Experiences of Dehumanizing: Examining Secondary Victimization Within the Nurse-Patient Relationship Among African American Women Survivors of Sexual Assault in the Upper Midwest

Abstract

Despite calls recognizing the need for culturally sensitive responses to minimize the occurrence of secondary victimization for African American women following an experience of sexual assault, few studies have focused on hearing from African American women survivors about their experiences receiving healthcare services in a hospital setting following sexual assault. Employing critical ethnography as our methodology and using intersectionality theory as a lens, we centered the voices of African American women survivors about their experiences receiving nursing care in urban acute care or hospital settings in the Upper Midwest of the United States following sexual assault. In this qualitative study, 30 African American women survivors were interviewed using in-depth, semi-structured interviews about their post-sexual assault care. Interviews were analyzed using thematic analysis. An important theme identified focused on survivors’ experiences of dehumanization when receiving healthcare services following sexual assault. These experiences included: discrediting, dismissing, shaming, and blaming. To mitigate and prevent secondary victimization in the future, we present practice and education change recommendations for nurses, and healthcare providers more broadly, based on the voices of African American female survivors of sexual assault.

African American¹ women are disproportionately affected by sexual violence (Campbell et al., 2003; Campbell, 2005; Campbell & Raja, 2005; Johnson & West, 2013). Over 20% of African American women are sexually assaulted throughout their lifetime (DuMonthier et al., 2020). Given the reality of racism, in addition to gender bias (Jackson et al., 2017), African American women may be especially vulnerable to secondary victimization (SV), or retraumatizing interactions that lead to a recollection of sensations or interpersonal dynamics experienced during sexual assault (SA). Leading scholars and advocates call for more culturally sensitive responses during post-assault care specifically for African American women in an effort to minimize SV (Campbell & Raja, 2005; West & Johnson, 2013). There is limited literature about African American women’s experiences accessing healthcare services in a hospital setting after SA. By hearing from African American women survivors of SA and their experiences of accessing healthcare services after experiences of SA, we can better understand and develop policies to mitigate and prevent SV. SV differs from secondary trauma or vicarious trauma, as this refers to emotional duress of those responding to people that have experienced trauma directly (Bhagwagar, 2022). In this manuscript, we examine the help seeking experiences of African American women following an experience of SA from their perspective. Based on the voices of African American women survivors of SA, we present health intervention recommendations for consideration to address their concerns. Although this study is focused on African American women survivors’ interactions with nurses, many of the women interviewed spoke about healthcare provider interactions in general after disclosing SA. The findings of this manuscript are therefore pertinent to not just nurses, but healthcare providers more broadly.

Intersectionality

Our study was informed by intersectionality theory, which is rooted in Black feminist thought. Intersectionality as a concept, lens, and methodology has been used around the world by a number of different social movements (such as the #MeToo movement) and collectives (such as the Combahee River Collective). As a concept, intersectionality rejects traditional single-axis analysis frameworks that fail to recognize the interconnectedness between the ways in which individuals and collectives hold unique and multidimensional social positions. For example, a gender-only framework may recognize the violence perpetuated as a result of patriarchal hierarchies, but fails to consider how violence perpetuated by patriarchy is also perpetuated by other social order hierarchies (i.e., racism, classism, etc.). This single axis analysis approach makes invisible the ways the cross-cutting relationships in a system of oppression support and amplify each. Instead, by recognizing the interconnectedness of multiple systems of oppression within the matrix of domination (Collins, 1998), constructed binaries traditionally viewed as separate (such as gender and race) can begin to be deconstructed.

As Patricia Collins (2017) explains, “Neither race- nor gender-only approaches adequately explain African American women’s experiences with violence, because African American women’s experiences with violence cannot be recast within the guiding assumptions of either approach” (p. 918). Thus, an intersectional lens is essential to understanding the ways in which various forms of violence, such as SA, have been used to advance multiple systems of oppression (Collins, 1998).

Intersectionality is also a methodology that enables scholars to analyze the ways in which multiple systems of oppression mutually interconnect to create and perpetuate oppression within the gestalt of societies globally (Collins & Bilge, 2016; Davis, 1981). It thus unlocks our understanding of a social system that legitimates sexual violence and stereotypes that underpin sexual violence (Kaplan, 2017). For example, African American women have historically been cast as illegitimate victims of SA by racist, classist, and sexist systems simultaneously. These oppressive realities have contributed to stereotypical sexual scripts used to justify the sexual violence inflicted upon African American women (Collins, 1998; Kaplan 2017). This resultant acceptability of victim-blaming and devaluation of African American women’s bodies has served to hinder their access to healthcare and other services following SA. This history informs present day dynamics in accessing healthcare following SA for African American women. For instance, within the literature, the likelihood of receiving unfair or unequal treatment after disclosing SA for ethnic minority women is described as a “double stigma” (Alvidrez et al., 2011; Munroe, 2015). This stigma includes stigma that one may face in relation to disclosing sexual assault itself, and then the stigma associated with being of minority status. As a result, many Black women may turn to informal supports to seek help (Finfgeld-Connett, 2015; West et al., 2014). Disclosure to informal social supports has a great impact on whether or not survivors decide to seek healthcare services (Paul & Sasson, 2013) that they may need for treatment of any related injuries, emergency contraception or other urgently needed follow-up care.

Interconnectedness of Racism, Classism, & Sexism

The perpetuation and acceptability of SA committed against African American women is foundational to the formation of the United States given that African American women were forced into chattel slavery for nearly 400 years (The Black Women’s Truth Commissioner Report, 2016). One of America’s first laws, a 1662 Virginia statute, codified children fathered by White men and born to enslaved women as slaves. This law, coupled with the 1807 Act Prohibiting Importation of Slaves into the United States, resulted in slave owners’ desire to maintain their affluence by sexually assaulting enslaved women or “breeding” them with male slaves (The Black Women’s Truth Commissioner Report, 2016).

Concomitantly, African American women were intentionally excluded from legal definitions of SA. During the Antebellum period (1832–1860), protection from SA under the law was solely provided to persons who were White (Stone, 2009). At this time, the protection of White womanhood represented protection of the White race and required submission of one’s genealogy to prove one’s worthiness of such protection (Stone, 2009). This was justified through White supremacist ideologies, in which the White race was viewed as superior, and African American people were seen as less human (Bardaglio, 1994). The SA of enslaved African American women served to benefit White enslavers in terms of expanding labor and exerting further social control over enslaved communities (Bardaglio, 1994). These brutalities against enslaved African women and girls occurred at a time in which White citizens were developing independence as a nation, while simultaneously “proliferating an extortionist project which annihilated indigenous lives, colonized and extracted natural resources, and enslaved, coerced and forcibly bred African human beings” (The Black Women’s Truth and Reconciliation Commission Report, 2016, p. 6).

