NCM 117
DATE RAPE
SEXUAL ASSAULT, DOMESTIC VIOLENCE & NEGLECT
Clinical Instructor: Ms. Alissandra Minoza-Sarvida, RN
●
SEXUAL ASSAULT
Let’s have a quick overview of what assault is. We have discussed
this during the first few weeks of our psychiatric nursing. I know
everyone is knowledgeable of what assault it, but just to define it
once again it is the deliberate threat coupled with apparent
ability to do physical harm to another. It’s also crucial to
remember that for one to accuse somebody of an assault, no actual
contact is necessary.
●
Sexual violence may include attempted or completed rape,
sexual coercion and harassment, sexual contact with force or
threat of force and threat of rape
● Sexual assault may include actions such as fondling or
indecent exposure
○ Even indecent exposure may pose a risk of you being
accused of sexual assault. Those people who are
exhibitionists may/can be accused of sexual assault.
Facts:
● More than half of all victims of sexual crimes, including rape
and sexual assault, are women younger than 25 years old;
often this violence occurs within the context of dating or
acquaintance relationship
○ If I may suppose, all of the ladies here in my class are
all under 25. Let’s just be careful when going on dates
or even just partying.
● Female partner is the likely victim of violence and the male
partner the likely perpetrator; however, underage males can
also be victims
○ It is not uncommon for us to hear news about younger
boys being violated or raped by older men.
RAPE
●
●
●
Defining issue is the lack of consent on the part of the victim
○ So the victim, most likely a woman, of course, is being
violated without her consent. Even if the couple is
married that can still be charged as rape. Legally, this
is our basis, the lack of consent. It has to be consensual
between both parties.
Rape serves nonsexual needs; it is the sexual expression of
power and anger
○ According to studies, they found out that rape in the end
does not look for any sexual needs. But actually, those
that are not sexual.
○ Individuals or men who didn’t have the chance, for the
longest time, to express their power, rage, anger, and
negative extreme feelings, tend to rape a woman or
somebody to express these qualities.
It is motivated more by retaliatory and compensatory motives
than sexual ones
○ This is what I mean by saying rape serves nonsexual
needs. So more on retaliatory (pagpanimaws) or to
compensate for what is lacking of him.
Myths:
● That women must have done something to provoke the rape
often keep women from reporting rapes
○ So women think or even ladies nga probably, they
have dressed indecently that’s why they were raped,
so dili nalang nila ireport since in the end they think
it’s still their fault that they were raped. So that is a
MYTH.
● That men cannot be raped prevent men from reporting rape
○ Actually, even men can report that they are being
raped. The one that I mentioned earlier, the younger
men that are being violated or even raped by older
men. So that is a MYTH, even men can report they
are being raped by somebody else.
● Incarceration increases risk of sexual assault while military
sexual assault is a growing problem
○ Those groups consist mostly of men, especially in
prison or when somebody is incarcerated, we know
that it is a community of men. So, of course, sexual
needs cannot be eliminated from them, so, they tend
to rape somebody else or to just explore their power
or how far they can go with their manhood or
masculinity with their rank in the prison. They
express those feelings or emotions by raping
somebody lower than them or more vulnerable than
them.
●
Although victims may be sexually assaulted after knowingly
ingesting illegal drugs (e.g. marijuana, heroine, cocaine), they
may also be drugged by so-called “date rape drugs”
Two most common drugs: y-hydroxybutyrate and
flunitrazepam (brand name: rohypnol)
○ Flunitrazepam is more common than the other
medication or the other drug.
○ In these medications or drugs, the person becomes
disoriented
and
confused.
Dissociation
and
unconsciousness for several hours may result.
○ Pharmaceuticals recently added a color additive in
Flunitrazepam
■ Most likely, kaning mga bright colors, because
this drug used to be colorless and odorless
when you add it into soda or different kinds or
drinks.
■ Because of the reports about this drug being
used in the wrong way, so the company added
a color additive para makahibaw na ang girls
nga– kanang magdate for the first time,
magmeet ang guy and the lady, and the lady
excuses herself to the bathroom, and then
when she comes back, she’ll drink her soda.
Without her knowing that the soda is being
drugged by the person she is dating with.
