Community health case study - Interpersonal violence: Nursing

Nurse. Alex is a school nurse who is caring for Charlie, a six year old who came to the nurse's office with a stomach ache.

Nurse. Alex goes through the steps of the clinical judgment measurement model to make clinical decisions about Charlie's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse, Alex recognizes important cues including Charlie's vital signs which are temperature 98.9 °F or 37.2 °C. Heart rate 102 BPM, respirations, 20 breaths per minute, BP, 96/64 millimeters of mercury.

They notice that Charlie doesn't make eye contact with them and seems withdrawn. After obtaining her ascent.

Nurse, Alex performs an assessment and notes. Charlie's abdomen is soft, nondistended with active bowel sounds and no guarding upon inspection.

They observe a small round burn mark on Charlie's chest and a couple of circular bruises on her upper arm in various stages of healing.

Tell me how you're feeling Charlie. My belly hurts, it's been hurting all morning.

I'm sorry, your belly hurts. I noticed you have some marks on your arm and chest where did those come from?

I don't know, probably from playing outside. Next.

Nurse, Alex analyzes these cues. They review the electronic health record or E hr and Note Charlie has been in the nurse's office several times over the last year with complaints of stomachaches and headaches.

They also note Charlie fractured her arm last year. Nurse Alex knows that child abuse is a type of adverse childhood experience or ace, which is a traumatic event in a child's life that has a lasting negative impact on their growth and development.

They also know that there are different types of abuse including physical abuse where there's intentional physical force resulting in harm like burns bruising and fractures.

Sexual abuse, which involves forcing a child into sexual acts, emotional abuse such as behaviors that harm a child's self-worth and emotional wellbeing and neglect where there's a failure to meet the child's basic needs like housing and food abuse can present with symptoms of stress like withdrawal and vague physical complaints such as a stomachache, headache, overeating or incontinence.

Additionally, unexplained injuries in various stages of healing or having improbable or conflicting stories on how they occurred can also indicate abuse as a result of abuse, Children may experience disrupted neurodevelopment, social, emotional and cognitive impairment, disease, disability, and even early death.

Nurse, Alex recognizes Charlie needs prompt intervention for possible physical abuse. Now, using the information they've gathered.

Nurse Alex chooses the priority hypothesis of physical abuse. Next.

Nurse Alex generates solutions to address Charlie's suspected physical abuse that will include nonpharmacologic interventions.

And they establish the expected outcome that after intervening Charlie will be placed in a safe environment. Nurse, Alex then takes action to implement these solutions.

They report their findings to the schools that designated liaison Lorna who provides assistance. When there are concerns about a child's health and safety.

Nurse, Alex makes their report to the child protection agency who dispatches social worker to the school upon arrival. The social worker interviews Charlie and chooses to place Charlie in the care of her grandmother.

While a more thorough investigation is completed. At the end of the school day, nurse, Alex evaluates the outcomes of their actions.

They and the social worker meet with Charlie's grandmother who has arrived to pick her up from school. Charlie's grandmother reports that she's had Charlie stay with her previously as her parents have had substance use problems previously.

And more recently, some financial concerns upon seeing her grandmother, Charlie appears excited and engaged stating she's happy to stay with her.

All right. As a quick recap, nurse Alex recognized and analyzed cues to Charlie's potential physical abuse and prioritized hypotheses and generated solutions to address this problem.

Nurse Alex then implemented non pharmacologic interventions and evaluated the outcomes compared to the expected outcomes.

Since Charlie was able to be placed in a safe living environment. Nurse Alex determined the plan of care was