A 24-year-old woman who was sexually assaulted went into the emergency room with bloody clothes and yelling for help. She asserted that on her way from a social gathering, she was the victim of an assault by an acquaintance. She looks stressed, with trembling hands, rapid breathing, and a high heart rate. In addition, she exhibits emotional components during this distress, including hypervigilance, withdrawal, and crying as well. Her reply is in synchrony with what her text stands for, wherein the abrupt phase is the reason for the overwhelming grief and the urgent need for help. Given how severe they were, I would include in a category of actions of the nurse by ensuring she is safe, providing her with emotional support, and conducting a full-scale, e-medical evaluation. This includes cleaning any physical wounds and getting the forensic evidence, suggesting the preventive courses of STI treatment, and giving counseling and support service direction.
Effective communication is crucial to patient education and putting it in the context of informed consent. A sexual assault victim must be able to understand their rights, what the examination process is about, and the sanctity of privacy and confidentiality. Initially, the survivor explains the privacy policies for maintaining confidentiality and not disclosing it to anyone (Lynch & Duvall, 2011). I will also tell you who will be allowed to see the information about treatment and diagnostics, and what measures they will take to keep this data safe. Crime statistics dictate the reporting of certain aspects of the crime, and there is a need to inform other health workers in the care setting.
The witness has an idea of the nature of the ruling in advance. This covers exploring each investigation stage, whereby physical evidence, fingerprints, chemical tests, and STD tests are used to solve the circumstances. By clarifying the goal and contribution of each kind of examination, the patient can see their medical options and become more aware of the purpose behind each action. The survivor of sexual assault is also sensitized to informed consent and autonomy being the key features in their decision to accept or decline any portion of the exam or medical procedures (Jae-Woo Oh, 2021). They are instructed that their consent to participate in the examinations is optional and that they have the right to exit the examinations at any moment. This facilitates the involvement level of the victim in the entire decision-making process, and at any time, they ask for clarification or support, which is what is offered. One significant aspect of providing psychological first aid is ensuring that the survivor understands the information and feels empowered to make the crucial decisions for their care.
As Lynch (2011) points out, I am ready to undertake the functions of a Sexual Assault Nurse Examiner (SANE) and provide services to sexual assault victims, which comprise several vital components. Conversely, the first duty is that I have to do a detailed and exhaustive evaluation of the state of her physical and mental health. This involves performing a complete bodily exam to spot injuries, collecting forensic evidence with the proper procedures to maintain the chain of custody, and providing a careful and thorough record of findings. The other aspect of my role necessitates me to care for the victim at their abode by addressing their immediate issues and apprehensions with compassion and trauma-informed care.
Therefore, crisis assistance, emotional support, and notable sources like support groups or counseling could be promoted. I also cooperate with other multidisciplinary team members and law enforcement to ensure a unified response and that the victim’s needs are a significant concern. On the other hand, it happens that the survivor is vital to provide them with information about their rights, the examination process, and treatment options so that they can identify and maintain control throughout the healthcare process (Campbell et al., 2021). Therefore, besides advocating for the rights and needs of survivors in the criminal justice and healthcare systems, I will contribute to facilitating better victim assistance.
When the patient started with the doctor for the first time, she told the doctor that she had been coming home from a social function when her colleague, who was a friend of hers, sexually attacked her. She described how the encounter just made her feel like nothing could be done, and the guilt and horror were sucking from her. The patient believed that she was waking up in a distant area where she was going through the aftermath of a sexual assault because she had been snatched from behind and knocked out immediately before (Jae-Woo Oh, 2021). On recovery, she started the medical examination without any second thought. The patient described herself in the first person mode using a very emotional tone, portraying a high degree of trauma. She explored the issue of justice in handling the attacker’s case, which included concerns for his legal implications and hers, both emotionally and physically.
Assessment of a sexual assault case should consist of a detailed systemic exam from head to toe, along with an in-depth, focused review of systems, which is in alignment with Lynch and Duvall’s (2011) criteria for forensic nursing evaluation. Close inspection of the head and neck unveils bruising, cuts, or petechiae in the form of scalp injury or bruising of the eyes, nose, or neck area. Checking the eye altogether for any trace of damage and redness was essential because such means forced contact or strangulation. The hands must carefully check the chest and abdomen for lumps, such as soreness, bruises, and cuts. If there are any complaints about practice or injury, it is necessary to pay closer attention to the breasts and the sensation associated with the nipple.