Probably, after two hours, maunconscious na
siya, maconfused, madisoriented. Finally, the
guy can do whatever he can do to the woman.
■ Para makahibaw ang women, dapat naay
mga indicators, such as the change in color in
her drinks, or even, naa sad kunoy bag-o
karon nga ang straw from the drink, they’ve
added an indicator if it’s being added with a
drug or another chemical apart from the drink.
Muturn into blue or orange or yellow daw to
ang straw.
○ Memory impairment, a common side effect of the
medication may make it difficult for victims to remember
and identify their perpetrators because in the first place
unconscious naman ang victim, ang woman
Effects of Rape on the Victim
● Rape Trauma Syndrome is a cluster of physical,
emotional, and behavioral stress reactions and symptoms
which most victims experiences (e.g. Shock, Disbelief, and
Dissociation from the event)
● Victims show two main styles of emotion:
1. Expressed:
● As the name implies, it is emotions or feelings
being expressed in this style
● Anger,
● Fear,
● Anxiety,
● Crying,
● Sobbing,
● Restlessness
2. Controlled:
● Masked or hidden,
● It is not uncommon of the patient or the client
to have a flat affect upon conversation,
● Stoic in demeanor; Stoic is manhid, without
feelings, dili ma incorporate, dili congruent
iyang feelings to whatever he or she is saying.
Stoic in demeanor mahimo na shag manhid.
● Some people shut down and inhibit feelings,
they don't even want to talk about it anymore
because of the trauma and great stress or
event it impose to him or her
● Dreams and nightmare are often seen among rape victims
○ This is common among rape victims
Nursing Care of Survivors of Sexual Assault:
● It is important to know before going to emotional or even
mental trauma, we need to be present for the client in case
if they have physical injuries or even just wounds
● Treat physical injuries, protect against STI, offer pregnancy
prevention and emotional support
● Create a safe environment in which victim may express
feelings and regain some sense of choice and control
○ So you cannot gain all of the information that you
need if ever the client himself or herself don’t trust
you first, you have to assure him or her that the
environment is safe, if he or she is safe and it is
actually helpful if he or she will express whatever
emotion, experience, or feelings she or he have
1
●
●
Provide support to family and friends of the victim and direct
them how to support the victim appropriately
○ So when the victim tends to just go home. It’s their
choice to go home or not
○ But if the victim insists on going home, then they
might as well educate the family and friends on how
to support the victim appropriately and not to
discriminate against him or her. Not to tolerate
discrimination from neighbors and from the rest of
the acquaintances.
○ It has to be the family and friends first that has to be
very strong for the victim
Refer to counseling centers
○ We know that counseling is still very helpful and is
one of the solid interventions that we can offer to our
patient.
●
Various triggers; with batterer
minimizing the severity
○ In the tension building, it’s the
battered person that’s trying to
minimize or to belittle the
tension, in the stage 2, the
batterer minimizes the severity
already. Kay ngano man? The
man tries to justify his behaviors
but does not understand what
happens.
○ He minimizes the severity of the
abuse kung pananglitan na hit
na niya, iya nang na sagpa, iya
na
nabunalan,
napatiran,
nasumbagan, he tries to
minimize and justify ngano iya
na nabuhat.
○ On the female side, she might
call for help if she is afraid of
being killed kay mao naman ni
ang serious battering stage and
commonly, this can be seen in
the squatter area.
○ Pwede gyud ni sha nga makit’an
gyud in the eyes of the public, sa
iyang mga neighbors, open to
the public. Mura na ni silag nag
drama nga nag sinagpaanay,
nag sinumbaganay
●
Behavior of batterer changes to loving
and begging for forgiveness; battered
person tries to make up with batterer
Commonly inig kahuman aning
honeymoon stage, mabuo nasad ang
laing anak, ang ika 8 nga anak, ang
ika 9th nga anak.
This is the stage nga ang women, mo
reconcile napud ug balik or
mopasaylo na like mo forgive na siya
because the behavior of the man,
pwede niya sunod sunoron, tries to
make amends, tagaag flowers,
chocolates, saying sorry publicly and
then ang babayi pud, mahug nagyud
ni sha nga magpauto napud ni siya
kay this is just a cycle (it ends with us
chz). It just goes back to stage #1 and
then magtuyok tuyok ragyud ni siya.
