In Times of Crises: Care of Adolescent Rape Patients
Emily J. Thoreson
Rape is a crisis that occurs everywhere, and that most health care professionals will be forced to deal with, whether in the clinical setting or in everyday life. Knowing the effects rape has on its victims is the first step in understanding and treating the rape patient. This article examines these effects, specifically on adolescent victims, and on the emotional state of the victim following the trauma. Techniques for examining the rape victim and opening lines of communication are discussed. Establishing a trusting relationship with the victim is emphasized and encouraged as the vital factor in successful communication with the patient.
It is ten p.m. already as Susan leaves the library and heads across the parking lot to her car. She has stayed later at the library than planned, trying to finish the last of the research she needs for her English paper, the final requirement before she completes her degree and moves on to the teaching job she has always dreamed of having. Crossing the aisle, she looks up when a familiar voice calls out to her. She knows she has too much to accomplish before she can crawl into bed and end what has been a hectic and draining day, but the invitation to unwind over a cup of coffee is too good to turn down. She’s been craving companionship, but has been too busy to spend any length of time with her friends. Besides, Tim’s a great guy, respected and well known on campus. A few minutes with him could be just the pick-me-up she needs, and if nothing else, the caffeine will do the trick. An hour later, Susan stumbles into her apartment, weary and slightly dazed. She collapses on her bed, curls into a ball, and sobs: "Tim is such a nice guy. How did this happen? What did T do to lead him on?"
Susan’s experience, unfortunately, is not that unbelievable. Rape is not something that only happens in bad neighborhoods or dark alleys. It is not only on the streets. It is in homes, and schools, good neighborhoods and bad, in the home of the known abuser, or in the home right next door. While some cases do occur in the dimly lit alleyway, that is not the one where most of the crimes are committed. Rape is a part of society and is a crime that every health care professional will have to deal with. Adolescence is an age at which the risk for rape is prevalent, with the highest rates of assault occurring within this age group (Committee on Adolescence, 2001). Knowing how to treat the adolescent rape victim is a key part of a nurse’s commitment to caring. In order to communicate with these young women, however, nurses must first learn, to the best degree possible, what the victims are dealing with and the emotions they are feeling, along with how to examine and treat their physical injuries.
Rape is defined as sexual intercourse that is forced, results in penetration, and entails the use or intended use of “physical force or psychologic coercion” to accomplish (Committee on Adolescence, 2001, p. 1476). This does not only include penetration of the vagina. Sexual assault encompasses “rape and attempted rape (including verbal threats of rape), oral sex, anal sex, the use of foreign objects to penetrate anal or vaginal orifices, and other acts the survivor may describe as sexual assault” (McConkey, Sole, & Holcomb, 2001, Definitions, para. 1).
An Emotional Patient
In order for nurses to truly be able to reach out and communicate with an adolescent victim, they must first understand, to the best of their ability, assuming they have not experienced such a crisis, how the patient is feeling after the attack. After the crisis, whether immediately following it or looking back, patients may have a mix of emotions including shame, anxiety, anger, dissociation, fear, detachment, guilt and a feeling of numbness (Kaysen, Morris, Rizvi & Resick, 2005). Nurses need to realize that not every rape victim is alike. While some come in battered and bruised, there are others who do not show such evident signs of assault. All rape victims should be treated in a nonjudgmental manner with the same sense of compassion and caring, no matter what their physical appearance may be.
