A nurse is caring for a 4-year-old child who was admitted to the emergency department with suspected physical abuse. The child has multiple bruises in various stages of healing on the back and buttocks. Which nursing action should be the priority?
1Confront the stepfather about the suspicious injuries immediately
2Document all findings objectively and report to child protective services✓ 정답
3Separate the child from the stepfather and begin questioning about the injuries
4Focus on treating the physical injuries before addressing the abuse concerns
해설
When child abuse is suspected, the priority is objective documentation and mandatory reporting to ensure child safety and legal compliance. Confronting the stepfather or separating the child could escalate risk, while focusing only on physical injuries delays protective intervention.
Clinical Judgment
This question assesses the nurse's priority action in a suspected child abuse situation. The key point is that bruises in various stages of healing and behavioral cues (withdrawal, avoiding eye contact, flinching) are clear signs of abuse. The nurse's top priority is ensuring the child's safety, which is achieved through objective documentation and reporting that follows legal procedures. The caregiver's statement ("falls often") is a classic example of a Discrepancy in Explanation that does not match the injury pattern. Immediately confronting or interrogating the child can cause additional emotional trauma and may interfere with the legal evidence collection process. Treating physical wounds is important, but it cannot be the top priority in an abuse situation unless the fundamental safety threat is addressed.
Memory Tip:
An Acronym to remember the priority of child abuse response: Protect → Document → Report → Collaborate (PDRC).
1. Protect: Maintain a safe environment for the child (safe observation rather than immediate separation).
2. Document: Objective and factual records (photos of injuries, precise descriptions, statements from child/caregiver).
3. Report: Mandatory reporting as required by law (Child Protective Services).
4. Collaborate: Work with a multidisciplinary team (social workers, physicians).
KR vs US:
In Korea, child abuse is also a matter that requires immediate reporting. According to the 'Child Welfare Act,' suspected child abuse must be reported immediately to a Child Protection Agency (dial 112 or 113 without an area code). This is similar to the Mandatory Reporting system in the US, but the reporting system, detailed procedures in the subsequent intervention process, and the names of the relevant agencies differ. In both countries, the nurse's core role is to be a Child Advocate.
Clinical Practice GuideSpecific nursing actions when child abuse is suspected:1. Objectively Document: Accurately record the location, size, color, shape, and healing stage of injuries. Use the phrase "bruises in various stages of healing." Record the statements of the child and caregiver verbatim in quotation marks. Attach photographs if possible (according to hospital policy).2. Mandatory Report: Notify the social worker or infection control nurse according to the hospital protocol, while simultaneously or subsequently reporting to the legal authority (US: CPS, Korea: Child Protection Agency). The report must be made without delay.3. Approach with the Child: Approach in a safe, quiet space, with one healthcare provider at a time, in a calm and non-judgmental manner. Use open-ended questions such as, "Can you tell me what happened when you got hurt?" Never ask leading questions like, "Were you hit?"4. Approach with the Caregiver: Without blaming or confronting, communicate the facts about what was observed, such as, "We have noticed bruises from different times; how would you explain this?"
Caution:* Trap in SATA (Select All That Apply) questions: "Immediately separate the child from the suspected abuser" is not always the correct answer. Sometimes it is more important to observe in a safe environment and preserve evidence. Separation is an action taken when there is a clear, immediate danger.* The option "Confront the abuser" is almost always incorrect. This can threaten the child's safety and interfere with the investigation.* "Treat physical injuries first" is a lower priority than abuse intervention, unless it is a life-threatening emergency. Ensuring safety and reporting should occur simultaneously or first.
Suspected Child Abuse — Suspected child abuse. Suspected due to injuries in various stages of healing, injuries inconsistent with explanations, unusual injury patterns (e.g., belt marks, handprints), and fearful behavior in the child.
Mandatory Reporting — Mandatory reporting. A legal requirement for certain professions, including medical personnel, to report suspected child abuse or neglect to the relevant authorities (e.g., Child Protective Services) when there is reasonable cause to believe it is occurring.
Bruises in Various Stages of Healing — Bruises in various stages of healing. This is a critical clue of child abuse, indicating injuries that occurred at different times and are difficult to explain with a single accident. (Fresh bruises: red/purple, old bruises: yellow/green)
Objective Documentation — Objective documentation. Recording observations in factual, non-judgmental language. It is very important as legal evidence in child abuse cases. Document as in: "Two oval-shaped purple bruises, 3cm in size, observed on the back and buttocks."
Child Protective Services — Child Protective Services. In the United States, this is a government agency that receives reports of child abuse and neglect, investigates them, and, if necessary, provides services to families or requests court intervention. It corresponds to the 'Child Protection Agency' in South Korea.