Measuring the aftermath of rape.
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Biomedical subjects
Publications and source records attributed to P DiVasto.
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Students in the health professions are working with a variety of anxiety-provoking patients, such as victims of child abuse or sexual assault, suicidal and terminally ill patients. Faculty have a responsibility to assist these students in maximizing the growth potential of the experience. This study, involving 22 female and three male students at the University of New Mexico Colleges of Nursing and Medicine, examines the effects of such an experience. Each participant worked on a Sexual Assault Response Team at the Bernalillo County Medical Center for an average of 8.6 months; each saw an average of 16 rape victims for whom they provided counseling services and assisted in medical care and gathering evidence. All of the students reported heightened awareness of their own vulnerability. They began to develop cognitive and behavioral strategies to cope with the possibility of being raped. Approximately one third of the subjects developed symptoms similar to those experienced by rape victims. Those who did not develop symptoms attributed it to being able to work through their feelings at team meetings. Students became more aware of their attitudes toward rape victims, both positive and negative. Moreover, the most significant change they experienced was in their own perception of themselves as care givers; they felt more confident and competent, both in medical and counseling areas. Faculty are encouraged to meet weekly with students involved in such experiences.
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Health care for rape victims traditionally has been crisis oriented, focused solely upon the victim, and provided either by a gynecologist or psychiatrist. A family practice health team, working in a county hospital, offered rape victims and their families crisis counseling in the emergency room, and follow-up care in a family practice clinic. Follow-up of victims markedly increased from 8% before initiation of the program to 86% afterward. Family members of more than half of the victims seen on follow-up received treatment. A wide range of health needs of both victims and their families, not identified in the emergency room, was identified on follow-up visits. In this way emergency care of the rape victim often became an entry point into the health care system. Rape must be viewed as a family's as well as victim's health problem, often demanding a broader service than can be offered by a gynecologist or psychiatrist alone.
Despite growing controversy surrounding its use as a "morning after pill," diethylstilbestrol (DES) is prescribed liberally for rape victims. Guidelines for its use in these patients is lacking. Of 150 consecutive rape victims treated at a university medical center, 63 (42 percent) received prescriptions for DES. Of the 55 (87 percent) on whom follow-up was obtained, in 40 (73 percent) there were substantial side effects-nausea or vomiting, or both. At least six (11 percent) did not complete therapy because of these side effects. The authors offer guidelines for use of DES for rape victims and a plan for patient education and follow-up.
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