“Universal Precautions”: Perinatal Touch and Examination after Childhood Sexual Abuse

Abstract

Childhood sexual abuse survivors experienced pain, dissociation, fear, blame, helplessness, and guilt in their encounters with health care practitioners. These experiences led to the development of a set of "Universal Precautions" for perinatal professionals responding to women and their children.

A Synthesis of the Literature on Trauma-Informed Care

“…The most common suggestions for mitigating distress given by survivors were assessing whether patients feel comfortable (Coles & Jones, 2009;Muzik et al, 2013) and allowing for breaks or stopping procedures when patients feel overwhelmed (Coles & Jones, 2009;Dunleavy & Kubo Slowik, 2012;Roberts et al, 1999;Seng & Hassinger, 1998). Similarly, Averbuch and Spatz (2009) recommend that postpartum nurses provide reassurance and support to female survivors of sexual abuse in stopping breastfeeding if they find the associated sensations distressing (Averbuch & Spatz, 2009).…”

“…Female survivors of child and adult sexual abuse in numerous settings and studies stated that being asked for their verbal consent by providers in health care settings before examinations or procedures made them feel more comfortable and in-control (Aaron et al, 2013;Coles & Jones, 2009;Muzik et al, 2013;Roberts et al, 1999). Female CSA survivors in Coles and Jones' study suggested that providers should ask for consent before beginning care and at points of transition between different steps and procedures.…”

“…These nurses indicated that intense response to touch, lack of eye contact, and restlessness indicated that a patient might have experienced sexual abuse (Ross et al, 2010). Coles and Jones (2009) suggest that providers should remain observant for such nonverbal cues in their interactions with all patients.…”

“…In one study (Coles & Jones, 2009), female survivors of CSA felt more comfortable if they were allowed to bring a support person to medical appointments. Two studies (Roberts et al, 1999;Robohm & Buttenheim, 1996) found that female CSA survivors felt more comfortable when they were allowed to wear more clothes during an examination.…”

Implicaciones de la seguridad del paciente en la práctica del cuidado de enfermería

“…Por tanto, la práctica de la enfermería debe estar centrada en el cuidado, con respaldo del conocimiento, en el diálogo y en el establecimiento de relaciones interpersonales satisfactorias, y basada en actitudes y habilidades en la promoción de un ambiente seguro, al poder promover cuidados sin que haya ocurrencia de daños y, por ello, una sensación de seguridad (7,(17)(18)(19) .…”