1. Rape-trauma Syndrome
    1. Definition: forcible perpetration of an act of sexual intercourse on the body of an unwilling person.
    2. Assessment:
      1. Signs of physical trauma - physical findings of entry.
      2. Symptoms of physical trauma - verbatim statements regarding type of sexual attack.
      3. Signs of emotional trauma - tears, hyperventilation, extreme anxiety, withdrawal, selfblame, anger, embarrassment, fears, sleeping and eating disturbances, desire for revenge.
      4. Symptoms of emotional trauma - statements regarding method of force used and threats made.
    3. Analysis/nursing diagnosis: rape-trauma syndrome related to phases of response to rape:
      1. Acute response: volatility, disorganization, disbelief, shock, incoherence, agitated motor activity, nightmares, guilt (should have been able to protect self), phobias (crowds, being alone, sex).
      2. Outward coping: denial and suppression of anxiety and fear (silent rape syndrome), feelings appear controlled.
      3. Integration and resolution: confronts anger with attacker; realistic perspective.
    4. Nursing care plan/implementation in counseling rape victims. Figure below is a summary of self-care decisions a victim faces the first night following a sexual assault.
      1. Overall goals:
        1. Acknowledge feelings.
        2. Face feelings.
        3. Resolve feelings.
        4. Maintain and restore self-respect, dignity, integrity, and self-determination.
      2. Work through issues:
        1. Handle legal matters and police contacts
        2. b. Clarify facts.
        3. Get medical attention if needed.
        4. Notify family and friends.
        5. Understand emotional reaction.
        6. Attend to practical concerns.
        7. Evaluate need for psychiatric consultations.
      3. Acute phase:
        1. Decrease victim’s stress, anxiety, fear.
        2. Seek medical care.
        3. Increase self-confidence and self-esteem.
        4. Identify and accept feelings and needs (to be in control, cared about, to achieve).
        5. Reorient perceptions, feelings, and statements about self.
        6. Help resume normal lifestyle.
      4. Outward coping phase:
        1. Remain available and supportive.
        2. Reflect words, feelings, and thoughts.
        3. Explore real problems.
        4. Explore alternatives regarding contraception, legal issues.
        5. Evaluate response of family and friends to victim and rape.
      5. Integration and resolution phase:
        1. Assist exploration of feelings (anger) regarding attacker.
        2. Explore feelings (guilt and shame) regarding self.
        3. Assist in making own decisions regarding health care.
      6. Maintain confidentiality and neutrality - facilitate person’s own decision.
      7. Search for alternatives to giving advice.
      8. Health teaching:
        1. Explain procedures and services to victim.
        2. Counsel to avoid isolated areas and being helpful to strangers.
        3. Counsel where and how to resist attack (scream, run unless assailant has weapon).
        4. Teach what to do if pregnancy or STD is outcome.

      Victim decisions following a sexual assault. (From the Rape Crisis Services of the YWCA, Greater Harrisburg, Pa.)


    5. Evaluation/outcome criteria: little or no evidence of possible long-term effects of rape (guilt, shame, phobias, denial).