Nursing Case Study: Child Abuse and Mandatory Reporting in Australia

This case study presents a complex scenario involving a six-year-old child, Andre, brought to a hospital for wound care, accompanied by his father, Boris. The nurse, Kimiko, observes multiple old wounds, inconsistent with the father's explanation, and notes the child's withdrawn behavior, raising suspicions of child abuse. The case study emphasizes the nurse's responsibility for mandatory reporting of suspected child abuse to the authorities, as mandated by Australian law, considering the NMBA standards of practice. It discusses the legal and ethical considerations, including the right of parents to make medical decisions for their children, and the varying child protection laws across Australian states. The study highlights the ethical principles of beneficence and non-maleficence, which guide the nurse's actions to ensure the child's safety and well-being. The nurse must navigate the complexities of parental rights, child protection laws, and ethical frameworks to make the best decisions for the child's health and safety, including reporting the abuse to the relevant authorities, despite potential parental objections.

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PROBLEM SOLVING CASE STUDY
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This case is one of the most complicated one that nurses have to handle while caring for
children who are of immature ages to take their own decisions. The case study shows that the
nurse has identified a number of aspects during her assessment and care for the child named
Andre who had come to the ward for dressing and monitoring of a wound he had faced. He is six
years old and his father named Boris had accompanied him. Several wounds had been found at
different parts of his body that are quite old and are very similar to wounds caused due to abuse
and not due to falls. Moreover, the child is also seen to be withdrawn and was not
communicating with the nurse that is often related to the symptoms of the abuse faced by the
children. Researchers are of the opinion that children who have been physically advised have
common signs that can help the nurses in identifying the possible cues of child abuse (Wisket,
2014). Bruises, welts as well as other injuries which cannot be explained or does not match with
story is one such cues and similar had been the case where the story told by Boris about the fall
of his son did not match with the wound that was present. Moreover, injuries those are at the
different stages of healing, the children avoiding any form of touch or physical contact, children
showing withdrawal, medical issues that goes untreated – all show that the children have been
abused (Turner et al., 2017). In cases of Andre, many such signs are present which states that his
father must have abused him. Moreover, the nurse had heard the father threatening his son to not
reveal about an incident to the other people. This raises a concern that he might be telling is son
to not reveal about the abuse incidents.
In this case, it is the duty of the nursing professionals to ensure mandatory reporting of
the child abuse to the concerned authorities to stop any further harm to the child. Mandatory
reporting can be a term that can be used in the description of the legislative requirement for
selected group of people for reporting suspected cases of child abuse as well as neglect to that of

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the government authorities (Johnstone, 2015). The Parliaments in all Australian states and
territories have enacted different mandatory reporting laws of some description but the laws are
not same everywhere across all the jurisdictions. The main concerns are the persons on duty who
have to report and what types of abuses that should be reported (McKinney et al., 2017). A list
had been provided where different states have their own criteria for reporting and extent of harm
that should be reported. However, this is a fact that it s legislation that very nursing professionals
need to abide by to ensure best healthcare and practices. Australian nursing and midwifery
Federation had put forward a position statement called the “Child abuse and neglect”. The
position statement had stated “Nurses and midwives play an important role in the prevention,
identification, and intervention in the case of child abuse and neglect and in the ongoing care,
education and support of the children and their families” (Child abuse and Neglect, ANMF
Position Statement, 2016). Therefore, in that way, it becomes the duty of the nursing professional
attending Andre to report the abuse case to the governmental authority so that the child can be
protected from further turmoil.
The NMBA standards of practice for the registered nurses has put forward standard 3
which shows the importance of “maintaining the capability of practice” of the nurses. The duty
of the nurses would be to “accept accountability for decisions, actions, behaviors and
responsibilities inherent in their role, and for the actions of others to whom they have delegated
responsibilities” (Registered nurse standards for practice, Nursing and Midwifery Board in
Australia, 2016). Therefore, Kimiko here need to be responsible with her professional and had to
take interventions by which she can provide a better quality life to the child and ensure that no
more harm can affect him specially from his father. Therefore, she needs to be not only
accountable about ensuring better health of Andre but she should also undertake initiatives that

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would be saving Andre from further abuses. Another standard that should be also ensured is
standard number 2 that suggests, “Engages in therapeutic and professional relationships”. Here
the nurses attending patients are advised to report “reports modifiable conduct of health
professionals, health workers and others”. Therefore, it is the duty of the nurse to report this
conduct to the concerned authorities so that the Andre can be saved from the domestic abuse,
emotional abuse and the neglect that he is experiencing. Another important standard called the
standard 1 states the importance of the “thinking critically and analyzing the nursing practices”.
Under this standard, it is important for the nurses “uses ethical frameworks when making
decisions” and “complies with legislation, regulations, policies, guidelines and other standards
or requirements relevant to the context of practice when making decisions (Registered nurse
standards for practice, Nursing and Midwifery Board in Australia, 2016).. Therefore, it becomes
the duty of the nurse to use proper ethical frameworks and abide by the laws and legislations
developed by the government to ensure best care to patients.
Another concern might act as barrier in the mandatory reporting of the child abuse.
Australian institute of family studies working under the Australian government had given parents
the total right to decide about the medical treatment of the child. This right of the parents is
absolute with a very young child and is seen to diminish to only a freedom to advice when the
child grows older and matures. The legal age of majority is 18 years in all the regions, states, and
territories of Australia and in New South Wales and South Australia (Families, policy and the
law 2014). The capacity of the child to consent for medical treatment is mainly seen to be
regulated by the statute and children can only consent to their treatment once they are 14 and 16
years in NSW and SA respectively. This is coming under (Section 49 (2) Minors (Property and
Contracts) Act 1970 (NSW); Section 6 (1) Consent to Medical and Dental Procedures Act 1985

