Survivors of childhood sexual abuse (CSA) are at risk for a wide variety of sequelae including posttraumatic stress disorder, relationship disorders, pain disorders and self destructive behaviors. Studies report that between 7% and 34% of women in the general population have survived CSA. There is a large body of evidence to support interventions for these survivors during their birth experience. The purpose of this poster is to demonstrate that those interventions can be successfully extrapolated into the care of CSA survivors in other health settings.

Fournier’s gangrene, a polymicrobial necrotizing soft tissue infection involving the genitalia requires multiple surgeries, antibiotic therapy and painful wound care. This disorder challenges the patient with changes in body image as well as the stress associated with critical illness. When a CSA survivor must face the necessary treatment, there is an added layer of complexity; helping her to feel safe and cope with care that may trigger severe psychological stress.

Case:

This case involved a 60 year old female survivor with an established diagnosis of post traumatic stress disorder. It was medically necessary initially to provide wound care under general anesthesia. During the first dressing change outside of the operating room, it was apparent to all that the team, the woman faced many challenges during this healing process. Her initial response was to refuse further care. She asked to be discharged with hospice, rather than experience the trauma of further dressing changes. The wound care nurse was familiar with the new survivor program in the community and decided to offer this program to this patient in the hope of making care acceptable.

Conclusion:

The wound care nurse met with the patient, elicited feedback about the specific fears, triggers and symptoms experienced during the wound care procedure. They discussed potential coping strategies and the patient agreed to move forward with care if she could be helped to feel safe and in control of her body during treatment. The multidisciplinary team met with the patient and agreed upon a plan of care.

Longitudinal follow-up the woman reported that for the first time in 20 years, the she began to date and later married with reports of satisfactory sexual function.  The case study demonstrates that the nursing interventions used to help CSA survivors cope during the birth experience may be used in the setting of other illnesses.

Keywords:

Womens' Health  

Holistic Health

Wound Care

Sexual Abuse