Ethical dilema on alleged sexual abuse.

[racing-mom4, BSN, RN]

Ok here is the scenerio. I am given report from ER that I am getting an admit who is 4x the legal limit of alcohol. I am told she is in 4point leather restraints, has been given gedon and ativan and is currently sedated. I am then told during report from ER that she came in with her friends and pt had made the statement that her boyfriend is "screwing" her 12 year old daughter, that she was sobbing "just ask her" the friends brought her in because boyfriend "allegedly" threw her and the kids out in the rain and locked them out of the house. Friends took the kids home. RN that gave me report said she called the boyfriend to get medical history and boyfriend said "tell her to get her own ride home" and hung up.( I already have an issue with her calling boyfriend--but that is another topic)

So pt arrives to unit and is basically unresponsive, I got zero verbal communication from pt.

Few hours later I see RN who had her in ER and asked "so did you call social services about the boyfriend?" I was told no they did not, because the child was NOT the patient.

I said that I was under the impression that all reports of abuse against children must be reported. She adamantly disagreed and we debated this issue for quite awhile. Finally she said if I felt so passionate about it, then I could call.

Well my thought is pt did not tell me this statement and no where was it documented in ER report. So I dont think it is right for me to report when I only heard it via hear say, as even though I was told it during report, it was not documented and the pt did not tell that to me.

had pt have told that to me, I would have.

FYI the nursing mgr agreed with the ER in that they did not have to report....now am I missing something here??

At 6am pt awakes and is crying that she wants to call boyfriend---that she loves him.

OK on the topic of calling the boyfriend--I was very upset about that, because now he knows she is in hosp--and a few hours later he did call back into the hosp and ask if she was still there and ER told him She is not here. So now I am thinking he could have easily have gone to friends house looking for her and the kids.

I was also given in report that her friends stated to the ER staff that this pt has no family in the state and is basically estranged from all family.

I only add this statement because another thing that bothers me is if we are given this social/personal information via report, but it is not documented in chart, do we really need to know it??? What is the difference between "gossip" and "facts needed to do our job"---isnt that kind of like the old telephone game we used to play as kids. I tell suzy one thing and suzy tells cathy another variation and cathy tells missy another--by the time it gets to the end, if it is not documented is it even valid???

So how would you all have handled this??? I plan on talking to my mgr on Monday to inquire about putting a specific policy in place--as I looked and did not find one.

FYI I did go to our in house social worker when I left and told her everything I was told, that I didnt know where to go from here but I wanted someone to talk to pt.

[CHATSDALE]

talk with the patient and see if she will make charges

you could also make an anon call to child protection services

this could have been a case of wrongful charges by a drunk woman or it could be a case of a little girl being abused and unlikely to be protected by a mother who wants boyfriend more than child

i don't know what to advise, glad i am not in your shoes

[GingerSue]

I was also given in report that her friends stated to the ER staff that this pt has no family in the state and is basically estranged from all family.

I only add this statement because another thing that bothers me is if we are given this social/personal information via report, but it is not documented in chart, do we really need to know it??? What is the difference between "gossip" and "facts needed to do our job"---isnt that kind of like the old telephone game we used to play as kids. I tell suzy one thing and suzy tells cathy another variation and cathy tells missy another--by the time it gets to the end, if it is not documented is it even valid???

I would check with the patient about family involvement/estrangement and then document.

So pt arrives to unit and is basically unresponsive, I got zero verbal communication from pt

What might be the reasons for this?

I am then told during report from ER that she came in with her friends and pt had made the statement that her boyfriend is "screwing" her 12 year old daughter, that she was sobbing "just ask her" the friends brought her in because boyfriend "allegedly" threw her and the kids out in the rain and locked them out of the house. Friends took the kids home

I thought that protection services are to be notified if there is suspicion that children are being abused. Are the friends going to provide ongoing home for the children?

That's good that you have contacted social services.

[justme1972]

If it makes you feel any better, who says you have to make a report and identify yourself.

I personally see alcohol almost equivalent to truth serum...I seriously doubt if a woman would make something like that up....especially if the child kept quiet about it.

It could also be the reason why she was drinking, especially if she felt she didn't have a place to go (b/c some women refuse to go to shelters).

Think of it this way:

If you had a woman that came in, had OBVIOUSLY given birth, but no baby...wouldn't you call the police?

Of course you would.