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(SA). Moreover, another most important legislation that the nurse in the case study should
remember is the (Sections 60E (1), (2), 60F Family Law Act 1975 (Cwlth); Secretary of Health
and Department of Health and Community Services v. JWB and 5MB (1992) 175 CLR 257,235
(Marion's case) (Mandatory reporting -Family Violence and the Criminal Law, 2016). This law
states each parent of the child is the guardian and either may or may not provide consent to or
refuse medical treatment. In that way, when Boris is preventing the administration of antibiotics
and not allowing the nurse to undertake different diagnostic tests of his son, the nurse cannot
legally force the father to allow the interventions. In such arena, the nursing professional need to
critically analyze the situation and undertake proper decisions to help in recovery of the health of
the child and also prevent the child for any abusive actions.
The child protection laws are seen to vary from state to state in the different parts of the
nation of Australia. The nursing professionals working in each of the states or territories need to
be aware of the Child protection act laws, Domestic and family violence laws, and many others
to identify their extent of role as well as their duties that they need to maintain in order to follow
the laws. Researchers are of the opinion that a duty of care is the legal concept that is historically
present n the different common law of the torts as well as specifically in the care of the tort law
called negligence in the nation of Australia. Within this arena of the law, “if a person owes
another person the duty of care and if he or she fails to do something to avoid unforeseeable and
important injury to that person, (when he or she could have taken practicable steps for avoiding
the injury), the person who should have provided the duty would be held under the negligence
act” (Citizen child: Australian law and children's rights, 2016). The law states that if the
nursing professionals are aware of the fact and had not stated about the issue of Andre to the
concerned authorities allowing more harm to take place on the child, the nurse might be held

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under the negligence act and could be punished by the law due to breaching in the duty of the
care.
Mandatory reporting of the laws had been passed by the Parliament, which states the
importance of the designated persons like the nurses, teachers, police and doctors to report
certain kinds of the child abuse and the neglect to that of the government authorities (Lines,
Hutton & Grant, 2017). Recent Australian State Government child protection inquiries in the
NSW as well as in Victoria have been seen to include mandatory reporting laws as important
competent of the child protection systems. Therefore, Kimiko should maintain these laws as
these laws would help her to follow the bio-ethical principles as well. The ethical principle states
the importance of maintaining beneficence. This law states the importance of providing
interventions, which would ensure safe and quality care to the patient ensuring development of
better quality life (Australian child protection legislation 2018). If the nurse leaves the patient
without completing the full treatment due to the instruction of the father, it will ultimately affect
the health of the patient (Craige et al., 2016). Moreover, the father is abusing the child and
therefore he does not want to carry on the treatment. Therefore, of the nurse does not care for the
child properly, it would lead to the breaching of the ethical principle of beneficence. Another
ethical principle that would be also broken would be non-maleficence, this principle states that
the nurse should not provide any intervention or take actions that cause harm or suffering to the
patient (Hooker et al., 2015). Here, Kimiko does not report the abuse; it would continue suffering
of Andre. Therefore, nurse needs to report it to the government to save the child and develop the
quality of his life.

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References:
Australian child protection legislation, (2018), Australian government – Australian Institute of
Family studies retrieved from : https://aifs.gov.au/cfca/publications/australian-child-
protection-legislation
Child abuse and neglect, (2016), ANMF Position Statemen, Nursing and Midwifery Board in
Australia Retrieved from:
https://anmf.org.au/documents/policies/PS_Child_abuse_and_neglect.pdf
Citizen child: Australian law and children's rights (2016), Australian Institute of Family studies,
retrieved from Retrieved from: https://aifs.gov.au/publications/citizen-child-australian-
law-and-childrens-rights/8-medical-procedures-children
Craigie, M., Osseiran-Moisson, R., Hemsworth, D., Aoun, S., Francis, K., Brown, J., ... & Rees,
C. (2016). The influence of trait-negative affect and compassion satisfaction on
compassion fatigue in Australian nurses. Psychological Trauma: Theory, Research,
Practice, and Policy, 8(1), 88.
Families, policy and the law (2014), Australian government – Australian Institute of Family
studies, retrieved from : https://aifs.gov.au/publications/families-policy-and-law/14-
mandatory-reporting-laws
Hooker, L., Small, R., Humphreys, C., Hegarty, K., & Taft, A. (2015). Applying normalization
process theory to understand implementation of a family violence screening and care
model in maternal and child health nursing practice: a mixed method process evaluation
of a randomised controlled trial. Implementation science, 10(1), 39.

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Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.
Lines, L. E., Hutton, A. E., & Grant, J. (2017). Integrative review: nurses' roles and experiences
in keeping children safe. Journal of advanced nursing, 73(2), 302-322.
Mandatory reporting -Family Violence and the Criminal Law—An Introduction 2016, Australian
government – Australian Law reform commission, retrieved from :
https://www.alrc.gov.au/publications/8.%20Family%20Violence%20and%20the
%20Criminal%20Law%E2%80%94An%20Introduction/mandatory-reporting
McKinney, E. S., James, S. R., Murray, S. S., Nelson, K., & Ashwill, J. (2017). Maternal-Child
Nursing-E-Book. Elsevier Health Sciences.
Muskett, C. (2014). Trauma‐informed care in inpatient mental health settings: A review of the
literature. International journal of mental health nursing, 23(1), 51-59.
Registered nurse standards for practice 2016, Nursing and Midwifery Board in Australia,
retrieved from : https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Turner, W., Hester, M., Broad, J., Szilassy, E., Feder, G., Drinkwater, J., ... & Stanley, N. (2017).
Interventions to improve the response of professionals to children exposed to domestic
violence and abuse: a systematic review. Child abuse review, 26(1), 19-39.