Question: Comment 1

I have never personally been put in this kind of situation but we have education every year about this at our hospital. A scenario, a young child, age 8, is brought into the emergency room twice in one week for "falling" and his arm is hurting again. The first visit's xray of his arm was normal, no broken bones seen. The child is discharged. The second visit, the xray shows a broken clavicle. The nurse and doctor assess the child and notice bruises all over the child's body under his clothes. The nurse and doctor know that they must be caution at this point. Start with questions to the child: How did you fall? Do you fall often? Ask where a particular bruise came from. The child shys away and start to hide his face. The healthcare team then turn to the mother and again are cautious with the way the questions are asked. The mother is reluctant to answer the questions but she does in a hesitant way but does not make eye contact. The healthcare team dismiss themselves stating they would return soon. The nurse and doctor have a private conversation and they both are suspecting child abuse and know that it is their duty to mandatory report their suspicions after their assessment. Our hospital policy for mandating reporting is to follow they chain of command before reporting. The manager must be notified and the administration on call must be notified along with the risk officer. When all has been notified then the local police station and DHR will be notified. This can flow very easily if done properly. The State of Alabama had changes to the mandatory reporting law in 2013. The changes are:

1) The State of Alabama mandates that the person who assess and has the suspicion on that assessment must be the one to support it to the police and DHR.

2) Any public or private employer who discharges, suspends, disciplines, or penalizes an employee solely for reporting suspected child abuse or neglect will be guilty of a Class C Misdemeanor (National, 2018).

Comment 2

The State of Texas has a law that mandates anyone who thinks a child, a person 65 years or older, or any adult with disabilities is being abused, neglected or exploited must report it to the department of Family and Protective Services (DFPS). The abuse report can be made by phone 1-800-252-5400 or online at Texas Abuse Hotline 24 hours, seven days a week or call 911 the Local Law enforcement.

A person who reports abuse in good faith is immune from civil or criminal liability. The DFPS keeps the name of the person making report confidential. Anyone who does not report suspected abuse could be held liable for a misdemeanor or felony.

In the State of Texas, nurses and doctors are mandated to report any suspected child or elderly abuse to the department of Family and Protective Services or the Local law enforcement agency. They also document all findings including physical findings in the patient's chart. Both nurses and doctors are also expected to report the suspected abuse to their immediate supervisors like nurse managers or senior doctors respectively (Texas Department of Family and Protective Services, n.d.).

Scenario: I was working in ER one evening when a 6-year boy was brought in by his parents with complaints of a painful leg secondary from fall. On assessment, the child looked frightened and withdrawn from the environment. Multiple bruises at healing stages, black eye and swollen left leg was noted. When I asked the parents what could have caused the findings, both mother and father stated " the boy is" messy" with himself and falls most of the time when playing". When I asked the boy what happened to his leg and skin, he just stared at me. The doctor ordered an x-ray of the left leg, which reviewed spiral fracture of the femur.