Sexual assault: the role of the advanced practice nurse in identifying and treating victims

Understanding feminism: considerations for nurses working to end violence against women

Violence against women is a pervasive and serious human rights and public health problem worldwide. As interdisciplinary research teams try to address the effects of this health problem of which the effects transcend all women, nurses are at the forefront. Using a feminist philosophy and methodology to explore violence against women is one way to uncover new knowledge to address this health epidemic. In this paper, we will review the basic concepts of feminism and provide examples of viewing violence research and forensic nursing practice through this theoretical lens. These perspectives provide a foundation for understanding feminism and facilitating nurses' awareness as they consider careers in research and practice. Through this lens, nurses who are helping to ease the burden of violence in our global society may affect change in women's lives.

The sexual safety of adolescents

In this article, the authors review issues that affect the sexual safety of adolescents. First and foremost, these issues include risks for unintended pregnancy and sexually transmitted infections. Clinicians also need to understand other critical issues that affect sexual safety. These include adolescent dating patterns, decision making, communication and negotiation skills, social and environmental influences, and risks related to violence. Suggestions for clinical interventions to promote sexual safety are discussed.

"Suffering in thought": an analysis of the mental health needs of female domestic workers living with violence in Malawi

The impact of violence on the mental health of women has been acknowledged but with limited exploration in resource-poor countries. Using critical ethnography and feminist methods, we analyzed the impact of violence on the mental health of a sample of Malawian women employed in domestic service. The analysis showed mental health as being situated in the context of poverty, inhumane treatment, social isolation, and the erosion of hope. We offer suggestions on how psychiatric nurses and other health care providers can promote the mental health of women employed in domestic service while acknowledging the limited mental health services in Malawi.

Surviving life as a woman: a critical ethnography of violence in the lives of female domestic workers in Malawi

A common form of employment for low-income third world women is domestic work. The power dynamics in this type of employer-employee relationship may place women at risk for abuse. Our aim in conducting this qualitative inquiry was to describe the experiences of violence in the lives of young female domestic workers in Malawi, a small country in South East Africa. Forty-eight women participated in focus group and individual interviews. "Surviving" was the main theme identified, with women employing creative ways of surviving the challenges they met at various points in their lives. This study provides information that health care professionals could use in assisting women through the process of surviving.

A psychoneuroendocrino-immune approach in the nursing treatment of anorexia and bulimia nervosa

Recent clinical reports have shown an increasing number of patients afflicted by eating disorders in the western world. There are numerous causes and mechanisms leading to eating disorders that affect the psychoneuroendocrinoimmune system. In this study, we define a novel psychoneuroendocrinoimmune nursing approach for anorexic and bulimic patients' treatment. According to the specific diagnostic items deriving from the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, and clinical guidelines in eating disorders formulated by the National Institute for Clinical Excellence, we carried out a qualitative study on the nursing treatment chosen by 210 international centers considered as a sample. This study was based on a no structured interview via e-mail to better understand the nursing approach in anorexia and bulimia nervosa. Thanks to the selected centers' answers, four different levels of nursing care were identified, that include: the nursing role analyzing the spectrum of patients' problems; the nursing intervention in inpatient care; the nursing intervention in outpatient care; the day hospital treatment. All four prove to be especially useful in the nursing practice.

Assault history and follow-up contact of women survivors of recent sexual assault

The purpose of this comparative descriptive study is to describe and examine differences in assault characteristics and the issues surrounding follow-up contact of women survivors of a recent sexual assault. This study identified assault characteristics: half of the assaults were by strangers; approximately one-third of the assaults occurred in the victim's home; 29% of the victims were abducted; weapons and physical force were used in over half of the cases; 63% were vaginal assaults; and 86% involved penile penetration. Three months after the assault and the initial examination, only 23% (n = 18) of the study participants could be contacted by telephone for follow-up. The study's findings provide not only data regarding the characteristics of sexual assault, but also the difficulties in contacting adult female survivors for follow-up services. Recommendations outline the importance of thorough, individualized examinations and the need for improved, timely, follow-up services for sexual assault victims.