Following the end of slavery, African American women continued to be denied protection from SA, based on race, class, and gender. The Black Codes, or the Black Laws, in the 1860’s attempted to limit African American capacity for economic mobility, while also denying African Americans full citizenship (Feimster, 2009). This meant little protection under the law was available and provided to African American women who experienced SA. Although slavery had ended, there was an increase in violence, often sexualized, committed by White men in support of White supremacy that challenged African Americans’ access to full citizenship (Feimster, 2009; The Black Women’s Truth and Reconciliation Commission Report, 2016).

This history, which deemed African American women as unrapeable, reverberates in our present-day context. Expanding police services as an intervention for SA in response to anti-rape movements is particularly problematic as these are the same institutions that have “historically assaulted rather than protected African American women” (Freedman, 2013, p. 286). Driven by a socio-ecological system of disbelief of African American women’s experiences of SA, stereotypes held by first-responders, concerns that drive African American women to protect their own community from policing, and the general social assumptions that women who have sex want it –there has been a “culture of silence” among African American women in relation to SA. As the National Center on Violence Against Women in the Black Community (2018) explain, “For every African American woman who reports SA, at least 15 African American women do not report”.

Further examination of the treatment of African American women and stereotypes formed during slavery provide some insight into low reporting rates of SA. Three culturally held beliefs about African American women were formed during slavery: women were seen as promiscuous and of low moral character and thus not credible if they reported an incident of SA; they were also deemed as being acclimated to violence and exceedingly aggressive (Jacobs, 2017). These stereotypes informed the way in which African American women were treated, as they were viewed and physically punished the same as men who were enslaved (Hooks, 1981). African American women being viewed as hypersexual, incapable of feeling pain, unrapeable, and superhuman continues to influence how they are treated within formal social institutions, such as the criminal justice and healthcare system (Crenshaw et al., 2015; Jacobs, 2017). These historical realities inform socially constructed ideologies that are currently embedded within healthcare, social service, and law enforcement institutions that African American women must navigate to experience health, wellness, and even safety, following a SA. The professionals functioning within these institutions are predominantly White, and in the case of nursing, are also predominantly female. These professionals often respond based on the aforementioned history and the ideologies resultantly formed, leading to SV of African American women and creating a culture of mistrust and barriers to help seeking following a SA (Ruiz et al., 2022). Yet, limited literature exists examining SV within healthcare settings that would help us minimize barriers to help seeking (Campbell, 2005).

Currently, the literature on SV following survivors’ experiences of SA focus on interactions with police or law enforcement (Campbell, 2005; Jackson et al., 2017; McQueen et al., 2021; Orth, 2002; Patterson, 2011). Given the unique context that shapes interactions within the healthcare environment, it is important to identify and understand experiences of SV within healthcare specifically.

The Urban Metropolitan Context of the Upper Midwest

Midwestern African Americans were drawn to urban Midwestern cities following the Northwest Ordinance of 1787, prohibiting slavery in northern territories (Milwaukee PBS, 2021). African Americans also migrated from the South to the Upper Midwest to escape the oppression associated with sharecropping² after the ending of slavery.

In the early 1900’s, one of the largest movements of African American people in United States history began (National Archives, 2021). Known as the Great Migration, African Americans moved from the South to Midwestern cities like Milwaukee, Chicago and Detroit because of economic opportunities available through employment in industrial jobs. Yet, in the Northern states to which African Americans migrated, other forms of oppression based on racist ideologies, policies and structures awaited, placing them in a position of economic disadvantage as they competed for low-income jobs and housing (Jones, 2012). For example, political leaders in these Midwestern cities created boundaries for where the Black population could live (Connell, 2017), giving rise to segregated neighborhoods in Midwestern cities, such as Milwaukee, which is known as “the black belt”, “Bronzeville” or the “Black Metropolis” (City of Milwaukee, 2023).

Restrictive covenants on housing divisions and restrictive deeds on individual properties became a way to limit ownership or occupancy of homes. Through the expansion of the suburbs in the 1940s through the 1960s, housing policies such as redlining restricted the growth of wealth and opportunity for African Americans (Connell, 2017). By 1965, 98% of African Americans in Milwaukee lived in the central city – the most concentrated population of African Americans in the United States (Jones, 2012). Confined until the 1968 Fair Housing Act, African Americans in Milwaukee remained limited to small, deteriorating neighborhoods, many bisected by the creation of highways with failing public schools and a pattern of disinvestment in African American communities. Factors such as White flight, economic globalization (relocating factories outside of states that had large industrial employment opportunities), and persistent hyper-segregation, all contribute to a vicious cycle of poverty and violence (Gillum, 2019; Levine, 2020; Jones, 2012).

The lack of opportunities for employment in African American communities accentuated poverty, which is a key factor for violence in the lives of women (Gillum, 2019). Women living in poverty lack the ability to exercise their full agency, as they are limited in their access to resources such as health insurance, transportation, and healthcare (Gillum, 2019). Difficulty finding a trustworthy first responder and longer-term healthcare provider remains an unaddressed problem in getting survivors to report experiences of SA. Continued hyper-segregation drives ongoing mistrust of White healthcare providers; and though many hospitals, nursing schools, and medical training programs are establishing statements of commitment to equity and justice, institutional changes remain fledgling at best. That noted, local companies are setting hiring goals (Metropolitan Milwaukee Association of Commerce, 2022) and Milwaukee County was the first in the nation to explicitly identify racism as a public health crisis and to move towards advancing policies accounting for this reality (Milwaukee County, 2020).

Discriminatory Responses & Secondary Victimization Within Healthcare

The literature identifies the notion of “double stigma” which speaks to the stigma that African American women face in relation to disclosing SA, in addition to the stigma associated with the treatment they receive based on their racial identity (Alvidrez et al., 2011; Munroe, 2015). These discriminatory practices not only perpetuate the normativity of denying opportunities for resources and healing but they also pose a significant risk of SV for African American women survivors of SA (Ahrens et al., 2001; Littleton & Ullman, 2013).

