VIOLENCE

ABUSE &
SEXUAL
ASSAULT
Prepared By:- Aadil Amin
Class:- B.Sc Nursing 3rd Year
Roll No :- 10
Government College Of Nursing Shireen Bagh Srinagar
(Government Medical College Srinagar )
DEFINITION:-
1. VIOLENCE:- It is defined as the Intentional use of a physical power or force that often
results in injury,death,psychological harm,abnormal development or deprivation.
Globally, 1.5 million people die because of Violence every year

2. ABUSE:- It is simply the harmful or offensive treatment of a victim from someone the
victim trusts.
Both violence & abuse can take many forms like:
 Physical
 Emotional
 Sexual
It can involve Children,Elders & partners (wife husband or two persons in intimate
relationship)
CLINICAL MANIFESTATIONS:-
Emergency department are often the first place where victims of violence and abuse go to seek help.The
victims may present with:-

1. Physical injury or Health problems Such Anxiety, Insomnia or Gastrointestinal Symptoms related to
Stress.

2. The possibility of Abuse or violence should be investigated whenever a person presents with
Multiple Injuries in various Stages of Healing which are unexplained & when his explanation does
not fit the physical picture.

3. The most common physical injuries seen are unexplained bruises, Abrasions, Lacerations, Head
Injuries or Fractures.
ASSESSMENT
 Nurses in ED’S are in ideal Position For Early Detection & Interventions for victims of Intimate
Partner Violence (IPV).This, requires an awareness of signs of possible Abuse & violence.

 A careful History is crucial in Screening Process. Asking questions in private- away from others
may be helpful in eliciting information about violence, Abuse or Maltreatment.

 Nurses need to be aware that women may withhold, Directly answering questions in fear of losing
children,retaliation & retribution against the children.

 Whenever Evidence leads a nurse to suspect violence or Abuse, Description of events & Drawing or
Photographs of injuries is important as Medical record can be used as a part of Legal proceeding.

 Assessment of patients General Appearance & Interactions With Significant Others.An

Examination of entire Surface of body & Mental Status examination are Crucial
 MANAGEMENT:-
1. The Aim of IPV SCREENING include Earlier Detection, Identification Of Patient Who
have Been Abused & thus prevention of Continuous Abusive Events,Violence including
Homicide.
2. Protocol of most ED’S require that a Multidisciplinary Approach is used. Nurses,
Physicians, Social Workers & Community Agencies work collaboratively to Develop
and implement a plan for meeting patients needs.
3. The treatment focuses on Consequences of Violence, Abuse, & Prevention of Further
injury.
4. If the patient seems to be in immediate Danger. He/She should be separated from
person who is posing Danger.
5. When Violence or abuse is result of stress experienced by Caregiver, who is no longer
able to cope with Burden of caring for Older Adult or person with Chronic Disease. In
such cases Support groups may be helpful to decrease burden of care givers.
6. Sometimes, Mental illness is reason for violence & abuse.In such cases alternative
Living arrangements may be required.

7. Nurses must be mindful That Competent Adults are Free to Accept or Refuse Help that
is Offered.Some patients may insist to live in home environment where abuse is
occurring. The, wishes of competent and Not Cognitively impaired should be
respected.

8. Health Care workers are expected to report suspected Child Abuse/ violence or Older
adult Abuse to Local Police Station.
SEXUAL ASSAULT:-
It is Defined as “Any sexual act, attempt to obtain a sexual act, unwanted sexual
comments or advances, or acts to traffic women's sexuality, using coercion, threats
of harm or physical force, by any person, regardless of the relationship with the
victim, in any setting, including but not limited to home, school, prison, the streets
and at work’. (World Health Organisation 2003)

