Question

a number of avenues of response have been proposed for a nurse caught in the predicament where the physician or some other de facto decision-maker has inappropriately claimed moral authority in patient care situations. Consider the following potential actions for the nurse. Do any of the persons to whom the nurse might appeal have any authority --moral or legal to override the decision made.  

1. Report the situation to local child abuse or other legal authorities for review?

Answer 1

Reporting child abuse to local child abuse or legal authority.

National Study of the Incidence and Severity of Child Abuse and Neglect suggest that hospitals and health care institutions faces higher cases of child abuse. Compared to other agencies in the sample, hospitals identified children who were younger, lived in urban areas, and had more serious injuries. Hospitals failed to report to child protection agencies almost half of the cases that met the study's definition of abuse. Analysis revealed that income, mother's role in abuse, emotional abuse, race, maternal employment, and sexual abuse distinguished the reported from the unreported cases.

Child abuse is one of the most challenging social problems worldwide. Failure to report child abuse may lead to the aggravation of the situation and increase the probability of further abuses.

Medical child abuse, sometimes referred to as Munchausen Syndrome by Proxy or childhood factitious disorder, poses significant diagnostic, intervention, and ethical issues for medical and mental health practitioners alike.

The statistics on physical child abuse are alarming. It is estimated hundreds of thousands of children are physically abused each year by a parent or close relative. Thousands actually die as a result of the abuse. For those who survive, the emotional trauma remains long after the external bruises have healed. Communities and the courts recognize that these emotional “hidden bruises” can be treated. Early recognition and treatment is important to minimize the long term effect of physical abuse. Whenever a child says he or she has been abused, it must be taken seriously and immediately evaluated.

Child abuse means doing something that hurts a child.

· Physical abuse includes hitting, kicking, shaking, pinching, and burning. It may leave bruises, cuts, or other marks and cause pain, broken bones, or internal injuries.

· Emotional abuse is saying or doing things that make a child feel unloved, unwanted, unsafe, or worthless. It can range from yelling and threatening to ignoring the child and not giving love and support. It may not leave scars you can see, but the damage to a child is just as real.

· Sexual abuse is any sexual contact between an adult and a child or between an older child and a younger child. Showing pornography to a child is a type of sexual abuse.

Though the nurse is facing much pressure from the doctors and medical authority, not to report the child abuse to any legal authority. But the abuse is not only legal but also moral which mostly affects the child and its family.

The forces of expertise ranged against the parents were formidable enough, but it is apparent too from their personal accounts that they were subjected to a series of intimidator tactics to silence their protestations of innocence and deny the validity of their testimony as the only witnesses of the circumstances surrounding their child's injury.

Barriers and pressure faced by the nurse from higher medical authority:

Individual barriers refer to personal barriers of healthcare professionals which prohibit the reporting process.                                                                                                                  As the results of the reviewed studies indicate, several individuals' factors influence the decision to report child abuse cases

Interpersonal barrier includes, fear of disconnecting therapeutic relationship.                        Based on the experiences of service providers, after reporting the child abuse, families of exploited children often may not refer to receive essential health services. Hence, there will be the risk that these families will lose health services, and healthcare professionals will lose the opportunity to monitor the well-being of the child and the possible intervention to improve individual and social performance of such children and their families. Mandatory reporting by healthcare professionals also causes parents to avoid bringing their children to receive medical treatment in case of future abuse. Therefore, some believe that children protection services should only be used when they are helpful to children and their families.

Violation of privacy and secrecy principles.
Some healthcare professionals believe that the commitment to mandatory reporting of child abuse endangers the confidential relationship between therapist and patient and many of them do not agree with the laws in this area. The reason for this concern may be that the report may require the doctor to breach his or her confidential relationship with the patient, which ultimately and as a result of the disconnection of the therapeutic relationship, leads to the loss of confidence of children and their families.

Organizational barriers.
One of the important barriers of reporting child abuse is related with organizational issues. This category refers to barriers of working environment which effect on reporting decisions.

Weak legal processes for reporting
Defects in laws and misinterpretation of the rules related to child abuse, lack of a precise definition of the rules in healthcare systems, and lack of implementation strategies are among legal barriers to the reporting of child abuse by healthcare professionals.

Despite of pressure from the Doctors and Medical Institutions, it’s the duty of the nurse to report the inappropriate act of child abuse, to the local police as well as the legal authority, so that some actions should be taken as soon as possible. If the nurse faces lots of difficulty in handling the situation, then she must also contact the NGO’s, who work for and in support of social welfare of children and try to remove such acts from being taken in society in future, as this is not only a legal violation but moreover moral violation.

· Consider abuse as a possible factor in the presentation of medical complaints.

· Routinely inquire about physical, sexual, and psychological abuse as part of the medical history.

· Not allow diagnosis or treatment to be influenced by misconceptions about abuse, including beliefs that abuse is rare, does not occur in “normal” families, and is a private matter best resolved without outside interference, or is caused by victims’ own actions.

· Treat the immediate symptoms and sequelae of violence and abuse and provide ongoing care for patients to address long-term consequences that may arise from being exposed to violence and abuse.

· Discuss any suspicion of abuse sensitively with the patient.

· Report suspected violence and abuse to the police and NGO’s.