Is the baby your patient/has been admitted?

Nope.

To me...it's the same thing.

Accurate or not, that child is in an abusive situation REGARDLESS if it's sexual or not, and social services needs to be notified....let them make the decision if it's accurate.

[racing-mom4, BSN, RN]

It is frustrating because by all accounts Iam sure once pt sobered up she has been dismissed. I did not write down any of her contact information so at this point I could not call, I only remember 1st name.

As far as pt being drunk and spouting her mouth that was one of the statements the house supervisor said why they were not calling as they didnt know if it was the alcohol talking or the truth---well I have been under the influence before and i can guarantee I never made that statement about something like that happening to my kids!!!

My point to the ER staff/Nursing supervisor was it is not up to us to decide if this family/child needs intervention it is up to the child protective services and or police to decide what to do, I believe it is only our job to report what we were told to the proper authorities and let them do their job to investigate.

So what are your thoughts on social/gossipy statements being made during report?? How do you all handle that--I guess I am in the belief if it is not documented in chart it didnt happen.

[diveRN]

Make the call. They'll investigate.

If there's an abusive situation there, you just started the process to end it. If there's nothing there, then no harm done.

In California, we're mandated reporters for "suspected" child abuse. Doesn't matter who or where the kid is, if we hear about it on duty we're obligated to report it. CPS will carry the ball from there.

[justme1972]

My point to the ER staff/Nursing supervisor was it is not up to us to decide if this family/child needs intervention it is up to the child protective services and or police to decide what to do, I believe it is only our job to report what we were told to the proper authorities and let them do their job to investigate.

She is correct, it is not your job to investigate, but YOU are also correct that it is your job to report it.

To me, I wouldn't consider a direct quote given to me by the nurse by report 'gossip'.

Now, if the woman had said something like, "Oh, that boyfriend of mine is probably screwing around with my daughter like he does everyone else."...then THAT sounds like a drunken rant, and I probably would have felt that it wasn't enough to report.

But that isn't what she said, she specifically stated that there was sexual contact followed by, "It's true, ask her!".

That's entirely different.

[OC_An Khe]

Check your stste laws regarding reports of suspected abuse and what are your legal responsibilities. Every Nurse should be aware of what their legal requirements are.

[suespets]

You call social services,tell them exact scenario, they take it from there.My adage is ,the childrens health is every human beings business.

[Agnus]

Turn it over to social services at your hospital. That is their area of expertise.

As far as her calling boyfriend, you can not really stop her.

Just let social services know.

You have no way of knowing the veracity of the words of an intoxicated person and it is not your job to figure it out.

I know this is difficult for you and you must feel caught between a rock and a hard place given the position you were placed in. We can not solve these delimas on our own precisely because it is a delima. That is why we enlist the appropriate experts.

[nuangel1, BSN, RN]

i work in the er .i cannot speak to your particular pt .as i wasn't there.but in my experience if pt states an abusive situation her or kids especially -regardless of drunk and /or on drugs .several things occur .1st i document word for word what the pt says .2 i would inform the er md.3rd we would make the mandatory call to dcyf .our states social services.we are mandated reporters .4th when pt not under influence she could be approached about what she said if she states it again then ask if she wants to file a report.unless we me/md had seen bruises ie sign of abuse on the pts body we can't call the police.lastly we contact our social services dept in our hospital .this is the best we can do.the social worker may be able to help with food and shelter for pt and any family ie kids.

[htrn]

In this state, nurses are mandatory reporters. I am in a small town and know most of the law enforcement and social services personally anyway. If I had a patient come in and say something like that to me (the ER nurse) I would make a referral. It's not my job to decide whether or not it is true, but it is my job to report any suspicion so that those that can investigate, will.

If it wasn't documented in the chart and the pt. didn't tell you - then you did the right thing by reporting to your nurse manager and hospital social worker. They can decide what to do with that information.

As far as the extra info you get in report that is not documented in the chart - background info is always helpful. I don't think I would ever chart in the pt. record that the family of such and such patient is a pain in the butt, demanding and looking for an excuse to sue - but I would definetly pass it on in report. I think the info you got was a nice heads up. If you have the pt. long enough and can build a trusting therapeutic relationship with her, that information can help you start a conversation about the alleged abuse and get her thinking about her options. Not always gossip, but not always appropriate to chart in that infamous "permanent recort".

Good luck.