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

Nurses General Nursing

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I've been working as an LVN with the same family (home health) for a little over a year now. This is pretty much my first case as a nurse and I think I made a BIG mistake getting too involved with the family that I work for.

My patient is a 27 month-old boy with one of the most complicated syndromes anyone could imagine (affecting almost every system in the body). I will call him Sam for this post. He has a trach, GT, has undergone open heart surgery, is moderately to profoundly deaf, wears a hearing aid, glasses, has yet to walk independently, and uses sign language to communicate (he knows and regularly uses almost 300 signs).

His mother insists on being with him at all times (she's a full time mom). I will call her Mary. Mary knows almost everything about his care and taught him most of his signs. When we first met, we clicked instantly and throughout the time I worked with her we became incredibly close. She also has another son, who is 9 months-old (I was there for the birth, at her request because we were so close).

The problem is that Mary absolutely hates her husband (the father of these boys, whom I will call Mike). Mike still loves her and believes marriage is forever, despite the physical and emotional abuse he takes from his wife; I have witnessed her verbally attack him dozens of times right in front of me (and Sam).

They recently went back to visit their families in the UK and while there, Mary hit her mother-in-law. When Mike and his mother tried to escape with the kids, Mary slashed her mother-in-law with her keys, grabbed Sam out of the car, and locked herself in the house with him. Mary's parent's managed to get Sam out of the house and take Mary and her other son into their care. Mike fled to his parent's home with Sam. A few days later, Mary shows up with her other son (sans formula, diapers, and adequate clothing for him) and says she wont leave without both boys. The cops say Sam needs to stay with his father.

Mike filed for divorce requesting custody of both boys two weeks ago, but I just discovered they've reconciled (because she realized she couldn't win custody... unbeknownst to Mike, who thinks she's back because she loves him.) The whole family will be back to the US next week. I am the only person in the US that knows what happened.

I wasn't there for any of this. I only know about this situation because I've become friends with Mike's sister.

Do I need to report this in the US after these incidents were already reported to police in the UK? There will be no question as to who reported them here AND I didn't actually witness any of this.

This is a nightmare and whatever comes from this situation will be a life lesson I will never forget.

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 . 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

A marital issue like this, and not actually witnessed? This happened in the UK and was witnessed by a biased person (his sister). Also, although it is alleged she attacked her mother-in-law, it does not say she attacked her husband or children.

For another thing, you are concerned that you will not get to see the child if DHS does not get involved, but it is extremely likely that you will not see the child again if they do get involved. It sounds like you have witnessed this mother doting on her child, caring for his disabilities, and teaching him to sign. It also sounds like she went back to her husband in order to stay with her child. That child would likely appreciate having his mother in his life. If there are no indications that the child is in danger himself, and he is not witnessing his mother beating up his father, I would stay out of it.

Specializes in ICU.

Mom sounds PTSD-ish. Makes me wonder what Dad does when no one's around to observe...

I agree with the ex-cop on this one. What happened in the UK was hearsay. Furthermore, mother-in-law issues are hardly uncommon and spousal issues are also not rare. If you did not witness domestic violence in front of a child with your own eyes, then you don't really have any situation to report. I think that it is important to use a little bit of discretion, and choose your battles. Clearly this mother is involved in her children's care, and frankly, she probably cares about her children more than you do.

Unless you actually witness abuse that would justify a child growing up in the foster care system as an orphan, stay out of their family business.

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