Looking closely at the hands, feet, legs, and arms from the next level of the body may indicate bruises, defensive wounds, or other struggles. The justice cannot hold back from the evidence, no matter how brutal. For instance, ensuring that monitoring symptoms or complaints in addition to physical injuries is part of a particular system assessment will be helpful (Gorea, 2020). Headache, dizziness, coughing, breathing, and gut symptom checks are the preliminary steps to this process. In the end, the results of the head-to-toe examination and the review of systems indicate the degree of impact on a physical state and highlight the factors that have played a role in the trauma, hopefully providing us with data on where to direct the next round of assessment and treatment.
As put forward by the set-off points recommended by Lynch and Duvall (2011), it is necessary to conduct a mouth examination to identify whether the survivors have signs of sexual assault. Findings from the oral exam illustrate marks of injuries in the form of bruises, cuts, or abrasions on the lips or gums, tongue, or oral mucosa, which are signs of trauma. Moreover, bodily wounds indicated forced oral intercourse. The final step is to investigate the microscopic and macroscopic injuries or evidence of sexual assault that are marked on the anal and genital exhumation; the medico-legal examination process requires a conscientious procedure. Usually, there were bruises, scrapes, or lacerations around the vagina and anus when looked at externally. It is necessary to be gentle when examining for any sign of forced penetration, which is likely to show as abrasions or a ripped hymen.
To check whether there were no secondary injuries or in case of the necessity to gather forensic evidence, an internal examination (of the body) was required. Our human and social impact examines the significance of our daily actions in shaping our communities and fostering sustainable development. We analyzed the interconnectedness of individual choices with societal outcomes and the positive role of ethics and responsibility in decision-making. This action led to regular use of an optical rectal speculum or a speculum that allows looking at the vaginal canal and cervix. Remarkably accurate details in case of any finding of injuries, foreign materials, or any other evidence could be taken out on record (Doğan et al., 2022). Biological materials- semen was obtained from vaginal and anal swabbing, which was one of the methods for obtaining evidence conducted by forensic experts. To keep the pear pieces intact for presentation to the court, swabs should be collected from any likely site of contact or injury, and they should be treated like other pieces of evidence with chain-of-custody procedures followed.
The proper method of saliva screening for cases of sexual crimes has to be performed with reasonable care and awareness to prevent any possible contamination of the evidence and to follow the rules of forensic nursing, as defined by Lynch. The nurse conversed with the patient for maximum information and compliance, explaining the procedure comprehensively. The labia majora and the clitoral area, in the case of women, were first done. The hypodermic needles are sterilized by performing a saline infusion to moisten cotton-tipped sterile swabs that will be used to sample the respective locations (Jae-Woo Oh, 2021). One breaks up the swabbed regions independently to minimize the chances of cross-contamination and the specific identification of any biological material from the respective area.
Finally, the examiner obtained the samples from the internal genitalia of the female vaginal cavity or cervix in females: The examiner gingerly stretched open the hemispheres using a speculum to observe the cervix and gathered the swab of any parts that were of interest and visible. In addition to throat swabs, other parts that may have met the virus or that were injured, such as the mouth, the anal canal, or the skin’s wounds or abrasions, were included for testing (Campbell et al., 2021). The integrity of the chain of custody and legal proceedings, the use of each swab is absolute. Therefore, it is carefully imprinted with the date, time, location, and the patient’s information. To establish the value and authenticity of the biological evidence gathered by swabbing, the examiner worked in a sterile environment where he quarantined the collected specimen and stuck to the chain of custody rules.
