Debbie has been homeless for 5 years. One night she was assaulted, resulting in damage to her spine. She has some trunk and lower-extremity weakness, but the neurologist believes that the damage will not be permanent. She is to wear a thoracic-lumbar-sacral brace to protect the spine and limit spinal motion when she is upright. Your initial examination is 2 days after her admission to the rehabilitation unit. During your examination, you will need to inspect different areas of her body for additional integumentary damage and will need to assess her mobility out of bed.
How will you initially approach this patient? Are there any considerations during the examination of this patient that may be different from other patients?
As you inspect her for injuries, how will you position and cover her, and why?
Draping, or covering, a patient appropriately during a therapeutic intervention is a relatively uncomplicated process, but at the same time it is one of the most powerful opportunities to create an environment that communicates respect and professional rapport and to establish the patient’s therapeutic expectations.
For the clinician, draping provides necessary access to specific areas of the body for examination and intervention and allows sufficient movement for functional tasks. For the patient, appropriate draping provides:
Protection of the patient’s modesty and dignity.
Warmth and comfort: Patients sometimes have conditions that make regulating body temperature difficult. Patients are also often more inactive than usual. Both situations can create a need for additional covering in an environment that already feels warm to the therapist.
Protection of vulnerable skin, such as wounds, surgical sites, scars, and neurologically impaired areas.
Protection of patients’ clothing: Fabric near the treatment site tends to become soiled with perspiration, wound drainage, lubricants, and so on.
Gaining an understanding of the patient’s personal sense of modesty, dignity, and personal boundaries is essential to effective draping and professional interaction. The greater the amount of exposure necessary during the treatment process, the greater the importance of that understanding.
Awareness of Abuse: Empowerment, Trust, and Control
Abuse may be physical, sexual, or psychological, or any combination of these. Although clinicians may have assumptions about who may be a victim of abuse, abuse is not limited to any specific age, gender, or economic group; adult men may be abused by their partners,1 and parents are sometimes physically abused by their children.2,3
Loss of trust, violation of boundaries, and disempowerment are common consequences of abuse among children and adults.4–6 Consequently, bodily exposure, touch, positioning, and particular exercises may trigger intense emotional reactions at any time during patient interactions with healthcare providers.
Exposure to other types of trauma can elicit similar responses as well. People who have experienced active military duty, for example, may ...