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  • 1. World Appreciative Inquiry Conference April 2012 A journey towards practicedevelopment for rape survivors   An  Apprecia*ve  Inquiry  approach         Tanya Heyns Department of Nursing Science Denkleiers Leading minds
  • 2. Backgroundq  Rape a  Global concern a  Millions of people are affected annually a  Underreported by as much as 2/3 a  Greatly underestimated a  South Africa? •  More that 4 000 women are raped every day •  One every 26 secondsq  Management principles aSouth African government recognise challenge aDedicated centres •  Open: business hours aEmergency units •  Open: 24 hours •  Private versus public sector •  Focus on forensic evidence collection 1   2  
  • 3. Settingq  Emergency unit [  Private Level I hospital [  Deliver emergency care to patients of all ages: neonate to geriatric patients [  Emergencies versus trauma [  Critically ill/injured + [  560 rape survivors (25% children) [  Approximately 46 female rape survivors per month 1   3  
  • 4. Realityq  Reflecting on practice a  “…it’s going to take hours…where is Celia [nurse]…she likes doing it…” a  “…I am not going to sit in court for days…nobody is paying me…let somebody else do it…I will not...” a  “…I just don’t have the energy for this now…” a  “…we [health care professionals] can’t help you [female rape survivor]…our kits [forensic evidence collection kits] are out of stock…” a  “…we [health care professionals] cannot help you [female rape survivor]…nobody here has the necessary training to help you…” 1   4  
  • 5. Reality (cont.) ABC’s1 24 5 3 1   5  
  • 6. Reality (cont.)q  Focus of emergency care [  Collection of forensic evidence [  “Ignore” female rape survivor’s needs [  Diagnosis? Reflections on practice Procedure –centred care 1   6  
  • 7. Procedure-­‐centred  care   Follow-up •  3 days •  3 months •  6 months Drugs •  One year Laboratory studies Forensic Examination History taking Examination RoomTriage area Incident
  • 8. Reflection on practicePractice development [  continuous process of improvement [  moving towards increased effectiveness in patient centred care [  healthcare teams to develop their knowledge and skills [  to transform the culture and context of care [  that reflect the perspectives of services usersq  Affirmative topic Towards Patient–centred care 1   8  
  • 9. Research methodologyq  Inductive [  Female rape survivor’s voice [  Stakeholders •  Nurse practitioners •  Medical doctors •  Police •  Ambulance personnel •  Counsellors Towards Patient–centred careq  Two phases [  Phase 1: Voice of the female rape survivor [  Phase 2: Interventions towards practice development 1   9  
  • 10. Research methodologyq  Ethical clearance… Inclusion criteria    •  Female rape survivor Counsellor •  18 years or older    •  Understand and speak English First contact with participant    •  unit (October 2010 – May 2012) Admitted and managed in the emergency Step 1: Identify participants based on inclusion criteria    •  Three months after the rape incident Step 2: Discuss information leaflet and informed consent document with individual Step 3: Assess willingness of individual to participate in the study Step 4: Confirm the identity that the individual prefer to use during contact with researcher Step 5: Negotiate preferable date and time during which researcher can contact individual Step 6: Provide researcher with Interview necessary information to contact •  Brief participant on aim and value of the potential participant   study •  Negotiate suitable time and place for Nurse practitioners conducting the interview •  Ensure participant of confidentiality •  Obtain written consent •  Conduct interview 1   10  
  • 11. Research methodologyq  Phase 1: Voice of the female rape survivor [  Target population [  Sampling [  Sample size [  Data collection [  Data analysis 1   11  
  • 12. Research methodologyq Phase 2: Interventions towards practice development [  Target population •  Stakeholders [  Sampling [  Sample size: 36 •  Nurse practitioners (16) •  Medical doctors (5) •  Police officers (2) •  Ambulance personnel (7) •  Counsellors (4) •  Social workers (2) [  Data collection [  Data analysis 1   12  
  • 13. Summary Research Methodology PROCESS = Appreciative Inquiry Additional LO’s & ...DESTINY... Skills Development Interventions Patient needs Forensic evidence Patient Centred Procedure Centred Design Discover Dream 1   13  
  • 14. Procedure-­‐centred  care   Procedure-­‐centred  care   Dream Design Follow-up •  3 days •  3 months •  6 months Drugs •  One year Laboratory studies Forensic Examination History taking Examination RoomTriage area Discover Incident
  • 15. Phase 1: Data analysis Follow-up Drugs •  3 days •  3 months •  6 months •  One year Laboratory studies Forensic Examination History taking Examination Room Discover Available  services   Triage area•  …  I  was  taken  in  [emergency  unit]  immediately…  •  …I  did  not  know  where  to  go…we  drove  around  from  one   hospital  to  another…  •  …we  first  went  to  Delmas  [85  km]…we  were  not  helped…then   we  phoned  our  doctor  and  he  suggested  we  must  rather  go  to   Springs  [100  km],  since  it  is  the  nearest…it  was  hours  before  I   was  helped  [emergency  unit]…   Incident   Dream Design
