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Immediately after the crime of rape has occurred, victims should be calmed as much as possible and assured that they are safe. Any bleeding wounds, fractures, or other existing injuries should be treated. They should be encouraged to obtain treatment as soon as possible and not to change clothes, bathe, douche, or urinate because that could destroy legal evidence needed to arrest and convict the attacker.
Rape is a physical and psychological emergency, and the victim must be treated with compassion as well as professional competence. The American College of Obstetricians and Gynecologists has provided guidelines for the physical care of a rape victim, identifying a twofold purpose for the physical examination: (1) to protect the victim against disease, pregnancy, and psychological trauma, and (2) to aid in the collection of legal evidence that could be used later in court.
Many hospitals have on call a rape counselor who can stay with the victim through emergency treatment and provide guidance and referral to a follow-up program of care. Recovery from rape is a difficult task. Some victims may appear to return to normal rather quickly, when in fact they are using temporary psychological mechanisms such as denial, suppression, and rationalization. Crisis intervention through all phases of the recovery period is a necessary component of the total care of a rape victim. The main purposes of follow-up are to keep channels of communication open to victims, assess their coping skills, to offer support and encouragement in efforts to resume life, and to provide assistance and referral if necessary. Rape is a crime of violence in which the sexual act is secondary to the brutality of the attack.
The American College of Emergency Physicians has published a consensus document called Evaluation and Management of the Sexually Assaulted or Abused Patient. It is available from ACEP Sales and Service, P.O. Box 619911, Dallas TX 75261-9911 or on their web site at http://www.acep.org. They can also be reached by telephone at 1-800-798-1822, ext. 6. A review of informative materials for women who have been raped or sexually assaulted, and practice guidelines for care, is available from the National Violence Against Women Prevention Research Center, whose web site is http://www.vawprevention.org.
There may also be either a compound reaction or a silent reaction. The nursing diagnosis rape trauma syndrome: compound reaction is identified as an acute stress reaction to a rape or attempted rape, experienced along with other major stressors that can include reactivation of symptoms of a previous condition. The victim suffers from the emotional and physiological manifestations listed above and may also resort to reliance on drugs or alcohol and experience reactivated symptoms of preexisting physical or psychiatric illnesses. The nursing diagnosis rape trauma syndrome: silent reaction is identified as a complex stress reaction to a rape in which an individual is unable to describe or discuss the rape. Characteristics can include sudden changes in relationships with men and in sexual behavior, increasing anxiety during interview, silence about the rape incident, and sudden onset of phobic reactions.
Like other posttraumatic stress disorders, this condition initially causes an acute phase of disorganization and involves a long-term reorganization of lifestyle. Sequelae may include marked changes in lifestyle and a variety of phobias.
Acute phase: Profound emotional responses mark the acute phase (i.e., fear, shame, and feelings of humiliation; self-blame and self-degradation; and anger and desire for revenge). Most commonly, rape victims exhibit crying, trembling, talkativeness, statements of disbelief, and emotional shock. Some may exhibit overt signs of hostility, which reflect their anger and feelings of powerlessness. Later, patient complaints of sleep pattern disturbances, gastrointestinal irritability, and genitourinary discomforts reflect physical responses to emotional trauma. Some victims may appear quiet, dispassionate, and smiling; however, these behaviors should not be misinterpreted as indicating a lack of concern; rather, they may represent an avoidance reaction.
Long-term phase: Many rape victims experience one or more of the following: nightmares; chronic suspicion, inability to trust, and altered interpersonal relationships; anxiety, aversion to men, and avoidance of sex; depression; and phobias. Paradoxically, patients express feelings of guilt and shame because they feel that either they invited the attack, should have prevented the episode, or that they deserved being punished.
The nurse exhibits empathy and understanding and ensures privacy and a quiet supportive environment. The patient is encouraged to verbalize feelings, fears, and concerns. Positive self-perception and self-esteem are promoted and supported. The nurse emphasizes that rape usually is an expression of the rapist's overwhelming feelings of psychosocial impotence and anger and that the act conveys a sense of power over others; the woman was a victim of the rapist's inability to contain a violent personal rage that is not related to her or to sex. The patient is referred to community resources (support groups) and for psychological counseling. Most patients prefer to have a counselor of the same sex.