Following an attack the victim needs to have an overall feeling of security. Most importantly, she needs to feel believed (Kaysen et al., 2005). Looking back at the traumatic experience, it is easy for an adolescent to begin to question her role in the rape. It is the nurse’s responsibility to discourage the adolescent from questioning herself, not to place blame. Adopting a nonjudgmental demeanor will help in providing the patient with the feeling of security essential for her complete recovery. Nurses must display certain characteristics when attempting to communicate with rape victims. While many of these, such as compassion, sensitivity, caring, and trustworthiness, can be applied to working with any patient, they are especially essential when caring for an adolescent rape victim. Victims of rape and sexual assault are vulnerable and often wonder what it was they did to deserve or encourage such treatment. Caring nurses need to recognize an adolescent is feeling this way, and be able to convincingly reassure the victim that in no way are they at fault or the behavior justified (Committee on Adolescence, 2001). Patients who are blaming themselves are not ready to confide in the nurse and allow open lines of communication. Without this patients will have a much more difficult time beginning the healing process emotionally. While any physical wounds can be treated and healed, emotional injury defeats the mind and spirit, and must be dealt with on a more intimate level, involving communication and time on the part of both the nurse and the patient (Duldt & Pokorny, 1999).
An important part of the nurse’s role when dealing with the adolescent rape victim is to encourage the reporting of the crime. Female adolescent victims are “more likely to delay seeking medical care after rape and sexual assault and are less likely to press charges” (Committee on Adolescence, 2001, p. 1477). Health care professionals are required, by law, to report the sexual assault of adolescents under the age of eighteen (McConkey et al., 2001). It is important to recognize, however, that adolescents may fear judgment or be reluctant to report the crime due to embarrassment. Developing a nonjudgmental attitude and ensuring a safe and confidential environment is essential in helping the victim to see past her fear of reporting and realize the importance. For older adolescents, where reporting may not be a requirement, nurses should know the significance of allowing the patient to decide and accepting her decision. While reporting can be suggested and encouraged, the adolescent should not be criticized for deciding not to, or harassed into doing so. The victim’s decision must be accepted, and the nurse should make every effort to help and support her no matter what the legal outcome.
Communicating with the Rape Patient
When working with a rape victim it is important to know that above all she needs to be believed, and have the support of those around her. In order for communication to be effective the nurse must be able to speak about sexuality, and the violation of it, in a mature and respectful way (Duldt & Pokorny 1999). Every step of the examination should be carefully and clearly explained to the adolescent so she knows what to expect and does not have the additional fear and anxiety of not understanding the exam and treatment protocols. It is important for nurses to know their own level of comfort with these topics, and to realize that any uneasiness they have speaking on such topics should not be displayed, as it will only make the adolescent’s that much worse. Knowing and using the correct protocols and terminology and having knowledge of how to speak openly about sexuality are important to preserving the victim’s dignity and encouraging confiding. With adolescents especially, it is important to ask whether the patient has an individual she trusts and feels comfortable with that she would like present during the interview and examination (McConkey et al., 2001). Having this personal support can greatly influence the patient’s ability to provide important information and make necessary decisions.
Actively listening to a victim’s retelling is imperative (Duldt & Pokorny, 1999). Active listening requires the nurse to listen not only to what is being said, but also to the emotion that is behind it. Listening for how the patient is feeling about what is being disclosed will help the nurse to have a better awareness of the impact of the experience. Nonverbal communication is an important part of active listening. Giving the victim signs, such as a nod of the head, and the occasional encouragement to continue, help the victim to feel as if the nurse truly cares, and gives them an encouraging sense of being understood and believed. Feedback is the final phase of active listening and serves to completely assure the patient that she has been heard and understood. Feedback should not be given in the form of advice. Advice serves to tell an adolescent what to do and takes the control away from the patient. Offering feedback in the form of opinions allows the nurse to guide the patient to an appropriate conclusion, but does not take away the control that is essential for a post rape victim to feel.
Knowing how to establish trust with an adolescent rape victim is the key to successful communication and treatment. Nursing, as a caring profession dedicated to holistic care, has the best opportunity to use therapeutic communication as a tool in treating an adolescent victim. Gaining a patient’s trust through knowing appropriate ways of interacting, knowing how to make the patient feel comfortable and safe, and ensuring confidentiality, is what will ultimately help in empowering the victim to accept and overcome the tragedy that has befallen her. Taking appropriate action to communicate with those unfortunate enough to be violated in such a way is an important step in taking action against the crime.
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