Enacting an “Empowerment Approach” After Sexual Assault

This month we talk with sexual assault nurse examiner Prudence Boylan. The paper discussed is:

Driver M. Enacting an “Empowerment Approach” After Sexual Assault: The Views and Beliefs of Forensic Nurse Examiners and Crisis Support Workers. Journal of Forensic Nursing. 9 February 2024

Host: Assoc Prof Kathy Kramer
Guest: Prudence Boylan

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info@famsacaustralia.org.au

Transcript

SPEAKER_00 0:02

Welcome to Medico-Legal Matters, a podcast where we explore the medico-legal aspects of clinical forensic practice, specifically criminal cases arising from violence, abuse, and neglect.

SPEAKER_01 0:16

That's episode three of the Fab Secker podcast, and today we've got Cru Boylan, who's one of the ordinary members on the committee, and she's a sexual assault nurse examiner by background. Crew, what paper are you going to talk about today?

SPEAKER_02 0:31

Enacting an empowerment approach after sexual assault. The views and beliefs of forensic nurse examiners and crisis support workers by Mary Driver and Arin.

SPEAKER_01 0:42

Lovely. I will put a link to the paper in the show notes so everyone can find it. So what piqued your interest about this paper?

SPEAKER_02 0:52

We're often asked at an executive level why we take so long to do what we're doing, and have to try to justify that. So I was looking for a paper that might validate what we're doing day to day. So this is why I picked this actual paper.

SPEAKER_01 1:10

How interesting. All right. So how did they go about looking at empowerment in this context?

SPEAKER_02 1:17

I think their methodology was pretty good. They used, and I may not say this word accurately, a phenomenological approach, which really is a qualitative study. And I think because they were interviewing people, it was the correct methodology to use for this particular paper.

SPEAKER_01 1:34

Yeah, because phenomenology, for people who aren't familiar with that term, it is the branch of philosophy that looks at the real world and how we understand the real world. It's all about your perceptual experiences rather than some kind of hypothetical understanding. Right. So they they were dealing obviously with real sexual assault nurse examiners. And then how did they, was it questionnaires, focus groups? How did they engage with the audience? Had a bit of both.

SPEAKER_02 2:00

They had singular interviews, they had two lots of focus groups. So they separated the counseling team from the sexual assault nurse examiners. But it was a very small study. That was the one thing that disappointed me. There was only seven people in this study. So it made it a very small study, really.

SPEAKER_01 2:19

Yeah, that's the challenge with that research because it's so labor intensive. You do these focus groups and then you've got all these transcripts to analyze, and that limits the size. And now you've got this risk that seven's not representative, and maybe you've got a couple of people with quite extreme views. But when you dump down into what they found, and did you get the you're a sexual sort of nurse examiner? Do you get the vibe that this was very much uh representative of what saints in the real world think? Did you think there was a bit of weirdness creeping it?

SPEAKER_02 2:50

No, I absolutely think that what they were saying and uh answers to the questions around empowerment and the empowerment approach, but also trauma-informed care was exactly what we tried to achieve through that holistic lens. And so I thought that really did resonate with our service. So I thought that came across quite well.

SPEAKER_01 3:12

Empowerment is such a tricky thing in our field, which is so protocolized. So, uh how did they go about defining empowerment and what do they mean by it in this context?

SPEAKER_02 3:24

I think the main thing that came out of it is choice. So giving people the independence to be able to choose the path they want to take. Because, as you say, it can often be a very clinical type approach to people. But in the paper, it does discuss giving them choice every step of the way and not trying to take or give our make our opinion more important than their opinion. So giving them the independence to feel that they could use their voice and make those choices around their care, where they wanted to be, how they wanted to move forward. So even giving them enough time to think through those different choices that you need to make. We have the counseling team and we have the medical team as well. There's different choices for each of those areas. So just giving people a lot of time and empowering them to make the decisions for themselves. Because sometimes I think as health professionals, we tend to, especially if you're working in the hospital, there's this implied consent. So people come and take blood, give you tablets, and no one asks any questions. Whereas when you're working in this area, I think it's very important, and I think that's what they discussed throughout this paper, was the importance of not doing that. To step back and let that person give them the knowledge that they need and the choices that they might have, and then giving them the time and the opportunity to make those choices as an individual every time. So I think that really did resonate throughout the paper.

