CLINICAL SCENARIO
You have been visiting Maria Summers twice a week for four weeks.
Each time you have visited, you have noticed that Maria’s 4 year old daughter,
Sharlee has bruises on her arms or legs. When you ask her about a biro mark on
her doll’s arm, Sharlee says “Susan is a naughty doll - just like me” and had to be
smacked very hard.
Today, when you notice Sharlee is limping, you casually ask Maria what happened.
Avoiding eye contact, Maria says that ‘as usual’ Sharlee was not paying attention
getting into the shower; Maria grabbed Sharlee’s arm to stop her falling and hitting
her head but Sharlee still stubbed her toe quite hard on the ledge.

How would you assess this situation?
Consider physical, mental health and social issues; as well as professional and
legal obligations.

What additional information do you need? Where would you access it?

What would your actions be and why?
This resource was developed by the Tasmanian Clinical Placement Partnership Project supported by funding
from the Australian Government under the Increased Clinical Training Capacity Program. December 2012.
CLINICAL SCENARIO-ANSWER GUIDE
How would you assess this situation?

What is the situation?

Sharlee has had bruises on her arms and legs over a four week period and is limping.
What additional cues or information do you need to consider?
Physical health:

The nurse needs to consider whether Sharlee may have any physical/ genetic condition that may
impact on her coordination, e.g. autism.
Mental health:

Maria Summers’ mental health status should be assessed and her previous history reviewed.
Social:

The nurse should take note of any facts that may suggest either abuse or neglect.

The presence of other children and/or adults in the house should be noted.
Professional - legal and employment:


If in the course of her employment, the Nurse believes or suspects on reasonable grounds that
that there is a reasonable likelihood of Sharlee being abused or neglected by her mother or
another person with whom she resides, the Nurse “inform the Secretary or a Community-Based
Intake Service of that belief, suspicion or knowledge as soon as practicable after he or she forms
the belief or suspicion or gains the knowledge”. (Children, Young Persons and Their
Families Act 1997 (Tas.) s.14(2))

Employer policies re assessment/ reporting of possible child abuse/neglect should be reviewed.
What are the likely reasons for the bruises/ limping?

Alternatives include accidental injury and physical condition, e.g. a haematologic disorder. The
likelihood and consequences of each must be considered before action.
What would your actions be and why?


What do you want to achieve? What are you going to do?

The nurse should be seeking a decision that ensures Sharlee is not at risk; and that s/he
complies with the legislative requirements of the nursing profession.

The nurse should review her/his legislative obligations; review their employer’s policies; discuss
this case with her manager. If s/he continues to believe or suspect that there is a reasonable
likelihood that Sharee has been abused, the case must be reported.
How do you think you may feel in a situation like this?
Refer to the following web sites/ resources for detailed information
Mandatory Reporting:


http://www.aifs.gov.au/cfca/pubs/factsheets/a141787/index.html
http://www.thelaw.tas.gov.au search for:



Family Violence Act 2004, Tasmania
Children, Young Persons and Their Families Act 1997 (Tas.) (Sections 13 and 14)
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/CodesGuidelines.aspx#professionalpracticeguidelines for:

Australian Nursing and Midwifery Council, A nurse’s guide to professional boundaries, February
2010.


Australian Nursing and Midwifery Council, Code of Ethics for Nurses in Australia, 2005.
Australian Nursing and Midwifery Council, Code of Professional Conduct for Nurses in Australia,
2006.