Sexual Assault Analysis - Essay Example

Sexual Assault Scenario Introduction Rape is one form of sexual abuse inferring any non consensual physical contact of a sexual nature that is unwanted, coerced, and/or forced sexual penetration. The scenario in the case represents acquaintance rape, whose prevalence is becoming more apparent as social network usage broadens. Abuse, whether physical or sexual, has become a prominent problem afflicting societies globally. The identification of sexual assault is difficult due to a number of reasons. Some of the reasons include hesitancy of sexually abused victims in seeking medical evaluation owing to feelings of shame, social stigma associated with rape, or inadequate understanding that they are victims of a crime and need to report the crime and seek proper medical care. The nurse is frequently one of the first contacts to sexual assault victims after the traumatizing incident. Thus, nurses can be conceived to possess a unique position to recognize, treat, and advocate treatment for victims of rape. In some countries, emergency nurses have an opportunity to access training as a Sexual Assault Nurse Examiner. The Sexual Assault Nurse Examiner normally possesses skills such as history taking (regarding medical and assault), physical examination, forensic evidence collection, specimen collection for serology, toxicology, and microbiology, documentation of findings, prophylactic treatment, reporting requirements, referral sources, advocacy services, crisis intervention, emotional support, informed consent and patient rights, discharge instructions and follow up, and court testimony (O'Brien 532). Rape is broadly a legal term and not a medical term, and the role of the nurse is not to determine whether rape has occurred, as this is the duty of the courts. In any alleged rape scenario, the nurse’s responsibilities encompass the following: (1) documentation of relevant history, (2) vigilant physical examination, (3) prompt interventions and treatment of physical injuries sustained in the ordeal, (4) psychological support and arrangements for future follow-up counselling, (5) gathering of legal evidence, (6) prevention of venereal diseases, and (7) prevention of pregnancy, if the patient so desires (Sommers 270). Nurses have an ethical, moral, and legal obligation to report incidences of abuse. Nurses play a fundamental role in screening for abuse by watching out for the red flags of abuse, especially injuries sustained from a sexual assault. The nurse should take proactive steps to aid the patient (Riviello 22). The nurse has a fundamental role to avail a safe environment for the 19-year old lady, treat the injuries sustained in the course of the rape, examine, listen and document the facts. Immediately on arrival to the healthcare facility, the nurse should usher the victim to a private, serene, comfortable area. The nurse should first and foremost obtain consent from the patient before beginning history, as well during every phase of the physical examination and collection of evidence (Smeltzer, Bare, Hinkle and Cheever 1620). The most suitable approach when caring for the rape victim encompass establishing a trusting relationship with the victim; treating all pressing injuries (in this case prioritizing genital trauma in order to stop bleeding), and then documenting a concise, factual, account of the case, inclusive of the patient’s narrative that details the time, location, and nature of the conflict/event and the parties involved in the episode. Being alert is essential in availing intervention for a problem that might, in some instances, go undetected. The nurse should always assure the patient of her safety, and should ensure that the patient has company. It is preferable that a rape crisis counsellor or a social worker be present throughout the examination (Riviello 24). In case such persons are unavailable, the patient can be permitted to have a friend or a relative stay with her. If present, life-threatening injuries (in this case genital trauma and the resultant bleeding) must be treated first. The vaginal bleeding (probably accompanied by vaginal pain and discomfort) is indicative that the genital trauma is severe and need an urgent treatment. The paper may be experiencing upper vaginal lacerations, which may be severe as to warrant surgical repair. Upper vaginal lacerations mainly manifest with profuse bleeding and pain. Once stabilized, the nurse should place the patient into a private room immediately. Specially trained healthcare personnel such as rape crisis advocate, social worker, or mental health personnel should provide crisis intervention, especially emotional support. In the encounter, safety, privacy, and confidentiality must be guaranteed (Sommers 270). Preferably, the information and evidence collected in the medical record should be made available to the government authorities only with the patient’s consent, and by following the proper chain of custody. Later