So dapat, as women we should know
our worth. If we are battered, if we are
being hitten or even a single sign of
violence or assault, dapat dili gyud na
nato i-tolerate.
Battering
DOMESTIC / INTIMATE PARTNER VIOLENCE
COURTSHIP VIOLENCE
● Courtship/ dating violence appears to begin as early as the
age of 15 or 16 years old
○ As early as the young dating stage. This is the time
where young boys or girls enter into relationships
where violence can already be seen in this stage
○ Typical tactics: slapping, beating, pushing,
threatening with or using weapons
■ If your boyfriend/girlfriend does that to you,
please don’t minimize that. That can be a sign.
■ Gawas ung lambing lang (that is an
exception).
■ If done in a serious manner, you need to be
very vigilant of that because it may grow
stronger, bigger as your relationship
lengthens.
● Recurring and escalating episodes of violence in a
relationship are quite common if the relationship is not
terminated which is termed as Cycle of Violence
○ The repetition of these typical tactics (slapping,
beating, pushing), if you observe your bf/gf doing that
to you, please call their attention or do not tolerate
them.
●
●
Honeymoon
CYCLE OF VIOLENCE STAGES
●
●
Tension Building
●
Batterer escalates and becomes
more controlling
Battered person tries to prevent angry
outbursts of batterer
○ So here let’s assume that the
batterer is the man and the
battered person is the woman/
lady. Assumption according to
reports that most commonly that
batterer is the male and the
battered
person
is
the
female/woman.
○ SHE or the woman tries to be
nurturing and compliant. Tries to
please her husband/boyfriend.
Kanang mu-ingon na, “It’s
alright, what do you want? Do
you want water? Ok, actually
ang katong atong gisturya-an
kanina, it was just nothing. Just
don’t mind it. Nasayop ra kog
sturya.”
○ SHE will try to reconcile or to
prevent further anger or rage of
her husband/boyfriend
○ SHE can blame the external
factors. “It’s not you, it’s the
alcohol that’s talking. It’s not you
as my husband/bf that’s talking.
Maybe you’re just tired, it’s
actually not you.” So in-ana, iya
i-try og minimize while ang
katong man or katong batterer,
tries to control his behavior
already and then verbal and
minor physical abuse may also
increase in this stage and also
here, the man gets really frantic
and more controlling.
This is called the battering stage or
the serious battering incident already.
●
STALKING
●
●
●
●
Stalking is a willful, malicious, and repeated following and
harassing of another person, with fear of violence, resulting
in the victim.
○ Kadtong mga uyab na wala ka tanggap na nag buwag
na sila, they tend to follow everywhere kung aha si
girlfriend kay na siya. He or she keeps on following
and knowing where the activities are na iyang gi
adtoan.
Can vary from seemingly benign acts or efforts at being
reasonable, to hidden, to threatening, and frightening
behaviors.
The aggressor may not want the relationship to end and
cannot tolerate the separation.
○ Hindi niya kaya na magbuwag sila. Example:
“Buwagan diay ko nimo ha, sige i-follow tika
everywhere, you might have another boyfriend nga
gipuli nako. So let’s just try and see kung aha ka kutob.”
Hence, fear of violence resulting in the victim. That can
be called stalking when the victim is starting to feel
violence and fear.
Rage is behind the depression as rejection is an attack on the
ego.
○ Since dili man siya ka tolerate sa separation, the feeling
of rejection on the part of the boyfriend (still referring to
the given example), is like an attack to his ego. It is also
like a compensatory mechanism for him, “Okay ha,
imo diay ko gi ilisan or gibuwagan, sundon tika bisan
asa ka. I will find you and I will know all of your activities
from midnight until noon.”
2
●
He or she feels abandoned, angry, depressed, and he or
she may be suicidal. The individual may feel they cannot
manage on their own.
○ Pwede sad ni na ang person nag stalk nimo kay
suicidal and manipulative. Just stay careful on people
who are very manipulative or if ever mu start na sila ug
stalk nimo because they tend to be manipulative in the
long run. The individual may feel they cannot manage
on their own. Grabe sila ka dependent. That's why
sige silag stalk nimo.
