Group 6’s Members:

Leong Yee Leng 99040

Noraini Daud
97519
Nur Atikah Abdul Halim
97523
 INTRODUCTION
• Rape is common form of sexual assault
• Rape or sexual assault, can happen to both
men and women of any age.
• Rape happens when a person has sex that he
or she didn't agree to.
• It includes intercourse in the vagina, anus or
mouth. Sometimes it happens when one
person forces another to have sex.
• It can also happen when the victim can't think
clearly due to drugs or alcohol.
 OBJECTIVES
At the end of this presentation, we should be able:
1. define sexual assault and types of sexual assaults.
2. explain the common effects of sexual assault
3. describe rape; incidence and prevalence of rape.
4. discuss Rape Trauma Syndrome
5. explain roles of nurses & application of nursing
process to victims of rape and sexual assault.
6. appreciate the importance of public education &
community awareness regarding rape and sexual
assault.
 SEXUAL ASSAULT
Sexual assault and abuse is any type of sexual
activity that can be verbal, visual, or anything
that forces a person to join in unwanted
sexual contact or attention you do not agree
to, including:

Inappropriate touching
Vaginal, anal, or oral penetration
Sexual intercourse that you say no to
Rape
Attempted rape
Child molestation

(National Women's Health Information Center)

 Statistics
1 in 6women have been the victim of an
attempted or completed sexual assault and
1 in 10men are sexually assaulted in their
lifetime

(National Institute of Justice and Centers

for Disease Control and Prevention, 1998.).
 Statistics Cont..
-67%of sexual assault survivors knew their assailant.
-47% were assaulted by a friend or acquaintance,
-17% were assaulted by an intimate partner
-3% were assaulted by another relative
(National Crime Victims Survey (NCVS), 2004.)

-Only 38.5% of males and females sexually assaulted

report the victimization to the police
(NCVS, 2004.)
 SEXUAL ASSAULT Cont..
Examples are:
Sexual harassment
- A form of sex discrimination
- Unwelcome sexual advances, requests for
sexual favors, and other verbal or physical
conduct of a sexual nature
- often manifests itself in subtle ways, such as
sexually suggestive comments, unwanted
touching or blatant demand for sexual contact.
(Office of Crime Victims Advocacy)
SEXUAL ASSAULT Cont..
Voyeurism- when someone
watches private sexual acts

Exhibitionism- when someone

exposes him/herself in public

Incest- intercourse or touching

of sexual parts between an
adult family member and a
child or between siblings.

Rape
 What is Rape?
Definition:
- a forcible, degrading, nonconsensual sexual
intercourse accompanied by violence and
intimidation
(Kathy Neeb, 2001)
- a sexual assault: a forcible, degrading and
humiliating act. It is a sexual intercourse by
force, without consent of the partner.
(Waughfield, 2002)
 STATISTICS OF RAPE CASE IN
MALAYSIA
States 2000 2001 2002 2003 2004 2005 2006

Perils 12 10 13 11 21 26 28
Kedah 110 123 132 119 127 163 21

Penang 61 75 73 70 89 71 115
Perak 91 79 100 118 121 148 183
Selangor 216 269 253 280 289 368 421

K/Lumpur 67 97 120 77 116 111 142

N/Sembilan 59 82 62 69 89 97 103

Melaka 43 43 57 67 100 77 125

Johor 194 234 235 312 323 324 343

Pahang 74 79 79 70 105 84 143

Terengganu 48 48 45 38 58 99 127

Kelantan 52 74 70 66 82 90 152
Sabah 109 94 115 111 149 156 199

Sarawak 81 79 77 71 94 117 129

Total 1,217 1,386 1,431 1479 1,760 1,931 2,431

Source: Polis di Raja Malaysia, 2007

 Types of rape
Rape, can be categorized by
reference :

to the situation in which it

occurs
the sex or characteristics of
the victim and/or
the sex or characteristics of
the perpetrator.
 Types of rape cont..
Date rape
Date rape (acquaintance rape) is a rape
committed by someone who knows the victim

