Dealing With Child Abuse

BabyLady, BSN, RN · Mar 8, 2011

I am currently finishing up my prereq's to apply to the nursing program this fall. I have spent a very long time thinking about possible things that could happen while I am a nurse and the only thing I think I will have a problem with is abuse. How do you deal with knowing that someone has abused a child, treat them without being judge mental (totally avoiding strangling someone). Do they train you for that? How do you deal with this when it comes through your department? What can I do to prepare myself if anything?

I had the same fear as well.

It is one of the reasons why many nurses work in the NICU and Labor and Delivery.

Granted, we see the results of very poor prenatal care, drug use during pregnancy, etc....however, we generally don't know what happens to the children after they are released.

Not that makes it better, because sometimes you worry about the environment some of them are going home in, but it does make it easier to emotionally manage.

merlee · Mar 8, 2011

We take care of patients ALL THE TIME whose backgrounds we never know. A man comes in with an MI, we never ask, "By the way, did you ever touch anyone inappropriately?"

A woman is having a gall bladder attack, we don't ask if she spanks her kids too hard.

I am not saying that there may not be a time when certain things come to light, but for the most part, we are caring for some one who has an acute need.

I worked in a jail, and even those people who have been convicted of crimes still get health care. BTW, I never asked what anyone was in for although some offered.

Your fear is generally unfounded.

kessadawn, BSN, RN · Mar 8, 2011

I have to disagree, I think this is a valid fear, especially for those of us who work in pediatrics. It makes one question oneself...can I be completely nonbiased and professional while caring for this patient? I have never worked in the adult world, I can't speak for that situation, but I do work peds, specifically PICU, and I have found myself in this corner a time or two. Most of the time, the person who ends up being charged and/or later convicted is rarely in the room, they take off. But sometimes the person who "fits the picture" is there, and is the primary caregiver of the child. What do you do? Truth be told, no matter how much you think someone is guilty, and I've been there, you never know 100% for sure, and you just need to focus on your patient's immediate needs. Smile, count to 10, and just be the nurse, that's all you can do. It's very frustrating, sometimes I want to scream I KNOW YOU DID THIS, but, I can't. And sometimes they don't recover, and that makes me really angry. My co-workers and I take turns with assignments like this, so no one nurse has to bear it all herself, and we are all very good at recognizing when a co-worker needs a break. I hope you never have to find yourself in this situation, but if you do, lean on your co-workers, take a deep breath, and remember, you can do anything for one shift.

MeganDM · Mar 8, 2011

I didn't mean knowing their history, I'm sorry for the unclear post. I meant what do you do when you are face to face with a child who has been severly beaten or burned a clear cut case of abuse. How do you handle such a thing? I'm sure you see that sort of thing, I was just wondering How you keep calm and mainly how you don't take those images home with you. Again, sorry for the unclear post and thank you for your answers.

GeneralJinjur · Mar 8, 2011

One of my instructors spent the majority of her career in Peds. She said that she tried hard to focus on the fact that the abusers had most likely been abused themselves as kids and did not know how to cope better. I will be borrowing her philosophy if/when I deal with this myself.

Dalzac, LPN, LVN, RN · Mar 8, 2011

every pt that came in with obvious beat marks on the we just would tell them it is the law we call the police and here it is the law but before I call the police I will have another nurse and the doc check it out so it is just more than one nurses opinion

rn/writer, RN · Mar 8, 2011

You don't focus on the visible signs of the abuse. You try to connect with the child behind the bruises and burns. You speak to them calmly and tell them everything you're going to do before you do it and communicate that the touch of an adult doesn't have to bring pain and fear.

You listen if they want to talk and let them know that you're sorry they're hurting, but you don't say anything bad about the abuser. For one thing, it may not be clear who that person is. For another, despite what has been done to them, most child abuse victims still love the parent(s) who hurt them.

After a trying case, you talk about your feelings with co-workers, friends or family who would be able to take it, the Employee Assistance Program at your facility or another trusted resource. No, you don't violate HIPAA concerns. You keep things general and you talk about your thoughts and emotions.

If you don't have what it takes to process your way through this, you'll either find a way to adapt or you'll move on.

Nurses aren't people who give up their feelings. They are people who learn to function in spite or--or even because of--their feelings.

Don't despair and think that your brief time with a hurting child is only a drop of mercy in a bucket of pain. Instead, imagine that those minutes are seeds being planted. Many adults who were abused as kids say that a few brief encounters with kindness kept them going. Those seeds took root and grew enough to let them know there were better things in the world than what they had seen.

echo56 · Mar 8, 2011

Focus on your patient, and just remember... God has a special place for people who hurt children.

kessadawn, BSN, RN · Mar 8, 2011

I didn't mean knowing their history, I'm sorry for the unclear post. I meant what do you do when you are face to face with a child who has been severly beaten or burned a clear cut case of abuse. How do you handle such a thing? I'm sure you see that sort of thing, I was just wondering How you keep calm and mainly how you don't take those images home with you. Again, sorry for the unclear post and thank you for your answers.

It's very difficult to see a child who has been abused. You just want to wrap your arms around them and protect them from everything! Keeping calm has not been a problem for me, I am just so focused on the immediate needs I'm too busy to do anything else, but I do work in a critical unit, and unfortunately our abused patients are generally gravely ill.

How do you not take it home with you? That is difficult, especially given the severity of the abuse I see. Co-workers are a godsend, unload on them. Hospital chaplains are another wonderful resource, have one paged. Go home and hug your children, especially if they look at you funny when you do. And always remember, it's okay to walk away sometimes, get another nurse to cover for you, go in the bathroom or step outside, have a good cry, or yell at the wall, or whatever you need to do to let it out. Don't keep it inside, let it out, and move on. On your next day off, spend at least a good part of the day focusing on you, get a mani/pedi, or a massage, or go for a run, whatever it is that helps you cleanse your soul. And remember that child is better for having you help save them from the terrors in their life.

SilentfadesRPA · Mar 8, 2011

best of luck when you apply for nursing school -

NicuGal, MSN, RN · Mar 8, 2011

I've had to deal with children of abuse...and I will confess, I have seen some horrifying things on our PICU and peds floors....a few of them have been graduates of our NICU. The first time I saw a child that had been beaten and sexually assaulted (she was 7 years old) I had to leave the room and throw up. Put I got myself together and went and gave that little girl the best care I could. Sometimes they come in with only a policeman/woman because the family is being held and there is noone else...you are it for that child.

It is hard, but it is part of our jobs.