Case Study 2 Marcia is a 26-year-old female-identifying patient who arrives in the emergency department stating that she was sexually assaulted earlier that day. She reports that she had been drinking beer with friends at a barbeque but only had two drinks when she began to feel “woozy and light- headed,” which is not usual for her. She went into the house to lie down and remembers nothing more until she opened her eyes to find a male guest on top of her without any clothing on and her own pants and underwear removed. She states that she has pain in her genital area and that she has not showered or changed her clothing since the assault. She tells the nurse that she is not sure if she wants to file a police report or have evidence collected because she cannot remember what happened and is concerned that no one will believe her. She wants to know if the nurses will be able to tell what happened to her “by looking.” During the assessment, Marcia tells the nurse that she is on an injectable contraception but that she is not sure when her last dose was. She is concerned about sexually transmitted infections and the possibility of pregnancy. She is also worried that her friends will be angry with her if she gets the assailant in trouble. She says that she was driven to the hospital by one of the party hosts who is her friend and is now in the waiting room. She also asks the nurse if what happened to her was her fault because she had been drinking. Responses In cases of acute assault, patients such as Marcia may experience a variety of emotions ranging from distress to defiance, to fear or even panic. Offering therapeutic messages, such as “ You are safe here ,” and “ This was not your fault—you did not deserve this ,” may help her to feel more in control of the situation and less fearful (Stewart et al., 2020). It is also important that Marcia understand her options in terms of proceeding with a forensic examination and/or reporting the incident to law enforcement. Under the VAWA, she can undergo a forensic examination without being required to involve the police (Biden, 2005), however, it is important that the nurse is aware of the local requirements of mandatory reporting. If there is a local sexual assault response team (SART) available, they can help with the next steps. Whether or not the hospital has a local SART, a consultation with a forensic nurse may help Marcia decide what she wants to do in terms of reporting. Forensic nurses are specially trained in the preservation of evidence, injury identification and documentation, and certain aspects of the legal system (International Association of Forensic Nurses, 2022). A forensic nurse can advise Marcia on the processes of the forensic examination and potential reporting, as well as provide information about her options for reporting now and later should she decide to do so. In addition, the forensic nurse may provide important testimony if the case goes to court. It is incumbent upon the nurse to know the regulations pertaining to sexual assault and mandatory reporting in their own state of practice. When the nurse is required by law to advise local law enforcement of the reported assault, the nurse should communicate that information to Marcia very carefully so that she understands the requirement. If the nurse fails to do so, they risk alienating and retraumatizing Marcia.
Questions 1. Marcia is tearful during the assessment and says she is scared of what is going to happen. What kinds of therapeutic messages would be most helpful in this situation? 2. The hospital offers a forensic nursing service. What would be the benefit to Marcia of consulting with a forensic nurse? 3. Marcia decides to proceed with a forensic examination but is not sure if she wants to report the results to the police. What are the nurse’s legal obligations in this case? 4. When the forensic nurse arrives, what can the nurse do to assist and support the forensic nurse while the examination is in progress? 5. How will the nurse document the encounter with Marcia, and what elements will be important to include?
It is important to assure Marcia that the person who performs the examination remains in the room with her for the duration of the examination to ensure that nothing changes from his or her first observation. Finally, the nurse should carefully and completely document any examinations and interactions with Marcia if that is the hospital’s policy. Written documentation should be made immediately after identifying actual or suspected IPV or SA, conveying the relevant information in a brief yet descriptive manner. Although providers and organizations may use a variety of documentation formats, many have standardized the format for all patients to maintain consistency. Regardless of format, documentation should always include the following elements: ● A description of the assault ● Details of any injury ● Any relevant medical history ● Sexual history, including documentation of the sexual acts occurring as part of the assault ● Any history of sexually transmitted infections ● Medication history ● Any relevant social history Specifics of the assault, such as the following, are also important: ● The person who inflicted the assault ● The perpetrator’s conduct and condition ● The health effect on the victim ● Whether weapons (particularly firearms) are available to the perpetrator Documentation of violence should always be as specific as possible. A good way to document this is “A man at the party attacked me.” The best documentation, however, reflects specific details that establish the assailant’s identity and relationship to the patient as well as details of the abuse. For example, “A man, John Smith, who was attending the party I was at, was on top of me on the couch. The party was at 20 Constitution Way, near downtown.”
EliteLearning.com/Social-Work
Book Code: SWFL1825
Page 93
Powered by FlippingBook