It can occur between two people who know one

another usually in social situations, dating as a
couple and have had consensual sex in the
past, starting to date, between friends, and
between acquaintances

include rapes of co-workers, schoolmates,

friends, and other acquaintances.
Types of Rape cont..
Spousal rape
• Is rape between a married
• also known as spouse, marital rape,
wife rape or husband rape, partner
rape or intimate partner sexual
assault (IPSA)
 Types of Rape cont..
Drug facilitated rape
- drugs or alcohol are used to
compromise an individual's
ability to consent to sexual activity
- often used in order to minimize the
resistance and memory of the
victim
 Types of Rape cont..
Gang rape
- occurs when a group of people participate in
the rape of a single victim

Prison rape
- These rapes are virtually always homosexual in
nature (since prisons are separated by sex).
War rape- rapes in war are often
systematic and thorough, and
military leaders may actually
encourage their soldiers
to rape civilians.
(http://en.wikipedia.org/wiki/Types_of_rape)
Date/Acquaintance Rape
Factors
Media.
Peer Pressure.
Lack of respect for
others.
Lack of self control
due to alcohol or
drug use.
False expectations
 When They Happened ?
• Four out of ten sexual • 24% occur between midnight
and 6am.
assaults occur at the • 33% take place between
victim’s own home. 6am and 6pm.
• Two in ten occur at the • Girls between the ages of 16
to 19 are four more times
home of a friend, likely than the general
neighbor or relative. population to be victims of
rape, attempted rape or
• About one in 12 rapes sexual assault.
occurs in a parking • 80% of all rape victims are
garage. under the age of 30.

• 43% of rapes occur

between 6pm and
midnight.
 EFFECTS ON VICTIMS
Psychological Effects
Feeling scared and panicky even having panic
attacks
Insomnia, nightmares, irritability and anger
Addictions to drugs or alcohol
Low confidence, low self-esteem, development of
depression or an eating disorder.

Sexual Effects:
There is sometimes a decrease in sexual activity
Sufferers occasionally stop having sexual
intercourse altogether
An individual can encounter problems getting
aroused or pain during sexual intercourse
Any sexual activity can bring back terrifying
memories to the sufferer
 EFFECTS ON VICTIMS
Physical Effects:
Chronic stomach pains, more intense menstrual
cramps, pain during intercourse
Headaches, migraines and all round aches and
body pains

Emotional Effects:
Denying the horrifying event to themselves and
others, avoiding talking about particular situations
Unintentional repetitions of the assault through
memories or nightmares forces victims to
experience their horror again.
 Rape Trauma Syndrome
• Rape Trauma Syndrome is a common
reaction to a rape or sexual assault. It is the
human reaction to an unnatural or extreme
event.

• There are three phases to Rape Trauma

Syndrome:

1. Acute phase
2. Adjustment phase
3. Resolution phase
 Acute Phase
Immediately after the assault and lasts a few
days to several weeks. They typically fall into
three categories of reactions:

Expressed
They appear agitated or hysterical, suffer from
crying spells or anxiety attacks.
Controlled
Be without emotion and acts as if "nothing
happened" and "everything is fine." This
appearance of calm may be shock.
Shocked Disbelief
They reacts with a strong sense of
disorientation. Maybe have difficulty
concentrating, making decisions, or doing
everyday tasks. Also have poor recall of the
assault.
 Adjustment Phase
During this phase the individual resumes what appears to
"normal” life. There are five primary coping techniques:
Minimization
Pretends that "everything is fine" or that "it could have been
worse."
Dramatization
Cannot stop talking about the assault and it is what dominates
their life and identity.
Suppression
Refuses to discuss
Explanation
Analyzes what happened- what the individual did, what the rapist
was thinking/feeling.
Flight
Tries to escape the pain (moving, changing jobs, changing
appearance, changing relationships, etc.).
 Resolution Phase
During this phase the assault is no longer the
central focus of the individual's life.

While he or she may recognize that he or she

will never forget the assault; the pain and
negative outcomes lessen over time.

