Question

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?

Answer 1

Ans.1.

Looking at Emma’s condition and history she is suffering from depression. As per DSMV diagnostic criteria for depression is as follows.

1. Depressed mood nearly almost every day.

2. Lack of interest in pleasure activities.

3. Feeling fatigued

4. Having guilt feeling, worthlessness,

5. Indecisiveness,

6. Thought of death or thought of committing suicide.

7. Loss of aptitude

8. Lack of sleep or too much sleep

To diagnose a person suffering from depression the symptoms should persist for more than 2 weeks.

Emma is suffering from from1. Lack of sleep or no sleep.

2. She feels guilty that she wants to hurt her children.

3. She is showing zero tolerance.

4. and a depressed mood

She has lost her husband a year ago and lost her job 3 months ago, she knows that she is going through a low phase but she cannot control herself and even wants to hurt her children in anger.

She can be admitted for short term in-patient care the causative factor is 1. There is a danger to the life of her children, she feels like crushing them to teach them a lesson. She is at risk of hurting herself and her children.

The symptomatic factor is;

2.  She is unable to control herself and gets no sleep at night she requires to be kept under observation while under treatment.

Ans. 2.

Looking at her condition she required further 72 hours of stay in the hospital and during that time the team would look after the children's need and safety. She agreed to it but later on that night she wanted to get out of the hospital and get discharged.

The nurses under these circumstances try to persuade the patient to stay in the hospital give an empathetic ear to her and tried to understand what does she wants.

As per the American Hospital Association, all patients have certain rights these are

1. They can refuse the treatment or procedure. 2. Discuss treatment options with the patients. 3. Educate the patient about the outcome of the treatment, 4. Educate the patients about the options and make the decision 5.privacy, 6.confidentaiality, 7. They can choose their doctor, 8.freedom from abuse and neglect, 9. Religious and social freedom. 10 Express their complaints and concerns addressed 11. Access to emergency service.

Emma is refusing treatment, she is angry and anxious she is not ready to listen and cooperate with the nurse. She is not ready to take the pill the nurse has given to calm her down so that she can sleep.

The nurse should inform about the situation to the doctor present at that time and inform the management about the patient’s condition and try to get help. There are chances that the patient can become physical.

Before getting any help she should engage the patient in conversation and try to convince her and make her understand by being empathetic towards her, and avoid arguing with her.

Difficult patients are part of nursing and one has to deal effectively with the.