on, the nurse should apply first aid to the abrasions to prevent infection. The first step should be geared at stopping any bleeding, clean the abrasion and remove debris if any, and then apply a bandage over the abrasion. A knocked out permanent tooth can be considered to be a dental emergency and may be re-implanted with an enhanced success (an avulse tooth can be re-implanted within 30-60 minutes). The nurse should control bleeding with sterile gauze and remedy the pain and swelling, while awaiting a dentist. History The questions asked during the taking of the history should avoid being judgemental, moralistic, or opinionated as the girl could believe that she caused the sexual assault. The nurse should stress and reassure the young lady that she is a victim and what transpired amid the date was not her fault (Smeltzer, Bare, Hinkle, and Cheever 1623). Instead, the questions advanced to the patient should be specific, especially in instances that the questions refer to details that might appear to embarrass. The wording of the medical report should reflect statements of fact on the ordeal. The nurse should document a number of issues regarding the incident. These issues include specifics of the incident (victim’s direct quotes, time, date, and place of the sexual abuse); the patient’s capability to give consent to the reported sexual activity; the application of force, weapons, threats of force, coercion, the utilization of drugs and/or alcohol to facilitate the assault; types or modality of assault; the incidence of penetration of any body part whether with a penis or object; whether the patient did vomit, urinate, douche, remove/insert a tampon, clean/wipe the genital area, bathe, gargle, change clothes, took medications after the assault, or engaged in events that might erode evidence, and whether the patient bite or was bit the perpetrator (Ledray and Netze l83). Second, the nurse should enquire about the patient’s medical history on aspects such as allergies, medications, immunizations, or the patient’s past medical history. Third, the nurse should enquire about additional pertinent history such as whether the patient uses contraceptive and of what type, last menstrual period, last consensual intercourse, is pregnant, and whether the patient has a recent anogenital surgery (Kennedy, Edleson, and Renzetti 230). Physical Examination The main purpose of physical examination is to assess and treat resultant physical injuries, while collecting evidence that is admissible in court proceedings. Evidence collection should be a priority regardless of whether the patient is decided or undecided to pursue a criminal prosecution. This is essential as evidence collected post 48 to 72 hours of the event is unrecoverable or invalid. One of the primary tenets of the forensic examination hinges on objectivity (Ledray and Netze l86). Hence, the nurse conducting the forensic examination should do so comprehensively and objectively. Documentation is essential, and the nurse has a responsibility to document every piece of information that the patient provides. Documentation encompasses noting the time and place of injury, the victim’s version of what happened documented in direct quotations, a detailed body map detailing exact location and all injuries, and all the other relevant facts. The nurse should not jump into conclusions regarding the situation, but should summarize the provided information accurately by using legal or otherwise impartial official language that might remove doubt on the accuracy of the rape victim’s statements (Ledray and Netze l82). Plainly, the nurse is supposed to observe, listen, and record what the patient says. Even though the nurse’s intent centres on recording facts about the patient’s injury for treatment and intervention purposes, the documented evidence should aid the authorities to gain a concise idea of the truth (Smeltzer, Bare, Hinkle, and Cheever 1622). The nurse should realize that it is the recorded information/ evidence, rather than the assumptions that he/she makes which could later help the victim in legal proceedings. When performing the physical examination, the nurse should be wary of cross- contaminating the evidence and record all findings clearly. In the physical examination, the nurse should record the presence of any physical injury, biological evidence, or foreign debris, but should desist from disturbing the evidence (Hammer, Moynihan, and Pagliaro 147). The nurse should utilize colposcopic genital examination so as to visualize and document genital abrasions, bruises, and tears. In noting all the injuries, the nurse should document the location, magnitude, and fully describe any trauma, whether occurring around the thighs, wrists, legs, back, breasts, upper arms, and anogenital region (Ledray and Netze l84). Other actions include conducting the appropriate photo-documentation and recovering moist secretions (if any) using a dry swab. Hospital Laboratory and Radiographic