FAQ W Ans (Pott 36-FAQ)

Frequently Asked Questions

You are working in a family clinic. Many of your clients come from different cultures and ethnic backgrounds. On several occasions, children have come in for checkups or treatment for respiratory infections or abdominal distress. You are facing an ethical dilemma when you see a child with cupping or coining marks. You know that these children have been treated using a “traditional” or folk medicine perspective. Unfortunately these types of treatments may create first- or second-degree burns or abrasions. The clinic is careful to respect and encourage clients to follow their traditional health and health care practices, but you are worried that this is considered child abuse. How should you handle these types of situations?

This situation presents an ethical and legal conflict. As a child advocate, any action or practice that results in injury to the child should be reviewed and evaluated. As a profession,nurses are also trying to acknowledge the impact that culture has on health, wellness, and illness, including the inclusion of traditional practices. Because you have several members of various cultures in your clinic population, you may want to provide a series of educationalpresentations regarding how you can help in treating and dealing with illnesses as well as discussing how traditional health practices can harm or injure the child. You may want to create a policy on how your clinic staff, medical provider, or nurse will respond when a child’s treatment results in an injury. Don’t forget that you do not want to destroy whatever trust and relationships you have established. Families who feel threatened or uneasy because of the reception they receive when coming to the clinic may decide not to seek health or medical care. Their children may suffer longer or more intensively because of this. Including traditional health care practitioners as part of your health care team may improve understanding of the possible harm and may promote more effective use of health care providers.

Teachers are often the first ones to identify children who are victims of child abuse. Because of this, it is important to keep them informed and educated about the signs and symptoms that children may exhibit that are warning signs of abuse. What are the most important warning signs for them to be aware of?

Child abuse is present in homes of all economic, social, and environmental levels. Abuse can be physical or psychological. Signs and symptoms of physical child abuse is more apparent: unusual bruises, scars, burns, or welts that appear to be in various stages of healing. Psychological abuse is more difficult as it is most often demonstrated by behaviors that could reflect other issues. However, common signs and symptoms may include a child who exhibits a timid, withdrawn, or frightened body posture when an adult approaches; anxiety and distress when other children are reprimanded or are crying; overeagerness to please or supplicate an adult or other child; behavioral extremes (aggression, passivity); attempts to stay at school and not return home; and self-isolation. If abuse is suspected, it is important that it be reported immediately to safeguard the child.

Susie and Billy are 2-year-old twins whose mother has been arrested and placed in jail. Susie and Billy were found in a motel room crying while their mother lay passed out in the bathroom. The twins have multiple bruises on their faces, backs, and abdomens. They are hungry and dirty. You have been assigned to be their primary nurse. What will your plan of care include?

Susie and Billy will require a lot of support, both physically and emotionally. Nursing considerations should focus on establishing a sense of trust and feeling safe, providing adequate nutrition, meeting hygiene needs, providing developmental stimulation, and encouraging them to express their fears and other feelings. It will be important to acknowledge that they love their mother and may be feeling abandoned. The twins may also be feeling guilty and blame themselves for their mother’s incarceration (they only know that she is gone). They will need counseling and interventions focused on helping them build self-esteem. Depending on what happens legally, Susie and Billy may be returned to their mother. If this happens, the mother will need to learn how to model appropriate parenting behaviors. She may also need counseling on how to deal with anger and to recognize when she is at risk for abusing the children. The family may need counseling to learn and develop appropriate relationships.

Erika is an infant admitted to your unit following an apnea spell at home. Her mother reported that before she stopped breathing, she seized and began to froth at the mouth. Mom performed cardiopulmonary resuscitation (CPR) for 5 minutes before the paramedics arrived. They found Erika to be lethargic, pale, but breathing. You learn that this is Erika’s fifth admission in 2 months. While participating in interdisciplinary rounds, you learn that Munchausen syndrome by proxy is being considered. What is this?

Munchausen syndrome by proxy is a term used to describe situations where caregivers fabricate signs and symptoms of disease or illness, administer potentially harmful substances to their child with resulting crisis, or cause their child to receive medical interventions that may be invasive or potentially harmful. Munchausen syndrome by proxy is considered to be child abuse.

As a nurse, you occasionally work with children who have been abused, but you have questions about possible legal issues. What are the issues you should be aware of?

It is important to practice in a professional and ethical manner at all times. If you are unsure of your state’s nurse practice act, obtain a copy and become familiar with it and practice within the defined scope. Be sure to document client and caregiver interactions. Maintain confidentiality, and follow federal and institutional guidelines regarding sharing or releasing information. Respect the right to privacy and the right to refuse treatment. For more information or assistance, contact appropriate team members, a supervisor, or the risk manager. They may be able to provide clarification and verification of policies and protocols.