Posts Tagged ‘Child Abuse Neglect Lawyer Attorney’


February 24, 2012

Documentation is critically important in obtaining any type of encounter in the ED, but yesterday I had the opportunity to apply what I have learned in the coursework to the fullest. My patient was a fifteen month old who was accompanied by her mother. The child was brought in for head injury. Her behavior was appropriate for a toddler, smiling and interacting with both mom, and me and very active. She was cooperative with the triage. Mom was concerned about the abrasion over her left eye and ecchymotic area under that eye which she stated had happened 2 days prior when the child had fallen off the couch and hit her head on the coffee table. She denied LOC, vomiting or lethargy and stated her activity level had been the usual state. On further exam, I noted a three cm ecchymotic area over the left sphenoid which could be consistent with the fall, but it troubled me that she also had ecchymosis lateral to the right eye, petechial contusions to the inner auricle of the right ear but none on the pinna and also noted pinpoint abrasions to the right occiput. This did not seem consistent with the story. I asked mom about these and she stated that “She is just learning to walk and falls a lot.” A fifteen month old is usually walking fairly well, and running unless developmentally delayed, which she seemed to be bright and happy, so this troubled me. However, since triage was busy and it is not the function of triage to document all findings but just identify them, I marked her as urgent and notated my suspicions of abuse due to the inconsistency. Later, when I got off triage, I took over this patient and got to interact with the police investigator and county child protective worker who had been called. The doctor felt that the findings were consistent with abuse and a report was filed with immediate action taken. I measured all the areas and took photographs and logged them as well as documenting all the individuals and actions we had taken. The child was CT’d which thankfully was negative. The mother had admitted that she had left the child alone with her significant other on a number of occasions. The investigator felt he had enough evidence to make an arrest. The child was released to the custody of the mother and her parents. This story had a happy outcome but I still feel troubled by it. How can a person abuse a sweet innocent toddler? How can the mother allow this? Aside from that, she was so benign about the whole matter and practically lied to me about it in triage. As a mother and patient advocate, this boils my blood. I fear for this child’s safety now and suspect will see more of her in the future. References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby.

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Importance of Skin Assessment in Elderly and Child Abuse, comment

October 18, 2010

Skin assessment is a more valuable tool than we give it credit or time for. There are so many clues to a long list of health issues; from the varience in color, turgor, texture, temperature and thickness, to hair distribution, and condition of the nails.  All of these variances from norm could be linked to some health issue.  Issues like nutritional deficiency, allergy, local or systemic disease; such as melanoma or systemic lupus erythematosus; or they could be signs or the ‘remnants’ of abuse.

Unfortunately, I don’t think the nurse on the floor routinely gives skin assessment the time or attention needed to pick up on these clues.  The most opportune time to find these signs would be on admission, during the initial assessment. What I see on the floor, is short staffing more often than not, trying to care for more patients than can be fully cared for during their shift, and bed shortages, requiring ‘quick’ turnover.  I am also afraid that the gains in my staffing numbers over the past year are in jeopardy with the reforms and cuts in reimbursement that I think are coming. Thorough assessments are an essential part of health care, of preventative medicine, and all of our professional practices; so I truly hope there will be the time and ability going forward to complete this valuable task.

Original Post

May 26, 2009

Title: Importance of Skin Assessment in Elderly and Child Abuse

In studying skin assessment, one cannot help feeling overwhelmed. Without a desire to pursue dermatology, the unlimited amount of skin lesions, pustules, macules and papules can lead one to skim over information out of the pure necessity for mental sanity. The mind can only hold so many pictures at once. However, I do see the need to ensure the memorization and ability to recognize and diagnose normal skin variations. In reading articles and working with children and the elderly, one unfortunately sees the reality firsthand of physical abuse and neglect. This can often be recognized by assessing the skin. Breakdown, malnutrition, physical abuse, bruises, injuries at different stages of healing can all be noted by a thorogh assessment of the skin. As follow up care and the big picture should always be a part of our thought process in nursing assessment, the ability to note whether a skin assessment finding is simply normal or abnormal is vital to our practice.

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Screening for abuse, comment

July 20, 2010

Screening for abuse is a very important element of the nursing assessment.  While screening for abuse should be included in every nursing assessment abuse is seen more frequently within certain patient populations; such as the very young and the very old.  Those patients who are very young or very young are more vulnerable to abuse by their caretakers.  This screening can sometimes be difficult to perform.  There needs to be attention to detail during the interview for any inconsistencies with information given and findings during the assessment.

The nurse assessment of the skin and musculoskeletal systems hold great importance when screening for abuse.  It is during these advanced assessments there may be evidence of abuse may be found.  Any suspicious bruising, welts, or marks that are found should be taken into consideration when screening for abuse.

When a nurse is functioning in the field of forensics their assessments and screenings for abuse may be called into use during a proceeding in court; the nurse may have to testify to their assessment findings.  Forensic nurses will also have to rely on their experience in advanced assessment to accurately screen possible victims for abuse.

Forensic nurse or any other area of nursing this screening for abuse is a vital part of the nursing assessment.  A nurse is responsible for advocating for the patient to their best ability.  Especially in circumstances when the caretaker of the patient is overpowering and does not cooperate with the patient being assessed without them present.

Original Post

September 28, 2009

Title: Screening for abuse, comment

I think that all nurses and doctors should receive additional training in screening for abuse depending on their specialty area. Patients will present differently depending on whom they are being interviewed by. Many times in the situation of children they are with their abuser when they present and it is difficult to separate the two. The abuser does not want you to have words alone with their child. I worked many years as a school nurse and suspected many cases of abuse that were reported to the appropriate authorities only to find that the child was disbelieved and then years later found to be telling the truth. Adults are very savvy at making a child look like a liar but seldom do these children have the capabilities to make up the horrendous story I heard. Unfortunately the investigators seem to want to believe the abuser. These children were also ones with poor grades (not sleeping at night due to the abuse), behavioral issues (they just wanted someone to listen) and many times documented storytellers (the only way to get attention) so it was very easy for the abuser to discredit them. If we are all trained to look for something other than physical marks we may start to diminish abuse against our children. Part of the assessment should not include where the parents reside in society. Several times the investigators simply found out what the parents did for a living and that in itself ended the investigation.

Original Post:
September 8, 2009
Title: Screening for abuse
Thank you for this important message. It is absolutely imperative that ALL providers know the signs and symptoms of physical, emotional and sexual abuse. Furthermore, it is absolutely necessary that ALL providers screen every patient at EVERY patient encounter for abuse. Providers should incorporate screening for abuse into their health assessment. It is very easy to do. Providers can accomplish this important task by 1. Printing the screening question on the pre-assessment paperwork, 2. Asking the patient during the assessment, “Do you feel safe at home?” 3. Knowing the s/sx and incorporating screening into every pt encounter. So very important.

Original Post
September 2, 2009
Title: Abuse
Child and elder abuse continue to be very under reported making it imperative that doctors and nurses have education on signs of abuse. Nursing home abuse is also very under reported since nursing home pts. are lacking in visitors and seen as demented. Nurses also need to know who to contact should abuse be suspected.

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