Identifying Vulnerable Populations in Abuse

Identifying Vulnerable Populations

• Domestic abuse is endemic, meaning it happens in every society.
• Individuals are targeted for abuse based on vulnerability:
  • Adolescents: Reliance on funding, investment in relationships with potential for children or finances.
  • College students: Reliance on funding, investment in committed relationships.
  • Older adults: Vulnerability due to fixed incomes and physical limitations.

Sexual Assault

• Sexual assault is not gender-specific.
• It includes any unwanted touching or penetration without consent, including forced anal, oral, or genital penetration.
• Over 50% of rapes are committed by intimate partners.
• One in four college students have experienced rape.

Caring for Survivors of Sexual Violence

• Immediate intervention: Assess for injuries and provide emergency care.
• Rape Trauma Nurse:
  • Collects evidence for the "Rape Kit," meticulously documenting the chain of evidence.
• Providing Support:
  • Stay with the survivor (highest risk for suicide).
  • Listen actively and empathetically.
  • Offer emergency contraception.
  • Understand and support the survivor's experience with Rape Trauma Syndrome (PTSD). Consider the potential for long-term triggering.
• Apply the Theory of the Cycle of Violence: This theory helps understand the patterns of abuse and supports effective intervention strategies.

Medicolegal Considerations

• Informed Consent: Obtain valid written consent for:
  • Examinations
  • Photographs of injuries
  • Laboratory tests
  • Release of information
  • Laboratory samples
• Chain of Evidence: Ensure appropriate documentation throughout the evidence-gathering process.

Nursing Assessment

• Subjective Assessment:
  • Gather detailed history of the assault, including acts, activities since the assault.
  • Inquire about the survivor's safety and emotional status assessing for symptoms of injuries.
  • Determine menstrual history, contraceptive methods, and medical history.
• Objective Assessment:
  • General Physical Examination: Assess vital signs, general appearance, and extragenital trauma.
  • Pelvic Examination: (performed by a qualified professional, not nurses)
  • Laboratory Assessment: Conduct baseline STI screening, following strict chain-of-evidence protocols.

Collaborative Management

• Initial Management:
  • Prioritize immediate medical needs (e.g., head injury, hemorrhage, wounds, fractures).
  • Assess the survivor's emotional state.
  • Contact support personnel (e.g., social workers).
  • Do not clean the survivor until all evidence has been collected.

Sexual Assault

• Sexual assault is not gender-specific and includes touching or penetration without consent
• More than 50% of all rapes were by an intimate partner
• 1 out of 4 college students have experienced rape

Vulnerable Populations

• Individuals targeted for abuse can be in vulnerable situations.
• Adolescents are particularly vulnerable due to reliance on funds, investment in committed relationships, and financial dependence
• Older adults are also vulnerable due to fixed income and physical limitations.

Nursing Care for Survivors of Sexual Violence

• Assessment:
  • Subjective:
    • Obtain a history of the assault including details about penetration, ejaculation, extragenital acts, activities after the assault, and safety concerns.
    • Inquire about the survivor's menstrual and contraceptive history.
    • Assess the survivor's emotional state and current symptoms of injuries.
  • Objective:
    • Conduct a general physical examination including vital signs, general appearance, and extragenital trauma.
    • Refer the patient for a pelvic examination.
    • Conduct laboratory assessments to collect evidence and obtain baseline STI screening.
• Care and Action:
  • Assess injuries for immediate intervention.
  • Stay with the survivor as they are at a high risk for suicide.
  • Listen to the survivor's experience.
  • Offer emergency contraception.
  • Understand that survivors may experience Rape Trauma Syndrome (PTSD) which can be triggered for a long time.

Medicolegal Considerations

• Obtain valid written consent for:
  • Examination
  • Photographs of injuries
  • Laboratory tests
  • Release of information
  • Laboratory samples
• Maintain an appropriate "chain of evidence" documentation.

Collaborative Management

• Initial care includes:
  • Treating shock and other urgent medical problems.
  • Assessing the survivor's emotional state.
  • Contacting a support person, such as a social worker.
  • Avoiding cleaning the survivor until evidence is collected.
• Important to emphasize that the pelvic examination is not conducted by the primary nurse.