SV leads to African American women experiencing poor quality care when seeking services post-assault (Campbell & Raja, 2005). Examples of poor-quality care include unaddressed pain management needs, not being provided accurate information to make informed decisions (such as a risk assessment for Sexually Transmitted Infection/Human Immunodeficiency Virus (STI/HIV)), and not being provided options of care (such as HIV/STI prophylaxis and emergency contraception). In one study conducted by Campbell et al. (2001) examining SV, ethnic minority women were found to be less likely than White women to receive information about HIV. This is of particular concern considering that African American women are already at higher risk for poor health outcomes post-assault due to higher rates of contracting HIV compared to White women (Al’Uqdah et al., 2016; Campbell et al., 2003).

Experiences of SV deter individuals from seeking health services in the future. For example, one study conducted with a sample of predominantly African American women veterans found that 80% of participants who received care during their military service felt the experience made them reluctant to seek further care (Campbell & Raja, 2005). The women veterans did not receive explanation on the risk of contracting STIs and also described encountering rushed healthcare services that overlooked their emotional state as survivors (Campbell & Raja, 2005). As a result of these realities, many African American women may turn to informal supports, such as friends and family to seek help (Finfgeld-Connett, 2015; West & Johnson, 2013).

Exploring the interactions between nurses in acute care settings and African American women who have experienced SA provides insight into understanding interactions that prevent or lead to SV. The knowledge generated from this study could be transferable to other urban American environments with similar populations and communities to ensure a more effective response to the healthcare needs of SA survivors’ who identify as African American women. Currently, no studies have explored African American women survivors of SA perceptions of SV when interacting with nurses practicing in acute care settings (i.e. hospitals). We considered the following research question:

1. What are African American women survivor’s perceptions of the nursing care they receive in acute care settings following an experience of SA?

Methodology

Since SV is a social phenomenon, utilizing qualitative inquiry allows for an in-depth understanding of SV from the perspective of African American women survivors of SA who are recipients of nursing services in an acute care setting. Application of qualitative inquiry is appropriate as responses to SA within American culture is complex and requires the consideration of historical and social contexts to fully understand the interactions that occur between nurses and patients. These contexts include the gendered and racialized realities of SA, and how history informs responses to SA today for African American women survivors. Understanding such contexts through qualitative inquiry contributes to our understanding of the existing barriers that nurses may perpetuate through their positionality as part of a predominantly White healthcare workforce.

Although this study involved interviewing both nurses and African American women survivors of SA, this manuscript focuses on centering the voices of survivors to bring awareness to survivors’ needs. This is consistent with our use of a feminist framework, which informed the study. Furthermore, although this study focused on nurses, survivors often referred to healthcare providers more broadly. Therefore, nurses and healthcare providers will be used interchangeably based on who survivors referred to in their narratives. Ultimately, the goal of this manuscript is to ensure that nurses, as well as healthcare providers more broadly, understand the context in which African American women seek healthcare services following SA to improve the delivery of healthcare services and to advance health outcomes for women.

We used critical ethnography as the research methodology. Critical ethnography allows for the examination of power dynamics within individual interactions, and larger social institutions such as healthcare (Vaught, 2011). Applying critical ethnography alongside intersectionality to this study enabled us to examine the power dynamics existing within interactions between nurses and African American women survivors of SA.

Participation in the study was voluntary. Survivors either responded to a flyer that was distributed at various sister circles³, women’s shelters, churches, or through advocate referrals. The recruitment flyer included an overview of the study, study objectives, as well as contact information for the Principal Investigator. Snowball sampling was also used to recruit survivors. Nearly half of all survivors who participated in this study were referred by another woman who had participated.

We used a purposive sampling approach with the following inclusion criteria: 18 years of age and older; self-identified as African American woman; had experienced SA at some point in their lives prior to recruitment; were proficient in English; had received care at an acute care/hospital setting in the United States; and had discussed their SA with a nurse at some point in their lives. Exclusion criteria included women with severe intellectual and mental disabilities without capacity to provide informed consent.

Individual interviews with survivors of SA were conducted between February and August of 2021 using in-depth semi-structured interviews. Since this study began during the COVID-19 pandemic, an amendment was approved to conduct interviews online via Zoom. Interview questions were designed to gain an understanding of survivors’ experiences accessing healthcare services after a SA. A total of 29 African American women survivors of SA were interviewed via Zoom, and 1 interview was conducted in-person, as per her request. Interviews were audio recorded and on average lasted approximately 1.15 hours. As a token of appreciation, survivors received a $40 Amazon gift certificate, and an additional $25 Amazon gift certificate if they referred other participants to the study.

Sample

A total of 30 survivors were interviewed (see Table 1). All survivors self-identified as African American women; survivors’ age ranged from 23 to 40 years old with a mean age of 29 years old. Women who participated in this study were predominantly single (73.3%). The majority of survivors interviewed resided in an urban metropolitan city, primarily from Milwaukee, Cook County (Chicago), and a few in Dane County (Madison). Over half of the sample interviewed reported being employed (56.7%) and making less than $30,000 a year (63%). Survivors were primarily self-employed, but others were employed in healthcare, accounting, and the food industry. Survivors’ education ranged from 8 years of education (middle school level) to 18 years of education (masters prepared level) with a mean of 14.3 years of education. Less than half (43%) of the survivors reported having healthcare insurance.

Table 1.

Participant demographics.

Women participant demographic
Age
18–24	3
25–30	16
31–35	10
36–40	1
Ethnic Identity
Black	30
Marital Status
Single	22
Married	8
Zip Code of Residency
Rural Wisconsin	4
Madison, Wisconsin	2
Milwaukee, Wisconsin	4
Chicago, Illinois	5
Cook County, Illinois	11
Winnebago County, Illinois	1
Lee County, Illinois	1
Atlanta, Georgia	2
Type of Employment
Cashier	2
Waiter	1
Cosmetics	1
Food Industry	2
Accountant	2
Healthcare	2
Sales	1
Social Work	1
Self-Employed	5
Unemployed	13
Annual Income
Below 20K	7
21–30K	9
31–40K	6
41–50K	3
51+	3
Not Answered	2
Highest Level of Education
Middle School	1
High School	3
Diploma	2
Associate	5
Bachelors	16
Masters	3
Health Insurance
Yes	13
No	17

Data Analysis

Interviews were transcribed verbatim and analyzed using thematic analysis, a systematic approach that involves “identifying, interpreting and reporting patterns and clusters of meaning within the data” gathered (Ritchie et al., 2014, p. 271). The process of data analysis begins with data management, which first involves familiarization, wherein researchers “immerse themselves in their data” to gain an in-depth understanding of what the content means to identify topics of interest (Ritchie et al., 2014, p. 282). The second step involves understanding different elements and dimensions within themes or subthemes. This requires analyzing different experiences, views, perceptions, and behaviors previously labeled to understand the various elements that occur in preventing or inflicting SV. After different elements and dimensions within themes and subthemes have been identified, the data is analyzed again to combine different elements to form new sets of categories (Ritchie et al., 2014). This stage involves incorporating literature and theory in creating new categories, rather than focusing just on the language and meaning of data gathered. During this stage, simple typologies may be constructed through identification of different dimensions related to SV.

