Recently, a couple brought their teenage daughter to the ED after she told them she'd taken an overdose of benzodiazepines that were prescribed for her panic attacks. She also claimed she'd swallowed half a bottle of vodka. Her parents didn't see her take these substances, and the lab work and physical assessment findings were all within normal limits. When the ED staff and her parents pressed her for the truth, she confessed that she'd lied to get her parents' attention. She was discharged in her parents' care.
I didn't speak up because I'm new, but I thought the staff was pretty hard on her. They claim their questioning was "firm and fair." Am I right to be concerned?-N.E., MASS.
Yes, I'd feel the same way-concerned that the patient may have felt coerced by staff, concerned that staff violated her right to privacy by questioning her with her parents present, and concerned about the dynamics that brought this family to the ED in the first place.
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I'm also troubled to hear that this patient wasn't evaluated by a mental health practitioner before discharge. She should have received follow-up treatment as an outpatient or, if appropriate, been admitted to an adolescent mental health program for further assessment and treatment for suicidal ideation (serious thoughts of suicide, perhaps with a plan for committing suicide). Hospitalization would also include reevaluation of her panic attacks and the type and dosage of medication prescribed, and psychological assessment to determine why she felt the need for such a dramatic gesture to "get her parents' attention."
Being the newbie is hard, but you should focus on your first concern: the patient's welfare. When you're unsure how to respond as a situation unfolds, ask your preceptor or nurse-manager for help. Jot down a list of options, including possible nursing interventions, as you discuss the situation. Putting your thoughts in writing forces you to move beyond the vague feeling that something's not right and toward concrete actions. Instead of trying to evaluate a negative perception (for example, is the staff being too hard on the patient?), consider positive alternatives (have the chaplain, social worker, or counselor talk with the patient privately).
Is it too late to speak up now? No!! Review the situation with your preceptor or nurse-manager and ask for her advice about writing an event report that details your concerns.