Sexual Assault

1
Sexual Assault

• Chapter 19

2
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

3
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

4
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 patients 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 survivors support systems

5
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

6
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

7
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

8
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