After data collection and analysis, construction occurs to understand patterns of association within the data, referred to as ‘linkages’ (Ritchie et al., 2014). Often referred to as mapping linkage, this stage considered the different types of patterns between subgroups in relation to SV. Types of potential linkages that may be identified in this stage include contextual and functional linkages. Contextual linkages may be identified by considering the types of behaviors that inflict or prevent SV that are specific to acute care settings. Functional linkages include attitudes that contribute to nurses’ infliction of SV.

Procedures

We enhanced trustworthiness of our study by attending to credibility, dependability, and transferability. Two techniques ensured credibility: reflexive commentary and the “background, qualifications, and experience of the investigator” (Shenton, 2004, p. 68). We recorded first impressions after each interview, monitoring for patterns. The first author is a forensic nurse and used journaling to practice reflexivity by considering her clinical experience as related to the unique needs of African American SA survivors (Shenton, 2004).

Dependability is enhanced by the researcher’s documentation of the processes used within the study (Shenton, 2004) to allow for possible replication of the study by future researchers. We created an audit trail that detailed the research design and implementation of the “operational details of data gathering”, and reflections on the interview process and effectiveness of the research protocols (Shenton, 2004, p. 71–72).

Transferability is defined as “the extent to which the findings of one study can be applied to other situations” (Shenton, 2004, p. 69). Detailed demographic information was collected to provide sufficient context for future researchers to consider how they might transfer the findings of the study to the contexts in which they practice and serve survivors of SA.

Ethical Considerations

Institutional review board (IRB) approval was obtained from X. Survivors volunteering to participate were required to provide written informed consent. Survivors were informed that participation was voluntary, that they could withdraw from the study at any time and that they had the right to not respond to any questions that they were not comfortable answering. Throughout the study, confidentiality was ensured for the protection of survivors. Interviews conducted via Zoom only recorded audio and no video. It is important to mention that for women survivors who discussed encountering dehumanizing interactions such as shame and blame, assurance to survivors was provided by the interviewer that the experience(s) of SA were not survivors fault. Participants were assured of this throughout the interview process as appropriate, as they narrated their experiences and at the conclusion of every interview.

Positionality Statement

The lead author of this manuscript is an Asian American Pacific Islander with clinical expertise in forensic nursing and scholarly expertise in violence in the lives of women who face the greatest vulnerability to violence while also experiencing the greatest barriers to care. Co-authors on the manuscript also include cisgender women who identify as Black and White, who also have scholarly expertise in the same area of violence against women.

Results

In analyzing the data, the main theme identified was dehumanization. Our definition of dehumanizing encompassed the four subthemes of dehumanizing: shaming, blaming, dismissing, and discrediting experiences of SA (See figure 1).

Figure 1.

Model depicting nurse-patient specific behaviors causing secondary victimization to survivors that fail to recognize and respond to survivors historical-social specific context. This failure leads to dehumanizing interactions (i.e. discrediting, dismissing, shaming, and blaming) within the healthcare experience.

Dehumanizing

Participants’ feedback mirrored the findings of Goff (2014), who described dehumanizing as the “denial of full humanness to others” (p. 527). Almost all survivors interviewed described dehumanizing experiences, although some survivors spoke to key themes of dehumanizing that denied full humanness while accessing healthcare services. The term ‘dehumanizing’ was used by participants to describe their experiences interacting with nurses and was not a component of the interview guide utilized.

Survivors explained how accessing healthcare following SA was just one aspect of the dehumanizing treatment they experienced in relation to accessing healthcare services. In this study, participants spoke of dehumanizing treatment when they accessed healthcare services prior to their SA, alluding to their overall experience of healthcare as dehumanizing. Survivors spoke of how their realities were poor treatment and poor care from healthcare providers following their disclosure of SA and resultant poor health.

For example, one woman described how her troubles with healthcare started at a young age, “In general it [was] absolutely horrible from the time, like the times that I remember[ed] …like around 13 … that began this like long history of being dehumanized”. Another woman expressed feeling misunderstood after disclosing SA to nurses, stating:

It [was] dehumanizing in a way in that…You feel like your whole, the whole process, you’re explaining…It… it feels your heart at the same time, no one is understanding you at the same time you are breaking down in the middle of everything, so it’s pretty much a very sad situation and you fe[lt] like… No one really underst[ood]. No one care[d] as at that point no one [knew] your pain.

This sentiment was echoed by another woman:

We experience[d] our mishandle. You’re being…mishandled in these hospitals. Maybe we fear[d] to go and face them because… They [faced] a lot of rejection, mistreatment and all that kind of stuff. Maybe they need[ed] to improve on how they treated their patients in making them want to come back another day.

Survivors made it clear how they thought twice before accessing healthcare following SA. Some felt so dehumanized that they were dissuaded from disclosing. For example, one woman admitted:

…when I got raped. I felt like I couldn’t disclose it to anybody because… It’s a shame these guilt[ed] you wondering what people say, especially the nurses”. Another woman noted why she did not talk about her experiences of SA with nurses, “I [didn’t] know how much they actually believe[d] that sexual assault happens to African American women. You know how valid it [was]…

Dehumanizing entailed past poor treatment of women within the healthcare system that led them to feel they would not be believed if they disclosed an experience of SA, on account of their racial identity as African American women. A 32-year-old woman who experienced SA discussed her hesitation to access healthcare services, “…I feared racism. I feared discrimination because of the case being a sexual assault case.” Another woman echoed these concerns:

First I went to seek…some health services I had that in my mind. I knew now I’m black and I [was] going to experience some sort of racism… discrimination. They may not attend to me. They may judge me…

Similarly, another woman shared, “I can say that it [was] some sort of discrimination by some of the nurses”. Yet another woman shared her specific experience with the services she received, “Another nurse discriminated me because of maybe the age I was and also because I was a Black woman, and I didn’t find it a cool thing to do.”

From these excerpts, we recognized that participants experienced dehumanization during care for SA and throughout other healthcare encounters, and that they attributed this to their racial identity. These past experiences informed not only how they navigated the healthcare system but also whether they disclosed SA at all.

