This document provides information about rape and sexual assault, including definitions, statistics, and the psychological and physical effects on victims. It describes the three phases of Rape Trauma Syndrome (acute, outward adjustment, and renormalization), common reactions in each phase, and long-term coping strategies. The role of Sexual Assault Nurse Examiners is outlined, including conducting a sensitive exam, collecting forensic evidence, and providing treatment and referrals. The goal is to reduce further trauma to victims and support their recovery process.

1. Linda H. Warren
EdD RN MSN CCRN
NUR 335
April is Sexual Assault
Awareness and Prevention
Month

2. RAPE: forced sexual acts involving vaginal
or anal penetration.
 Can happen to males or females.
 Legal definition
 Penetration of victim without consent.
SEXUAL ASSAULT: sexual contact OR
behavior that occurs without consent.
 Includes more than “rape”
 Fondling, unwanted touching, attempted
rape, forcing a person to perform oral sex.

3.  44% of victims are under age 18
 80% are under age 30
 Every 2 mins: someone in the US is sexually assaulted
(2007= 248,300 victims)
 60% of sexual assaults are not reported to police.
 15 of 16 rapist will never spend a day in jail
 r/t lack of physical evidence or proof
 1 in 4 college women will be raped during their academic career

4.  Rape & sexual assault are violent
crimes of POWER & CONTROL that
are acted through sexual means.
 Rape is a crime of VIOLENCE,
not sexual passion.

5.  Patient’s reaction to the rape.
 Disruption of normal physical, emotional, cognitive,
behavioral, and interpersonal characteristics of the pt.
 Seen as an acute stress reaction to life threatening situation.
 Psychological and physical S&S and reactions:
 Can be during rape, immediately following rape, and for
months or years after a rape (form of PTSD).
 Most victims of rape go through these S&S.
3 PHASES:
• Acute Phase (disorganization)
• Outer Adjustment stage
• Renormalization stage

7.  Occurs days or weeks after rape.
 Duration varies
 Acute stage can be classified as one of three responses (RAINN):
 Expressed: trouble remembering or concentrating.
 Controlled: survivor may appear to be without emotion or act as if
nothing actually happened. Downplay event.
 Shocked/disbelief: strong sense of disorientation or confusion.

9. Behaviors survivors may display:
 Diminished alertness
 Numbness
 Dulled sensory, affective, and memory function
 N/V
 Disorganized thoughts
 Paralyzing anxiety
 Obsession to wash or clean themselves
 Hysteria, confusion, and crying
 Acute sensitivity to the reaction of other people

11.  Survivors seem to resume their normal life:
 Victim begins to reorganize themselves.
 Attempts to adjust to new life as a survivor.
 Last several months to years.
 Maladaptive coping mechanisms.
 RAINN identifies 5 main coping strategies:
 Minimization: person pretends everything is fine
 Dramatization: can’t stop talking about, trying to justify events
 Suppression: do not talk about it, withdraw
 Explanation: analyzing what happened, what they did/could have done
 Flight: moving to another state

12. Other Coping Mechanisms:
 Poor health in general
 Continuing anxiety
 Sense of helplessness
 Inability to maintain previously close relationships
 Experience a general response of nervousness
 Persistent fear and or depression
 Mood swings from relative happy to depression to anger
 Insomnia and flashbacks
 Panic attacks
 Dissociation
 Poor appetite

13.  Changes to Lifestyles:
 Personal security and safety
 Hesitant to start new relationships
 Questioning sexual identity or orientation
 Sexual relationships become disturbed
 Physiological Responses:
 High rate of poor health
 Somatoform disorders (physical symptoms with no identifiable cause)
 Tension headaches
 Fatigue
 Pain: chest, throat, arms, legs

19.  Fears and Phobias Develop:
• Being in a crowd
• Being left alone anywhere
• Men; Women
• Going out at all
• Being touched
• Specific fears related to certain characteristics of the assailant
- Tobacco smoke
- Curly hair
- Beards
• Suspicious and paranoid feelings of strangers
• Fear of people in general

20.  Recognize their adjustment phases
 Integrate the SA into their life:
 The rape is no longer the central focus of their life.
 No longer blame themselves for the attack.
 Able to move forward with their lives.
 Survivor attempts to resume relationships, work, and regain
a personal sense of safety and wellbeing.
 Require counseling

21.  I'm going crazy.
 I can't remember what I wanted to do next.
 I want to drink all the time, I just want to forget about it.
 I can't get to work on time or meet simple deadlines.
 I'm having nightmares and flashbacks all the time.
 I can't eat or sleep.
 All I want to do is eat.
 I'll never trust anyone again.
 All I want to do is sleep.
 Everything is just fine. Everyone is making such a big deal about this.

