Use the following scenario for this discussion: You are a community health nurse in a small, rural community assigned to visit the home of Malcolm, an 8-year-old boy, to check on the home situation and his safety. Your agency was asked to make a home visit by the school principal. She was alerted by Malcolm’s teacher who became concerned about changes in Malcolm’s behavior and bruising on his upper arms. The teacher mentioned that he has been increasingly withdrawn over the past few weeks becomes angry if addressed, has difficulty paying attention, and his grades are slipping. Yesterday (Monday) he came to class with a resolving black eye that he explained as being caused by a fall at home.

Since you are unsure of the family dynamics, your main purpose of the visit is to assess the home environment and concerns over Malcolm’s safety. Your plan is to focus on the concerns expressed by Malcolm’s teacher regarding the changes in his classroom behavior and not address the bruising – at least not initially.

When you arrive at the home a diminutive black woman opens the door, invites you in, introduces herself as Keisha, and seems friendly. She gestures to a woman sitting on the couch with a baby on her lap and says, “That’s my partner, Miranda, and our daughter Reyna. She’s 6-months old”. Miranda is a white woman with very short hair, styled in a crew cut, and dyed blond. She is wearing a t-shirt with the sleeves cut out revealing tattoos covering both arms. On her lap sits a little girl, sucking on the fingers of one hand. Reyna appears to be biracial, with light black skin, curly light brown hair, and blue eyes. The baby appears clean and is wearing a diaper and a t-shirt, appropriate for the temperature of the room.

Miranda does not speak but glares instead. She soon turns her attention to the baby, cooing at her and bouncing her on her knee. Malcolm is at school but should be arriving home any minute. You take a seat in a chair in the living room facing the couple on the couch. Reyna looks at Keisha and smiles. Keisha takes her from Miranda and places the baby on her lap. The small apartment is fairly clean with somewhat tattered furniture. You attempt to engage Keisha in conversation about Malcolm, but she seems reluctant to answer your questions. She does talk openly about Reyna when asked about her. You learn that Keisha was inseminated with donor sperm to conceive Reyna, which was a mutual decision between the two women. 

When Malcolm arrives home, you notice that he appears healthy. His t-shirt is full of food stains, but he appears clean. As he starts to walk toward the kitchen, he trips over the corner of the rug and his backpack goes crashing to the floor, hitting the coffee table, and sending a plastic glass of water to the floor, startling Reyna who begins to cry. Miranda jumps to her feet and grabs Malcolm by the back of his t-shirt and brings him to his feet, scowling at him, and saying, “Now look what you have done!” in a raised voice. She also raises her fist as if to threaten to hit the boy. Malcolm cowers, breaks free of her hold on him, runs into his room, and shuts the door. Miranda continues to berate Malcolm in a raised voice toward the closed door, which seems to escalate the volume of Reyna’s cries. Keisha appears unnerved, as well. You ask Keisha where you can find a rag to wipe up the water and proceed to take care of the spill. While you are wiping the floor, Miranda leaves the apartment, slamming the door. After she is gone, you calmly say to Keisha, “I remember being a bit clumsy as a child, and I know boys will be boys. Was Miranda’s reaction to this accident typical for her?” Keisha mumbles, “I guess – she often gets mad at Malcolm. I had him before we got together, and I think Miranda doesn’t like that”. Your next question is one you must ask. “Has she ever hurt Malcolm?” Keisha averts her gaze and does not answer you.

Just then, Miranda stomps back into the apartment and quietly asks you to leave. You gather your things and comply.  In your discussion please address the following questions:

o   Family is defined in many ways. Based on your personal beliefs, the families you are assigned to visit may not meet your definition. How do you come to terms personally with the various family structures you may encounter during home visits?

o   You learned to start a plan by identifying each family’s strengths. What are the strengths of this family?

o   Because your visit was so brief, the main question about potential child abuse remains heavy on your mind. You suspect that Miranda has been rough with Malcolm and possibly hit him to cause the bruising. What is your plan of action? What is your duty to report when confronted with potential child abuse? What agency drives your course of action?