Learning what to say in horrible cases


I am working as an ER tech while I wait to start nursing school as a second bachelor's degree in the fall. I also volunteer for a rape crisis center, which sends me on a lot of ER calls.

I saw a victim of a particularly heinous sexual assault in the ER a few weeks ago. Keeping with my role as an advocate, I asked her how she was doing emotionally. She opened up to me and told me how she was feeling. She felt dirty. I really didn't know how to respond to that and just hugged her and let out a sympathetic "Oh, honey".

This did nothing for her and I got a sense that I lost the connection with her. So, I resorted to bringing her pillows and blankies and not talking much more.

In the ER, we see a lot of horrible things. How do you find the words to say in cases like these? Is this something that can even be learned?

JustBeachyNurse, LPN

1 Article; 13,952 Posts

Specializes in Complex pedi to LTC/SA & now a manager. Has 13 years experience.

Don't patronize even though you were trying to be sympathetic you likely minimized or infantilized her feelings. But you realize that by posting here.

Hugging may have made it worse as you invaded the personal space of someone in an crisis.

Think of terms of endearment (sweetie, honey, kiddo, sugar, dear, etc) and hugs for people that are dear to you. I learned that years ago working in the ED and it stuck with me

Look up therapeutic communication. Don't talk about your experiences. Don't empathize by saying "I know how you feel" or often even "I understand"

Instead of saying how are you doing when you can't be prepared for the response and aren't a crisis counselor isn't the best...

Ask questions that you can help with:

Can I get you anything? A drink? more blankets?

Is there anyone you want me to call for you?

Learn from and be better prepared moving forward


20 Posts

Thank you. I really appreciate your advice.


20 Posts

Does anyone else have anything to add? I would really like to improve any way that I can.

Specializes in Emergency/Trauma/Critical Care Nursing. Has 11 years experience.

I too, struggle with finding the right words in these situations. I tend to say things like "I can't begin to imagine the pain/sorrow/grief etc that you are feeling right now, but I am here to listen when you are ready to talk." In a rape/assault case, I'd also tell them that they are safe now and that I will do everything in my power to keep them safe.

Trauma Columnist

traumaRUs, MSN, APRN

153 Articles; 21,229 Posts

Specializes in Nephrology, Cardiology, ER, ICU. Has 31 years experience.

You will see awful things in the ER - and you will never get used to them. For sexual assaults especially because the victim herself/himself is the crime scene its best to let the SANE (sexual assault nurse examiner) be the only person to interact with the pt. This is for legal reasons.

As to providing comfort to people in distress, heres some of the things that have worked for me:

1. I worked level one trauma center ER for 10 years and those pts/visitors have no relationship with me so I kept my interactions to providing info as best as I could, provided kleenex, warm blankets and physical items. I never really had time to provide much emotional support.

2. Now, as an APN taking care of chronically ill pts and dealing often with end of life issues, I have much more time and a much deeper relationship with the pts/families. I start talking to them right from the beginning about symptom relief, death, etc., and provide more emotional support.

llg, PhD, RN

13,469 Posts

Specializes in Nursing Professional Development. Has 46 years experience.

What exactly is your role as a volunteer? What type of training/orientation did you have for that role? If it is not your role to be their counselor, it is probably best to NOT try to provide more than you have been trained to give.

I recommend that you have a talk with your supervisor and clarify what your role is expected to be with these patients -- and then make sure that you have gotten sufficient orientation/training to fulfill that role. Your agency should be able to provide you with those things -- role clarification and appropriate training.

Wanting to help more is admirable ... but overstepping your boundaries could cause more problems than it solves.

nurse2033, MSN, RN

3 Articles; 2,133 Posts

Specializes in ER, ICU.

"I'm sorry that happened to you".

"That sucks".

"I can't imagine how you must feel".

"That sounds awful".

"Is there anything I can do for you?"

If you feel they would be comfortable, you can put your hand on their arm or shoulder- but no hugs.

Do not press them, and let them talk if they want to. Make yourself available.

Julius Seizure

1 Article; 2,282 Posts

Specializes in Pediatric Critical Care.

If they had said "I feel dirty" to me, my response would likely be to tell them something along the lines of "You are not dirty/None of this is your fault/You did nothing wrong".

I would probably be fairly matter of fact about that statement, rather than emotional (this is their crisis, not mine). I'm not sure how to explain my viewpoint on this without seeming cold...but it isn't my job to cry with them, it is my job to be dependable and calm even when they feel weak and vulnerable. Similar to when someone is grieving the loss of a loved one...they should never feel like they have to be comforting those around them who were further removed from the death/crisis.

If they seemed like they wanted to talk more about feelings-stuff, I would ask them if they wanted me to contact anyone for them - family, social work, chaplain, etc. Because those people are better equipped for that than I am.


1,142 Posts

Specializes in ED, Cardiac-step down, tele, med surg.

"Active listening" is helpful I have found during my experience as a crisis counselor. Validating feelings and reflective communication is important. She said she felt "dirty" I'd say something like "it must be difficult for you right now, to have experienced such a trauma and then to have those feelings" "you did not deserve to have this happen to you" "I don't think you are dirty". But the first part "it must be hard for you to have those feelings" might get her to talk more about it, which is the therapeutic part for the person. I have noticed people tend to get relief from expressing their feelings and having a non-judgemental listener validate their experience.

I don't think you did anything wrong in your response and her reaction was probably not related to anything you did or didn't do. One downside to working in the ER is that there doesn't seem to be enough time to talk to patients.

Specializes in Psychiatry, Community, Nurse Manager, hospice. Has 7 years experience.

There isn't any reason to assume that you did nothing for her. What you said was likely fine. Therapeutic communication is not about making it better. It's more about being present with her, however she is at this moment. So if she feels dirty at this moment, that is how she feels until she is done feeling that. Your presence and acceptance supports her to move through the experience at her own pace. You don't alter or control her feelings, you empower her to be where she is right now.

"I feel dirty" is a tough one. I would probably respond with, "Many people who've been sexually assaulted feel this way after the assault.

Specializes in Flight Nursing, Emergency, Forensics, SANE, Trauma. Has 9 years experience.

Reinforce this wasn't her fault. That I think is the strongest message. I have had women tell me "I should have fought; I should have done something". I like to reinforce that they did what they had to to survive whether it's fight back, run, or let it happen if they fear for their lives. We never know HOW we're going to react until it happens (and hopefully it never does).

Careful using familiar terminology like honey, sweetie, etc. you don't want to sound patronizing.

I like to keep my questions open ended and never give my personal sight or pretend I understand. We cannot see inside this person's brain and soul so we don't know. And although some of us have been assaulted, this is not our moment and this isn't about us. Keep focus on her. No touching them unless they initiate it (like a hand hold or hug). You don't want to physical stimulate after an assault... They just had lost control of their bodies, we don't want to revictimize. I would not offer anything to eat or drink until after they've seen the SANE (because of evidence swabbing) and honestly, after a case I've read about collecting semen from sputum in the nose (the perpetrator ejaculated on her face *cringe*) I wouldn't dispose of any tissues of you offer them until the SANE evaluates.