Sexual Assault Chapter 19

Concept of Sexual Assault Sexual assault is act of violence, not sex – Results in devastating, severe, and long-term trauma – Encompasses crimes of rape, date rape, acquaintance rape, marital rape, intimate partner violence, molestation or incest, and sexual assault of older adults Legal definitions of rape vary among states – In general, sexual assault includes use of force or any nonconsensual contact involving breasts, genitals, or anus with or without penetration

Cultural Considerations Cultural attitudes play part in forming attitudes – Some groups maintain women as inferior and support male superiority and sexual entitlement – Some college fraternities reflect attitudes that could encourage violence toward women – Military groups have supported norms of male superiority and dominance

Nursing Process: Assessment Guidelines Use institutional protocol for evidence collection (rape kits) Consent forms are essential (right to refuse treatment) Specific guidelines Document event in patient’s own words Gather data useful for criminal prosecution following protocol After consent forms signed, forensic evidence collected Assess for physical trauma, psychological reactions, use of drugs by victim/perpetrator Identify survivor’s support systems

Nursing Process: Diagnosis and Outcomes Identification Common nursing diagnoses – Rape-trauma syndrome: Compound reaction rape- trauma syndrome Acute phase: shock, numbness, disbelief Long-term phase: symptoms of posttraumatic stress syndrome Outcomes identification – Short term: plan for handling immediate needs after ED, written list of reactions that may follow sexual assault, written information about legal counsel, community support groups, follow-up appointments – Long term: return to previous level of functioning

Nursing Process: Planning and Implementation Planning – Nurse plans to approach victim in nonjudgmental and empathic manner Implementation for sexual assault – Maintain confidentiality – Listen and let patient talk, stressing patient did right thing to save his/her life – Use only nonjudgmental language – Explain to patient long-term signs and symptoms many people experience – Conduct forensic examination after explanation and permission obtained from patient

Therapies for Patient Experiencing Sexual Assault Emergency department – Address physical injuries, pregnancy, and STD prophylaxis – Short-term treatment with benzodiazepines or antidepressants (SSRIs) – Psychotherapy: crisis counseling Follow-up care – Follow-up visits at 2, 4, 6 weeks after initial trauma with assessment for pregnancy, STDs and/or psychological trauma – Community-based supports: group therapy for survivors of sexual assault

Nursing Process: Evaluation Evaluation of outcomes include: – Patient has returned to previous lifestyle – Patient has taken advantage of supportive services and crisis counseling – Survivor is relatively free of signs of PTSD