How to safe guard adult and children?

Meriwhen, ASN, BSN, MSN, RN · Sep 19, 2013

You could flat-out ask if someone else has hit him. Though make sure to ask when mom or dad isn't there visiting. If you don't have a good rapport with him but another staff member does (and it doesn't have to be another nurse), have them talk to the patient and report back to you.

However, don't start the parent witch hunt just yet.

Because a child responds like this to your question doesn't automatically mean child abuse. There are other valid possibilities that you must consider. My child bruises himself all the time since he takes after me--he is an anemic klutz--but if asked couldn't tell you how he got them.

Is your patient involved in any sports/physical activities at his school?

Are they on medications that may make them prone to bruising? It doesn't have to be a medical med; some psych meds mess with liver function and blood cells too.

Your patient may have a history of self-injurious behavior and is not willing to talk about it just yet. What was his reason for admission to the facility?

Also, consider that your child is 13 and his non-commital response could be as much due to him being an angsty teenager in an inpatient psych facility.

All that being said...as your patient is legally a minor, you need to err on the side of caution. Do a thorough assessment, and follow your facility protocol for documenting and reporting such findings.

One thing about your scenario that rings glaringly wrong (and this is not your fault). Every inpatient facility that I've worked at will perform a complete head-to-toe inspection of the patient in order to document if they came in with any bruises and injuries. That way if any issues come up later, we have documentation that the patient was admitted with said injuries.

So this bruise should have been noted at admission. If it wasn't noted at admission but is now present on day 3, that should tell you something.

moplez1 · Oct 1, 2013

Thank you so much.

However i think i would do the following:

-i would not jump to conclusions

-1:1 with the child to find out about the origins of the bruises. Dont ask leading questions

-Seek medical assistance

-report to senior nurse

-document

-risk assessment(look at child's history)

-inform parents

-if bruises are the result of harm inform child protection, social worker, police and ward manager.

Meriwhen, ASN, BSN, MSN, RN · Oct 1, 2013

And you SHOULD be doing all of that :) Good thinking.

The important thing is to conduct a thorough, unbiased assessment and not jump to conclusions. Yes, it very well could be child abuse...but not always. If you are going to make that call, you need to base it on solid facts--you need to go on more evidence than a teenager not wanting to answer a question.

TerpGal02, ASN · Oct 2, 2013

Everything Meriwhen said :) This is why it is SO important to build a trusting rapport with patients, ESP teenagers. If they trust you, they will be more willing to disclose abuse, self injurious behavior. Also consider how the patient acts when the family is around. Do they seem afraid of family. Do they have escalating behaviors only when family is about to arrive or already there? You should let the patients therapist know about the bruises also. If you DO discover there is physical abuse, it is your duty to report it to the proper agency. Refer to your state laws/facility policies and procedures on what is considered a mandatory report. In Maryland its only elder or child abuse. Domestic violence between adults is not a mandatory report (which I think is bs by the way)

moplez1 · Oct 2, 2013

Thank you very much