Issues and Trends in Nursing: Essential Knowledge for Today and Tomorrow
Student Elements

Reflective Case Studies

Please read each question below and type your response into each corresponding box. When you are finished, fill out your name, e-mail address, and instructor's e-mail at the bottom of this form, and click submit to send a copy to your instructor.

A 6-year-old has come to the attention of the child welfare department as a possible victim of sexual abuse. The child lives in a very rural part of a western state. Rather than have the child travel a distance to experts, she was taken to the nearest clinic with sexual assault nurse examiners (SANE) and a knowledgeable pediatrician skilled in sexual abuse examinations.

At the time of the examination, pictures were taken of the child's body, including the genital area. These pictures are crucial if charges are filed. To ensure that an accurate diagnosis is made, local experts wish to have a second opinion because the physical examination was not felt to be completely clear. The experts for the second opinion were linked via the Internet and Internet videoconferencing equipment so that the two teams could talk and view de-identified (because the information was going across unsecure Internet channels) photos.

Within 15 minutes, it was determined that the hymen was intact, and no penetration had occurred. Other markers indicated that there was evidence of child abuse, but none that supported sexual assault.

This case used an electronic medical record, digitized photos, and Internet consultation to arrive at a diagnosis that had both medical and legal implications.

1:  Discuss the impact of the use of these methods in the case on the nurse-patient relationship and on patient confidentiality.

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