22.  How the patient is received & treated in the ED is
important to his or her psychological well-being.
• First responders have a big impact on the psychological
wellbeing of victims.
• Need to be treated professionally and with dignity.
• Provide reassurances
• Non-judgmental, empathetic care
 Crisis intervention begins as soon as patient arrives to ED.
 The patient should be seen immediately.
 Pt needs to consent if evidence is to be gathered.
 GOALS: provide support, reduce emotional trauma, and
gather evidence for possible legal proceedings.

26.  Patient reaction
 Rape Trauma Syndrome (RTS)
 History taking and documentation
 Physical exam
 Collection of forensic evidence
 Role of the SANE
 Want to give pt some control back.
 Sit at level of patient (not above or below)

27.  ER trained nurses
 Specific Training in:
 Forensic evidence collection
 History taking
 Documentation (may be used in court)
 Photography
 Assessments
 Colposcopy (assessing for microtrauma)
 Light-staining microscope to identify:
 motile/nonmotile sperm
 infectious organisms

28. • SA kit uses paper products & paper bags for collection.
• Plastic promotes moisture & organism growth that may
contaminate the forensic evidence.
• Once the SA kit is sealed, it should NEVER leave the SANE
nurse’s hands (unless being handed to police).

29. Colposcopy: identifies microscopic tears or injury

30.  Since 1998 there has been a range of 95-100% successful
prosecution rate in Massachusetts when a SANE has
collected evidence and testified in court.
 SANEs have testified and provided quality forensic evidence
in 54 sexual assault trials, 51 of which have resulted in
conviction. Evidence collection and SANE testimony were
important elements in achieving convictions in all of the
cases.
 Massachusetts DA’s anecdotally report alleged perpetrators
are more likely to plead guilty before trial when the
prosecution presents evidence collected by SANEs, saving
enormous prosecution costs.

31. Sympathetic Support
 Privacy, empathy, sensitivity
Reduce patient’s emotional trauma
Gather evidence
 Ensure pt leaves hospital with a trusted person & has
proper clothing (collected original clothes for evidence)

32.  Consent***
 Document
 History of event: in patients OWN WORDS. Do not lead responses.
 General appearance / Emotional state
 Did they bathe, brush teeth, void, have BM?  can destroy forensic evidence.
 Time & date of attack
 Time & date of admission to ER
 LMP and any use of birth control
 Patient is undressed completely and provided a gown
 Head to toe examination

33. Focus on the following:
 External evidence of trauma
 Dried semen stains on body or clothing
 Broken fingernails
 Body tissue and foreign material under nails
 Oral examination:
 Specimen of saliva and cultures of gum and tooth area
 Pelvic and rectal exam
 Fluorescent light to detect secretions

34.  Vaginal aspirate
 Secretions from vaginal area
 Oral, vaginal, and anal smears
 Gonorrhea cultures
 Blood test for HIV, syphilis, DNA analysis
 Pregnancy test
 Foreign material: grass, leaves, dirt
 Tetanus shot
 Pubic hair samples

35.  Prophylaxis against STDs
 Gonorrhea: Rocephin (ceftriaxone) IM with 1% lidocaine (very painful)
 Syphilis and Chlamydia: Doxycycline taken for 10 days
 Anti-pregnancy measures (Plan-B)
 Catholic hospitals will not provide plan-B
 Give pt opportunity to wash and clean themselves.
 Provide fresh, clean clothes.

36.  Counseling services for patient and family.
 Rape support groups and organizations.
 Follow up appointment for monitoring pregnancy and STDs.
 Encourage to return to their level of functioning as soon as possible.
 Family or friend should be with them with they leave the hospital.