One woman described what she experienced as sexualized touch by a physician during a medical exam. While only one woman disclosed such an experience in our study, this is important to note as it demonstrated the dehumanizing treatment that survivors experienced when accessing healthcare services that deterred them from accessing care following SA. She stated:

I was getting a pap smear by a doctor and I felt like uh he went overboard with the pap smear like touching me places that he shouldn’t have been that really had nothing to do with the pap smear.

Discrediting

Many survivors identified discrediting as a response that was characterized by not understanding or by invalidating a survivor’s reality. One woman said, “They treated me very badly like I had a doctor say… Like I had a doctor…Yeah a resident sa[id] that he [asked] me the same questions because he wanted to see if I would change my answers.”

A woman captured the importance of providing validation to others’ realities. She also illustrated how she was discredited due to her racial identity as a Black woman:

We need to be validated and believed we need...Nurses who c[a]me in without bias and without like preconceived notions of who we [we]re and what our experiences [we]re, I th[ought] that… Umm, we need[ed] people to consider the inhumane treatment that Black women have received on this continent. You know it’s also… [took] into consideration that sexual violence [was] a part of our ancestral history. You know, like since this… this continent was colonized. You know, so it’s not it’s… It’s also intergenerational… It’s also historical… it’s ancestral. Uhm, and to know that like we carr[ied] not only the sexual assault that happened to us, but also what happened to our mothers and our grandmothers and our ancestors… Remember that there [wa]s a lineage...

Another woman’s comments introduced dismissing as an experience related to discrediting. This woman described discrediting as survivor’s interactions with nurses that make them feel that they are unreliable when they disclose and seek help following SA:

It [wa]s very devastating if you get someone who [did]n’t understand you, someone judgmental or someone dismissing or denying allegations. It [was] hard, especially if you [we]re dealing with professional nurses which… who at times [were] very rude.

Dismissing

The survivor described treatment that made them feel as though they were unworthy of protection or consideration. This form of dehumanizing entailed keeping women survivors in the dark about information regarding treatment options available to them and not including them in decision-making in their own healthcare. One woman explained, “…not being heard being dismissed…like almost being railroaded through decisions and not giving like all of the options”. Another shared that she was not screened at a hospital for violence or SA, adding that she did not disclose the SA directly, “I just didn’t go too direct and say that I was beaten. I just said there was so much in pain and my teeth had fallen off. My fingers had bent”.

This woman withheld her actual experiences on account of her injuries being dismissed by healthcare providers. This led to a poor and inaccurate assessment of the violence that she endured even though she presented with injuries. In yet another example, one woman experienced SA in relation to sex trafficking. This particular woman also shared that she lived with substance use disorder. She discussed her experience accessing healthcare services through an emergency department, and how services were not offered even though she requested services. At the time of the interview, this woman was in the process of recovering from her experience with sex trafficking, which she believed led to her struggles with substance misuse and drug-induced epilepsy, for which she took medication. She shared her experiences with multiple SAs, starting at the age of 18, between 2010 and 2018. While accessing healthcare services, she explained that she did not receive the healthcare services requested, which included testing for STIs. In discussing her experiences, she said:

Um...It was the time that I had. I got assaulted by a young man and um...I went to the emergency and I came to get a…the STD check and all of the you know all of the above because this [wa]s a person I didn’t know. They… it wasn’t a welcoming experience. I asked for a test. Uhm, it’s like they perform[ed] a rape kit on you and they supposed to give you meds to protect you from receiving HIV or herpes. If you believe[d] you came in contact with the person and the way they treated me was not… Umm, understanding. They seen the warning signs of me working with the individual and they didn’t do the right documentation. They didn’t offer me any services… umm. It was just it wasn’t a pleasant feeling.

In this case, the woman felt that the dismissal she experienced from healthcare providers was perhaps as a result of what they might have seen as “prostituting”, and that perhaps they were dismissive because they did not actually believe her to be a victim of SA.

Shaming

Shaming was a subtheme that survivors identified where nurses actively engaged in behaviors or responses that affected how they felt. These behaviors or responses that facilitated experiences of shame for survivors included making negative judgements related to the survivor (i.e. attending parties, attire, assumptions of engaging in sexual risk behaviors), as well as the community in which survivors are a part of. These experiences of shame resulted in survivors internalizing a negative sense of self that impacted their sense of worth. Survivors specifically spoke of experiencing embarrassment after disclosing to nurses in acute care settings as a result of nurses’ responses. For example, one 23-year-old woman who was sexually assaulted during a party when she was 18, and then sought healthcare services at a local emergency department after the assault described the following experience:

OK, it was not helpful because…When I shared my story the nurse was not welcoming and so she [said] that I am so young [and] we start[ed] going for house parties and so on. And that [wa]s the cause of the problem…That I was assaulted. And she said that even my parents [we]re not so good in raising their kid because they were not concerned about where I was going at night, which [wa]s not a good thing to do as a kid. So I found that not welcoming because this [wa]s a case that one had been assaulted and one didn’t want to have that problem. But unfortunately, it just happened.

Similarly, one woman who experienced sex trafficking and SA shared how she experienced shame (as a result of blame) following disclosure of SA to healthcare providers in an emergency department:

I just feel like they [judged] me, you know, yeah. They [did]n’t look at me as a victim. They looked at me as the basically the perpetrator and then I really was the victim. Just the looks, the whispering in the chart. It’s just little things like that ma[d]e you uncomfortable.

Another woman shared her experience of feeling shame following disclosure to emergency room nurses:

I d[id]n’t. I d[id]n’t feel like she was sensitive because I fe[lt] like if she was. Uhm, she couldn’t try to like push me so hard yeah yeah. And also tr[ied] to be understanding and patient so it’s all... It’s all about having those efforts. So for me I fe[lt] like... So that’s what she kind of laughed, and that made me even much more uncomfortable to even like share. And because she was the first person that I actually encountered. So even the second nurse I was kinda hesitant because I felt like a…yeah, she’s kind of like the same.

Experiences of shame perpetrated by nurses were noted in our analyses across the data. Survivors spoke of feeling that nurses overestimated the risk of contracting STIs following SA as a way of pushing them to disclose, and how this also caused them shame and discomfort:

…And then and they also advised me it’s no good to shy away because some of these such experiences could render you sick for a lifetime. You could end up having STD’s or HIV.

