Transcript Chapter 027
Chapter 29 Sexual Assault Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. Sexual Assault and Sexual Violence Unwanted sexual advances and sexual harassment Stranger rape Marital rape Date rape Drug-facilitated sexual assault Incest Human sex trafficking Female genital mutilation Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 2 Rape 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) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 3 Epidemiology 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 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 4 Sexual Offenders and Relationships with Victims Spousal (or marital) rape Acquaintance (or date) rape Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 5 Clinical Picture Acute stress disorder Posttraumatic stress disorder (PTSD) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 6 Psychological Effects of Sexual Assault Depression Suicide Anxiety Fear Difficulties with daily functioning Low self-esteem Sexual dysfunction Somatic complaints Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 7 Effects of Incest Incest victims may experience Negative self-image Depression Eating disorders Personality disorders Self-destructive behaviors Substance abuse Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 8 Specialized Sexual Assault Services 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) Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 9 Case Study A woman who has been raped comes to the ED. What information should be obtained during the medical exam? Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 10 Application of the Nursing Process General assessment Level of anxiety Coping mechanisms Available support systems Signs and symptoms of emotional trauma Signs and symptoms of physical trauma Self assessment Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 11 Case Study (Cont.) What would be some appropriate questions to ask the patient to determine her coping mechanisms? Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 12 Best Practice Guidelines 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 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 13 Case Study (Cont.) What areas should the nurse include in the assessment? Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 14 Nursing Process (Cont.) Diagnosis Rape-trauma syndrome Outcomes identification Absence of any residual symptoms after the trauma Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 15 Nursing Process (Cont.) Interventions Counseling Promotion of self-care activities Case management Advanced practice intervention Psychotherapy Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 16 Evaluation Sexual assault survivors are considered to be recovered if they are relatively free of any signs or symptoms of acute stress disorder and PTSD. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 17 Audience Response Questions 1. By virtue of the legal definition of the relationship, rape cannot occur within a marriage. A. True B. False Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 18 Audience Response Questions 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 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc. 19