Often the individual will begin to accept the

rape as part of his or her life and chooses to
move on.
(Rape, Abuse and Incest National Network)
Preventing Sexual Attacks
Look out for your friends
Stay in Groups
Never be alone with someone you don’t
know
Never leave your beverage unattended
Decide what your limits are and
communicate them clearly
Learn to be assertive
Do not assume anything
Preventing Sexual Attacks
cont..
Know who you are going to be with and where
you are going to be.
Know if drugs and alcohol are going to be
readily available and avoid them.
Recognize warning signs of potential abuse.
Avoid controlling and dominating people.
Be Assertive; When you say NO, Mean It!
Trust your instincts, if you suspect something
is not right, it probably isn’t.
Alcohol + Drugs = Date
Rape
Date Rape Drugs Prevention
Date Rape Prevention
*Don’t leave drinks unattended
*Don’t accept open containers at parties
*Avoid Party Punches or Party Bongs
*Be aware of what might be in Jell-O Shots
*Have a Back Up Plan if you are in a potentially
dangerous situation
*Accept drinks only from bartenders or servers
and watch them open it
 Survival Tactics
• Stay calm and think.
• Stay “no” strongly.
• Shout “Stop, this is rape.”
• Assess the situation.
Assa
• Act quickly. ult
• Ask yourself, “Is it safe to
resist?”
• If attacker is unarmed, weigh
your options
• If attacker is armed, submit.
Management
 Psychotherapeutic
management of patient
Built nurse-patient relationship
The rape @ sexual-assault victim needs
continual empathy and support
The best approach in collecting evidence
and providing nursing care is to move
slowly and supportively, and to give
rationales for each procedures.
The victims needs to be assessed for and
helped with any new problems, such as
anxiety, excessive anger and guilt,
depression, acting out, isolation and etc.
They more likely to attempt suicide.
Longer-term counseling is a necessity and
hospitalization may become essential
Psychopharmacology
-althought rarely
prescribed to victims, it
Benzodiazepin work to reduce anxiety.
es -also privide for sleep
-may be used on
temporary basis

-Taken at bedtime
alternatively.
-especially Trazone, may
Antidepressan
be ordered if
t
symptomps of depression
exist with a sleep
disturbance
 Milieu Management
Referral can be made to a rape support
group, which encourages:
-expressing anger
-overcoming guilt and shame
-building self-esteem and trust
-assisting in regaining control of one’s life
-sense of safety.
Support groups are sometimes available for
relatives, especially partners of rape victims
Help them deal with the trauma, the
stereotyping and myths, and the changes
occurring in the victim and themselves.
How the Nurses Can Help the
Victim ?
Let victims make
decisions
Listen with
patience
Active Listening
Provide victims
with information
and referral
 Role of The Nurses
Obtain information about the
victim’s pertinent health history
and the crime.
Assess psychological functioning
sufficiently to determine whether
the victim is suicidal and is
oriented to person, place, and
time.
Perform a physical examination to
inspect and evaluate the body of
the victim (not a routine physical
exam).
 Role of The Nurses cont..
Collect and preserve all evidence and document
findings.
Collect urine and blood samples for analysis
Treat and/or refer the victim for medical
treatment (minor injuries such as minor cuts and
abrasions, but further evaluation and care of
serious trauma is referred to a designated
medical facility or physician).
Provide the victim with prophylactic medications
for the prevention of sexually transmitted
diseases (STDs) and other care needed as a
result of the crime.
Role of The Nurses cont..
Provide the victim with referrals for medical and
psychological care and support.
Promote informed decisions on police reporting
by helping victims understand what will occur if
they choose to report the crime.
Explain the criminal law and physical behaviors
that define rape and criminal sexual activity.
Explain the need to collect forensic evidence
from victims’ bodies to provide valuable
information to aide in prosecuting a crime.
Provide support during the examination process.
 NURSING CARE…
ASSESSMENT
Physical assessment
 evidence of trauma ( laceration,
contusion)
 vaginal, oral, anal examination with
victim permission (in rape
case)
Mental State
assess for cognitive, behavioral, and
affective changes.
Spiritual State
related to feelings of guilt and
sinfulness.
Family Response
 NURSING DIAGNOSIS
DSM-IV and NANDA both proposed either Post-traumatic Stress Disorder,
Acute Stress Disorder and Rape Trauma Syndrome as the most
appropriate nursing diagnosis.

