Question

A preschool teacher called a child protective services about a child who appeared to have a vaginal infection and the child protective services worker instructed the mother to take her child to the emergency center at the local acute care facility. In the emergency center, the child was examined by an APN who found a vaginal tear, which the ANP felt could have been caused by digital penetration. The child would not talk about the injury with the APN.

The APN then discussed the child's case with the child protective services worker, and the child was admitted to the facility. The parents were subsequently questioned regarding potential abuse of the child. Charges of child abuse were filed against the father, who is now a registered sex offender in the state. The parents filed suit against the preschool teacher, the caseworker, and the ANP.

At trial, evidence was presented that the APN did not share her findings or impressions of possible child abuse with the mother, the child's primary pediatrician, or other emergency center physicians. She also did not recommend that the mother contact the child's pediatrician for an evaluation and a second opinion. The ANP also admitted that it was possible that the child had scratched herself as a result of the infection and that the child herself had caused the vaginal tear.

Did the ANP have a duty to consult with the child's physician or another emergency center physician regarding the possibility of child abuse before she reported her findings to the caseworker?

What questions would you anticipate might be asked regarding the injury itself and the possibility that the child had caused her own injury?

Did the ANP have a duty to report the injury, even though the diagnosis was not absolutely conclusive at the point that the child was initially examined?

How would you determine liability in this case, assuming that the trial court found liability against any of the three defendants?

Answer 1

Yes. Even though it is an accident or self-injury, the nurse needs to consult with the child physician before reporting to the caseworker. ANP have to clearly explain about the vaginal tear with the mother. The child's condition should be examined and investigated thoroughly. A multidisciplinary team should assess the condition before reporting to the child protective services. If needed laboratory tests must be done to make a conclusion.

Give enough space and time for the children to realize the situation. Provide privacy and comfort to the child. Support the child to build trust with the child. Reassure the child to feel safe. Make her explain what has been happened in detail. Provide stuffed animals or toys and to explain how the injury has happened.

Yes. It is the duty of the nurse to report verbally about the child's injuries at the initial examination. The child has to be examined thoroughly to collect the evidence of injury. Even further evaluation and tests are needed for the conclusion, the initial oral report of child condition has to inform.

The court will take action if fail to protect the child against harm. The evidence should strengthen the point of defendants. The concept of relevance plays a role in the trial court. The evidence of child abuse must safeguard the nurse. The court has to fully evaluate the chain before the liability is imposed.