Ethical Issue- Is this child abuse? Do I need to report this?

I've been working as an LVN with the same family (home health) for a little over a year now. This is pretty much my first case as a nurse and I think I made a BIG mistake getting too involved with the family that I work for.

My patient is a 27 month-old boy with one of the most complicated syndromes anyone could imagine (affecting almost every system in the body). I will call him Sam for this post. He has a trach, GT, has undergone open heart surgery, is moderately to profoundly deaf, wears a hearing aid, glasses, has yet to walk independently, and uses sign language to communicate (he knows and regularly uses almost 300 signs).

His mother insists on being with him at all times (she's a full time mom). I will call her Mary. Mary knows almost everything about his care and taught him most of his signs. When we first met, we clicked instantly and throughout the time I worked with her we became incredibly close. She also has another son, who is 9 months-old (I was there for the birth, at her request because we were so close).

The problem is that Mary absolutely hates her husband (the father of these boys, whom I will call Mike). Mike still loves her and believes marriage is forever, despite the physical and emotional abuse he takes from his wife; I have witnessed her verbally attack him dozens of times right in front of me (and Sam).

They recently went back to visit their families in the UK and while there, Mary hit her mother-in-law. When Mike and his mother tried to escape with the kids, Mary slashed her mother-in-law with her keys, grabbed Sam out of the car, and locked herself in the house with him. Mary's parent's managed to get Sam out of the house and take Mary and her other son into their care. Mike fled to his parent's home with Sam. A few days later, Mary shows up with her other son (sans formula, diapers, and adequate clothing for him) and says she wont leave without both boys. The cops say Sam needs to stay with his father.

Mike filed for divorce requesting custody of both boys two weeks ago, but I just discovered they've reconciled (because she realized she couldn't win custody... unbeknownst to Mike, who thinks she's back because she loves him.) The whole family will be back to the US next week. I am the only person in the US that knows what happened.

I wasn't there for any of this. I only know about this situation because I've become friends with Mike's sister.

Do I need to report this in the US after these incidents were already reported to police in the UK? There will be no question as to who reported them here AND I didn't actually witness any of this.

This is a nightmare and whatever comes from this situation will be a life lesson I will never forget.
I should also say that I am madly in love with this little boy. Being in the same room with him is pure joy (even for total strangers). He is just so pure of heart, beautiful, smart, and full of love even the coldest of people melt when they meet him! I would do anything to protect that little boy, but I think I need to be careful about reporting anything....His parents would know 100% that it was me and if the Dept of Children's Services decided not to act, it would be the last time I'd ever see Sam! I don't ever want that to happen!

Whoa...this is a very complex situation.Not trying to be negative, but in my opinion, you've got a boundaries issue. Becoming friends with family of the client, being present for the birth of a child of the same client, not appropriate. But it seems that you realize that there is a problem in becoming too involved, so you hopefully won't do this again. I am not well versed in child abuse protocol and laws, but it would seem to me that you can only really report what you have witnessed yourself. You might be able to allude that there were big problems in the UK that need further followup. I am not sure what laws are out there internationally that mandate reporting between two different countries, but it seems to me that there should be. In my opinion, you need to extricate yourself from this situation. Hopefully you've documented well and kept your agency in the loop about what is going on. Be prepared for this to get really, really ugly. It wouldn't surprise me if you end up in court one day, you might consider legal counsel.Also, be very careful about how much info you post in a public forum. You never know who might be reading.

Thank you so much for your reply!This was bad, I know. But, I've thankfully always been careful, detailed, and honest in my charting, knowing full well that the only time anyone will seriously read what I write will be in a courtroom (somehow I always knew it might end up like this).All names were changed in my post and I did not disclose any info about my patient that would be detailed enough to identify him or his family. Thank you so much for your honest answer. It helped more than you know.

I know you changed names etc, but in your profile it lists you as living in LA. I realise LA is a big place, but you just never know who knows who/what/where. I think AntFlip7395 has given you some good advice.It is never a wise thing to mesh the boundaries between you, the nurse, and those in your care. I wish you - and this unfortunate family - the very best.

