Sexual assault is a world-wide mental and physical health epidemic (Dartnall & Jewkes, 2013) and often results in peri-traumatic symptoms, such as loss of memory, or changes in consciousness or awareness (van der Kalk, 2014). Nurses across the globe treat victims of sexual assault and need to be knowledgeable about peri-traumatic symptoms of sexual assault in order to provide evidenced-based care. The purpose of this presentation is discuss how the care of sexual assault victims can be transformed through improved understanding of the prevalence of peri-traumatic symptoms, and the alterations in brain function that underlie these symptoms (Valentine, Mabey, & Miles, 2016, Wheeler, 2014). The presentation is based on the results and implications of a large retrospective chart review (n=2350) of sexual assault nurse examiner records, exploring the prevalence of peri-traumatic symptoms of sexual assault, and factors associated with vulnerability to them. Background information on the neurobiological mechanisms which produce peri-traumatic symptoms will be discussed, and nursing implications will be explored utilizing a case study. Next steps in improving the care of sexually assaulted will be proposed.
Methods:
A retrospective chart review of 722 sexual assault victims was completed to identify peri-traumatic symptoms from written statements by sexual assault nurse examiners on a chart section inquiring about victims’ reports of loss of consciousness or awareness. Themes related to victims' disclosures of peri-traumatic symptoms were identified from both male and female victims using Nvivo10 software. The emerging themes included loss of consciousness, alteration of awareness, memory loss, tonic immobility, and dissociation from self and/or environment. These themes were then coded as variables in SPSS for analysis of study sample of charts from 2,350 sexual assault victims. Frequencies were calculated for variables measuring peri-traumatic symtoms. These themes were then transferred as variables into SPSS to calculate frequencies. Chi-square tests of association were completed to identify factors associated with loss of memory or change in consciousness or awareness. Logistic regression was conducted on the predictor variables with statistical significance from the Chi-square tests of association. The logistic regression model was especially important to explore if the predictor variables explain all of the occurrence of changes in or loss of consciousness, awareness or memory, or if there might be other factors such as the neurobiological effects of sexual assault trauma that influence changes in or loss of consciousness, awareness or memory.
Results:
The majority of sexual assault victims (54%) who had a forensic examination reported loss of memory, or changes in consciousness or awareness. Themes identified from victims’ statements about loss or change in consciousness or awareness included loss of consciousness, changes in feelings of awareness, memory loss, symptoms of dissociation, and symptoms of tonic immobility. Factors associated with peri-traumatic symptoms of memory impairment and loss of consciousness or awareness identified through Chi-square tests of association were: use of drugs prior to the assault (Χ2 = 9.645, df=1, p=.002); use of alcohol prior to the assault (Χ2= 126.011, df = 1, p= .000); suspected drug facilitated assault (Χ2= 178.246, df = 1, p = .000); strangulation (Χ2= 208.610, df = 2, p= .000); and history of sexual assault prior to age 14 (Χ2= 7.100, df = 2, p = 0.029). The logistic regression model predicted 71.5% of the cases in which victims reported a loss in consciousness or awareness, but failed to classify 28.5% of the cases. These results indicate variables not measured in this study impact victims’ peri-traumatic loss of consciousness or awareness during a sexual assault.
Conclusion: The findings from this study indicate that a significant portion of victims, 28.5%, reporting peri-traumatic symptoms following sexual assault of loss of consciousness and memory loss have these symptoms without the statistically significant predicting variables of use of alcohol or drugs, suspected drug-facilitated assault, and strangulation. We postulate that the victims experience loss of or changes in consciousness and memory loss due to the brain's response to the traumatic event of the rape. Peri-traumatic symptoms have significant consequences for sexual assault victims, including rendering them unable to defend themselves at the time of the attack and difficulties describing the attack to health care providers and law enforcement personnel. Nurses should conduct sexual assault victim interviews and examinations with the knowledge of how peri-traumatic symptoms present, and provide nursing care utilizing trauma-informed approaches that do not further traumatize victims (Substance Abuse and Mental Health Services Administration, 2015). They can act as advocates for victims of sexual assault by improving the process of sexual assault examinations, and educating healthcare providers and community justice system partners about peri-traumatic symptoms of sexual assault. Finally, because sexual assault is a global health issue affecting individuals, families, communities, and nations, nurses must be in the forefront of a world-wide effort to improve the care of victims of sexual assault.