Kelsie Pead and Julie Valentine, College of Nursing
Introduction
Unfortunately, sexual assault (SA) is a highly prevalent problem. In Utah, rape is the only Violent Crime Index offense higher than the national average (Federal Bureau of Investigation, 2013). One in six women report being raped, and one in three women report being sexually assaulted throughout their lifetime (Mitchell & Peterson, 2008). Over the past few years, research on the neurobiology of SA trauma has provided significant information regarding the effect SA has on both memory and consciousness; the release of a variety of hormones directly affects how the brain interprets information, stores memories, and responds both physically and emotionally to SA (Campbell, 2012). Despite the impact this research could have, a retrospective chart review measuring the effects of SA on memory and consciousness has not yet been completed. The purpose of this project was to evaluate the effects of SA on memory and consciousness through a retrospective chart review. This information will aid in providing a greater understanding of the effects SA has on memory and consciousness and, consequently, will benefit all community partners involved in SA cases: forensic nurses, advocates, therapists, law enforcement, prosecution, and victims.
Methodology
To conduct this retrospective chart review, we continued BYU IRB approved study #14196 (“Examining the effects of sexual assault on memory and consciousness: Results from a retrospective study”). We analyzed charts including data from 2011-2013. A mixed method approach was implemented as both quantitative and qualitative data existed. Subjects included patients involved in the retrospective chart review seen by Salt Lake Sexual Assault Nurse Examiners from January 1, 2010 to December 31, 2013. Quantitative data was entered into the SPSS program and included the percent of patients who reported “yes” to whether or not they lost consciousness or awareness during the assault; the percent of patients who reported one “unknown” answer or more during a SA examination when asked about a specific question regarding contact between the patient’s body and the suspect’s body; the percent of patients who reported “unknown” to an entire block of questions related to the actions of a suspect during a SA; the percent of patients who reported “unknown” to all questions related to the contact between the patient’s and suspect’s body; and the percent of patients who reported being asleep and then awakened to being sexually assaulted. Descriptive statistics, chi square analysis, and logistic regression analyses were also completed.
Qualitative data from this retrospective chart review consists of the statements written by forensic nurses after patients were asked whether or not they lost consciousness or awareness. Some statements were written as direct quotes while others are interpretations written by the forensic nurses. These statements were entered into NVIVO10 in order to more effectively organize the qualitative data and identify presenting themes.
Results
Descriptive statistics represent the entire study population. In 45% of cases, victims were between the ages of 17 and 25 years. In 45% of cases, victims had self-disclosed either mental illness or use of psychotropic medications. The mean time between the assault and evidence collection was 22 hours. Strangulation was reported in 12% of cases. Victims reported suspected drug facilitated rape in 18% of cases. The victim or suspect used drugs or alcohol in 60% of cases. In 57% of cases, the perpetrator was an acquaintance. Other relationships between victims and perpetrators included stranger (18%), spouse/partner (9%), unknown (6%), ex-boyfriend (6%), and other (5%). Fifty four percent of patients seen for a forensic examination following SA reported loss of consciousness or awareness. Themes identified in analysis of patients’ statements were loss of consciousness, altered feelings of awareness, memory loss, dissociation, and tonic immobility.
Chi-square tests found significant associations between patient reports of loss of consciousness or awareness and the following variables: prior history of SA before age 14 (p = 0.29), use of drugs prior to SA (p = .002), use of alcohol prior to SA (p = .000), suspected drug-facilitated SA (p = .000), and strangulation (p = .000). The logistic regression model predicted the likelihood of a victim reporting loss of consciousness or awareness in 72% of cases. The remaining 28% demonstrates that some victims experience loss of consciousness or awareness with no connection to included risk factors.
These results were presented to the following audiences: the BYU College of Nursing Scholarly Works Conference in October, 2015; the International Association of Forensic Nurses 2015 Conference; and BYUs President’s Leadership Council 2015.
Discussion: Limitations and Implications
One limitation for this study is that the data was not gathered by interviewing patients, but through a retrospective chart review. Consequently, data was limited by what was written by the SA nurse examiners. These nurse examiners only asked the question, “Did you lose consciousness or awareness?” as written on the state examination forms. They did not specifically ask about memory loss, dissociation, or tonic immobility. It is likely that other patients experienced memory loss, dissociation, or tonic immobility, but it was not recorded by the nurses.
The results of this project hold a wide variety of implications for many professions and include but are not limited to the following: increased awareness of SA victim and suspect demographics; increased community education about SA and victim experiences; increased collaboration between professions regarding treatment and care of SA victims; greater understanding of physiological responses to SA, resulting in improved interview protocol and heightened understanding.
Conclusion
The results of this project add to the growing body of research on the effects SA has on memory and consciousness. Due to the significance of the results, many professions can embrace a greater understanding of the physiological responses to SA, common themes, and predictive variables. This heightened understanding can lead to advances in many all professions that interact with SA victims, including forensic nurses, advocates, therapists, law enforcement, and prosecution.