Abuse cases in the ED. How....?

Specialties Emergency

Published

I'm new to the ED, have been working the floor for a little less than a month, still in orientation. I do have prior nursing exp, 3yrs on an acute cardiac medsurg floor, different hospital.

Anyway, this morning, last case of the day for me, was a 2.5yr old darlin little girl that weighed 8kg. No other obvious signs of abuse, just [EVIL]gross neglect.[/EVIL] HOW do you deal with it? I was having the hardest time not punching mom's lights out. I'm still angry about it. Yes, CPS was contacted, and the child was sent out to a Children's Center.

I knew that these cases would be the roughest for me to handle, but I need some help on how to deal with this. Any advice would be appreciated. Thanks

Specializes in Nephrology, Cardiology, ER, ICU.

How sad! The ten years I worked in the ER were both the most rewarding as well as heartbreaking. You never get used to it. However, you do learn to separate things (as one poster said, to compartmentalize). You have to, to survive.

Talking it over afterwards and defusing the situation for you is very important. Does your ER offer a Critical Incident Stress Debriefing? I have found them very helpful.

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Specializes in Critical Care: Cardiac, VAD, Transplant.

Often times a family with several children will select 1 child to receive the brunt of the abuse and neglect. Medical personnel often forget this when doing evaluations. When they see the other children all healthy they just assume that the 'sickly' child just has something unknown wrong with them. It is so hard to see these kids like this.

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Possible, check genes for father being both gf and f?

that was my thought...

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Specializes in Cardiac, Med-Surg, now in ED.
is it possible that the baby is actually the grand child?

I thought about that, but didn't have time to go that far before we transferred the baby out. I'd like to follow up on the child, but am unsure of the p/p on that. Maybe its better if I just let it go as the child is in another hospital, and CPS has been contacted? Don't dwell on it. I know I can't let this get personal.

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Specializes in Trauma, Teaching.
I thought about that, but didn't have time to go that far before we transferred the baby out. I'd like to follow up on the child, but am unsure of the p/p on that. Maybe its better if I just let it go as the child is in another hospital, and CPS has been contacted? Don't dwell on it. I know I can't let this get personal.

Yeah, but it is personal. Whether it should be or not, sometimes one just gets to your heart. Easy to say don't dwell on it, hard to do. The last one that really hit home for me, it helped a lot just being able to talk it out a few times with dh, crying really hard, and praying about it. Time and talking lessened the grief.

You do have to let it go though. All the suspicians we come up with, so will the receiving hospital and CPS. CPS can likely think up even more than we can, sadly enough.

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Specializes in NICU, ER, OR.
Possible, check genes for father being both gf and f?

I am confused, please enlighten me.... why would we suspect this from what was posted?

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Specializes in Cardiac, Med-Surg, now in ED.
I am confused, please enlighten me.... why would we suspect this from what was posted?

I don't think I posted anything that might lead to that thought, but it sure was in my mind that morning. Just from watching the 13-14 yr old interact with the baby. She showed more concern than mom, was more attentive to the baby, acted more like a mother than big sister. I have 4 children of my own, and though all of my older ones were concerned about the younger siblings, it was nothing like what I saw. She acted responsible for the baby, was able to give more concisde information than mom, etc. I really don't know if the 13 yr old was the mother, but thats what my gut instinct was telling me. And, though not a lot of yrs experience as an RN, have learned to go with my instincts, and am rarely wrong. Unfortunately, I cannot follow up on this one to see.

Minor update about the baby: spoke with the medic who transported her and he said that after the bolus and infusion we gave, by the time they got 3/4 way to Children's in Columbus, the baby was up on all fours, crying (with real tears finally), cyanosis was mostly gone, and generally acting more alert. Good news, and made me feel a lot better.

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"I don't think I posted anything that might lead to that thought, but it sure was in my mind that morning. Just from watching the 13-14 yr old interact with the baby. She showed more concern than mom, was more attentive to the baby, acted more like a mother than big sister. I have 4 children of my own, and though all of my older ones were concerned about the younger siblings, it was nothing like what I saw. She acted responsible for the baby, was able to give more concisde information than mom, etc. I really don't know if the 13 yr old was the mother, but thats what my gut instinct was telling me. And, though not a lot of yrs experience as an RN, have learned to go with my instincts, and am rarely wrong. Unfortunately, I cannot follow up on this one to see. "

The 13 yr old could very well be the mother, but it could be a very concerned older sister. I have heard of siblings turning into "mother" figures when there is abuse in the family. She may have witnessed (or has been) abused and wants to give this child some sort of mothering. I have a friend that came from a very abusive family (drugs, very violent mother, etc) and she turned into the mother for her siblings. At 10 yrs old she did the best she could, but what 10 yr old really knows how to be a parent? After years of abuse, the state finally took the kids and she was able to be a child also.

Either way, my prayers go out to this child and the other children living in that household. Hopefully the state will come in and help this poor inocent kids from their worthless mom. Thank you for being concerned about this child and showing her some compassion in her life. You are a wonderful person and nurse to care about her.

JMHO

Erin

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1) "all children appeared on the small side"

2) oldest appeared about 13 (hmm maybe as much as 15 if small?)

3)lack of attachment from "mom" ie couldnt/wouldnt take older childs hint that baby needed diaper change

4) older child stepped in and took charge...

5) "mom" was upset her DAUGHTER would not be allowed in the ambulance

6) my gut instinct

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