It is important for all RTs to recognize that assault, harassment and sexual abuse7 can be perpetrated against individuals from all cultures and economic backgrounds. The prevalence of abuse is such that a significant number of health care consumers are survivors of some form of interpersonal violence (abuse, sexual abuse/assault), and their past experiences may affect how they perceive the treatments provided to them.

Prevalence & Implications of Abuse

Accurate statistics on the prevalence of abuse, particularly sexual abuse, are difficult to obtain as only “about one in ten sexual assaults are reported to police”8 However, it is likely that health care practitioners will encounter survivors of sexual abuse/assault and other forms of abuse in their practice9. Research indicates (as of February, 2014) that:


Approximately 33% of women and 14% of men are survivors of childhood
sexual abuse10; and


Indigenous women were almost three times more likely than non-
Indigenous women to report having been a victim of a violent crime, such as sexual assault11.

The effects of assault are far reaching and can severely impact an individual’s emotional stability, physical health, and the ability to form and maintain adult relationships. A history of childhood sexual abuse or a range of childhood traumas is correlated with:

Greater use of medical services;


Substance abuse, self-mutilation, suicide; and


Ischemic heart disease, cancer, chronic lung disease12.

Principles of Sensitive Professional Practice

The primary goal of Sensitive Practice is to facilitate feelings of safety for the client.
Procedures that may appear routine to the RT may be very traumatizing for abuse survivors, as it can cause them to feel exposed, vulnerable and powerless. The Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse outlines nine principles of sensitive practice that include respect, taking time, sharing information and respecting boundaries 13. The primary goal of sensitive practice is to facilitate feelings of safety and control. The following should be taken into consideration during every patient/client interaction:

Obtain consent at every stage of the procedure;
Ensure the patient/client knows they can stop the procedure at any time;
Allow as much time as needed for the patient/client interaction; and

Be aware of potential triggers (e.g., exposing the chest, touching, inserting
objects into the mouth)

While providing care, RTs must respect their patient’s/client’s cultural diversity, sexual orientation and physical and intellectual differences.
In Western culture, eye contact is generally interpreted as attentiveness and honesty. However, other cultures may perceive direct eye contact as being disrespectful or rude.

Communication Principles

Communication occurs through words, body language and active listening. RTs can ensure that they practice in a sensitive manner by:

Being aware of the communication needs and styles of others;
Introducing themselves using their name and professional title (this also
includes introducing any students or other staff members who may be
Explaining the procedures carefully, choosing words that ensure the patients/clients understand what will be done and what is required of them;

Obtaining consent (whenever possible) prior to touching patients/clients and informing them that they may withdraw their consent at any time;

Speaking directly to patients/clients and maintaining culturally appropriate eye contact;
Allowing the patients/clients opportunities to ask questions;
Providing reassurance and explanations throughout the procedure;
Asking for the patient’s/client’s consent for student or staff observation, assistance or performance of a procedure; and
Refraining from making any sexually suggestive or other types of inappropriate comments (e.g., sarcasm, racial slurs, teasing,

What a health care professional might view as “terms of endearment” such as “honey”, “sweetie”, “dear” can be interpreted by others as “terms of diminishment”

(Ontario Human Rights Commission, 2013)

Speaking about a patient/client in their presence or carrying on a conversation near a patient/client in a language other than English or French (and that the patient/client likely does not understand) can be perceived as disrespectful and unprofessional.


A physician obtains consent from a female patient/client for a Pulmonary Function Test (PFT). However, she arrives for the test and the RT explains that the she must put a device in her mouth and a have a clip put on her nose. The patient/client becomes agitated and refuses to have the test done.

What do you do?

It should be remembered that consent is a process, not a single event. Despite the best attempts to obtain prior informed consent, the patient/client may not fully anticipate how they could react to a test or procedure until they are actually in the situation. If it is an RT performing the task, then it is the RT who is responsible for ensuring that the patient/client understands that consent is a process and that it can be withdrawn at any stage of the interaction.

Touching Principles

Appropriate words, behaviour and touching can reduce the embarrassment, distress, and fear that some patients/clients experience in the course of receiving care. Touching must be appropriate to the service the RT is providing. RTs can ensure that they practise in a sensitive manner by:

Obtaining consent, whenever possible, prior to touching the patient/client;
Allowing the patient/client to disrobe themselves and only touch body areas needed to facilitate removal of clothing when providing assistance to disrobe;
Respecting the client and their personal space;
Providing the patient/client with an opportunity to have another person
present during the interaction;
Respect cultural diversity;
Avoid placing instruments or other materials on a patient/client; and
Help maintain the patient’s/client’s dignity wherever possible (e.g., use appropriate draping to provide privacy)

Time and space constraints, especially in an acute care setting, sometimes mean that things are done to and around a patient/client that would not normally occur in other person-to-person interactions (e.g., intubation equipment placed on patient’s/client’s chest, oxygen tanks placed between a patient’s/client’s legs). RTs must always do what is necessary in a given situation to provide the best possible care to their patient/client, while also respecting the patient’s/client’s personal space and autonomy.


A male RT is required to set and perform a Cardiac Stress Test (CST) on a female patient/client.

What do you do?

In this situation, if at all possible it is advisable to give the patient/client the choice of having another person in the room during the preparation phase. Many organizations also have a policy that deals with this type of patient/client interaction.

  1. CRTO A Commitment to Ethical Practice
  2. CRTO Funding for Supportive Measures (Non-Patient/Client) Policy
  3. CRTO Funding for Supportive Measures (Patient/Client) Policy
  4. CRTO Mandatory Reporting by Member Fact Sheet
  5. Pause Before You Post: Social Media Awareness for Regulated Healthcare Professionals
    eLearning module
  6. CRTO Standards of Practice
  7. Zero Tolerance of Sexual Abuse and Other Forms of Abuse Position Statement
  1. Child and Family Services Act
  2. Criminal Code of Canada
  3. Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of
    Childhood Sexual Abuse. In Public Health Agency of Canada (Eds.),. Ottawa: Public Health Agency
    of Canada
  4. McPhedran, M., & Sutton, W. (2004). Preventing Sexual Abuse of Patients: A Legal Guide for Health
    Care Professionals. Toronto, ON, Canada: LexisNexis Butterworths.
  5. Ontario Human Rights Commission (2013). Policy on Preventing Sexual and Gender-Based
  6. Regulated Health Professions Act
  7. Statistics Canada. (2011). Violent victimization of Aboriginal women in the Canadian provinces,
  8. Statistics Canada. (2012). Family violence in Canada: A statistical profile, 2010
  9. Statistics Canada. (2013). Measuring violence against women: Statistical trends


8. Statistics Canada. (2008). Sexual assault in Canada 2004 and 2007. (Canadian Centre for Justice Statistics Profile Series). Retrieved from

9. Public Health Agency of Canada. (2009). Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse. Ottawa, ON: Public Health Agency of Canada.

10. Ibid.

11. Statistics Canada. (2011). Violent victimization of Aboriginal women in the Canadian provinces, 2009. Retrieved from Juristat (

12. Public Health Agency of Canada. (2009). Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse. Ottawa, ON: Public Health Agency of Canada.