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Approximately 30% of all women have experienced some form of sexual abuse in childhood or adolescence. This abuse may result in serious long-term sequelae for the survivor, such as depression, low self-esteem, post-traumatic stress disorder, and addictive behaviors. Nurse-midwives are uniquely equipped to provide health care to survivors of childhood sexual abuse because of their commitment to thorough, sensitive health education. This article draws on current literature and the clinical experience of a nurse-midwife who has cared for many survivors of sexual abuse. It offers suggestions for incorporating identification of survivors into the initial health assessment. Interventions are reviewed including how to approach the physical examination of a survivor and how to provide appropriate care in the intrapartum and postpartum period. Emphasis is given to the development of a referral network.

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1. Many adolescent victims of sexual abuse display symptoms that reflect alterations in individual coping and thought processes, social isolation and impaired verbal communication, and alterations in spiritual well-being. 2. Nursing interventions based on a multidimensional model of sexual trauma focus on helping the adolescent learn to plan and carry out activities within a safe environment to improve a sense of self, improve interpersonal relationships, and decrease spiritual isolation and hopelessness. 3. Nursing interventions are designed to assist the adolescent to integrate past experiences, including memories and feelings, with current decisions to engage in self-protective and health-promoting behaviors.

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An alarming increase in cases of child abuse compels the nurse to become an active participant in the prevention and early detection of cases of child abuse. Although the Child Care Act, 74 of 1983, imposes a legal duty on nurses to give notification of suspected cases of child abuse, the nurse can play an even greater role by anticipating problems and assisting families to avoid or minimize them. The increased opportunities for nurses to share the responsibility for the prevention of child abuse are challenging.

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Many American women who were sexually abused as children seek mental health services to help them heal from their abuse. An appreciation of the varied sources of trauma that may stem from a sexual abuse experience may guide clinicians in facilitating a meaningful discussion with survivors of the ways in which their childhood development and their current lives have been influenced by their sexual abuse. Therefore, the goal of this study was to provide a beginning delineation of possible sources of trauma in the abuse situation, based on the retrospective reflections of women who have survived abuse. One hundred and eighty-six survivors were asked to identify the most traumatic aspects of their abuse experience. A content analysis was performed on their written responses, and the following eight categories, reflecting different sources of trauma, were identified: abandonment, powerlessness, violence, betrayal, guilt and shame, loss of self, loss of childhood, and impact on sexual adjustment. Possible treatment implications and suggestions for future research are discussed.

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The prevalence and consequences of the sexual victimization of young boys is tragically underestimated. The author provides data on the incidence of sexual abuse in boys and girls, ages 3-10, in an inpatient psychiatric children's unit. A retrospective chart review is presented including variables of coexisting maltreatment and symptomatology. Commonly found nursing diagnoses are identified with appropriate nursing interventions. Assessing a sexually abused boy, developing a comprehensive nursing care plan, and intervening effectively in assisting a child to assimilate and cope with his abuse experience are discussed in depth.

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Nurses play a valuable role in helping victims of child sexual abuse. Through constant reassurance and skilled assistance the victims can realize that they can survive the abuse experience. The nurse wishing to work with this group of patients has an ethical and moral obligation to develop the necessary expertise and clinical competence to ensure that the intervention does not cause further harm and the development of maladaptive behaviour.

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It is estimated that over 6600 children under the age of 16 years are sexually abused each year in England and Wales (NSPCC, 1990). Of these incidents, 78% involve female children and 22% male children. The effects on the child range from self-mutilating behaviour and dissociative disorders to suicide. Consequently, nurses caring for victims of sexual abuse need to be aware of the trauma involved.

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The phenomenological study described in this paper examined the lived experience of adult women survivors of childhood incest. Self-identified incest survivors (N = 5) participated in non-structured, audiotaped interviews. Subsequent transcripts were analyzed by a team of researchers using Heideggerian phenomenology to identify common meanings and themes in the texts. The major findings of the study suggested two constitutive patterns of lived experience among incest survivors: "Remembering As a Coming of What Has Been" and "Care: Reconstituting a Sense of Me."

