexual abuse/assault and responding to victims/survivors.
• Participate in local efforts to prevent violence
• Educate your colleagues and patients that women, men, children, people with disabilities, lesbians and gay men, individuals who are mentally challenged, people from different racial and cultural backgrounds, and elderly people etc. can be victims and perpetrators of sexual violence.
• Teach parents, caregivers, students and staff members to recognize the signs and symptoms of sexual violence
• Be sensitive to the health and emotional issues victims/survivors may be facing
• Report all cases in which you suspect that a child or vulnerable adult has been abused. Be aware of your legal and professional responsibilities to report child and adult protection issues, as well has respecting patients’ rights. Familiarize yourself with the reporting/legal/medical process after sexual assault.
• Be aware of community programs and agencies that deal with sexual violence issues. Know how and when to refer clients
• Document a patient’s symptoms or injuries that may be important to a sexual assault/abuse investigation
• Lobby for and develop/support sexual assault services, a Sexual Assault Response Team (SART) as well as a Sexual Assault Nurse Examiner program in your community
• Discuss sexual violence issues at staff meetings and in-services about patient care.
• Lobby for medical/nursing schools to included sexual assault/abuse as part of the curriculum for medical and nursing students. If you work with students, include sexual assault issues in that work
• Attend and offer workshops on sexual violence, awareness and prevention, healthy sexuality, and other issues pertaining to sexual violence for colleagues, students, patients, and the general public
• Encourage your office/hospital/clinic, etc. to collect general statistics about patients who are sexually assaulted/abused
• Develop and follow policies on respectful and confidential practices in record documentation and storing as well as dealing with medical practices for sexual assault survivors

You will know you have made a difference when…

• More people are screened for a history of sexual violence
• Efforts are made to address the emotional and health related needs of patients who may be survivors of sexual violence
• All agencies that deal with sexual assault cases communicate with each other and respond effectively to victims/survivors’ needs
• More cases of children and adults in care are reported
• You see fewer clients with health problems related to sexual violence
• More survivors of sexual violence seek out the services of the medical community

This handout is adapted from tools from A Place to Start: A Resource Kit for Preventing Sexual Violence, Minnesota Department of Health Developed 2006