Emma Jackson, a 1-year widow who lost her job 3 months ago, has spent 2 days in a row, from morning till time to pick up her kids at the school bus stop, waiting in an emergency department to get help for what appears to be severe depression.
Now, at the end of this second day sitting in the waiting area, she approaches the admitting nurses’ station in tears and says, “I don’t know how much longer I can take this. Don’t you recognize me?”
“No, ma’am, I’m sorry,” the nurse says. “Offhand, I don’t.”
“Well,” says Emma, “I’ve come in here 2 days in a row. I need help, and I can’t get in to see anybody because I’m not bleeding to death, but I’m desperate! I’ve spent the last 2 weeks, until yesterday, in bed. And yet I can’t sleep. Do you know how many days I’ve been without sleep? I’m so exhausted and so depressed I’m tempted to shake my kids for the least little thing, and I now have zero tolerance for careless drivers and sometimes I just want to drive straight into them to teach them a lesson, and that’s not like me. My kids are becoming my only reason for going on, and that’s not good for them. I think they can see it, and it scares them. They’re trying to be super-good…”
Thinking of how her despair is affecting her children, Emma bursts into uncontrollable sobs.
1. The psychiatric nurse takes Emma into an examining room immediately to interview her. Based only on what you’ve just read, what in your opinion is the likelihood of Emma being admitted for short-term inpatient care? Give at least two admission criteria that may apply to her situation. Offer (a) a possible causative factor and (b) symptomatic evidence.
2. Further assessments lead the psychiatric mental health team to recommend that Emma agree to a 72-hour inpatient visit to stabilize her current condition. The team would work with her to ensure that her and her children’s needs are being met and to explore ongoing treatment options as well as social, psychiatric, and other services. Emma agrees and arranges for a church member to keep her children during that time.
Later that night, though, she changes her mind and approaches the night nursing staff about checking herself out. The nurse on duty discourages her; when Emma then asks to take her cell phone back to her room to call her brother, the nurse says, “Why don’t you stay here at the station while you make your call.”
Emma becomes very angry and anxious, so the nurse isn’t sure if she should hand her the phone in that condition. The nurse tries to give her an oral sedative to help her calm down awhile before making her call, but Emma pushes it angrily away and says, “I’m not leaving this spot until I can talk to my brother!”
What should the nurse do in this situation? What recourse does she have when this patient will not comply with requests and, more significantly, refuses her medication?
