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Pediatric forensic nurses, with their specialized training and wealth of experience working with children, can augment clinical and law enforcement interventions in sexual abuse cases.

Forensic nursing as a specialty has only recently appeared on the radar screen of public consciousness, but it’s now growing rapidly. In 2002, the Forensic Nursing Certification Board was established, and now nurses who want to work with adult and adolescent victims of sexual assault can earn the SANE-A credential, becoming Board-Certified Sexual Assault Nurse Examiners-Adult/Adolescent.

However, there is another sector of the population for whom a national certification does not yet exist: pediatric victims of abuse or trauma.

That soon will change, according to Patricia Speck, MSN, APRN, SANE-A, FAAN, president of the International Association of Forensic Nurses. Speck explains that the association is establishing pediatric education guidelines for the sexual assault nurse examiner with the goal of creating a pediatric certification by the end of this year.

And it’s long overdue, says Speck, who has been evaluating young victims of sexual assault for more than 20 years. That’s because interacting with children who are victims of abuse is different from the approach taken with adults.

“If you’re an adult or adolescent, the assailant could be a neighbor or someone you’re dating,” Speck says, “but children are generally assaulted by people who have access to them. And that usually means family members.”

A heightened awareness

There is a perception that more assaults on children are taking place now than in the past, but Speck notes that the increase in reported incidents is mostly a function of societal changes.

“We think that only a very small proportion of cases were being reported,” she says. “Today, we’re getting a higher percentage, because there’s no community tolerance for child assault any more. The children who were victimized in the ’60s, ’70s, and ’80s are adults now, and they’re through putting up with it.”

Pediatric forensic nurses don’t work only with victims of sexual abuse. “The subspecialty deals with any type of crime that a child might be involved in,” says Ann Burgess, RNCS, DNSc, FAAN, professor of psychiatric mental health nursing at Boston College.

“It also involves abduction or any other type of crime against children. The pediatric nurse has been trained specifically in the evidence collection phase: observation, collection of evidence, and documentation.”

Paul Clements, RN, PhD, is an assistant professor at the University of New Mexico College of Nursing who specializes in the assessment of children who have witnessed the murder of a family member. Clements explains that in dealing with that kind of emotional trauma, a high degree of sensitivity is necessary, since children process the experience differently depending on their developmental level.

“I had four kids who witnessed the murder of their mother by their father’s hand,” he says. “Three of them were terribly traumatized, but one had no symptoms at all. Everyone thought he was in denial or was repressing his emotions, but he wasn’t.

“No matter how many times I’d meet with him, he’d say ‘Look, this was terrible, and yes, Dad should not have killed Mom. But he did, and what are you going to do? We have to move on.’”

One of the challenges of pediatric forensic nursing is to explain those kinds of situations, Clements says. “We don’t know a lot about kids who are able to
successfully integrate the trauma because those without symptoms are not usually brought in for help.”

Supporting victims of child abuse

Even more sensitivity is necessary in cases of sexual abuse because the trauma is not only emotional but physical, says Russell Rooms, RN, MSN, SANE-A, CMI, a forensic clinical nurse specialist based at Memorial Hermann Hospital in Houston.

According to Rooms, a forensic nurse examiner often can make all the difference when sexual abuse is suspected, not only in acting as a first line of support for the victim, but also in determining whether an assault has actually taken place.

“Recently, there was a case where abuse was suspected, and nobody believed the girl when she said she hadn’t been touched,” Rooms says. “They brought her to a forensic nurse, and the first thing she told the girl was ‘I believe you.’ That was the first time anyone had said that to her.

“The physician had insisted that it must be abuse because of a lesion on her genitalia. The forensic nurse found that it was a naturally occurring disorder called Behçet’s syndrome. She was then able to get the child into follow-up care, but the most important thing she did was just tell the child she believed her.”