Date of Award

May 2022

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Lucy Mkandawire-Valhmu

Committee Members

Joshua Mersky, Peninnah Kako, Lynne Woehrle

Keywords

African American, Black Feminist Thought, Intersectionality, retraumatization, secondary victimization, sexual assault

Abstract

Sexual assault (SA) is a public health and human rights problem disproportionately affecting women globally (WHO, 2013). A report conducted by the World Health Organization (2013) indicated that one out of three women globally experience sexual or physical violence. Although sexual assault is widespread, many survivors of SA encounter further traumatic experiences after disclosing experiences of SA and seeking care (Campbell, Wasco, Ahrens, Sefl, & Barns, 2001; Campbell & Raja, 2005; Jackson, Valentine, Woodward, & Pantalone, 2017; Patterson, Pennefather, & Donoghue, 2017). Referred to as secondary victimization (SV), SV has yet to be explored in women’s interactions with nurses across specialties including in acute nursing care. Through this qualitative study, I sought to address this gap by examining the help seeking experiences of African American women following an experience of sexual assault from the perspective of women. I also sought to gain an understanding of the interactions between African American women and the nurses responsible for their care in order to analyze nurses perceptions about provision of care to survivors of sexual assault.In this qualitative study, 30 African American women survivors of sexual assault and 16 nurses were interviewed using in-depth, semi-structured interviews. Most of the participants resided in urban metropolitan areas across the upper Midwest. Using thematic analysis, two themes were identified. The first theme identified focused on the dehumanizing interactions experienced by African American women when receiving healthcare services in a hospital setting following sexual assault. Experiences of dehumanizing included: discrediting, dismissing, shaming, and blaming. To mitigate and/or prevent future interactions of secondary victimization, we present practice, education and policy recommendations for nursing and healthcare more broadly, based on the voices of African American women survivors of sexual assault. The second theme identified is called the 4th step. The 4th step entails the process that allows for safe disclosure for African American women who experience sexual assault. The 4th step included (a.) establishing a relationship, (b.) creating a therapeutic space, (c.) providing non-judgmental care, (d.) ensuring a culture of transparency, (e) standing in solidarity, and (f) communicating empathy. Given that healthcare is integral to the healing of women who experience sexual assault, eliminating barriers for African American women’s access to healthcare is key. This involves addressing systemic oppression to ensure that women feel valued more broadly in society, and at every interaction with the healthcare system. By incorporating anti-oppressive practices, nursing can lead the cultural shift needed to respond to African American women survivors of sexual assault in a way that facilitates healing at the individual, institutional, and societal level. Considering the suffering that African American women have experienced dating back to the time in which enslaved women were brought to the shores of the Americas, and the suffering continued after slavery, sharecropping, and the great migration, it is our responsibility as nurses to ensure that women are cared for to first prevent sexual violence. We thereafter need to support policies that ensure the reinvestment in African American communities that would assure the protection of women and support when sexual violence does occur, to foster healing.

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