Take these 4 steps if you suspect abuse
August 1, 2002 2 minutes read
When a 6-week-old infant was brought to an ED with a "soft" spot to the left parietal area, the parents insisted there was no history of an injury or fall. The child looked stable and was triaged as a nonurgent. But within one hour, the child was intubated, and a computerized tomography revealed a depressed skull fracture and subdural hematoma.
"The staff immediately suspected the parents, but once they were interviewed, we discovered that the child had been with a baby-sitter since the previous night," says Angie Black, RN, BSN, clinical educator for the ED at Children’s Memorial Hospital in Chicago. This underscores the need to find out who the caregivers actually are before you confront anyone, she says. Here are steps to take if you suspect that abuse is occurring:
1. Don’t jump to conclusions.
It is imperative that you remain nonjudgmental, advises Black, as hard as it may be. "You will have a difficult time gathering important information if you put the caregiver on the defense," she says.
2. Watch the child and caregiver interact.
Lynn Daum, RN, BSN, an ED nurse at Children’s Hospital Medical Center in Cincinnati, recommends staying in close proximity to the area where the child and caregiver are together and "letting your ears work for you. What do you hear? Normal conversation, dead quiet, or threats?" she asks. Daum also advises paying close attention to the way the child interacts with the caregiver. Does the child sit with eyes looking down, or does he or she flinch when the caregiver moves? "These type of behaviors should raise red flags," says Daum.
3. Don’t accuse a suspected abuser.
Deborah St. Germain, RN, MN, a clinical nurse specialist at Louisiana State University Health Sciences Center in New Orleans, stresses that the alleged perpetrator is innocent until proven guilty. "This occurs outside of the ED by a judicial process," she says. She also notes that your role as an ED nurse is to protect the child, not to accuse and anger the family member or perpetrator who may be in the ED. When approaching the family, St. Germain says a compassionate, concerned practitioner should inform the child and significant caregivers that you feel "someone may be hurting (use the child’s name)."
When the family asks you who is doing this, St. Germain recommends saying "we cannot determine this yet, but we are concerned for your child’s safety." This approach may minimize altercations among family members, the potential to flee with the child, the chance of additional violence against the child, and anger directed toward the health care team, she says.
4. Don’t hesitate to call social services.
If there is any doubt in your mind whatsoever, Daum recommends erring on the side of caution and calling social services. "That is the key to saving kids," she says.
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