Since no two victims of sexual assault react in exactly the same manner, the emotional support they require both during and after a forensic examination can vary greatly.
To treat patients with the best care possible in the emergency room, upon discharge and even weeks or months later, Bon Secours St. Mary's Hospital in Richmond, Va., has a volunteer advocacy program to assist individuals coping with the aftermath of trauma. In the months since it was founded in November 2009, the reach of the Regional Hospital Accompaniment Response Team has grown.
The 132 trained volunteers on the team serve in 26 adjacent communities.
Now, if a victim of sexual assault arrives at any of the four area Bon Secours Richmond Health System facilities — St. Mary's, St. Francis Medical Center, Memorial Regional Medical Center or Richmond Community Hospital — the forensic nurse on call can contact the volunteer hotline to dispatch a trained advocate. As of early April, the program had helped 443 assault victims find the resources necessary to resume their normal lives.
"Reactions to rape vary greatly, depending upon a victim's age, gender, life experiences, maturity and support systems," says Bonnie Price, director of Bon Secours St. Mary's forensic nurse program.
Most survivors of rape trauma syndrome go through foreseeable psychological healing stages — including an acute stage, a reorganization stage and finally a renormalization, or integration stage. But the manifestations of each phase are different for every person, she says.
"When victims arrive at the hospital, many are outwardly emotional — crying, screaming, trembling or nauseated. Some are in complete shock — withdrawn, disoriented, unable to concentrate or make a decision. Still others appear to be calm and in control, insisting that they are fine. And some are so relieved to have simply survived the attack that they appear ecstatic," she says.
Whatever the mental state of the patient, the forensic nursing team has to focus on the physical exam, collecting evidence and filling out necessary paperwork in detailed fashion. In addition, choices on medical treatments must be made in a timely manner. Nurses often have precious little time to spend on counseling or emotional support.
Recognizing this as a compassion gap, Bon Secours administrators held a meeting with three other agencies in the Richmond area — the YWCA Rape Crisis Center, Safe Harbor and Hanover Safe Place — to brainstorm ways to make the ER experience easier on sexual assault victims. Out of that came the suggestion of having patient advocates on call around-the-clock to respond to crises alongside the forensic nurses.
To join the response team, volunteers are assessed in interviews, pass background screenings and participate in more than 40 hours of training. Most, but not all, of the volunteers are women.
A sexual assault exam can last two to four hours at the hospital. The volunteer typically helps a patient understand the procedure and options for medical treatment. Just as important, though, is the role advocates play after patients are discharged.
"Our volunteers serve as a bridge between patients and community services," explains Price. "Through the Virginia (Sexual and Domestic Violence) Action Alliance, they can look up shelters, resources and counseling contacts throughout the state to help victims begin the healing process."
That, adds Price, makes the response team a priceless asset. As victims enter the reorganization stage of rape trauma syndrome, they can experience any number of symptoms, from flashbacks and recurring nightmares to feelings of shame, guilt and depression. These symptoms can manifest in sleep or eating disorders, detachment, difficulties with work or school activities, hypervigilance, loss of control or lack of interest in relationships.
"So often a patient will leave the hospital saying, 'I'm doing okay, I don't need any follow-up,' and a month or two later, she'll call back and admit she's having a tough time," says Price. "Our advocates are available to listen and make referrals for care for as long as it takes to get a person back on track."
"Back on track" usually means victims have entered the renormalization stage of the syndrome. At that point they can integrate the sexual assault so that it is no longer the central focus of their lives. Guilt and shame become resolved and survivors no longer blame themselves for the attack. It is, unfortunately, a phase that can take a long time to achieve.
"We serve such a large area that sometimes our patients come from communities located an hour or two away from the hospital," says Price. The response team "has proven invaluable in directing people to nearby programs that are available to help facilitate full recoveries."
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