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Difficulty: MediumEthical Practice

An emergency department nurse is caring for a school-aged child who presents with a spiral fracture of the humerus. The child's caregiver states, 'He just tripped and fell while running in the yard.' The child remains unusually quiet, avoids eye contact, and flinches when approached. Based on the ethical principle of nonmaleficence and legal mandates, which actions should the nurse take? Select all that apply.

  1. Document the objective physical findings and quote the caregiver's exact explanation in the medical record.Answer
  2. B
    Delay filing an official report until conclusive evidence of abuse is confirmed by radiography and the attending physician.
  3. Report the suspected abuse immediately to the designated state child welfare authorities.Answer
  4. D
    Confront the caregiver directly about the inconsistencies between the child's injury and the provided history.
  5. Collaborate with the healthcare team to ensure the child remains in a safe environment away from potential harm.Answer
  6. F
    Focus exclusively on the physiological stabilization of the fracture before addressing any psychosocial safety concerns.

Answer

The nurse must document the objective findings and the caregiver's exact quotes, report the suspected abuse immediately to state authorities, and collaborate with the team to ensure the child remains in a safe environment.
The correct actions prioritize the ethical principle of nonmaleficence by taking immediate steps to protect the vulnerable child from further harm. This includes fulfilling the legal obligation of mandated reporting based on reasonable suspicion, securing the child's environment, and practicing veracity through objective, factual documentation of the inconsistencies.

Step-by-Step Solution

1
Analyze the clinical scenario for red flags.
The nurse identifies an inconsistency between the injury (spiral fracture, often caused by twisting) and the history (tripping), alongside suspicious behavioral cues (flinching, avoiding eye contact).
Recognizing signs of potential abuse is the first step in protecting vulnerable populations.
2
Identify the relevant ethical principles and legal mandates.
The principles of nonmaleficence (preventing harm), beneficence (advocating for safety), and veracity (truthful documentation) apply, alongside the legal mandate to report suspected abuse.
Nursing actions must align with the ANA Code of Ethics and state reporting laws.
3
Select interventions that uphold these principles without exceeding the nursing scope of practice.
The nurse documents objectively, ensures a safe environment, and reports the suspicion to authorities, while avoiding direct confrontation or investigative roles.
These actions fulfill the duty to protect the child while leaving the formal investigation to designated professionals.

Key Concept

Ethical Practice: Mandatory Reporting and Nonmaleficence
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Ethical Practice

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