Hospital
You are a nurse working in an urban emergency department. A 13-month-old girl is brought in by her mom her and her mom’s boyfriend with swelling and pain to the left leg and hip and a bruise on her forehead. The mom reports that her daughter won’t stop crying. During your examination, you notice bruising of various sizes and colors on her trunk, including the abdomen and back.
The boyfriend reports that the child fell off her highchair earlier in the day while his girlfriend was at work. He seems overly protective and won’t allow the mom to answer any questions. She manages to timidly say, “she’s my daughter, you haven’t been living with us for very long and don’t know her.” The child is crying uncontrollably and screams and pulls away from the boyfriend when he tries to touch her.
You send a nurse and the mom for an x-ray of the girl’s leg and hip, which shows a buckle fracture of the tibia. You ask the boyfriend to wait in the room, but he is becoming increasingly agitated and impatient and says he is going to take “his daughter” home. When the girl returns from his x-ray, the doctor recommends that she be admitted for more tests.
Discussion
You are concerned that the child is being abused. You and your colleagues feel the child is also in imminent danger due to the leg fracture, bruising of different levels of healing, depth of bruising, and bruising in atypical locations*, as well as the child’s fearful reaction to the boyfriend.
*Atypical bruising caused by inflicted trauma includes bruises inconsistent with the mechanism of injury, bruises on soft parts of the body such as the ears or neck, patterned or clustered bruises, and bruises that are not consistent with a child’s developmental level (Chapple, 2015).
Your suspicions are aroused further when the boyfriend tells you he is going to get a cup of coffee. On his way out he says, “there’s nothing wrong with the kid—she’s just being a baby.” The boyfriend does not return.
What Action Do You Take?
- Monitor the situation.
- Report your concerns to the hospital administrator.
- Make an immediate report to the Statewide Central Register.
- Ask the sheriff to arrest the father for leaving the hospital.
Answer: C
You correctly decide to make an immediate report to the Statewide Central Register. Because you feel the child is imminent danger, you also call the police. Unfortunately, law enforcement does not arrive in a timely manner. Until law enforcement arrives, hospital personnel are in a bind. The mother can leave at this point against medical advice although this will not look good for her if there is a CPS or criminal hearing. The situation is fraught with ethical and legal issues for healthcare providers.
The bottom line: Do your duty, make your report to the Statewide Central Register, call the police, and continue with your work.
Neonatal Drug Withdrawal
A mother delivers a baby who has neonatal drug withdrawal. When talking to the mother, you learn she has not prepared for the baby to come home. You additionally learn that she has been using drugs throughout her pregnancy and did not see a healthcare provider at all during the pregnancy.
What indicators are present?
- Neonatal drug withdrawal
- No plan for the baby
In your role as a mandated reporter, is there reasonable cause to suspect abuse or maltreatment?
Yes
Is there a person responsible for the suspected abuse or maltreatment?
Mother
What are your next steps?
Call in a report to the Statewide Central Register