Angela Heckman

“Self-Esteem and Childhood Sexual Abuse”

IU Kokomo School of Nursing

A survivor of childhood sexual abuse, IU Kokomo master’s student Angela Heckman hopes her research will help other nursing students face the issues that come with being a victim of a sexual predator.

Heckman says, “If people start talking about it and opening up about it, then healing can start taking place. Sexual abuse is built around shame and guilt because, as a child, you keep it a secret and it ends up destroying you, as is evident with self-esteem. I hope to bring about more awareness and open up communication.”

Heckman devised a research project that enabled her to learn the prevalence of childhood sexual abuse among nursing students in the Kokomo area and to see whether having a history of sexual abuse affects one’s self-esteem. For her project, titled “Self-Esteem and Childhood Sexual Abuse,” Heckman visited nine classrooms telling students about her childhood of abuse and what she hoped to gain from the study.

She distributed a survey and consent form, and out of 372 students at IU Kokomo and Ivy Tech State College Region 5, Heckman had a 98 percent participation rate. The sample included both men and women, which she combined into one sample called “nursing students.”

After compiling the data, Heckman was shocked by the participation rate, “especially when I thought it was going to be such a touchy subject,” she says. For the study, it was important to survey both abused and non-abused subjects to measure the self-esteem levels between the two groups.

When Heckman began to look at her data, she saw that prevalence of sexual abuse among nursing students in the Kokomo area is higher than the rate of sexual abuse the World Health Organization reports among various populations. Heckman says the World Health Organization reports one in five girls will be abused by the time they are 18. In her study, 31.5 percent of the students, or about one in three students, is a victim of sexual abuse.

Her preliminary findings show a significant difference in self-esteem levels in students who have been sexually abused. Sue Hendricks, associate professor of nursing at IU Kokomo, is sponsoring Heckman’s research. Hendricks said the study is significant because Heckman found a fairly high prevalence of past history of sexual abuse among nursing students, corresponds to the only other similar study she found, which was reported in 1989.  

Heckman said additional research must be conducted to determine why there is a high incidence of nursing students in the Kokomo area who are victims of sexual abuse. She has a couple theories, including the idea that those who are abused become caregivers to heal others. Another theory is that the World Health Organization’s numbers are wrong because they are taken from children, not adults, and children are less apt to talk about sexual abuse. Often, children who are victims of sexual abuse will talk about the abuse only when they are adults. Heckman is one of those children who did not talk about the abuse until she was married and had children.

The final part of Heckman’s study asked each student who reported being abused about the length of the abuse, the nature of the abuse, and the frequency (one time or many times through several years). She then asked about the relationship of the perpetrator to the victim—whether it was a family member, friend, or someone else.

“I thought maybe if someone had a one time incident with a stranger, that wouldn’t affect self-esteem like it would if it had been a family member over time,” Heckman says. “In my analysis there was no correlation. It could be there are other factors that do correlate, even though the questions that I asked did not. It leads to further research.”

Examining the data she has collected, Heckman is concerned with the high percentage of nursing students who are sexual abuse victims and have self-esteem issues. She believes it is important for nursing faculty to examine this issue and to address it. “We want our nursing students to be confident caregivers by the time they finish nursing school,” she says.

Establishing support and counseling groups is one way to help these students so they can increase their self-esteem and be confident caregivers when they graduate.

Hendricks said there is no way to know, based on the study, if nursing students are more willing to report past history of abuse than the general public. It is possible that nursing students are more willing to divulge their history of abuse because they have learned about it in class. However, the prevalence just may be much higher than the normal population.

“Either way, it is important for educators of nurses to know, since it may affect different aspects of both education and practice,” Hendricks said. “The study did find that self-esteem was significantly lower among students who had a self-reported history of sexual abuse, and we both expected to find this—it matches findings in other studies in non-nurse populations.” The mean difference is not that great, but definitely different, she notes.

“For the profession of nursing, these findings are important, since self-esteem relates to the presentation of the self and has a bearing on the public image of nursing,” Hendricks says. “These are issues that educators of nursing students can work with positively if we are aware of them.”

With her data gathering complete, Heckman plans to finish the study before earning her master’s in community health nursing at IU Kokomo.

For more information see:

IU Kokomo School of Nursing

Indiana University School of Nursing