  • 16. Phase 1: Data analysis Follow-up Drugs •  3 days •  3 months •  6 months •  One year Laboratory studies Forensic Examination History taking ExaminationDiscover Room Costs  Triage area•  …I  thought  that  because  I  didnt  have  a  medical  fund,  that   they  (the  health  care  professionals)  would  not  help  me…  •  …because  a  lot  of  people,  if  they  dont  have  a  medical   insurance,  immediately  think…  that  there  is  no  hope…I   think  everybody  must  know…there  is  hope…   Incident   Dream Design
  • 17. Phase 1: Data analysis Follow-up Drugs •  3 days •  3 months •  6 months •  One year Laboratory studies Forensic Examination History takingDiscover Examination Police/EMS   Room•  …The sergeant [police officer] was there the whole time…heTriage area everything….he was so kind…very nice… arranged•  …he gave me his jacket…I was cold…he was very helpful…•  …he [police officer]…he helped me…he was friendly…I think he felt bad…guilty…•  …he [police officer] put the man who raped me in the van [police van]…I sat next to him [rapist] when we drove to the hospital…it was a nightmare…this should not happen…it is so unfair… Dream Design Incident  
  • 18. Phase 1: Data analysis Follow-up Drugs •  3 days •  3 months •  6 months •  One year Laboratory studies Forensic Examination History taking Examination RoomDiscover Police/EMS  Triage area•  …the room is small…there is no bell…I was scared and wanted somebody close to me…•  …it is uncomfortable…the door must have a lock…anybody can just walk in…•  …it will be nice if the bathroom is next to the examination room…then you don’t have to walk through the passage...   Dream Design Incident  
  • 19. Phase 1: Data analysis Follow-up Drugs •  3 days •  3 months •  6 months •  One year Laboratory studies Forensic Examination History taking Discover Examination J88   Room•  …because  the  examinaMon  on  its  own  is  a  nightmare…but  it   is  good…it  is  important…for  jusMce…other  woman  should  Triage area not  go  through  this…  •  …[forensic  examinaMon]  is  what  needs  to  be  done,  and  it  is  a   part  of  their  [health  care  professionals]  work…it  is  serious…it   is  important  if  I  want  to  go  forward…if  I  want  to  get  over  it…   Dream Design Incident  
  • 20. Phase 1: Data analysis Follow-up Drugs •  3 days •  3 months •  6 months LaboratoryDiscover •  One year studies Information •  Family/Significant other Forensic •  Information pamphlet Examination•  …everything [drugs] is for free…I did not know…•  …the nursing sister explained taking History everything to me very nicely…but I told her that I was going to forget… Examination•  …the sister [nurse] gives you a paper [information pamphlet] which tells Room you the times when the tablets should be taken…but then they give youTriage area more tablets than those described on that pamphlet…•  …she [nurse] concentrates on the antiretroviral treatment…but I could not remember it all…when you should take the other tablets…•  …I could not remember anything…it was so difficult when I went home… Dream Design Incident  
  • 21. Phase 1: Data analysis Follow-up Drugs •  3 days •  3 months •  6 months LaboratoryDiscover •  One year studies Laboratory results Forensic•  …the nurse came to speak to me Examination the results [laboratory and tell me that studies]…it was all negative…this naturally made me feel very happy History taking because on that day you go to get a death sentence…•  …In my mindExamination I saw being listed as HIV-positive…you know that that is what Room you think about. ..now this is your life…are you going to test HIV-positive?•  …and all the time I was lying there alone [emergency unit] with theseTriage area thoughts…I am going to be HIV-positive…my life is over…I am going to die… Dream Design Incident  
  • 22. Phase 1: Data analysis Follow-up Drugs •  3 days •  3 months •  6 months LaboratoryDiscover •  One year studies Family/Significant other Forensic•  …They [health care professionals] explained everything, they spoke to my Examination friend…it helped…I could not remember anything that night…•  …I dont know…my husband didtaking History everything...I dont know…•  …It was important to me…to have my mother with me was important, and my Examination father… Room•  …and he [friend] was with me in the emergency unit…for follow ups asTriage area not have to go alone…I would not have made it alone…their well…I did support carried me through the whole process… Dream Design Incident  
  • 23. Phase 1: Data analysis Follow-up Drugs •  3 days •  3 months •  6 months LaboratoryDiscover •  One year studies Privacy Forensic•  …and then they [health care professionals] told me that whenever I came Examination back (follow-up in emergency unit], I could just walk through… I didnt need to ask anyone for anything…but then, on the third day, when I arrived again, I History taking was not allowed to walk through…the young lady at reception wanted to know Examination the reason why I was there…then I had to tell the whole story again… RoomTriage area Dream Design Incident  
  • 24. Procedure-­‐centred  care   Procedure-­‐centred  care   Destiny Follow-up •  3 days •  3 months Drugs Information pamphlet •  6 months •  Family/Significant other •  One year Laboratory studies Forensic Laboratory results Examination •  As soon as available History taking Examination Room Examination room •  Moved: bigger + showerTriage area •  Lock G-file •  Admission in the examination room by nurse versus admin clerk •  Follow-up Awareness •  Transporting female rape survivors Incident Awareness campaigns • Available services • ARV costs
  • 25. Conclusion 1   25