Primary
Prevention
Secondary
Prevention
Tertiary
Prevention
DOMESTIC VIOLENCE/NEGLECT
Nursing
Care
of
Situations
of
●
●
●
●
●
●
●
●
●
Unexplained or frequent injuries or accidents, conflict
stories about injuries, delayed treatment for injuries in
various stages of healing.
○ This is the most common symptom of neglect and
violence. For those who aspire to be ER nurses,
these are common scenarios when clients/patients go
to the emergency department and present
themselves na daghan injury. The nurse would
probably think na “Common naman ni sya na
pasyente, last month mao ni iyang problema, basin
gina abuse ni kay daghang samad. Sa ulo na samad
hapit na maayo, sa hawak fresh pa na wound, sa tiil
daghan kaayong bruises. Those are injuries in various
stages of healing. But the px may state na “Ah
natakag rako sa hagdanan.” As nurses, you tend to
become curious because the injury should be at the
same stages of healing sa tanang wounds. So that’s
what makes you question as a nurse na ngano
daghan samad ang px unya different ang stages of
wound healing.
○ You may also observe cigarette butt na burns sa px.
Pwede na ang perpetrator or aggressor or abuser kay
iyang samad-samaran ang likod or ang paa ba karon
napasoan ba og langsang or flat iron. Those things
are really much a concern for a nurse. Dapat able or
skillful pud ta to identify those things.
Inadequate
hygiene,
inappropriate
dress
and
eating/sleeping disorders
Depression may also be present
STIs, inappropriate (Premature) nursing knowledge on
sexual matters (in relation to STI)
Be alert to the possibility of human trafficking
○ Basin d i noh there is already human trafficking behind
the injury or physical symptoms that the nurse is
seeing.
Report suspicion of child and elder abuse to the appropriate
government agency
○ This is again the duty to warn for us nurses and by
the way we don’t really have to be sure, we don't
have to bring to the authorities huge or heavy
evidences that suspicion enough of a nurse and
somebody from a healthcare team and the action of
reporting it to the appropriate government agency
is quite enough for you to execute your duty to
report or warn. Dili kailangan na daghan mog
ebidensya, according to your nursing knowledge
and clinical assessment to your client
Describe frequency of abuse
Develop a safety plan with critical papers, money, clothing
and other essentials to be set aside for emergency exits
○ Pwede sad ka mo ingon “Okay ma’am and sir it is
the time for you to exit from your relationship, you
have the money, you have all the resources you
need for you to just move on from the relationship
because it is really becoming not healthy for you”.
You may tell that to the patient. It is not really
suggesting but it is more of laying down the choices
and cards in front of your patient
Point out increasingly violent behavior of the relationship
○ Because sometimes man gud they are blinded in
the relationships they are in. In the stages of the
cycle of violence, they dwell more on the
honeymoon stage than on the first and second
stages. So mao ra to highlight nila permi, they tend
to be blinded by the two stages. You, as a nurse
you need to point out and highlight that in the
relationship of your client.
LEVELS OF PREVENTION
Begins with making nonviolence a priority
So educating and informing our
clients
Early case finding and decisive intervention
● If you need to intervene then
intervene
then
begin
your
intervention
Required when the women has been
repeatedly abused; focus is to overcome the
physical and psychological side effect
ABUSE OF CHILDREN AND ELDERLY
Domestic
Violence/Neglect
●
●
●
●
●
●
●
It is the intentional physical infliction of injury by a parent or
caretaker
○ So diri, common man kaayo ang abuse because the
willpower is not enough among children and elderly.
These age groups are very vulnerable.
Types of abuse (4):
○ Bruising
○ Burns
○ Fractures
○ Convulsions
Blue areas - normal, because we can’t isolate the fact they
are lihokan, and we can’t limit and get this from them as
children
○ Location where injuries are expected
○ Naturally-occurring injuries
Orange areas - areas where it is suspicious of child abuse
○ Suspect that something is fishy
○ Covered areas; in the upper portion of the thigh,
these are covered with shorts, the anterior and
posterior part, wounds may be located here
○ Soles of the foot: usually covered with socks or
slippers, the only things you can see there is that
their gait is not proper, mag kindang-kindang
○ Outer portion of the elbow all the way to the hand
○ Scalp: usually opawan or lesions that we can see
in the parietal area (top of the head)
○ Earlobe: kusion ang ears, samaran or sagpaon
○ Eyeballs: periorbital area, dira gyud na ang
wounds (blackeye)
○ Mouth: pwede samaran diri, regardless if the
parents or relatives or where the child lives
○ Biggest area: posterior portion going to the gluteus
area
Behavioral changes may be evident as well
Violent to other children (managpa, manumbag)
Nursing Intervention for Abused Children:
● Objective data does not match stories told by parents.