Blaming

The response of blame by healthcare providers made survivors question their role in the SA, as it placed the responsibility of the assault on the victim. The following excerpt was from a woman who was made to feel responsible for the SA experienced:

Uh, in the first time on time, like when I went to seek help… I remember[ed] one of the nurses saying I was the one who was allowing this to happen, like it’s part of my fault because of the situation that happened for me to get assaulted. So I felt like she didn’t understand me. She didn’t understand my pain but later on, I realized that partly I had myself to blame.

Throughout survivor’s narratives, we noted how survivors internalized the shame, which led them to blame themselves, due to the feelings put upon them as a result of the nurses’ and healthcare providers’ responses. In the above excerpt, the woman ended up blaming herself for a SA that was solely the responsibility of the perpetrator. Another woman encountered blame within the nurse-patient relationship and described it as follows, “Then they were like traumatizing me because she was asking what were you wearing or so it means that my dressing code that led to these, sexual assault…”

Similarly, another woman said, “They looked at me different than a person that just got raped on the street by accident, you know? …It’s kind of like this [wa]s what I’ve brought on myself.”

The following excerpt is yet another example of how blame manifested within a nurse-patient relationship:

The way she approached me. I didn’t like it because she was like like she was judging me. She was asking me for something like what were you wearing during that time? Was it because of maybe alcohol consumption and contact me, which I thought that It’s like she’s blaming me for the act. Yeah, I felt that she’s blaming me for that for the act. Or like I [was] the cause of the sexual assault.

Discussion

In summary, African American women survivors interviewed for this study described interactions of SV by speaking of the dehumanizing interactions they experienced. This dehumanization occurred in spite of differences in health insurance coverage, income, and education (Table 1). Dehumanizing interactions encompassed discrediting, dismissing, shaming, and blaming. These findings are consistent with previous literature examining experiences of SV following SA. Although much of the literature focuses on experiences of SV within the context of survivors’ interactions with police or law enforcement, this literature iterates the negative health outcomes resulting from these interactions on the part of survivors (Annan, 2011; Lorenz et al., 2019; McQueen et al., 2021; Patterson, 2011; Rich & Seffrin, 2013; Wilson & Hanley, 2022). Of the studies conducted examining SV in healthcare, most studies focused on survivor interactions with mental healthcare professionals or social workers (Annan, 2011; Campbell, 2005; Campbell & Raja, 1999). To our knowledge, there are no studies that specifically focus on SA survivors’ interactions with nurses in acute care settings beyond Sexual Assault Nurse Examiner (SANE) specialties. Of the literature that exists examining interactions between SANEs and survivors, adult survivors spoke about varying experiences from receiving “humanizing” care to survivors who described their interactions with SANEs as harmful (Buchbinder et al., 2021; Fehler-Cabral et al., 2011). Humanizing care included being provided clear explanations for exam processes and findings, choices during the exam, and being treated with compassion. Harmful care included not being provided options, explanations for exam processes and findings, and being treated in a distant manner (Buchbinder et al., 2021; Fehler-Cabral et al., 2011).

In addition to the novelty of examining SA survivors’ interactions with nurses broadly in acute care settings, this is the first study to date that focused on centering the voices of African American women SA survivors about their experiences interacting with nurses. The knowledge generated from this study demonstrates how SV by nurses’ mirrors and extends a historical legacy of denying African American women survivors protection and support following experiences of SA on account of their gender and racial identities. This SV is a unique type of SV not analyzed within the literature before, that urgently calls for nurses to understand the socio-historical context in which African American women may experience SA and the systems informed by that socio-historical context that they must then navigate following SA in order to access help.

Although this study focused on the socio-historical context of African American women in the United States, examples of dehumanizing treatment in healthcare of women of African descent globally, have been noted, particularly in nations that have a history of colonialism. One study, for instance, notes the mistreatment of Sub-Saharan African immigrant women attempting to access public health systems in Basque Country, Spain (Perez-Urdiales et al., 2019). In this study, Sub-Saharan African immigrant women discussed their experiences of encountering poor treatment such as being characterized as a Black woman in the health record and encountering stereotypes perpetuated by healthcare providers. Women spoke of how histories of colonialism and slavery have led to the internalization of devaluing Black African women, both systematically and in interpersonal interactions with healthcare providers (Perez-Urdiales et al., 2019).

Our study shows that if women ordinarily encounter and anticipate encountering racism and dehumanization from healthcare providers, they are hesitant to disclose SA within the healthcare system. The experience of SA is one that is deeply and personally traumatizing and requires trust of professionals within any system that a woman needs to navigate in order to obtain help and for health outcomes to improve.

Another example of the effects of mirroring the societal devaluation of women of African descent or women in the African diaspora in healthcare delivery is demonstrated in countries such as South Africa, where despite apartheid ending in the 1990’s, there continues to be evidence of the delivery of racialized and inequitable healthcare (de Villiers, 2021; Deacon, 2000; Nguse et al., 2022; Swartz, 1999). Inequitable healthcare is likely to lead to SV. In our study, SV specifically encountered with nurses, usurped survivor’s rights to opportunities for healing that would ordinarily come from healthy nurse-patient relationships and interactions.

Dehumanizing interactions within the healthcare system in the form of SV for women who have experienced SA is also likely to occur for women who have historically not trusted the healthcare system and are likely to experience racism from healthcare professional. This would include Indigenous women and in the North American context and the Upper Midwestern context specifically, Indigenous women. Our colleagues working in this space have noted that American Indian women are unlikely to seek healthcare following any experience of gender-based violence including SA and intimate partner violence. This hesitancy is on account of stereotype threat, racism ordinarily encountered upon accessing various systems, and how women then perceive their value on account of systemic and historical racism and racist acts that include genocide (Luebke et al., 2022; Luebke et al., 2021).

In being prepared and able to provide healthy nurse-patient relationships with African American women survivors of SA, it is essential that healthcare providers uphold and maintain an anti-oppressive stance that translates into all aspects of nursing practice and education. By unifying healthcare providers in opposition to violence, rather than perpetuating its acceptability, through applying an anti-oppressive framework across the institution of healthcare, we can provide safe healthcare services. These services could then be guided by nursing knowledge that minimizes the potential for re-traumatization within healthcare provider and patient relationships. The following section delineates recommendations for healthcare practice and education.