The manner in which patient is received & treatment in ED’S is important to

their psychological well being. Crisis intervention should be given When patient
enters the Health Care Facility.
SIGNS OF SEXUAL ASSAULT:-
 Unwanted touching.
 Rape: actual or attempted unwanted vaginal, oral, or anal penetration by an object
or body part.
 Forcing or manipulating you into doing unwanted, painful or degrading acts during
intercourse.
 Taking advantage of you while you're drunk or otherwise not likely to give consent.
 Denying you contraception or protection against sexually transmitted diseases.
 Taking any kind of sexual pictures or film of you without your consent.
 Forcing you to perform sexual acts on film or in person for money.Threatening to
break up with you if you refuse sex.
 ASSESSMENT:-
The patient’s reaction to Rape has been Termed “RAPE TRAUMA SYNDROME” &
is seen as an acute Stress reaction to a life threatening situation.
The nurse Performing Assessment must be aware that the patient may go
through several phases of psychological Reactions which may manifest as:-
1. Acute Disorientation Phase:-
It Manifests as an Expressed State in which
Shock,Disbelief,Fear,Guilt,Humiliation,Anger & other such symptoms are
encountered.
OR
As a controlled State in which Feelings are Masked or Hidden & victim appears
Composed.
2. A Phase Of Denial:-
In This Phase the patient is unwilling to talk about the Event.
3. Phase of Heightened Anxiety,fear,flashbacks,sleep disturbance,hyperalertness.

4. A Phase Of Reorganization:-
In this phase the incident it put into perspective, Some victims never fully recover
& go on to develop Chronic Stress Disorder & Phobias.

PROTOCOL FOR RAPE MANAGEMENT:-

1. DIAGNOSIS :-
# History Record, Details of events before and after sexual assault.
# Drugs taken Voluntarily or involantarily.
# Weapon Used.
# Condom used.
# Timing & sequence of events.
# Post Assault Events & Hygiene.
2. PHYSICAL EXAMINATION:-

It is done to visualize entire body to draw detailed Body Map.The, client is examined head to toe for injuries
especially head,neck, breasts,thighs,back and buttocks. Physical Examination Focuses on:

1. External Evidence of Trauma( Bruises laceration,stab wounds etc)

2.Dried Semen Stains(crusted) on patients body/ clothes.

3. Broken Fingernails & body tissue & foreign material under Fingernails ( if found
sample is taken)

4. Oral Examination including Specimen of Saliva & Cultures of Gum and Tooth Areas.

5. Pelvic & Rectal Areas are also examined with Filtered UV light. Areas, appearing
Fluorescent May indicate Seman Stain.

6. Rectum is examined for signs of Trauma, Blood & Semen.

3. INVESTIGATIONS:-

During Physical Examination Numerous Lab Specimen May be Collected including:-

VAGINAL ASPIRATE:-
For presence & Absence of Motile/Non-Motile Sperms.
SECRETIONS:-
They are obtained with sterile swab from Vaginal pool For Acid phosphatase, Blood
Group Agents of Semen.
# Separate smear for Oral, Anal, & Vaginal Areas.
# Culture Of Body Orfices For Gonorrhea.
# Blood serum For HIV & SYPHILLS testing & DNA analysis.
# Pregnancy test if possibilities og pregnancy.
# Fingernail Scrapping.
NURSING MANAGEMENT:-
# Provide support to reduce the patients emotional trauma & gather available
evidence for legal proceedings.
# All interventions are aimed to help the patient gain control over their life.
# Throughout the stay patients privacy & sensitivity must be respected.
# The patient should never be left alone, support & caring are crucial.
Stepwise Management:-
Step 1:-
1. Access & treat serious injuries first.
2. Obtain verbal consent to conduct physical Examination.
3. Conduct full body examination & document all findings.
Step 2:-
Manage physical effects of assualt such as wounds and provide antibiotics to prevent
wound infection & pain relief, anxiety medication.
Step 3:-
1. Provide Emergency Contraceptive if the victim has started Menarche & presents
within 72 hours post Assault.
# Postinor-2 ( onetablet given orally every 12 hours)
OR # LO- Femenal (4 tablets repeated every 12 hours)
Step 4:-
# Treat presumptively for STD,S ( or Conduct Lab investigations)
Eg, Ceftriaxone( Rocephen) given IM with 1% Xylocaine for prophylaxis of Gonorrhea.
Step 5:-
# Provide HIV testing counseling.
# Conduct an HB Baseline test to select drug accordingly.
# Provide counseling on PT Stress to Victim and Guardian.
# Refer to support service, such as Victim support Unit In police
# Advise Dates for Follow Up Visit.
# Record all Findings & Treatment in “Examination Record Book”.