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The relationships between maternal support and stress response are examined in this study of sexually abused girls, ages 6-12. Study participants included 20 mother-daughter pairs in which the daughter had been sexually abused, and 50 mother-daughter pairs in which the daughter was not known to have been sexually abused. Both groups were convenience samples. When the variables that significantly differentiated between the two groups (abused, nonabused) were held constant, the relationship between maternal support both as perceived by the mothers (Pr = -.58, p < .02) and as perceived by the daughters (Pr = -.68, p < .003) and stress response (as perceived by the mothers) was significant in the abused group and was not significant in the nonabused group. No significant differences were found in the levels of maternal support and stress response between the two groups when controlling for other stressful life events. However, the abused group had significantly higher levels of stress response overall (F [1, 68] = 2774.56, p < .02) and had significantly more (one and a half times as many) stressful life events (M = 15.10, SD = 6.39) than the nonabused group (M = 10.55, SD = 6.39).

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The curriculum revolution might have been born at the University of Detroit in their RN-to-BSN program. Situated in an urban environment where violence is an ever-present problem, the faculty developed an innovative clinical course for senior students, entitled Nursing and Crises Intervention for Victims of Family Violence. The curriculum was designed to respond to a social problem that affects individuals, families, and groups at both physical and psychological levels. It was hoped that creative use of the educational process would promote nursing intervention with a population whose needs have traditionally been unrecognized and unmet by the profession. The response to the course has been very positive and students have applied the content in nontraditional clinical agencies such as shelters for battered women and children, sexual abuse centers, and phone crisis centers. More importantly, these RN students report not only a change in personal attitudes, but an integration and application of their knowledge in their own professional practice. They act as educators to their peers and colleagues while reshaping their own practice in light of their newly acquired sensitivity. By creatively using the nursing curriculum, educators can prepare nurses to deal with many of the social ills affecting individuals, families, and groups. In so doing, they encourage nurses to step into the forefront of health care. They invite nursing practitioners to become proactive rather than reactive. Ultimately, such curriculum creativity will ensure that clients currently ignored or unrecognized by the health care system are identified and treated in a caring fashion by the profession that prides itself on its ability to care.

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This report addresses the integration and application of empowerment support with Orem's methods of helping, which include (1) providing a developmental environment, (2) psychological support, (3) guiding another, and (4) teaching another. Empowerment support is viewed as basic helping methods (supportive psychotherapy) for the psychiatric nurse to use with adult female survivors of childhood incest.

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This report is concerned with the concept of empowerment support as a nursing intervention that facilitates the development of mastery, competence, self-worth, and control in the adult female survivor of childhood incest. Empowerment support has been derived from Orem's theory of nursing system. In that theory, empowerment support is encompassed in particular "methods of helping." Theories and research that relate to incest trauma and empowerment support are discussed from an interdisciplinary perspective.

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The recorded incidence of child abuse is higher than many nurses might imagine, and adult incest survivors often suffer long-term psychological effects. An awareness of the characteristics marking families where abuse takes place can alert nurses to such cases--both past and present.

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1. Although the management of sexually abused children is not new, a comprehensive approach is often lacking, especially as it pertains to dealing with sexually acting-out children. 2. In addition to the usual social work measures of child protection, a program of developmentally and psychoeducationally based interventions supplemented by behavioral techniques were found to be most effective. 3. Acting-out children often provoke reactions of rage, betrayal, and impotence among the staff. Discussions of interventions must take into account the staff's own philosophy about how sexuality should be taught to these children. 4. The treatment team leader must decide whether the sexual acting-out among children is due to active solicitation from sexually abused children, delinquent acting-out, or age-appropriate exploration.

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