Practice

The experiences of SV within healthcare served to re-enact historical trauma by placing the responsibility of SA upon African American women, rather than the perpetrators. Despite national discourse generated by movements such as the #MeToo movement that iterated the importance of acknowledging that SA is never a survivors fault, in this study this seemed to not translate or apply to African American women as they attempted to access the healthcare system. African American women anticipated and commonly encountered dehumanizing interactions that compromised opportunities for establishing and building trust, which is necessary for facilitating women’s willingness and safety to disclose and to obtain the necessary healthcare services to begin the journey of healing. The reality of anticipating and encountering dehumanizing interactions among African American women survivors is indicative of continued mistrust of the healthcare system across generations, given the age range of women interviewed (Table 1).

An example of a dehumanizing interaction compromising trust was the assumption by healthcare providers that African American women engaged in risky sexual behaviors that placed them at risk for STIs. Problematic assumptions like this mimic societal discourse in relation to SA culture, perpetuated by racialized and sexualized histories of oppression that were used to justify SA. These assumptions created barriers for disclosure, prevented trust building, contributed to health inequities, and deterred African American women from accessing healthcare services that could improve health outcomes following SA (Prather et al., 2018). Assumptions and discourse related to SA culture also removed the blame from the perpetrator and placed it on women.

For all healthcare providers, not just nurses, it is important to recognize that SA, and anything that perpetuates its acceptability, is the result of oppression for survivors of SA. For African American women, this encompasses the intersecting oppressions of sexism and racism. Placing the blame of SA on African American women within present-day contexts, is a continuation of the historical legacy of social institutions and systems that deemed African American women as “unrapeable” and non-human, a legacy that needs to end if we were to assure the effective treatment and support of African American women following an episode of SA (Ruiz et al., 2020).

As the results of this study demonstrated, survivor’s humanity, including their self-worth and dignity, were not upheld. Instead, survivors shared experiences of feeling like the offender, and from their narratives, it was clear at times that survivors internalized the attitudes and responses of nurses and other healthcare providers. As healthcare providers responsible for optimizing human health, nurses especially are in a position of power to support actions and interactions that advocate for social justice through the delivery of quality care, particularly for survivors encountering oppression in their everyday lives. Providing quality care includes ensuring basic protections are met when people encounter SA. To provide basic protections for survivors, it is essential that healthcare providers believe survivors.

To optimize and support best health outcomes for survivors seeking healthcare, survivors need to also receive the necessary treatment available. Further research needs to be done to ensure that the current standard treatment in healthcare is relevant to and effective for African American women survivors.

Many survivors reported not being screened for violence when accessing healthcare services after SA. National policies require healthcare institutions to screen all patients accessing care for violence (U.S. Department of Health and Human Services, 2013). This is particularly important for populations that disproportionately experience violence including African American women survivors. As a population that disproportionately experiences violence and is also often hesitant to disclose or even to seek care (Ruiz et al., 2022), failing to screen further negates the opportunity to engage appropriate interventions that would meet the healthcare needs of survivors and ultimately exacerbates already existing poor health outcomes.

Providing nursing services safely requires the establishment of a trusted partnership with the community. This means members of the community should be involved in the development and implementation of community-based programs that allow for the delivery of nursing services in collaboration with other disciplines including social workers and mental health professionals. For example, when considering community-based options, nurses and allied health professionals in the community could be involved in the creation of programs and can be at the forefront of delivering services. By centering members within the community to drive the establishment of community-based programs designed more broadly to provide healthcare and other services following experiences of SA, we can better ensure the effectiveness of interventions, while also valuing the expertise of community members. This will enhance the delivery of healthcare services that are intricately tailored to meet the actual needs of the community (Kuo et al., 2019). Creating such programs requires confidentiality, particularly within smaller communities; however, it is the connectedness of a community that offers opportunities for fostering accountability in ensuring the delivery of high-quality care.

Finally, women explicitly mentioned feeling safe to disclose when the nurse was a non-White female, or a non-White female nurse they knew from the community. In situations where women were able to find a nurse who was a non-White female, women spoke to how having someone who shared a similar socio-historical context enabled them to feel safe discussing the SA they had experienced. It should be noted though that receiving care from a nurse that was non-White and female did not always equate to not encountering dehumanizing experiences. This finding speaks to the harm in homogenizing populations that while sharing a common racial identity, are actually quite diverse. By homogenizing populations of women, we can easily overlook the way in which power and oppression function within a system, regardless of the identity of the professional that is a part of that system. In the United States, as is the case with many western nations, nurses and allied healthcare professionals are part of a healthcare workforce that is predominantly White. This is especially the case in the Upper Midwestern United States.

Additionally, although SA occurs across all ages, SA experienced by women later in life is a complex and unique phenomenon that has not adequately been explored (Band-Winterstein et al., 2021). Of the limited literature examining healthcare professionals’ interactions with women experiencing SA later in life, healthcare professionals’ responses often overlook experiences of SA among older adults (Fileborn et al., 2017). This overlooking of experiences of SA among older women is perpetuated by social constructions of ageism and sexism, which include the belief that older adults, particularly women, are not sexually active or attractive. Of the few studies examining SA in the lives of older women, no studies, to our knowledge, focus specifically on African American women. This apparent dearth in the literature indicates that there is a need for future studies that examine the experiences of not only SA but also SV by healthcare professionals to be able to inform future practice that appropriately attend to women’s unique needs across their lifespans including the experiences of older adult African American women. Our study does not address this gap in the literature as the age range of women in our study was 18–40 years of age, constituting young to middle age adults as opposed to older adults. Studies that would enable us to understand the experiences of SA and SV across the lifespan given the generational trauma experienced by Black women (Hankerson et al., 2022; Yates et al., 2022) and specifically in the lives of older adult Black women are thus urgently needed.

Education

In nursing education and the education of healthcare professionals more broadly, future nurses and allied healthcare professionals need to understand the historical context of marginalized populations. If understood, healthcare providers can then understand the importance of providing interventions that account for this context when interacting with survivors from populations that historically and systemically face oppression. Incorporating anti-oppressive curricula with strategies and tools needed to address bias are essential. By incorporating these strategies and tools, future healthcare professionals can be better prepared to provide inclusive and equitable care prior to entering practice.

Accurate screening of women who experience SA requires specialized training and education. Incorporating specialized training into the training of healthcare students and professionals already practicing was not iterated in the Violence Against Women Act (VAWA). In the VAWA, every healthcare institution was required to have a person trained in administering a state kit for collecting evidence. This does not mean that this individual received specialty training in providing care to survivors of SA. There are no minimum requirements for training, and it is not clear as to the type of training required for a person to be considered as meeting the standard for evidence collection. Incorporating such training throughout nursing education, for example, could help address this problem in addition to addressing individual beliefs and values that harm patients who have experienced SA.

