# A nurse is caring for a 3-year-old child who has been admitted to the hospital with suspicious injuries consistent with physical abuse. The child's mother is present and becomes increasingly agitated when questioned about the injuries.

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> subject: Mental Health

## 문제

A nurse is caring for a 3-year-old child who has been admitted to the hospital with suspicious injuries consistent with physical abuse. The child's mother is present and becomes increasingly agitated when questioned about the injuries.

The nurse observes multiple bruises in various stages of healing on the child's arms and legs, along with a recent laceration on the forehead that required sutures.

## 보기

1. Confront the mother directly about the suspected abuse and demand an explanation for the injuries
2. Immediately separate the child from the mother and restrict all visitation until child protective services completes their assessment.
3. Document all observations objectively and report findings to the appropriate authorities according to hospital policy and legal requirements. **✔ 정답**
4. Wait for additional evidence before taking any action to avoid making false accusations

**정답: 3**

## 해설

Documenting observations objectively and reporting to authorities ensures child safety and follows legal protocols in suspected abuse. Other options may escalate conflict or delay protection.

## 심화 해설

Understanding the Clinical Scenario

This question tests your ability to prioritize nursing actions when child physical abuse (CPA) is suspected. The key elements are a 3-year-old with injuries in various stages of healing, a laceration requiring sutures, and an agitated caregiver. This pattern of injuries is a classic red flag for non-accidental trauma (NAT).

Analyzing the Correct Answer (Option 3)

The correct action is to document all observations objectively and report findings to the appropriate authorities. This aligns with both the legal mandate and professional duty of a registered nurse. As highlighted in research on pediatric NAT recognition, effective management hinges on a structured response that overcomes emotional and interpersonal challenges to ensure reporting [1]. Your primary role is not to investigate or confront, but to provide accurate clinical data. Documenting the exact location, size, shape, and color of each bruise using objective descriptors—not subjective terms like "abuse"—is a critical first step. This documentation becomes a vital part of the medical record, which studies show is often under-documented in cases of suspected CPA, making accurate ICD-10 coding and clinical notes essential for the child's protection [3].

Analyzing the Incorrect Options

**Option 1: Confront the mother directly.**

This is a non-therapeutic and potentially dangerous action. Confrontation can escalate the caregiver's agitation, compromising the safety of the child, the nurse, and the therapeutic environment. Research into the challenges of recognizing NAT emphasizes that emotional and interpersonal dynamics significantly influence real-world decision-making, and a confrontational approach is counterproductive to a safe, structured response [1]. Your role is to maintain a non-judgmental, supportive presence to keep the child and caregiver calm while the proper authorities are notified.

**Option 2: Immediately separate the child and restrict visitation.**

This action is outside the nurse's independent scope of practice. While separation may eventually be necessary for the child's safety, this decision is made by child protective services (CPS) or law enforcement, often with a court order. Prematurely restricting visitation without legal backing can create legal liabilities for the hospital and further agitate the family, hindering the investigation.

**Option 4: Wait for additional evidence.**

This is a dangerous and legally incorrect delay in care. Nurses are mandated reporters. You are legally required to report a reasonable suspicion of abuse, not to prove it. Waiting for more evidence places the child at continued risk of escalating harm. Research on distinguishing accidental from inflicted injuries shows that certain patterns, such as multiple fractures or injuries in various healing stages, are strongly associated with suspected abuse . The presence of these findings in your assessment is the "additional evidence" that compels immediate reporting, not a reason to delay.

Pathophysiology and Injury Pattern Recognition

The assessment findings are highly specific for NAT. Bruises in various stages of healing indicate repeated trauma over time, which is inconsistent with a single accidental event. A study on extremity injuries found that certain fracture patterns and the presence of multiple injuries at different healing stages are key clinical indicators that help distinguish suspected inflicted injury from an accidental fall . Furthermore, the location of bruises on the arms and legs, away from bony prominences typically injured in falls, raises clinical suspicion. Your thorough physical assessment and precise documentation of these patterns provide the objective data that forms the basis of the report to authorities. The low rate of abuse-specific ICD-10 coding in hospital databases underscores the critical importance of clear, detailed nursing documentation to ensure these cases are correctly identified and tracked [3].References (research sources)

- [1]An immersive simulation and virtual reality-enhanced course for the recognition of pediatric Non-Accidental Trauma (NAT) and abuse: A proof-of-concept study.Research articleYechiam H, Shles A, Fridler D, Harel DS, Schildkraut Y, Rimon A, Capua T. (2026) · DOI: 10.1016/j.chiabu.2026.108128

- [3]The use of ICD-10 coding for children hospitalized with suspected child physical abuse at a tertiary care pediatric hospital in Greece.Research articleKaradima E, Panos A, Leventhal JM, Soldatou A. (2025) · DOI: 10.1007/s00431-025-06655-y

## 임상 시나리오

Suspected Child Physical Abuse: Nurse's GuideMandatory Reporting and Objective Documentation
When a child presents with injuries suspicious for non-accidental trauma (NAT), such as bruises in various stages of healing, the nurse's primary responsibility is to report the findings to child protective services or law enforcement, following hospital policy. This is a legal mandate, not a discretionary choice.

Before reporting, ensure thorough objective documentation. Describe each injury using factual details: exact location, size in centimeters, shape, and color. Use body diagrams or photographs per facility protocol. Avoid subjective terms like "abusive injury" in the medical record.

CautionDo not confront or accuse the caregiver. This can escalate the situation and compromise the child's immediate safety. Your role is to provide care, document, and report, not to investigate. Never delay reporting to gather more evidence; reasonable suspicion is the threshold.

## 핵심 개념

- **Mandatory Reporting** — A legal requirement for healthcare professionals to report suspected child abuse or neglect to designated authorities based on reasonable suspicion, not confirmed evidence.
- **Non-accidental Trauma (NAT)** — Injuries purposefully inflicted upon a child, often presenting with patterns inconsistent with the reported history, such as bruises in various stages of healing.
- **Objective Documentation** — Recording factual, measurable, and observable findings (e.g., size, color, location of a bruise) without subjective interpretation or diagnostic labels like 'abuse'.

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