Dapat naa nay suspicion
● Evidence of past injuries and failure to thrive. Probably
gineglect or giabuse ang bata
● Child cringes when physically approached, seems unduly
afraid. Mahadlok, makuratan, or muigking iapproach sa
nurse
● Provide consistent caregiver
● Learn about childhood growth and development,
expected
behavioral
characteristics,
realistic
expectations. We know the growth and development, the
different milestones that the child needs to undergo at a
certain age and stage according to Jean Piaget. Dili pa lage
ni siya kakuan, small ra lage ni siya sa iyang age or
underweight sa iyang height or BMI.
● Use therapeutic play to express feelings. You cannot
make them sit across you, face to face, eye to eye and let
them tell you what happened because you have to do it
through play. Tagaan ug teddy bear. You make it an
example. Let’s play pretend that you are a teddy bear,
3
●
●
giunsa ka sa imo mama or sa imo papa. Maexpress nila
through play.
Provide emotional support and therapy
Refer family for group therapy or home visits
Nursing Intervention for Abused Elderly:
● It is not uncommon for both the abuser and the abused to
maintain secrecy about the abuse.
● A great deal of time is needed before the abused elder is
comfortable disclosing the mistreatment
When you interview or assess an abused elderly patient,
questions may include:
QUESTIONS:
● “Are you happy living with (name of suspected abuser)”?
● "Please tell me about your financial assets and how they
are managed" so possibly gi abuse na siya because ang
elderly kay pensionada because sa iyang net worth and the
money that she is keeping
● "Whom do you turn to when feeling down?" kinsa imong
ama adtoan sir kung down ka
● "How are family disagreements handled in your
household?" pananglit sir naa moy mga disagreements in
your household unsaon ninyo paghandle o pagsulbad
● "Has anyone hurt you or touched you when you don't want
to be touched?" nana bay nag among-among nimo or
pasakit nimo pananglitan di ka ganahan hikapon di ka
ganahan inanaon ka, nana bay gabuhat nimo ana?
● These questions are really helpful for abused elderly clients
on the case if there is violence even the slightest thing,
pwede na nila ma mention dire
Physical Assessment:
● Decubitus ulcer or bed sores
○ Usually in the bony prominences
○ Not just a sign of neglect but also a sign of poor
nursing management
○ Px in the hospital area confined for a long period of
time, one measurement of how good of a nurse you
are is when your bedridden px does not develop
any bed sores
○ Do passive exercises, change linens
○ Seen in px especially you are community health
nurse, since these px di ma da sa hosp
● Contusions, abrasions, bleeding, distended abdomen,
vaginal lacerations, UTIs, bruises, poor eye contact
(maulaw na makig eye contact kay daghan shag samad or
bruises, no glasses false teeth or hearing aid despite need
(maka ingon kag able raman ta sha, stable ra sya financially
pero ngano wa man sha palitig anchuhos/glasses, posteso
or even hearing aid na kinahanglan man kaayo ni mam or
sir), looks to caregivers for answers (pananglitan ig
interview sa di pa sha mo answer motan aw sha moyango
sha ni caregiver just to confirm sakto ba iyang tubag, pwede
ba sha motubag or dili), physically handicapped,
malnourished or underweight
● Key sign for neglect: Poor grooming
● Highest priority is to balance elder's safety and
autonomy
● Explore options that provide client with increase self-control
● Evaluate the client's coping skills
● Coordinate referrals
● Evaluate possible substance abuse by caregiver so
possibly iya caregiver drug addict, alcoholic, abuser mas
mo grabe noon ang abused because of the influence of
drugs or alcohol
● Evaluate the caregiver's willingness to acknowledge and
work on family problem, as nurses we lay out the choices
of our patients
—–———————————— END —————————————
4