SPEAKER_01 4:56

And I think that's one of those things that we think we are delivering, and maybe we aren't. If you haven't watched the episode from season two, where we interview two people who'd had a forensic examination about what the experience was like, again, I'll put the details for that episode in the show notes that we want to go back and listen to. Were there any could differences because you imagine there was a counselling focused group and a nurse focused group? Were they on the same page, or were they did they look at this in a subtly different way?

SPEAKER_02 5:27

I didn't notice very much of a difference between the nurses and the counseling answers, or how they they thought empowering approach actually looked in practice. I think they both pretty much were on the same page, it seemed, throughout the There was a couple of things I did notice that weren't discussed when talking about empowerment. And I know these women were all white people from and there wasn't any cultural backgrounds, but they didn't talk about the awareness of a person's culture, any type of culture and their cultural belief, or need to ensure that they had interpreters so they could make those choices in their own language or having that background. And they also didn't talk about the different sort of resources that you might use, especially if you had an intellectually disabled person, or they didn't discuss that either. They talked about verbally giving people choices, but not so much around what other ways would you be able to make that person feel more comfortable? Because to empower someone, you need to take, I think, all of those things into account.

SPEAKER_01 6:33

And it's a conversation for another day uh about when people are getting substitute consent and what does that look like for the person's actual experience and they're with us. Did they talk uh to anyone with lived experience or were they focused on the delivery side?

SPEAKER_02 6:48

They were actually focused on the delivery side. They did talk within the paper of how important it would get it would be to get lived experience, but I know from my own experience that it's been really hard to do that. Often trying to get people that have come through the lived experience area, it's they don't often want to talk about that publicly, or especially just after they've been through trauma. Usually they don't want to come back into our space, or we've put surveys out there and tried different ways of trying to get people to talk to us. But yeah, I think it's it is tricky to do. But I think it would be really important type of research to try to get that lived experience feedback.

SPEAKER_01 7:28

So, was there any practical take-homes, do you think, from this paper?

SPEAKER_02 7:34

I think, yeah, I know I think it actually validates the work that we are doing and how important it is to continue to try to empower our clients, but also we don't do very well at putting our service out into the public eye. There's that really fine line between you don't want to frighten people, you don't want to upset or trigger people, but also them not having any idea where we are. And I think that came out in the paper, which is great for me as well, because we are trying to even update our web page and make it more accessible and user-friendly. I think, yeah, that was something that really resonated out of this paper for me particularly. And I just think it's the education side of things as well, making sure that not just our counselling, it seems like a lot of the counseling staff get trauma-informed care, but the medical staff, it doesn't always seem as important. And I think that's a really important thing is to make sure that all the staff that are in the service, and sometimes we just have on-crawl staff who aren't in the building during the day, and remembering that they should be able to get that trauma-informed practice as well, because I think that really gives you that holistic approach to and that empowerment approach to looking after our blinds.

SPEAKER_01 8:49

And coming back to the original purpose of your delving into this article, do you think you are going to be able to use it politically in the workplace again to make that argument for that this is why it's such a labour-intensive and such an expensive process?

SPEAKER_02 9:04

Sadly, I don't think I will be able to, only because it's such a small study and it it could be seen to be a biased type of study as well, because you're talking to the people that are actually so it's like talking to me, and I'll I will brag about my service to the nth degree and will say all the right things. So I think, yeah, it could and also the person writing the research article was a saying at the time working in this area. Whilst I think it's a good article for me, I think that it's probably not strong enough to help us in the future, sadly.

SPEAKER_01 9:39

Hopefully, now that this sort of foundational paper's been written, somebody will go and do the next step and do a larger paper. Like this would make such a great PhD topic. Yes, I agree. It would. Well, thank you so much for your time today. I encourage you to read the paper.

SPEAKER_00 9:56

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