Ultimately, it is healthy relationships with individual survivors and their communities that prevents SV following experiences of SA. Fostering healthy connections and a commitment to comprehensive care for the health and well-being of all survivors requires a united stance against oppression among the healthcare workforce. As the largest workforce in healthcare, if nurses were to support a stance that is anti-oppressive, this could facilitate a cultural paradigm shift across healthcare, with a healthcare workforce that is better prepared and able to provide safe and equitable care to all SA survivors, without causing SV.

Table 2.

Analysis Results

Theme Subtheme	Quotes
Dehumanizing	“In general it [was] absolutely horrible from the time, like the times that I remember[ed] …like around 13 … that began this like long history of being dehumanized” “It [was] dehumanizing in a way in that…You feel like your whole, the whole process, you’re explaining…It… it feels your heart at the same time, no one is understanding you at the same time you are breaking down in the middle of everything, so it’s pretty much a very sad situation and you fe[lt] like… No one really understood]. No one care[d] as at that point no one [knew] your pain.” “We experience[d] our mishandle. You’re being…mishandled in these hospitals. Maybe we fear[d] to go and face them because… They [faced] a lot of rejection, mistreatment and all that kind of stuff. Maybe they need[ed] to improve on how they treated their patients in making them want to come back another day.” “…when I got raped. I felt like I couldn’t disclose it to anybody because… It’s a shame these guilt[ed] you wondering what people say, especially the nurses”. “I [didn’t] know how much they actually believe[d] that sexual assault happens to African American women. You know how valid it [was]…” “…I feared racism. I feared discrimination because of the case being a sexual assault case.” “First I went to seek…some health services I had that in my mind. I knew now I’m black and I [was] going to experience some sort of racism… discrimination. They may not attend to me. They may judge me…” “I can say that it [was] some sort of discrimination by some of the nurses”. “Another nurse discriminated me because of maybe the age I was and also because I was a Black woman, and I didn’t find it a cool thing to do.” “I was getting a pap smear by a doctor and I felt like uh he went overboard with the pap smear like touching me places that he shouldn’t have been that really had nothing to do with the pap smear.”
Discrediting	“It [wa]s very devastating if you get someone who [did]n’t understand you, someone judgmental or someone dismissing or denying allegations. It [was] hard, especially if you [we]re dealing with professional nurses which… who at times [were] very rude.” “We need to be validated and believed we need…Nurses who c[a]me in without bias and without like preconceived notions of who we [we]re and what our experiences [we]re, I th[ought] that… Umm, we need[ed] people to consider the inhumane treatment that Black women have received on this continent. You know it’s also… [took] into consideration that sexual violence [was] a part of our ancestral history. You know, like since this… this continent was colonized. You know, so it’s not it’s… It’s also intergenerational… It’s also historical… it’s ancestral. Uhm, and to know that like we carr[ied] not only the sexual assault that happened to us, but also what happened to our mothers and our grandmothers and our ancestors… Remember that there [wa]s a lineage…” “They treated me very badly like I had a doctor say… Like I had a doctor…Yeah a resident sa[id] that he [asked] me the same questions because he wanted to see if I would change my answers.”
Dismissing	“Um…It was the time that I had. I got assaulted by a young man and um…I went to the emergency and I came to get a…the STD check and all of the you know all of the above because this [wa]s a person I didn’t know. They… it wasn’t a welcoming experience. I asked for a test. Uhm, it’s like they perform[ed] a rape kit on you and they supposed to give you meds to protect you from receiving HIV or herpes. If you believe[d] you came in contact with the person and the way they treated me was not… Umm, understanding. They seen the warning signs of me working with the individual and they didn’t do the right documentation. They didn’t offer me any services… umm. It was just it wasn’t a pleasant feeling.” “I just didn’t go too direct and say that I was beaten. I just said there was so much in pain and my teeth had fallen off. My fingers had bent”. “…not being heard being dismissed…like almost being railroaded through decisions and not giving like all of the options”
Shaming	“…And then and they also advised me it’s no good to shy away because some of these such experiences could render you sick for a lifetime. You could end up having STD’s or HIV.” “I d[id]n’t. I d[id]n’t feel like she was sensitive because I fe[lt] like if she was. Uhm, she couldn’t try to like push me so hard yeah yeah. And also tr[ied] to be understanding and patient so it’s all… It’s all about having those efforts. So for me I fe[lt] like… So that’s what she kind of laughed, and that made me even much more uncomfortable to even like share. And because she was the first person that I actually encountered. So even the second nurse I was kinda hesitant because I felt like a…yeah, she’s kind of like the same.” “I just feel like they [judged] me, you know, yeah. They [did]n’t look at me as a victim. They looked at me as the basically the perpetrator and then I really was the victim. Just the looks, the whispering in the chart. It’s just little things like that ma[d]e you uncomfortable.” “OK, it was not helpful because…When I shared my story the nurse was not welcoming and so she [said] that I am so young [and] we start[ed] going for house parties and so on. And that [wa]s the cause of the problem…That I was assaulted. And she said that even my parents [we]re not so good in raising their kid because they were not concerned about where I was going at night, which [wa]s not a good thing to do as a kid. So I found that not welcoming because this [wa]s a case that one had been assaulted and one didn’t want to have that problem. But unfortunately, it just happened.”
Blaming	“Uh, in the first time on time, like when I went to seek help… I remember[ed] one of the nurses saying I was the one who was allowing this to happen, like it’s part of my fault because of the situation that happened for me to get assaulted. So I felt like she didn’t understand me. She didn’t understand my pain but later on, I realized that partly I had myself to blame.” “Then they were like traumatizing me because she was asking what were you wearing or so it means that my dressing code that led to these, sexual assault…” “They looked at me different than a person that just got raped on the street by accident, you know? …It’s kind of like this [wa]s what I’ve brought on myself.” “The way she approached me. I didn’t like it because she was like like she was judging me. She was asking me for something like what were you wearing during that time? Was it because of maybe alcohol consumption and contact me, which I thought that It’s like she’s blaming me for the act. Yeah, I felt that she’s blaming me for that for the act. Or like I [was] the cause of the sexual assault”

Highlights.

• Examines a unique type of secondary victimization caused by nurses and healthcare providers

• Calls for nurses to understand socio-historical context of patients to safely respond

• Preventing secondary victimization requires tailored nursing and healthcare responses

• Urgently calls for preventing dehumanizing interactions from healthcare providers broadly

• Anti-oppressive practices need to be interwoven throughout healthcare education curriculum