• Rape Trauma Syndrome related to rape evidence by emotional

reactions, physical trauma, genitourinary trauma, and spiritual
distress.

INTERVENTION RATIONALE

- Approach in consistent - allows development of

and non-threatening trust & decrease client’s
manner. anxiety and fear.
- trust relationship with

- Delay questions about nurse helps client

details of the attack until express feelings in
trust established. supportive environment.
• Risk for injury or trauma related to violent
physical and sexual assault.
INTERVENTION RATIONALE

-Provide physical care to treat -Promotes recovery from

injuries, prevent pregnancy, traumatic injuries.
and treat infection.
-Ensure accurate evidence -tohelp apprehension &
collection. conviction of assailant.

Risk for infection related to sexual assault.

-Giveclear and concise -Assessment and prompt
explanation about procedures interventions reduce course of
and their rationale. infection.

-Givespecific, written directions -The client most likely did not

regarding follow up medical hear or misinterpret
appointments and information given.
administrations.
 …SUMMARY OF NURSING
INTERVENTIONS
• Promote client’s safety

• Help client cope with stress and emotions.

- Increase client’s contact with reality.
- Teach deep breathing and relaxation technique.

• Help promote client’s self esteem.

- Refer client as ‘survivor’ rather than ‘victim’.
- Give list of people & activities in community for
client to seek help when needed.
What To Do If You Are Sexually Assaulted

•Get to a safe place. Report the

attack to a staff member.

•Request immediate medical

attention. You may have serious
injuries and can expose you to
sexually transmitted diseases.

•Do not shower, brush your

teeth, use the restroom, or
change your clothes. You may
destroy important evidence
What To Do If You Are Sexually
Assaulted
• Seek the support
(trusted friend, family
member)

• Seek professional help

with a trained crisis
specialist

• They can help you sort out

your thoughts and feelings
STANDARD PROCEDURE
• Lodge a police report.
• Go to the hospital - accompanied with a
policewoman.
To determine the truth of report made
To obtain specimens for evidence.
• Assigned to a social group support or protected
under police surveillance depending on
presence of threat.
OR
• Went to hospital for treatment  detected to
be victim of rape @ sexual assaults.
(especially if <16 years old)
• Doctors make a report and case is further
investigated by police.
 Where to go??
• POLICE
IPK Kota Bharu
09-7455622

• HOSPITALS
Hospital Kota Bharu
 09-748 5533

Hospital Universiti Sains Malaysia

09-7663000

• Call your nearest trusted friend.

Case Study
 Case study (Rape)
Doreen, a graduate student at the local
university, was brought to the hospital by
the police who found her running down
the street half- clothed. In the hospital
she was able to tell the staff she had
been raped by her date, Mike, another
graduate student. She exhibited outward
calmness but kept repeating “ This cannot
have happened to me. My fiends introduced
us and he seemed so nice.” She was
unable to decide who to call to take her
back to the dorm or what to tell her
friends about what happened.
 Nursing assessment
• before assessment, client must be informed of their rights:
1. A rape crisis advocate present in the emergency department
2. Their personal physician notified
3. Privacy during the assessment and treatment process.
4. Family, friends, or an advocate present during the questioning
and examination.
5. Confidentiality maintained by all members of the staff.
6. Gentle and sensitive treatment
7. Detailed explanations of, and giving consent for, all tests and
procedures, including photographs.
8. Referrals for follow-up treatment and counseling.
 Physical assessment of the
Rape Victim
Head:
Evidence of trauma Abdomen:
Facial bruises Bruises or wounds
Facial fractures Evidence of internal injuries
Eyes: swollen, bruised, hemorrhages
Skin: Others:
Bruises Have physical injuries such as scratch
Genital Trauma Bruises and cuts been recorded and
Rectal Trauma Photographed?
Musculoskeletal:
Has genital trauma been recorded and
Fractures of the ribs
Photographed?
Fractures of the arm/legs Has the clothing been preserved?
Dislocated joints
Impaired mobility
 Nursing Diagnosis
• Trauma related to Rape trauma syndrome, post-
rape emotional and physical disturbance
evidenced by patient condition.
• Anxiety related to rape trauma evidence by
patient unable to express herself through verbal.
• Mood disturbance related to post trauma
evidence by patient emotional changes.
• Potential of sexual dysfunction related to post
trauma .
 Nursing planning and intervention

