Chapter 29 Sexual Assault Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Unwanted sexual advances and sexual harassment  Stranger rape  Marital rape  Date rape  Drug-facilitated sexual assault  Incest  Human sex trafficking  Female genital mutilation Sexual Assault and Sexual Violence 2 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Nonconsensual activity  Any penetration of the vagina or anus with any object or body part, or the oral penetration by a sex organ of another person  Second most violent crime (FBI, 2008) Rape 3 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 1 in 5 women and 1 in 71 men in the United States have been raped at some time in their lives  Race and ethnicity Epidemiology 4 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Spousal (or marital) rape  Acquaintance (or date) rape Sexual Offenders and Relationships with Victims 5 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Acute stress disorder  Posttraumatic stress disorder (PTSD) Clinical Picture 6 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Depression  Suicide  Anxiety  Fear  Difficulties with daily functioning  Low self-esteem  Sexual dysfunction  Somatic complaints Psychological Effects of Sexual Assault 7 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Incest victims may experience  Negative self-image  Depression  Eating disorders  Personality disorders  Self-destructive behaviors  Substance abuse Effects of Incest 8 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Sexual Assault Nurse Examiners (SANEs) RNs with specialized training in caring for sexual assault patients Demonstrated competency in conducting medical and legal evaluations Ability to be an expert witness in court  Sexual assault response team (SART) Specialized Sexual Assault Services 9 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 A woman who has been raped comes to the ED.  What information should be obtained during the medical exam? Case Study 10 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 General assessment  Level of anxiety  Coping mechanisms  Available support systems  Signs and symptoms of emotional trauma  Signs and symptoms of physical trauma  Self assessment Application of the Nursing Process 11 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 What would be some appropriate questions to ask the patient to determine her coping mechanisms? Case Study (Cont.) 12 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Examination involves five steps 1. Head-to-toe physical assessment for signs of injury 2. Detailed genital examination 3. Evidence collection and preservation 4. Documentation of physical findings 5. Treatment, discharge planning, and follow-up care Best Practice Guidelines 13 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 What areas should the nurse include in the assessment? Case Study (Cont.) 14 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Diagnosis  Rape-trauma syndrome  Outcomes identification  Absence of any residual symptoms after the trauma Nursing Process (Cont.) 15 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

 Interventions  Counseling  Promotion of self-care activities  Case management  Advanced practice intervention  Psychotherapy Nursing Process (Cont.) 16 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Sexual assault survivors are considered to be recovered if they are relatively free of any signs or symptoms of acute stress disorder and PTSD. Evaluation 17 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

1.By virtue of the legal definition of the relationship, rape cannot occur within a marriage. A.True B.False Audience Response Questions 18 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2.Flashbacks, frightening thoughts, recurrent memories or dreams are associated with which category of symptoms in posttraumatic stress disorder? A.Re-experiencing B.Hyperarousal C.Avoidance Audience Response Questions 19 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.