Suggestions for Sonographers

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Sonographers usually see a patient only once, and have little if any information about the patient. The interviews indicated that most sonographers regularly encountered patients with severe anxieties who were unable to proceed with certain tests, sometimes to the detriment of a needed diagnosis. Those interviewed also noted the difficulty of securing an accurate ultrasound without the patient being in a somewhat relaxed state.

Ultrasound testing is perceived by sonographers (and others) as inherently technical in nature, and not a setting in which to pay particular attention to psychosocial issues of the patient. Despite this perception, some of the tests done are highly personal and invasive. They may be fraught with meaning, related to pregnancy and loss, past traumas, and anxieties. Some background information about patients may be helpful to have before examinations and procedures. This would allow for specific provisions for people who need it (e.g., increased support and time, allowing the patient to insert the probe herself). The following are ways to help survivors of abuse.

  1. Practitioners in our study suggested an approach of "Universal precautions"
    • Routinely ask patients how you could help them feel more comfortable with the examination, procedure, or test, and if there is anything they think you should know before proceeding. Consider a possible abuse history if patients show signs of anxiety or tension. A "universal precautions" approach indicates an awareness of the prevalence of abuse, and sensitivity to any signals that may suggest an abuse history. It also demonstrates respect for the patient and offers them control and input into the test, examination, or procedure without necessarily needing to disclose their history.
  2. Become more informed about childhood abuse
  3. Make your clinical setting more client-friendly
    • Most medical environments are intimidating rather than accommodating to patients. Provide a comfortable office environment for patients, particularly if they choose to disclose an abuse history.
    • Making small changes to the physical environment (e.g., cartoons, artwork, adjustable lighting, music, and informational posters on walls) can ensure a safe and welcoming environment to anxious clients.
    • Pamphlets or articles in waiting areas should describe what patients can expect from medical examinations. Materials that mention abuse and that it can be a part of a patient's history may also help.
  4. Approaching patients
    • Use a gentle touch, it is less frightening.
    • Use relaxation techniques with women who have difficulty with certain examinations.
    • Be aware of cultural and/or other differences where women have disabilities, are immigrants or visible minorities from diverse cultural backgrounds, are aboriginal, have literacy challenges, or are lesbians.
  5. Respect boundaries
    • Use curtains, ample cloth gowns appropriate for all sized women, knock or gently announce before entering the examining room, and discuss sensitive information only when women are sitting and dressed.
    • Ask patients beforehand if they would mind somebody in training being involved in the examination or procedure. Include a description of the sex and status of the person, and ask this question ahead of time without the person standing there, so patients are given the option, without having to say in front of somebody, "No I don't want you there."
  6. Find ways to provide patients with a greater sense of control and comfort over procedures
    • Offer an initial appointment just to talk.
    • Involve the survivor in care and plan treatment together.
    • Provide a checklist that helps women identify which concerns they have about the health care encounter (e.g., discomfort with certain procedures, boundary issues and others).
    • Ask patients for ideas to make the examination or procedure more comfortable (e.g., specific signals to stop or have a time out)
    • Start with a straightforward procedure with patients who require a lot of time and are fearful. Also, suggest the patient come back another day.
  7. Use interdisciplinary team meetings, hold case conferences, debrief with others, and share ideas and strategies for different ways of improving care for women survivors of abuse.
  8. Help patients stay in the present and avoid dissociating
    • Use the patient's name.
    • Help them to stay connected by asking for example, "Are you able to hear me? Is this okay?"
    • Engage the patient in what is being done in each part of the examination, test or procedure (e.g., what you are doing and why), rather than in talk that distracts from what you are doing.
  9. Integrate survivors' suggestions into your work situation

    The women interviewed with histories of CSA made suggestions for providing care to make things easier for them.

    • Having a support person with them
    • Being asked before any examination what might make it easier
    • Having examinations or procedures fully explained
    • More privacy in terms of gowns/drapes
    • Dimmer lights or brighter rooms
    • Being able to see a practitioner of a specified gender to perform certain procedures
  10. Let the patient know that she can stop the procedure or exam at any time if she finds it too uncomfortable and that you will respect her wishes and limitations.

    For examinations requiring a vaginal probe, tell the patient how far it will be inserted and whether it will involve any pain.

    With endovaginal ultrasound, show the woman the probe, explain that it is sterilized and that a condom is placed over it. Inform her that she has choices of external scanning or an internal probe. Let her know how far it is inserted and what she will feel.

    If it would be helpful for the patient and the exam can be adequately carried out, consider having the patient insert the endovaginal probe herself.

    If the patient is interested, show on the screen how the ultrasound is able to picture the area being examined; this is informative and leads to a sense of being included in the procedure.

    Allow patients who may be uncomfortable with undressing, to keep as many of their clothes on as possible. This can mean for a breast ultrasound the patient keeps the side not being scanned covered. For an abdominal scan, pants can be lowered but not removed.

    Be sensitive and respond to reasons other than pain for which a woman might want a scan stopped.