Unit 5 Case Study Erica Meyers

You are working at a free clinic for the summer. Even though it is not strictly in the field of
psychiatric or mental health, you feel that the experience is invaluable, and you are appreciative
of the fact that you still have a chance to work with varied and interesting mental health issues.
Today brings you a particularly unusual family, one that does not really seem to fit in. Mindy
Harper is a mother of three children under the age of 5. Mindy, a petite, pretty woman with very
carefully done hair and nails, her clothing and her children’s clothing perfect, has come to the
clinic with all three children today. She asks to have one of the children, an 18-month-old boy
named Charlie, examined for a possible inguinal hernia.
Mindy and her children are very well dressed, standing out among others in the free clinic’s
waiting room. However, something strikes you as odd: it’s a hot summer day, yet Mindy and her
5-year-old daughter are both in long sleeves. When you smile and comment on this, escorting
them back to an exam room, Mindy smiles and says, “Oh, I know! It’s hot! But Ella and I don’t
like air conditioning, do we, Ella? So we wear our sleeves!” She smiles a little excessively at
Ella, who nods, her face serious. The family sits down in the exam room.
“I like to go in the pool,” Ella says quietly, looking at you and pulling on her long sleeves.
“Well, yes,” says Mindy, shifting uncomfortably, “but not today. We need to get Charlie looked
at today, don’t we?”
Ella nods and looks up at you again. Mindy quickly hands Ella a book.
As the examination of Charlie’s possible inguinal hernia begins, you see no signs of bruising or
other injuries, but there is an enlarged testicle suggesting the possible beginning of an inguinal
hernia. Mindy says suddenly, “I apologize for coming to the free clinic, when we obviously don’t
fit in. I hope we’re not taking your time away from someone more needy and deserving!”
Before you can say anything, Mindy says, “It’s just that, well, even though he’s an attorney, my
husband doesn’t like me to make frivolous use of the doctor’s office. He thinks our copay is too
high as it is, and it’s because I’m the one who wanted kids, you know? So we pay more because
of me. So if I come here, he won’t see a check carbon for a copay.”
She’s watching you anxiously.
“I’m sorry!” she says. “That’s selfish, isn’t it? I’m so stupid!” She has tears in her eyes and, as
she raises her hand t o stop them, you see a bruise on her wrist where her sleeve rides up.
“Listen,” she says, “I can pay you in cash! I have the money, see? But my pediatrician’s office
said they have to record copays, so I couldn’t do it there. Please let me pay you to check Charlie?
Please?”
1. What clues do you have to possible abuse in this family? List all possible types you see,
providing rationales.
 The first red flag is Mindy and Ella wearing long sleeves on a hot summer
day. It is obvious that they are hiding something beneath those clothes, which
is more than likely bruises. It is common for someone to try to cover up the
physical signs with clothing because they are ashamed.
 Another clue is the behavior of the five-year-old daughter, Ella. A typical 5
years old would be playing or running around the clinic, however, Ella is very
timid and seems afraid of talking. She kept looking at the nurse indicating that
she is wanting to say something but could not. Ella tugs on her long sleeve
shirt as she informs the nurse that she would like to go to the pool which again
indicates the mother is trying to use the long sleeves as a cover up.
 When Mindy is confronted about wearing long sleeves on a hot summer day
she turns and smiles excessively at her daughter who then nods with a serious
face. This could indicate Mindy is trying to remind her daughter to keep the
secret they are hiding.
 Mindy’s fear towards her husband is also a red flag for abuse. Fear of the
partner would not be present in a healthy relationship. Her husband also has
power and authority over Mindy which is a big indicator as well that the
relationship could be abusive. He tells her where she can go and controls their
finances. Mindy also stated that her husband did not want children, although
Charlie does not show any physical signs of abuse this makes me question if
his injury could be a form of abuse as well since he did not want children
anyway.
 Mindy’s anxious behavior, bruise seen on arm, and crying as she expresses
her concerns with her husband and getting Charlie examined all indicate abuse
as well. When the victim is away from the abuser, anxious or nervous
behaviors are usually portrayed.

2. What ethical/legal implications are involved in this situation?

 Safety and well being of child is always number one priority.
 When child abuse is suspected, the nurse, is legally responsible for reporting to
the appropriate child protective agency.
 Ensure that proper procedures are followed, and evidence is collected.
 Keep accurate and detailed records of incident.
 Be non-judgmental.
3. What therapeutic communication techniques should the nurse use in this situation? Give
examples.
 Children should be questioned gently and not pressured and may be better at
expressing themselves through drawing or playing with dolls.
 Reassure the child that the situation is not their fault.
 Open-ended questions may elicit in a better response.
 Do not promise everything being said will be confidential because suspected
child abuse must be reported.
 Avoid showing shock.
 Be direct, understanding, and professional to parent suspected of child abuse.
 Do not display anger, horror, or a judgmental attitude towards parents.
 Coordinating services such as parenting skills, anger management, and coping
skills.
 Strengthening family ties and linking the family with community supports

4. Provide possible nursing diagnoses for this family situation.

 Safety and risk for injury.
 Fear and anxiety related to the threat of punishment.
 Social isolation related to the parents fear of disclosure to others outside of the
dysfunctional family unit.
 At risk for trauma and post trauma syndrome related to parental abuse.
 Impaired family functioning related to the family’s pattern of abuse.
 Impaired self-esteem related to poor coping or negative family interactions.

5. What is the proper way to interview a child patient?

 Children should be questioned gently and not pressured.
 Do not suggest answers to the child.
 Reassure the child that the situation is not their fault.
 Sitting next to the child may help them feel supportive.
 Use open-ended questions.
 Avoid showing shock.
 Child’s privacy must be maintained.

6. What collaborative disciplines should be involved?

 Social services, law enforcement to obtain an order of protection, Woman’s shelter
incase mother leaves abuser, and possibly a domestic violence advocate to testify in
court.
7. What goals would you want to achieve in this situation? Provide 2.
 The abuse or neglect has discontinued.
 Notifying appropriate child protective services within one hour.
 Receiving medical care within 1 hour.
 Maintaining child’s safety and well-being until appropriate arrangements have
been made.