In this paper, I will discuss the ethical dilemma faced by a nurse who is caring for an eight month old patient, who reports with his mother to the emergency room with a suspicious fracture. The mother provides a plausible story, and the physician knows the family and does not suspect abuse. I will discuss the action I would take in order to provide the appropriate care for this patient. As a registered professional nurse, I feel the only approach to the case is to report the injury to Department of Family and Child’s Services (DFACS) for their investigation. When a report is made, DFACS will complete an investigation and make the ultimate decision if abuse or neglect was the cause of the injury. Each nurse has a duty to report all suspicious injuries to DFACS, regardless of her feelings on abuse or neglect. This is true even when the physician knows the family or does not suspect abuse.
The nurse is responsible for her own actions. In order to provide the best quality of care for this patient, I would take the statement from the parent about how the patient was injured, and then talk to the physician to gather the physical finding, which may include x-ray reports after this information is gathered, I would report the case to the local DFACS. Anytime there is a suspicious injury regardless of the plausibility of the story, or if the physician knows the patient and does not suspect the parent, the DFACS case must be reported. The nurse in this situation has a duty to report this injury and let child services decide if the patient is in danger. I would perform a complete examination of the patient and communicate with the physician, in addition to noting any other signs of abuse, along with paying close attention for indicators of abuse. Indicators of abuse can warn healthcare providers to pay closer attention to situations that may indicate abuse or neglect and sometimes there are not indicators even though the child may be abused (Henderson, 2013).
Three indicators of abuse or maltreatment include physical, child behavioral and parent behavioral indicators (Henderson, 2013). These indicators should not be considered in isolation but should be considered along with the child’s condition in the context with overall physical appearance and behavior; however, it is conceivable that a single indicator may be consistent with abuse or neglect (Henderson, 2013). Considerations of abuse are raised by injuries to both sides of the body and/or to soft tissues, injuries with a specific pattern or injuries that do not fit the explanation, delays in presentation for care, and/or untreated injuries in multiple stages of healing (Henderson, 2013). It would be helpful to check the patient’s record for previous unexplained injuries or history of frequent visits to the emergency room or physician’s office. Any burns or patterns of bruising during the examination would warrant further investigation.
Other signs of physical abuse I would monitor for include signs of pain where there is not visible injury and lack of reaction to pain. I would also note any emotional signs of physical abuse, which include passive, withdrawn or emotionless behavior, and fear when seeing parents. Any symptoms noted on exam should include this in the report to DFACS. Since the physical signs of abuse are often visible, most cases of abuse are recognized by a healthcare provider (Padera, 2009). These signs may be noted at routine appointments or while providing acute care. The ethical principle of non-maleficence and beneficence are addressed with this case. The ethical principle of non-maleficence helps to ensure that healthcare providers do not harm to their patients. If I did not report this case to DFACS for investigation and the abuse continued causing any harm to the patient, this would be an ethical violation of non-maleficence on the part of the nurse.
The ethical principle of beneficence ensures that health care provider’s actions benefit the patient. By choosing to report this case to DFACS, my actions would benefit the patient and help ensure that the patient was no longer being abused. As a nurse, if I did not report this to DFACS for investigation, I would be in violation of the nurse practice act, and I could be held liable if the patient suffer more injuries or death at the hand of an abuser. My report of child abuse or neglect is confidential and immune from civil or criminal liability as long as the report is made in “good faith” and “without malice” (https://www.oag.state.tx.us/victims/childabuse.shtml). Provided these two conditions are met, as a nurse, I am immune from liability if they are asked to participate in any judicial proceedings resulting from the report (https://www.oag.state.tx.us/victims/childabuse.shtml).
In conclusion, mandatory reporting can produce unanticipated and unwanted consequences (Buppert & Klein, 2008). Nurses may be concerned about reporting suspected abuse especially, when the investigation is completed, no abuse or risk to the patient is found (Buppert & Klein, 2008). Boards of Nursing rarely discipline nurses for failure to report and nurses are covered with their nurse practice act when they make reports in “good” faith (Buppert & Klein, 2008). Given this information there is no reason not to report this mother to DFACS for investigation.
Buppert, C. & Klein, T. (2008). Dilemmas in Mandatory Reporting for Nurses. Medscape. P. 4- 16.
Henderson, K. L. (2013). Mandated reporting of child abuse: Considerations and guidelines for mental health counselors. Journal of Mental Health Counseling, 35(4), 296-309. Padera, Connie. (2009). Nursing, Child Abuse, and the Law. 7(37). P. 122-126. When you suspect child abuse or neglect: A general guide. Retrieved from https://www.oag. state.tx.us/victims/childabuse.shtml
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