In the sexual assault case, swabs of oral, genital, and anal areas are generally used. Therefore, biological samples can be collected there. Besides that, forensic investigators take down documentation and photographs for visible injuries such as bruises, cuts, or abrasions, as well as head-to-toe examination and genital inspection, which serve as forensic evidence. In this case, the diagnosis included sexual assault trauma, PTSD, and possibly some STIs. Interventions such as wound care, pain relief, and prophylactic antibiotics were implemented to stop the most severe injuries from developing (Gorea, 2020). A psychologist provided crisis intervention, psychotherapy, and psychiatrists and other mental health providers as referrals based on what happened. Consumed immediately are these preventive measures for STIs, either option B for HIV, which is a group of antiretroviral drugs, or antibiotics for common infections.
The survivor was referred to the specific agency to secure survivor access to all-inclusive services and support, such as counseling, sexual assault, supportive groups, and legal representation. Early intervention is part of the evaluation process. Constant monitoring of the psychological and physical symptoms is essential, as well as the proper execution of follow-up examinations and tests to make sure the survivor can function fully in society (Campbell et al., 2021). The discharge plan has short suggestions, reporting choices, a safety plan, information about consistent support services, and comprehensive instructions on follow-up treatment. The advocacy effort encapsulates all the approaches and puts the survivor first. It prioritizes the survivor’s physical and mental well-being and helps them be equipped with the necessary tools and support.
The medication was ordered, and it was given as needed following the assault, including pain relief/and antibiotics in case of potential future infections. To decrease the chance of losing her evidence, she was allowed to shower to make her comfortable and hygienic. To increase the chances of removing any remaining biological elements that may have been retained within the body, the survivor was advised to urinate and defecate (Berishaj et al., 2020). A forensic examination was based on maintaining the strict sanitation of garments worn during probing. Before the jury room, the clothing was exchanged for a uniform, and all details were accounted for, including the warrant for evidence for the court trial. The gift of food and a toothbrush was also given to the encountered agent. However, it is essential to obligate themselves to brush their teeth. All these actions were taken in a manner that diminished the possibility of missing the evidence and improved the living conditions of the survivor. This post-event history demonstrates why it is of utmost importance to be meticulous and dexterous when handling and recording crucial evidence to not only put the perpetrator in the dock but also to guarantee that justice is done to the survivor.
A comprehensive trial in the case of sexual assault involved a 24-year-old female victim who needed immediate medical attention after being molested by a friend. The evidence was collected as instructed and comprised biological samples and injury records within the law. The victim was offered all-around treatment, which included care for her physical wounds, mental health support, and precautions against STDs. To ensure continued help and assistance, we labeled with support service facilities. Moreover, utmost diligence was required for the accuracy and continuity of the guarding process within the evidence-gathering process. However, the victim-centered strategy model was utilized, in which the survivor’s self-determination, well-being, and fair chances of justice were taken to a higher degree of importance. This instance shows the very significance of inter-disciplinary cooperation for addressing the divergent needs of sexual assault survivors at the background of approaches and practices evidence-based and trauma-informed.
Berishaj, K., Boyland, C. M., Reinink, K., & Lynch, V. (2020). Forensic nurse hospitalist: The comprehensive role of the forensic nurse in a hospital setting. Journal of Emergency Nursing, 46(3), 286–293.
Campbell, R., Javorka, M., Gregory, K., Vollinger, L., & Ma, W. (2021). The right to say no: Why adult sexual assault patients decline medical forensic exams and sexual assault kit evidence collection. Journal of Forensic Nursing, 17(1), 3–13.
Doğan, M. B., Eycan, Ö., Yazıcı, A., Gülatar, B., Çapan, M., & Temel, S. M. (2022). Evaluation of teaching a forensic nursing course to undergraduate nursing students’ forensic nursing knowledge. Egyptian Journal of Forensic Sciences, 12(1), 52.
Gorea, R. K. (2020). Forensic nursing in humanitarian forensics. International Journal of Ethics, Trauma & Victimology, 6(02), 1–5.
Lynch, V. & Duvall, J. (2011). Forensic Nursing, 2nd ed. St. Louis: Elsevier/Mosby
Jae-Woo Oh, H. J. (2021). A Study of Between Forensic Nursing Competence, Ethical Decision-Making Confidence, and Nursing Professional Value among Nursing Students. Annals of the Romanian Society for Cell Biology, 846-853.