Evaluation of a rape protocol: a five year follow-up with nurse managers

PURPOSE

To evaluate the use and effectiveness of a protocol developed for emergency nurses and other medical personnel to use with survivors of sexual assault. The Ohio Department of Health (ODH) Protocol for the Treatment of Adult Sexual Assault Survivors was developed by a multi-disciplinary team in 1991-92 as a written guide to provide comprehensive, standardized, non-judgmental, and equitable treatment for survivors. In 1993, this 118-page manual was sent to all Ohio hospitals. In 1994, a follow-up video and training guide were also delivered. In 1997, Victims Rights Advocacy, a non-profit agency in Ohio, and the Center for Social Work Research at The University of Texas at Austin collaboratively conducted an evaluation of the utilization and effectiveness of this protocol at Ohio hospitals.

DATA SOURCES

Emergency departments at Ohio hospitals were asked to complete a mailed survey regarding their policies and procedures for treating sexual assault patients. Telephone calls were made to the hospitals that did not return a survey, and site visits were conducted at 20 hospitals in diverse areas of Ohio.

CONCLUSIONS

Overall, respondents concurred that hospitals can benefit from using a standardized protocol, such as the ODH Protocol, for treating victims of sexual assault. Survey participants also indicated that training is needed on several topics, especially testifying in court, cultural awareness, and the needs of special populations, such as male, gay, lesbian, and bisexual survivors. In addition, findings indicate that survivors need more follow-up services, and written information about these services should be provided to them.

IMPLICATIONS FOR PRACTICE

Nurse practitioners can improve the treatment of sexual assault survivors in their communities through a variety of actions, such as gathering information about available protocols and training opportunities for personnel, and becoming familiar with resources that can help victims.

Efficacy of a 2-year-old sexual assault nurse examiner program in a Canadian hospital

INTRODUCTION

The purpose of this study was to describe a sexual assault nurse examiner (SANE) program at a hospital-based sexual assault care center in Ontario, Canada, and assess its efficacy in comparison with physician examiners.

METHODS

Data obtained from the hospital records of 515 women who came to a Toronto sexual assault care center were examined. A number of variables relevant to this assessment of services were examined, including client demographics and presenting history, aspects of the sexual assault, and characteristics of the treatment.

RESULTS

Average assessment times were shorter for victims seen by SANEs than for victims seen by physicians (approximately 3(1/4) hours versus 4 hours). Physicians had more interruptions (25.1%) than did SANEs (20.0%). Client characteristics and presentation were similar regardless of who provided care, with some exceptions.

DISCUSSION

The results of the study support the utility of the SANE model as an efficient program for the assessment and treatment of victims of sexual assault.

Women dwelling with violence

PURPOSE

To explore the Heideggerian concept of dwelling as revealed in the lives of women who have experienced sexual violence. Sexual violence against women by men known to them is a significant health problem, yet little is known about how such violence affects women's everyday experience.

METHODS

Phenomenologic, integrating (a) data collected in 1996 and 1997 from 10 American women who had experienced sexual violence, (b) Heideggerian philosophy, (c) other literature, and (d) excerpts from the communications media. In-depth, open-ended interviews with women, followed by analysis of transcripts using Heideggerian hermeneutics.

FINDINGS

Women "dwelling with violence" were living among and inseparable from violence, abuse, and maltreatment. Violence resulted in their "living-in-exile"--feeling uprooted, unsettled, unprotected, and distrustful. Yet their stories were about "preserving and sparing amidst violence"--caring for things they value, creating a safe place for themselves, guarding that which is essential to their nature, and seeking to protect others.

CONCLUSIONS

Sexual violence can profoundly affect the lives of women. Women's narratives indicate complex and creative response to living in a violent environment. Nurses who seek to understand the effects of violence on a woman's daily life should focus not only on symptomatic responses to a single violent event, but also should consider her life history, the social context of her daily experiences, the degree to which violence has alienated her from others, and her unique way of responding to violence.