Sexual Abuse
Scenario 9 - Professionalism and language
Heather, a registered nurse working in an emergency department, examines a male patient who presents with chest pain. Heather asks the patient about his sexual orientation and if he is sexually active. The patient appears to be uncomfortable and says that he has a boyfriend.
Now assume the patient presents in the ER with pain during urination. Heather asks the patient if he is sexually active and if so, the nature of his sexual behaviours. The patient appears to be uncomfortable and says that he has a boyfriend.
Questions for discussion
- Is it appropriate for Heather to ask these questions?
- Would you characterize Heather’s line of questioning as a boundary crossing, violation or sexual abuse? If so, which and why?
- Why might the patient feel uncomfortable with this line of questioning?
Key concepts this scenario illustrates:
- Professionalism and language use
- Harm to patients
It is unclear from the first part of this scenario whether Heather had a clinical need to ask about the patient’s sexual activity. If it is clinically necessary to ask these questions, Heather should put the patient at ease by explaining the need for taking this type of history, and questions like this should be asked in a way that minimize the risk that the patient may interpret these questions as anything other than clinically necessary.
By asking about sexual orientation, the nurse is missing key information about that patient’s sexual behaviour. To avoid making assumptions about a patient’s sexual activity based on their sexual orientation, a better approach would be to ask about specific sexual behaviours.
Heather should only be asking these questions if they are clinically necessary. Remarks about sexual activity that are not clinically appropriate to the service provided is sexual abuse. Heather doesn’t need to open herself up to such risks in her professional role. It is advised that Heather focuses on her professional role with her patients, ensuring she asks only questions that provide needed information for clinical assessment.
In the second part of this scenario, the patient’s health concerns and the symptoms presented warrant taking a full history, including sexual activity. The patient presented with pain during urination, a possible indication of a sexually transmitted infection. Therefore, Heather has a clear clinical basis to ask these questions.
The patient appears uncomfortable with the questions Heather is asking, even though these questions are clinically appropriate. It is recommended that Heather explain why she’s asking these questions so the patient understands they are clinically relevant.