Data The nurse should consider appropriate tests that can be conducted on the 19-year old girl as appropriate. These tests may encompass aspects such as serum or urine pregnancy test; cultures and syphilis testing; Hepatitis B testing; laboratory and radiographic studies as necessary and HIV counselling, as well as follow-up tests. It is essential to institute referral of the sexual assault victim to a facility that avails confidential counselling; testing within the first 72 hours of exposure is extremely essential. Medical treatment Based on the circumstances, the nurse should consider availing the following interventions as appropriate; Antibiotic prophylaxis for STDs, Hepatitis B immunization if the 19-year old sexual assault victim has not been previously immunized, HIV prophylaxis informed by risk assessment of exposure, and pregnancy prevention. These interventions should be accompanied by treatment to the face abrasion and knocked out tooth. Coordination of Care The nurse should give the patient referrals to established local resources for follow-up counselling and advocate services. In addition, the nurse should advice the patient referral for follow-up examination in a period of two weeks, three months, and six months for evaluation on aspects such as pregnancy and STDs. It is also critical for the nurse to provide written documentation to the patient touching on a number of topics such as tests done, treatment given, follow-up appointments, community resources, and what to expect with regard to the test results and the legal process. The Victim’s Rights and the Nurse’s Legal Obligation Nurses have an ethical, moral, and legal responsibility to report abuse, especially when the abuse centres on maltreatment of children and other vulnerable groups. The nurse should assist the patient to make an informed decision by explaining that this is the only opportunity to collect certain forensic evidence. Informed consent should be gained from each of the following elements of the sexual assault evaluation. The elements include medical evaluation and treatment; reporting the crime; undertaking a physical examination; photo-documentation; evidence collection, and transferral of the gathered evidence to the law enforcement personnel/agency. Rape Trauma Syndrome In addition to the medical treatment given to the rape victim, the nurse should also be aware of the psychological aspects of the rape. The first phase (acute phase) encompasses disorganization, which explains the reason the 19-year old victim appears withdrawn. In this phase, the victim experiences shock and disbelief and may display anger, fear, and anxiety or may remain calm and exposed with minimal outward display of emotion (Carpenito-Moyet 475). The second phase (reorganization phase) details a long-term process whereby the victim develops coping mechanisms manifested by stages of outward adjustment, personal integration, and recovery. It is essential that rape survivors are directed to rape crisis centres or helped to access resources to discuss their experience and obtain professional counselling. Conclusion All healthcare facilities should have an established standard that lays down the criteria to identify, assess, and avail suitable treatment for victims of abuse (sexual, emotional, or physical) or neglect. Crisis intervention should start the moment the patient enters the healthcare facility guided by the hospital’s written protocol addressing both the patient’s physical and emotional needs, as well as a collection of forensic evidence. The wishes of the rape victim, who is competent and not cognitively impaired, should be respected; all potential and available resources should be explored. Nurses should be careful not to a make mistake of blaming the victim, but rather should present the patient with appropriate resources necessary to overcoming her ordeal. Works cited Carpenito-Moyet, Lynda. Nursing Diagnosis: Application to Clinical Practice. Philadelphia: Lippincott Williams & Wilkins, 2008. Print. Hammer, Rita, Moynihan Barbara and Pagliaro Elaine. Forensic Nursing: A Handbook for Practice. Burlington: Jones & Bartlett Learning, 2013. Print. Kennedy, Raquel, Edleson Jeffrey, and Renzetti Claire. Sourcebook on Violence against Women. London: Sage, 2011. Print. Ledray, Linda E. & Netzel, Linda. "Forensic Nursing: DNA evidence collection."Journal of Emergency Nursing 23.2 (1997): 182-186. Print. O'Brien, Coleen. "Sexual Assault Nurse Examiner (SANE) Program Coordinator." Journal of Emergency Nursing 23.5 (1996): 532-533. Print. Riviello, Ralph. Manual of Forensic Emergency Medicine. London: Jones and Bartlett, 2010. Print. Smeltzer Suzanne, Bare Brenda, Hinkle Janice, and Cheever Kerry. Brunner & Suddarth's Textbook of Medical-Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins, 2008. Print. Sommers, Marilyn. “Defining Patterns of Genital Injury from Sexual Assault: a Review.” Trauma, Violence, & Abuse 8.3 (2007): 270-280. Print. Read More