Psychiatric Mental Health, part 11: Sexual Assault and Suicidal Patients

by Cathy Parkes July 30, 2021 Updated: August 04, 2021

Content warning: This nursing education video covers sexual assault and suicide.

Full Transcript

Hi, I'm Cathy with Level Up RN. In this video, we are going to talk about the nursing care of victims of sexual assault. We're also going to talk about the nursing care of suicidal patients. If you are new to our channel, be sure to subscribe. We have hundreds of free videos to help you along your journey to becoming a nurse. At the end of this video, I'll be providing a quick little knowledge check to see how well you've picked up on some of the key concepts that I will be covering in this video, so stay tuned for that.

All right. Sexual assault is a crime of violence, not of passion, where sexual contact happens without consent. When we are caring for a patient who's a victim of a sexual assault, there are a number of labs that we're going to want to collect and some of this forensic evidence will require informed consent from the patient before we can collect that evidence. So some of those things include blood, hair samples, genital swabs, anal cultures, as well as scrapings of material from underneath the victim's fingernails. We're also going to want to do STI screening and pregnancy testing as well. In terms of medications that we can provide the patient, we can give them emergency contraceptives. We can give them post-exposure HIV prophylaxis, as well as STI prophylaxis. So we always want to allow the patient to be accompanied by a friend or a trusted person during the exam. Again, we want to make sure informed consent has been obtained before we do that collection of forensic evidence. We want to utilize the services of a sexual assault nurse examiner, if possible, because they are specially trained in these situations. And then afterwards, we're going to want to really follow up with the patient, assess for signs of PTSD, and something called rape trauma syndrome, which we'll be talking about next. And then we want to facilitate referrals to mental health specialists as indicated for the patient.

All right. Now let's talk about rape trauma syndrome. This syndrome describes the psychological, physical, and behavioral reaction of the victim following a sexual assault, and it can be broken down into three phases, which is the acute phase, the outward adjustment phase, and the resolution phase. During the acute phase, there are a wide range of emotions that are possible from the victim. They may include an expressed reaction, like crying and yelling. It may be a controlled reaction, such as the victim may present with a flat affect and be outwardly calm, or they may exhibit shocked disbelief. So they may be disoriented and have difficulty concentrating. After the acute phase, we move into the outward adjustment phase. This is where the individual kind of resumes their normal daily activities but may suffer from a number of symptoms that can include sleeping and eating disturbances, physical pain, phobias, flashbacks, sexual dysfunction, and/or depression. And then, finally, we move into the resolution phase. This is where the sexual assault is no longer the central focus of the victim's life, and then their pain and symptoms decrease over time.

All right. Now let's transition to talking about nursing care of suicidal patients. Let's first talk about some of the risk factors that place an individual at high risk for suicide. I'm not going to go over all the ones on our card here, but I will hit some of the highlights. So having a family history does place an individual at higher risk. If the person is unmarried and single, they're at higher risk. Previous suicide attempts, chronic illness, mental health disorders, substance abuse, and isolation are all risk factors. Job loss, financial difficulties, and access to a firearm are also risk factors. So what are protective factors? What factors exist that help decrease the risk for suicide? This includes access to mental health services as well as family and community support. If the patient has effective coping skills, that's obviously going to decrease their risk of suicide. And then if the patient has religious beliefs that discourage suicide, that is also protective.

In terms of the signs of impending suicide, some of the things I'm going to talk about here are kind of straightforward, more obvious, but some may not be. So if the individual is talking more about death and suicide, that's obviously a red flag. Statements about hopelessness are also suspect. If the individual starts getting their affairs in order, like making a will, that is a clear warning sign that suicide may be impending. Also, if they start giving away their prized possessions to others, that is a warning sign. If their substance use increases, if they become more withdrawn, and if there's a sudden improvement in their mood, and they say things like, "Everything's going to be all right soon," then that red flag should come way up there, and you definitely should suspect that suicide may be on their mind.

Treatment options for a patient who is suicidal can include talk therapy as well as pharmacological interventions such as anti-depressive medications. We also want to do routine screening for our patients to check for suicide ideation and intent to commit suicide. One thing to note, as a patient who is suicidal begins pharmacological therapy, it may result in their depression lifting enough that they are more energized to carry out their suicidal plans, so we're definitely going to want to closely monitor our suicidal patients as they begin pharmacological therapy because of this increased risk as their depression lifts. In terms of nursing care, it is a priority that you ask the patient directly, "Have you thought about harming yourself or killing yourself?" And as a nursing student or a new nurse, it can be a little bit uncomfortable or hard to do this, but you will get used to being very direct with your patients and asking them these things. You'll just get used to it as you get more experience as a nurse.

And then if they say yes, they have thought about harming themselves or killing themselves, then you need to ask them directly about their plan and see if a means to carry out that plan. For example, do they have access to a firearm? If the patient is at risk for suicide, you want to implement one-on-one observation. Someone needs to be watching that patient at all times, and you do not want to assign them to a private room. In addition, you want to place them in a room close to the nurse's station. You want to remove any potentially harmful objects. So this could include belts, shoelaces, and anything sharp. You want to make rounds frequently on your suicidal patient, and you want to do so at irregular intervals. So you don't want the patient to think, "Oh, well, he or she is only going to come by every hour on the hour." You want to kind of change things up so that you are coming by on irregular intervals. And then you want to perform room searches as needed, and you definitely want to search all items brought in from visitors.

Okay. It's time for a quiz. I have three questions, and they are all true, false. First question, collection of forensic evidence following a sexual assault requires informed consent, true or false? The answer is true.

Second question, it is best to assign a patient who is at risk for suicide to a private room to keep things quiet and calm, true or false? False. The patient who is at risk for suicide should not be assigned to a private room.

Question number three, giving away prized possessions is a sign of impending suicide, true or false? The answer is true, in addition, getting your affairs in order, like making a will, is also a potential sign of impending suicide. All right. That's it for this video. I don't know about you guys, but I'm happy to be done with these topics. They're really important topics, so we definitely have to talk about them and cover them in nursing, but I'm anxious to move on to some other material. Take care.

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