Community health case study - Interpersonal violence: Nursing

Nurse Alex is a school nurse who is caring for Charlie, a 6-year-old who came to the nurse’s office with a stomachache. 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 beats per minute, respirations 20 breaths per minute, blood pressure 96/64 mmHg. They notice that Charlie doesn’t make eye contact with them and seems withdrawn.

After obtaining her assent, Nurse Alex performs an assessment and notes Charlie’s abdomen is soft, non-distended, with active bowel sounds, and no guarding.

Upon inspection, they observe a small, round burn mark on Charlie’s chest and a couple circular bruises on her upper arm in various stages of healing.

Nurse Alex: Tell me how you’re feeling Charlie.

Charlie: My belly hurts. It’s been hurting all morning.

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

Charlie: I don’t know. Probably from playing outside.

Next, Nurse Alex analyzes these cues. They review the electronic health record, or EHR, 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 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 well-being; 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.