Denise Cornell, assistant professor in the University's Orvis School of Nursing, recently became Nevada's first certified Sexual Assault Nurse Examiner for Pediatrics (SANE-P).
"I decided to get involved with the program after being recruited by the Victim's Witness Assistance Program through the Washoe County district attorney's office," said Cornell, who conducts her exams at the Northern Nevada Medical Center in Sparks. "They were looking for nurse practitioners that had an interest in doing exams on children and I had developed an interest in forensic nursing. This was a good place for me to start."
Because of an increasing number of sexual assault examinations being requested for children under the age of 13, the International Association of Forensic Nurses (IAFN) and Sexual Assault Nurse Examiner (SANE) Council developed standards to address the specialized educational requirements needed for understanding signs of abuse and those symptoms that mimic abuse.
"Over the last three years, I have conducted more than 300 exams," Cornell said. " enjoy serving as an advocate for abused children, feel good about helping the voiceless and am proud to have the opportunity to do the kind of work that makes a difference in someone's life. I like to participate in the process that can bring closure to the children and the families I help. I hope it helps them begin their healing process." During an exam Cornell said she looks for certain signs of injury, either physical or behavioral. "Sexual assault doesn't have to mean penetration or injury," Cornell said. "Things like inappropriate touching, atypical or unusual behavior and old injuries may also serve as an indication of assault." Behavioral changes can include disturbed sleeping patterns, poor diet, atypical sexual behavior, bed wetting, fearfulness of people, clinginess, failure in school and fighting.
"The main difference between adult sexual abuse victims and child victims is that adults typically immediately disclose the abuse to the authorities," Cornell said. "Many times children take longer, even years, to disclose what has happened to them." According to Cornell, children may take longer to report abuse because they may not know that it is wrong, they block it out or can not articulate what happened. "Abusers of children also groom their victims by paying lots of attention to them, buying them gifts and developing strong relationships," Cornell said. "Once the child realizes what is happening is wrong, they may feel trapped, are threatened by their abuser or worry about getting in trouble if they disclose the abuse to someone."
The typical abuser tends to be a family member or family friend. Many times it is a person the child knows well and trusts. Cornell advises parents to keep a close eye on their children to ensure their safety. She also recommends an open, ongoing dialogue with children about what is appropriate. "Parents should always talk to their kids about inappropriate touching," Cornell said. "Parents can teach their kids that their bodies are their own and people should not be touching any part of their body that is covered with clothing. [Washoe County] District Attorney Dick Gammick has been very committed to making these programs successful." Cornell said. "Senator John Ensign has also worked to obtain funding to build a Victims Advocacy Center near the Northern Nevada Medical Center. The center will be completed in summer 2008 and will provide all levels of service a sexual assault victim may need at the adult, adolescent and pediatric levels."
Cornell passed the certification exam in October, 2007 at the annual IAFN conference in Salt Lake City in October, 2007. The SANE-P national certification examination was given for the first time in May 2007 at a nursing forensic conference. In order for Cornell to qualify for the exam she had to meet several requirements. First, Cornell participated in a Child Abuse Response Exam (CARES) training program at the University of California, Davis. She was required to have two years experience performing examinations under the direction of the program's medical director. Thirdly, she was required to provide documentation of training and education. Cornell also needed the endorsement of the medical director.
The IAFN Sexual Assault Nurse Examiner Council has developed standards of practice and educational guidelines for nurses who practice in the specialty of forensic nursing. The council's existing educational guidelines and standards of practice were developed in 1996 for adolescents and adults. Cornell is a two-time Orvis School of Nursing graduate. An assistant professor for the undergraduate nursing program for six years, she has also practiced as a licensed family nurse practitioner for the past 17 years.