Sexual assault is an assault of sexual nature or sexual act directed on another person without their consent. Most Sexual assaults are committed by men towards women but it may also involve man to man, woman to man, woman to woman or even towards children. The term sexual assault may be defined as an involuntary sexual act in which a person could be threatened, coerced or even forced to engage in sex against their consent or any sexual touching of a person against their will.
Rape is a form of sexual assault in which there is intercourse or actual penetration either vaginal, anal or oral, inappropriate touching, forced kissing or torture of a victim in a sexual manner.
Sexual assault also takes many other forms such as attempted rape, un-consented touching /fondling or even threats. Victims of sexual assault are usually attacked or molested by known or unknown assailants who may include acquaintances such as friends, relatives, parents, co-workers, dating partners, neighbors, strangers, gangs etc.
Child sexual assault is the commonest form of abuse and has a long standing psychological and physical impact on the victims. Forms of child sexual acts include exposure of genital, physical contact with a child’s genitalia, pornography, actual sexual intercourse, incest etc.
The effects of a Childs sexual assault include depression, post traumatic stress disorder, anxiety, physical injuries and re-victimization in adulthood.
In adults alike, sexual assault has profound emotional and psychological effects besides the physical trauma. They include denial, anxiety, dislike for sex, shame, anger, nightmares, fear, depression, guilt mood swings, promiscuity, drug abuse etc.
PROMOTION OF MENTAL HEALTH
The psychiatric nurse identifies and works with victims of sexual abuse/rape. These include the vulnerable populations like the internally displaced persons, refugees, mentally handicapped, orphans, schoolchildren etc. A psychiatric nurse will help to develop research capacities for sexual violence and violence based practice in psychiatric nursing, adopt concepts in promotion of neutral health, emerging evidence, effectiveness of interventions, and develop policies to deal with the problems of sexual violence.
Professional organizations of nurses e.g. the international council of nurses emphasizes on the education and training of nurses in psychiatry and other specialized fields like Sexual Assault Nurse Examiners (SANE). The Sexual Assault Nurse Examiner provides a thorough assessment of the patients’ physical psychosocial status based on available data from the patients and forensic records. This assessment also provides the data base that determines the patient care plan. This is achieved through a comprehensive medical-legal examination by a specially trained SANE.
Child and adolescent mental health form the highest number of victims of sexual assault.
Finally prevention of mental disorders linked to human rights issue, trauma, stigma, abuse, and victimization etc. will help to explore on the preventive and treatment modalities.
PREVENTION CARE & REHABILITATION OF MENTALLY ILL
Health care providers mainly nurses should look for the root cause of sexual violence and help in developing best solutions is them. Rape prevention programmes and education should be initiated to sensitize victims and perpetrators of these acts and achieve behavior change in the community.
Professional organizations and human rights bodies advocating for laws and regulations aimed at reducing sexual assault. Nurses should establish a coalition with law enforcements personnel, social service workers, clergy, teachers, government, and judiciary etc to enforce laws and bring justice to the victims.
Prosecution:-Reporting, investigations and conviction should be a multidisciplinary effort between all the above stakeholders.
Victims of sexual assault and rape should be treated and handled with sensitivity due to their physical conditions as well as psychological instability in order to achieve both physical and mental heeling.
Psychiatric hospitals, rehabilitation centers and psychiatric units should develop and implement training programmes targeting health workers on how to handle victims of sexual violence.
There should be emergency medical, legal and psychiatric services for victims, emergency room crisis counseling and a waiver process for the medical bills incurred by the victims.
Hospital based Sexual Assault Nurse Examiner (SANE) will be very useful towards the initial examination of victims and in collecting & preserving evidence for future use, she also offers the initial counseling services that are very pivotal in the healing process of a rape victim.
Nurses should respect the confidentiality and privacy of their patients and try as much as possible to win their trust.
HIV testing should be conducted at an anonymous testing site where pre-test and post- test counseling is administered to the victims.
Nurses should have knowledge and understanding of the pathologies of mental disorders related to sexual assault/ rape.
An understanding of the psychological, biological and sociological aspect of their victims is an important milestone in the management and treatment of victims of sexual violence.
There is a high prevalence of post traumatic stress disorder (PTSD) among victims of sexual assault. Individual approaches, community based response, government initiative e.t.c all will help prevent deterioration and complications of the problem.
Education is important for rape survivors and fostering a supportive environment for their recovery and victims should be supported to regain full confidence, gain stress reduction skills, personal strength, self control and more so to forgive and forget.
In other words management is centered on holistic and individualized therapies. Healing from a sexual assault /rape trauma does not mean the victim will forget the experience and will never experience the symptoms in future. The rate and success of recovery of a sexual assault/rape victim depends on a number of factors;namely,the degree of support he/she receives, previous self concepts, personal strength and quality of professional treatment from the health care providers ,therapists and the justice process. Most of the survivors develop post traumatic stress disorder (PTSD) due to failure of the recovery process. In the US the prevalence of PTSD among sexually assaulted women is 50%.
The following is summary of the management of a victim of sexual assault /rape.
Pharmacotherapy
Aimed at alleviating pain and suffering and preventing complications e.g. treatment of injuries tears,ARV’s etc
Reduction of symptoms such as anxiety, to improve the quality of life, reduction of disability, promotes wellness and prevent relapse.
Early intervention is critical for victims of sexual assault and rape because the level of distress following this traumatic experience is directly correlated to future development of PTSD
Psychotherapy
Nurses should focus on changing thought patterns, decrease negative emotions, develop skills to cope with anxiety, restore social skills, anger management skills e.t.c
Group therapy is very important as it helps victims to share experiences with others in a safe environment.
Sociological Interventions
Recovery process of these victims is a sociological issue and societal aspect should not be ignored. Family support and encouragement of victims to discard myths related to rape.
Rationale
This paper explores the importance of having a consistent and multidisciplinary response to sexual to violence and the nurses role in the management and prevention of mental problems that may arise from this act and more so towards eliminating sexual violence in the community.
The nurse should work towards providing equal opportunities and access to services for all victims.
Educate professionals within the health, social and justice systems and the community at large in order to overcome the silence and stigma surrounding sexual violence.
She should establish and implement standards of practice to ensure consistent response to such incidents. Inform victims about their rights and choices and help them in the recovery process. Finally it helps to prevent deterioration or complications to the mental status of the victims resulting from this trauma. Recovery from sexual assault /rape trauma is deeply personal and highly individualized process. There’s need for establishment of rape prevention centers and education programmes to help debunk rape myths, change the victims blaming attitudes and help de stigmatize the problem of rape in the society.
Brunello N, D. J. (2001). Post Traumatic Stress Disorder. Diagnosis and Epidemiology in Psychiatry , 43:150-162.
Julia Whealin, P. (2007, May 22). Child Sexual Abuse. Retrieved November 22nd, 2012, from www.ptsd.va.gov/public/pages/childsexualabuse: http//www.ptsd.va.gov/public/pages/childsexualabuse.asp
Rose DS. (1986). Worse Than Death;Psychodynamics of Rape Victims and the Need for Psychotherapy. The American Journal of Psychiatry , 43(7):817-824.
Sexual Assault and Post Traumatic Stress Disorder. (2010, June 10). Retrieved November 22, 2012, from www.sexual assault.com: http//www.sexualassault.com
