Sexual Abuse and Assault Care
Key Points
- Sexual assault is any nonconsensual sexual contact or penetration and can occur across all relationship contexts.
- Survivors may show physical, psychologic, or delayed trauma responses.
- SANE/FNE-led care improves forensic quality, survivor support, and legal outcomes.
- Immediate nursing priorities include consent, stabilization, prophylaxis, evidence preservation, and follow-up planning.
Pathophysiology
Sexual assault trauma combines bodily injury risk, infection risk, reproductive risk, and acute stress responses that may evolve into chronic PTSD-spectrum symptoms. Rape trauma syndrome describes staged recovery processes with non-linear progression.
Without timely care, survivors may experience untreated injuries, STI/HIV acquisition, unintended pregnancy, prolonged trauma symptoms, and barriers to legal recourse. Trauma-informed clinical environments reduce retraumatization and improve continuity.
Classification
- Assault type: Penetrative and nonpenetrative nonconsensual sexual acts.
- Trauma phase: Acute, outward adjustment, and resolution trajectories.
- Clinical-response domain: Medical stabilization, forensic evidence, and psychosocial/legal support.
- Prevention domain: STI/HIV prophylaxis, hepatitis prevention, and emergency contraception.
Nursing Assessment
NCLEX Focus
Obtain consent at each step and prioritize safety, dignity, and evidence integrity.
- Assess urgent injuries and clinical stability before forensic workflow.
- Determine timing since assault and eligibility for forensic collection window.
- Screen for language/cultural needs and provide qualified interpretation.
- Obtain consent for exam, evidence collection, photos, prophylaxis, and reporting pathways.
- Evaluate acute psychologic distress, suicidality risk, and safe discharge support.
Nursing Interventions
- Coordinate SANE/FNE evaluation when available.
- Administer guideline-based STI prophylaxis, HIV PEP when indicated, and hepatitis prevention.
- Provide emergency contraception when pregnancy risk exists and test is negative.
- Maintain chain-of-custody and meticulous documentation.
- Arrange follow-up at recommended intervals and connect to counseling/advocacy services.
Consent-Skipping Error
Proceeding with exam or evidence collection without explicit stepwise consent can retraumatize survivors and compromise care integrity.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| hiv-postexposure-prophylaxis | Postassault HIV prevention contexts | Must start rapidly and requires adherence/follow-up support. |
| emergency-contraception | Ulipristal and related contexts | Prevents pregnancy by delaying ovulation; does not terminate established pregnancy. |
Clinical Judgment Application
Clinical Scenario
A survivor presents 36 hours after assault, is fearful of police involvement, and requests only medical treatment.
Recognize Cues: Time-sensitive prophylaxis and evidence options remain available. Analyze Cues: Survivor autonomy over reporting must be respected while preserving options. Prioritize Hypotheses: Priority is consent-based medical and forensic care with trauma-informed support. Generate Solutions: Offer staged consent choices, prophylaxis, emergency contraception, and advocacy resources. Take Action: Provide care without coercion and document preferences. Evaluate Outcomes: Survivor receives timely treatment and retains informed options for next steps.
Related Concepts
- domestic-and-intimate-partner-violence - Sexual violence may occur within IPV.
- psychological-trauma-of-violence-against-women - Longitudinal trauma recovery often requires mental-health support.
- sexually-transmitted-infections - Postassault STI prevention and testing are core components.
- therapeutic-communication - Survivor-centered language improves safety and trust.
- culturally-competent-care - Cultural humility is essential in forensic and crisis care.
Self-Check
- Why is stepwise consent essential in sexual assault nursing care?
- Which interventions are most time-sensitive in the first 72 to 120 hours?
- How can care remain supportive when a survivor declines reporting?