Neglect? What would you do?

[KATRN78]

I care for a lovely,girl who has CP, non-verbal, 15 years old, 95 lbs, profound mental retardation. she has a GT. she lives with both parents and 2 adult sisters. the family is very nice. they hug and kiss her often. they talk to her. joke with her etc...

the problem is that Mom seems lax on ordering things and making appointments. the girl has not been to a dentist in 3 years, her wheel chair is too small. I don't think they bathe her on saturday and Sunday (no nurses these days).

her insurance lapsed 3 weeks ago and she had no nurses for 8 days. when I came in she was a mess. breakdown under arm due to wheelchair supports, stage 2 on sacrum, breakdown on face where she drools.

i documented everything, notified management.

this is very sad.

[LPN4life2004]

It's seems that mom has got her tush in gear a bit. That's a start! It's never easy to call CPS on a family when you know they love their child. But as a parent there are priorities that have to be made. You gotta take care of your kid, if you don't, people may get involved and there may be consequences.

[LaughingRN]

I feel bad for everyone overall. I agree with the poster that said that abuse isn't always intentional.

I can clearly see both sides of this issue.

1. Family----loving, but failing to keep up with the standards. I can't even imagine the amount of time dedicated to the care of one family member with medical needs. Then I multiply it by X amount of years and my head is spinning. I have one son (no medical needs for the record), one husband, one full time job, one house to clean, one yard to take care, one fridge to keep stocked with food....and sometimes I fail to be perfect in all those obligations. Between driving to multiple sporting events, planning our days, fitting in everything, I fall short of perfect.

Sometimes my son doesn't shower for 3 days (which he gets excited about the fact that I forgot to tell him to shower, but he's at that age I guess) and I feel exasperated when I remember.

Sometimes we run out of milk because I just worked 4 12 hour shifts in a row....midnights at that!

Sometimes I even forget to change to laundry over! (And then have to re-wash it all, and don't get me started on when I have to re-wash after I re-washed)

Sometimes I put off appointments to optometrists and dentists because the timing isn't right and the money isn't right and because I have a deep rooted tendency to procrastinate.

I could go on with examples to show I'm not perfect, but I find my life challenging to keep up with and I don't have a medically impaired individual that I'm responsible for.

With all that said, as nurses we are hyper-vigilant to noticing that q 30 minute turns weren't done and that it is a failure. However, skin breakdown happens everyday in nursing homes, hospitals and even with the best private healthcare money can afford (didn't superman die from complications of a pressure ulcer?)

Would the solution be to remove the child from a home with genuine love and place her in an institution (see above) that has no glowing track record of preventing the same deficits in care but would be loveless???

I digress.

2. The child- dependent and vulnerable, can't speak up and demand proper care, but deserves the utmost care and highest quality of life that is achievable, like all of us. Nothing more to say.

If we can all admit that healthcare (especially long term care) is understaffed, struggling to meet standards of care...why are we not as understanding on a family consisting of multiple people with extraneous circumstances.

I am aware that the family has been reported already, but maybe it is a lack of resources and time and money that is making the family fall short. Maybe it is simply caregiver burnout. Caregiver burnout is not synonymous with not caring.

Conclusion: life is not black and white. What is the solution, I don't really know. Is there always a solution....probably not. Should we go out with guns blazing, guilty until proven innocent on this family? I just know that the pressure of being under such a microscope of having nurses In your home day in and day out, ready to chart your flaws must be tremendous. I'm a nurse, and I wouldn't want to be under anyone's microscope.

Ethical dilemma for sure.

[KCMnurse, BSN, MSN, RN]

I agree with most of what has been posted by others. There is a clear distinction though between a harried parent forgetting to buy milk and a licensed professional witnessing clear signs of neglect. As much as we hate to use that "n" word sometimes you have to call a spade a spade. The nurse did the right thing and positive things resulted. Mom managed to shift gears and get her priorities straight and help her daughter. At the end of the day when there is a bad outcome all the excuses won't matter. Unfortunately the nurse is usually the one that the fingers point to for blame.

[amoLucia]

OK - so the fuse has been lit for that family's Mom. But now it must be seen that there's followup. Or else all the excuses will continue.

That 'N' word, neglect, can be direct or indirect, intentional or by default. But it's still neglect and it's still considered a form of abuse. Abuse isn't just someone whacking at someone else. We all know that abuse can be physical, mental, verbal, monetary, etc. Neglect of physical care needs falls under that umbrella - whatever it's cause.

Hopefully, things will work out for that kid and her family, but it needs continued monitoring. Kudos to whomever took that leap of faith to get others higher up involved.

[KATRN78]

Update:

Things are going very well for this patient. All needs are being met even when nursing is not there. Also, after social services visited they were approved for more nursing hours. Everyone is happy.

[Elektra6, ASN, BSN, RN]

Glad to hear it!

[thenursemandy]

Neglect does not mean intentional harm. Neglect is an act or inact that causes unintentional harm. Ie. Not repositioning or padding bony prominences and an ulcer develops.

P.S. it is not up to us to decide whether something is abuse or neglect. if we have even the slightest inkling that it might be, it is our duty to report. It is up to Child Protective Services to make the determination, not us.