• Provide a written
Nursing Intervention Rationale
list of referrals of
Help client indentify Focusing on immediate problems lessens
community
immediate concerns and resources before
the client’s confusion and the client
feeling of
prioritize them. being overwhelmed.
are discharged from the emergency
department. perceive Crisisinput,intervention
Give them ample time to anxiety will decrease their ability to
respond to simple thereby slowing down their
counseling can
questions help
response time.minimize the

longthe
Encourage –term
client to emotional impact
many client will have of need
compulsive rape.to
talk about the rape recount the assault

Listen patiently and understanding that compulsive retelling is a

supportively natural way by which the victim is
gradually desensitized to the trauma.
Nursing intervention Rationale

Identify specific coping behaviors Recognizing that their behavior was

client used during the rape such as an adaptive mechanism for survival
screaming, fighting, talking, will raise self-esteem and decrease
blacking out or remaining passive. their feelings of guilt.

Emphasize that survival is the most

important outcome.

Help client identify immediate Focusing on immediate problems

concerns and prioritize them. lessens the client’s confusion use
the problem-solving process
Discuss beliefs about postcoital
contraception and abortion if
appropriate.

Help client to identify who tell about Help them take advantage of
the rape. available support system.
 Evaluation
• Control over remembering: can elect to recall or not
recall the rape; decrease flashbacks and nightmares.
• After tolerance: feelings can be felt, named, and
endured without overwhelming arousal or numbing.
• Symptom mastery: anxiety, fear, depression, and
sexual problems have decreased and are more
tolerable.
• Reconnection: increased ability to trust and attach to
others.
• Meaning : has discovered some tolerable meaning to
the trauma and to self as a trauma survivor; feels
empowered.
 Conclusion
• A person who is raped or sexually assaulted in either way
suffers emotional and physical trauma.

• Thus, each of us can play an important role by educating our

family members, our colleagues and people we interact with.

• Men and women must treat each other with respect and
women should not be treated as subordinates because no one
has the right to be sexually assaulted or to perform one.

• Victims may need help in overcoming difficulties in sleeping

or eating, relationship problems, lowered self-esteem, and
depression.

• The goals of recovery from rape and sexual assault are the
same as for all victims of crime. In addition, these victims
need to develop or regain healthy sexual functioning and
relationship.
 References
• Keltner. N.L, Schwecke. L.H and Bostrom. C.E (1997) psychiatric Nursing, (5th
Edition), Mosby
• WILSON.KNEISL; Psychiatric Nursing (Fifth Edition); Addison Wesley;
ISBN 0-8053-9408-7
• Neeb, K. (2001). Fundamentals of Mental Health Nursing. 2nd ed.
Philadelphia: F.A. Davis
• Waughfield, C.G. (2002). Mental Health Concepts. 5th ed, Delmar
• http://www.scarleteen.com/article/crisis/dealing_with_rape
• http://www3.interscience.wiley.com/journal/119177631/abstract?
CRETRY=1&SRETRY=0
• books.google.com.my/books?isbn=0521552079...
• http://www.google.com.my/search?hl=en&source=hp&q=rape+victims-
psychological+treatment&btnG=Google+Search&meta=&aq=o&oq=
 References cont..
• WILSON.KNEISL; Psychiatric Nursing ;Fifth Edition; Addison
Wesley; ISBN 0-8053-9408-7
• National Women's Health Information Center, Sexual assault, 16 Julai
2009- last updated, http://womenshealth.gov/faq/sexual-assault.cfm
• http://en.wikipedia.org/wiki/Types_of_rape
• http://kidshealth.org/teen/safety/safebasics/rape_what_to_do.html
• Office of Crime Victims Advocacy,
http://www.commerce.wa.gov/site/261/default.aspx
• Rape,Abuse and Incest National Network, http://www.rainn.org/get-
information/effects-of-sexual-assault/rape-trauma-syndrome
QUESTIONS
&
ANSWERS
SESSION