Tanya Heyns, Isabel Coetzee Presentation at the #2012waic Conference - Ghent, Belgium

1. World Appreciative Inquiry Conference
April 2012
A journey towards practice
development for rape survivors
An
Apprecia*ve
Inquiry
approach
Tanya Heyns
Department of Nursing Science
Denkleiers Leading minds

2. Background
q 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 seconds
q 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
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3. Setting
q 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
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4. Reality
q 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…”
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5. Reality (cont.)
ABC’s
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4 5
3
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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
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7. Procedure-­‐centred
care
Follow-up
• 3 days
• 3 months
• 6 months Drugs
• One year
Laboratory
studies
Forensic
Examination
History taking
Examination
Room
Triage area
Incident

8. Reflection on practice
Practice 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 users
q Affirmative topic
Towards
Patient–centred care
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9. Research methodology
q Inductive
[ Female rape survivor’s voice
[ Stakeholders
• Nurse practitioners
• Medical doctors
• Police
• Ambulance personnel
• Counsellors
Towards
Patient–centred care
q Two phases
[ Phase 1: Voice of the female rape survivor
[ Phase 2: Interventions towards practice development
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10. Research methodology
q 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
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11. Research methodology
q Phase 1: Voice of the female rape survivor
[ Target population
[ Sampling
[ Sample size
[ Data collection
[ Data analysis
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12. Research methodology
q 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
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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
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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
Room
Triage 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
Examination
Discover Room
Costs
Triage area
• …I
thought
that
because
I
didn't
have
a
medical
fund,
that
they
(the
health
care
professionals)
would
not
help
me…
• …because
a
lot
of
people,
if
they
don't
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 taking
Discover Examination Police/EMS
Room
• …The sergeant [police officer] was there the whole time…he
Triage 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
Room
Discover 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
Laboratory
Discover
• 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 you
Triage 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 Laboratory
Discover
• 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 these
Triage 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
Laboratory
Discover
• 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 don't know…my husband didtaking
History everything...I don't 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 as
Triage 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
Laboratory
Discover
• 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 didn't 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…
Room
Triage 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 + shower
Triage 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
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