It
is really hard to be professional with these parents sometimes. It's painful to have to be polite and helpful and offer family-centered care when the parent is the abuser. But often times the facts of the abuse haven't all come out when the child is admitted; when there are multiple caregivers it's sometimes impossible to identify the perpetrator.
The first case I ever was involved in was while I was still on orientation. The patient was a 9 month old girl who came in with septic shock from peritonitis. The imaging wasn't really helpful in revealing the exact cause so she went to the OR for exploration. I asked if I could help readmit her after her surgery, thinking it would be good experience for later.
The surgeon came to the unit with her and told us that her small bowel was ruptured; this kind of injury in an infant or toddler is NEVER accidental. He said the only way she could have gotten this way was by being stomped on. We were all reeling from that, but got to work with the admission. I was doing the tasks of admission: sorting out lines, transferring drips to pumps, calibrating transducers, measuring output, getting the low suction going and the rest of the drill. I was really not prepared for what I discovered when I went to replace her rectal temp probe. Her anus had been torn from the introitus of her vagina posteriorly to her coccyx. It wasn't a new injury, there was no redness or swelling or any sign of bleeding, and no one had documented it. I was nearly sick to my stomach. What made me sicker still was that no one was ever charged with these heinous acts. When she died the following day, I was relieved.
The following year, we had a spate of shaken babies, all nine month old girls, all shaken by their fathers, all died. The dads were all charged, pleaded out and got two years less a day in a medium security facility.
Recently I cared for a three month old who had a 4 cm tear at the base of her tongue. The dad was alone with the baby when the bleelding was noted. The aunt convinced the mom to disclose that the dad was abusive to her and the baby was apprehended.
I prefer informal debriefing with other nurses in my unit when I have patients like these. I don't find that the one-size-fits-all approach of critical incident stress management is all that helpful. The buzzwords and platitudes aren't my schtick. Our chaplain is always willing to talk to us individually and she's really supportive in whatever method of debriefing we choose. At the end of the day, I think it helps to remember that these families are really few and far between and that someone needs to care for the children.
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