Ethical Issue- Is this child abuse? Do I need to report this?

This is child abuse....Exposure to domestic violence is child abuse. I agree with the others that you are way to close and need to redraw your boundries. Also since the family sees you as "family" you are in the line of fire as well. Report this as YOU saw it. Good luck

Agree with above. To me it seems a good idea to remain with this family for the sake of Sam. You could be his only true ally. However, boundaries with Mary must be reestablished. She clearly is not mentally stable. Avoid personal conversations and contact outside of the professional setting. It is possible, though tricky to withdraw from her without alienating her. Document everything.
As far as child abuse...yes it is. But knowing what we know about CPS services in most areas of the country you must show good judgement when deciding to report. What happened in the UK is most likely not really something they would pursue here. However, what you see in the home should be carefully documented, even if you do so in a personal journal that you tell no one about. Of course any direct physical or even emotional violence that you see should be reported. Mary will most likely become violent again, Dad will see eventually that his wife is crazy and you will be on the stand in a heated custody case. Prepare yourself for this. Do not involve yourself in their marital issues. They are grown ups and he will have to sort this out himself. I know it is not right that the children are in the middle and will be affected tremendously. Unfortunately it happens in millions of homes in America every day.
Sorry to go on so long. Please keep up posted. Best wishes to you.

Hi exhausted:

Do you have a social worker you can consult? Ask their opinion only on what YOU have witnessed first-hand.

Unfortunately, you have become a participant in this crazy-making. My advice is to extricate yourself....Talk with your superior, have someone else assigned. You do not have to remain directly involved to ensure this child's well-being.

In fact, I would argue that a more objective nurse will be a far more effective advocate for the child because his/her judgment is not clouded by a "friendship" with the family.

Without going into detail, give your supervisor and/or replacement a heads-up about your concerns regarding the family dynamics, so he/she will be alert for signs of trouble.

Please take the advice our experienced, learned colleagues have given you. Thay know what they are talking about!! Good luck!

Exhausted,

You might want to look for signs of Munchausen syndrome by proxy. She sounds suspicious.

As a former cop (yes, I was a cop!), you can't report (and expect action on):

(1) hearsay, which is what this whole UK story is, or
(2) something that happened outside (in this case WAAAYYY outside) the jurisdiction of your local law enforcement agencies.

The dispatcher will think you're nuts since none of this has anything to do with either you or them, and what if the sister's crazy and YOU end up in trouble for filing false allegations or for defamation of character?

If this woman is indeed a basket case, I'm sorry for the kids, but you can't prove a thing here (mainly because you've witnessed nothing, based solely on what your OP says) and you're only going to end up in the middle.

Ultimately we can't tell you what to do here, but please - be careful.

I agree that you can only report what you witness. If some one else tells you, that person needs to be encouraged to report what they saw.
Please reconsider being a home care nurse! It is very hard on these special one on one cases not to get too close to the pt and family! When I did home care I did short 30-60 min visits and still became way to involved in my pt family life! I know it is hard not to cross that line and that is one of the reasons I quit home care.
Good luck to you and stay safe!

Its very easy to overstep boundaries in home care. at least this is my experience. however you must review your personal values and find balance with them against the laws of ethical nursing. While I do not see where you can report this as child abuse to the child protection agency. as has been said you did not witness this, I do not see why you could not mention the incident to your immediate supervisor, in fact I would highly suggest that you do so. By being aware of the mother's radical behaviors and having witness many episodes of inappropriate lashing out. It seems to me that the husband may call you to testify on his behalf as a witness to her erratic behaviors in order to promote his claim of being the more fit parent. And I am concerned for you because having witnessed these events, I feel you should have suggested the mother leave and take time for herself, after all you were there to provide respite for her.

I am a mother of 2 boys with autism and I understand having little to no family support and no time away from the children. I was unable to qualify for respite because my income is too high, so basically if I didn't provide care, no one else did. I will give my dad credit as he would take my youngest son occasionally, often at the end of his wits by the time he returned. My youngest has severe behavior issues and is very socially inappropriate 99% of the time. The school even did not help me find any respite, and on top of that refused him to be schooled within the public school. His school for the past 2 years has been 1 hour, 3 days a week at the public library. And even then those sessions did not go well more often than not. So I can relate to this mom not having anytime away from the kids, time to relax, calm down, think about something besides suctioning and signing, etc. You being the childs nurse and closest healthcare worker to the family should have seen this and suggested she take time. Perhaps insisted. You also might have consulted with your supervisor who could have met with her and suggest she seek psychological services for herself, and presented it in a manner to show it would benefit her and her children as well.

I had a social worker suggest I seek psychiatric help and when she did I felt like she was blaming me for all my son's behavior issues. I was angry with her and left her office with a chip on my shoulder. However after a few months went by I took a look at myself and realized I did need help. I saw a psychiatrist, got some antidepressants and an antipsychotic and within a few weeks felt so much better. And I was better able to handle my son's behavior, he didn't break me down to the point where I felt defeated anymore.

I feel bad for this family and I hope things will work out for all in the end. I would definately discuss this with your supervisor and find out if they have you covered with malpractice insurance. I really don't think you will be sued, but if you are called into court as a witness you might be acused of neglecting to report the mothers need for help to your supervisor. Good Luck