Ethico-Moral Responsibility Nurse is often the first person the victim sees after the incident, you're in a unique

position to recognize, treat, and advocate for patients who've experienced abuse. Patient should be ushered to a private, quiet, comfortable area. The patient's consent should be obtained before beginning the history and during each phase of the physical examination and collection of evidence. The nurse should explain each step of the examination process to Alissa and Daisy, because it allows the patient some control over her situation. The patient should be reassured of her safety; if at all possible, she should not be left alone. Take general information about the victim, a description of the incident, and a description of the actions the victim has taken since the incident. Ask Alissa if this is their first time reporting the incident. If yes, ask her why it took long to report it. Is there a history of violence and battery in the family? (The home situation; has the child a secure place to return to; How the rape/abuse was discovered; the number of incidents and the date of the last incident.) The questions asked while the history is being taken should not be judgmental, moralistic or opinionated. Be patient, go at the childs pace, dont interrupt his/her train of thought. The dynamics of the sexual abuse in children is generally different from adult abuse. Never restrain or force a frightened, resistant child to complete an exam. Restraint and force are often part of sexual abuse; and if used by those attempting to help, will only heighten the childs fear and anxiety, and worsen the psychological impact of the abuse. They need to be reassured that they are victims and that what has happened was not their fault. Confidentiality should be stressed. All information is carefully recorded in the patient's medical record and/or in a rape evaluation flow sheet (enclosed in rape kits). Because the determination of rape is made in a court of law, the wording of the history should reflect only the patient's report of the incident. The nurse should do everything possible to treat immediate injuries and STIs and prevent HIV transmission, tetanus and Hepatitis B and C. Since Daisy is only three years old, pregnancy is ruled out. Nurses are expected to perform in accordance with nurse practice acts, standards of care, and agency policies. Doing so provides the best prevention of or defense against malpractice claims. Support the clients right to make a decision and to act on their choice.

Legal Responsibility The nurse needs to cooperate with law enforcement officials, gathering evidence that can be used in the prosecution of the rapist.

Evidence should be collected by the nurse in a systematic way, using established terminology and objective methods. Evidence of injury: Trauma to the genital area or other parts of the body should be documented in pictograms or photographs. Clothing: Items of clothing that are torn or that may contain spermatozoa or other bodily fluids. Replacement clothing should be provided to the survivor. Foreign material: Any organic material, like leaves or grass. Hair: Hair can be taken from the victim, either her own or foreign, on the body or genital region. Sperm and seminal fluid: Swabs should be taken from anywhere on the body where penetration occurred (includes vagina, anus, and mouth). All evidence should be documented on a standardized form that can be provided to the survivor and/or transferred to law enforcement with the consent of the survivor. At a minimum, the certificate should include the name and signature of the examiner, the victims name, and the date and time of the examination. Cameras may be used to photograph physical injuries on the body. However, the nurse should fully respect the wishes of those who do not want to be photographed. To give informed consent, the client must be competent, receive full information, understand that information, and consent voluntarily. Since, Daisy is only 4 years old. Her mother, Alissa would be the one to receive the information and sign the consent. Complete documentation is the best evidence that the standard of care received by a client was met. Therefore nurses must ensure their documentation accurately reflects the care given. Philippines has enacted several laws protecting women from violence Anti-Sexual Harassment, Anti-Rape and Rape Victim Assistance and Protection, Anti-Trafficking in Persons, Anti-Violence against Women and Children with Womens and Childrens Desks and Services. RA 7610, known as the Special Protection of Children against Child Abuser exploitation and Discrimination Act and for other purposes mandated the Department of Social Welfare and Development to formulate a comprehensive program against abuse and exploitation. RA 8505, Rape Victim Assistance and Protection Act of 1998 - an act providing assistance and protection for rape victims, establishing for the purpose a rape crisis center in every province and city, authorizing the appropriation of funds therefore, and for other purposes, mandated the DSWD to provide support services to rape victims and their families such as residential service and community-based service and establish linkage with the academe and all NGOs for the necessary support services to rape victims/survivors and their families. The Republic Act 9262 - The Anti-Violence Against Women Act. Republic Act No. 9710 AN ACT PROVIDING FOR THE MAGNA CARTA OF WOMEN Section 9. Protection from Violence Section 42. Protection of Girl-Children

Collaboration and Teamwork As a nurse, act as both the adviser and counsellor for the victim and her family. Contributing to decision making regarding her needs and concern. Identifying a team of professionals and volunteers either within or outside the affected community to work with the victim. (Psychiatrist/Psychologist, therapist, etc.) Identifying safe shelters and witness protection programs for victims and potential victims and family members in need of protection and security. (Bathaluman Crisis Centre Foundation Inc.; National Commission on the Role of Filipino Women (NCRFW), Department of Social Welfare and Development (DSWD), Home for Girls in Cabatuan, Department of Justice (DOJ), and Civil Service Commission (CSC). Refer Alissa and Daisy to the Women's Crisis Center (WCC), provides a supportive and affirming environment in which women who have survived violence can interact with other survivors through group counselling, education programs, recreation activities or skills training. Two-way referral system ensures monitoring of the situation, follow-up of required interventions, case or services and evaluations of Daisys status or familys problem or situation. Coordination/networking with other agency for the conduct of home visitation to families and relatives for their reintegration.

Quality Improvement Identify a team of professionals and community members who are involved in caring for survivors of rape. Convene meeting(s) with medical staff and community members. Create a referral network between the different sectors involved in caring for rape survivors (community, health, security, protection). Identify available resources in the country you are working (drugs, materials, laboratory possibilities), and the relevant national policies and procedures relating to rape (standard treatment protocols, legal procedures, abortion laws, etc.). Develop a situation-specific medical care protocol (rape kits, forensic systematic gathering of data) Train providers on the use of the protocol including what must be documented during an exam for legal purposes. Inter-agency and inter-sectoral co-ordination should be established to ensure comprehensive care for survivors of sexual violence. Be sure to include representatives from social/community services, protection, police/legal justice system, and security. Depending on services available in your setting, others may need to be included. As a multi-sectoral team, establish referral networks, communication systems, coordination mechanisms, and follow-up strategies.