You are welcome, exhausted.Just wanted to add, and not to beat a dead horse, but there have been many, many cases of boundaries violations that have not only gotten nurses fired, but have caused restrictions to be placed upon their license or even license revocation. Home health is particularly risky, obviously due to the long-term bonds that develop. It is very difficult not to get attached to clients and families that you get to know so well. Despite your attachment to this child and his family, you have a responsibility to protect the children involved. They are in a volatile situation that could escalate at any given moment as mom is unstable at best. You must report to child protective services, despite your misgivings. Really, you need to sever ties with this family anyway. Don't risk your license, your livelihood, and your sanity for people that you know would turn on you in a heartbeat if it came down to it.

This sounds like a marital issue here and one that you aren't even hearing about firsthand. Mike's sister who will be on her brother's side is telling you about an issue that happened in another country. You have no way of knowing if it is even true. You are going to call CPS and say a patient's father's sister told you about a situation that happened in the UK? It sounds like they need marriage counseling more than CPS. The parents have decided to stay together and unless you witness any actual abuse to the child I'd stay out of it. You need to re-define your boundaries here at once.

Im still trying to trying to see how it could be child abuse ...but nothing is coming up. Like someone mentioned..its a marital issue and they need to work on themselves..so far u did not notice any form of child neglect or abuse ..either reported or observed and all ur information is from a third party. I think u definately over stepped your role as a nurse. The lines are blurred now between professional nurse and best buddy friend. I would look for another case to work on and slowly sever my ties before things get too complicated...

I agree with the above. The boundaries are gone and you need to decide whether you want to be their nurse or their friend, because you can't be both.You are a mandated reporter to what *you* witness, not to what a third party tells you. If you observe anything while you're in the home that could constitute abuse/neglect, then you are obligated to report that. Examples might be lack of food in the home, poor care by parent, hitting, severe diaper rash from neglect to change nappies, bruises/injuries that don't match explanation, s/sx dehydration or malnutrition (other than what may be expected r/t disease process), sudden lack of communication by a formerly communicative child, etc.If you do expect this case to go into litigation, anything you've posted online or talked about in person is potentially discoverable. Discuss this only with your employer and if you don't already have malpractice insurance, please go get a policy *today.*

Quote from SurvivorRNI think u definately over stepped your role as a nurse. The lines are blurred now between professional nurse and best buddy friend. I would look for another case to work on and slowly sever my ties before things get too complicated...

This is child abuse....Exposure to domestic violence is child abuse. I agree with the others that you are way to close and need to redraw your boundries. Also since the family sees you as "family" you are in the line of fire as well. Report this as YOU saw it. Good luck

Agree with above. To me it seems a good idea to remain with this family for the sake of Sam. You could be his only true ally. However, boundaries with Mary must be reestablished. She clearly is not mentally stable. Avoid personal conversations and contact outside of the professional setting. It is possible, though tricky to withdraw from her without alienating her. Document everything.As far as child abuse...yes it is. But knowing what we know about CPS services in most areas of the country you must show good judgement when deciding to report. What happened in the UK is most likely not really something they would pursue here. However, what you see in the home should be carefully documented, even if you do so in a personal journal that you tell no one about. Of course any direct physical or even emotional violence that you see should be reported. Mary will most likely become violent again, Dad will see eventually that his wife is crazy and you will be on the stand in a heated custody case. Prepare yourself for this. Do not involve yourself in their marital issues. They are grown ups and he will have to sort this out himself. I know it is not right that the children are in the middle and will be affected tremendously. Unfortunately it happens in millions of homes in America every day. Sorry to go on so long. Please keep up posted. Best wishes to you.

Hi exhausted: Do you have a social worker you can consult? Ask their opinion only on what YOU have witnessed first-hand. Unfortunately, you have become a participant in this crazy-making. My advice is to extricate yourself....Talk with your superior, have someone else assigned. You do not have to remain directly involved to ensure this child's well-being. In fact, I would argue that a more objective nurse will be a far more effective advocate for the child because his/her judgment is not clouded by a "friendship" with the family. Without going into detail, give your supervisor and/or replacement a heads-up about your concerns regarding the family dynamics, so he/she will be alert for signs of trouble. Please take the advice our experienced, learned colleagues have given you. Thay know what they are talking about!! Good luck!