EmmaJackson, a 1-year widow who lost her job 3 months ago, has spent 2days in a row, from morning till time to pick up her kids at theschool bus stop, waiting in an emergency department to get help forwhat appears to be severe depression.

Now, at theend of this second day sitting in the waiting area, she approachesthe admitting nurses’ station in tears and says, “I don’t know howmuch 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, andI can’tget in tosee anybody because I’m not bleeding to death, but I’mdesperate! I’vespent thelast 2 weeks, until yesterday, in bed. And yet Ican’tsleep. Doyou know how many days I’vebeenwithout sleep? I’m so exhausted and so depressed I’m tempted toshake my kids for the least little thing, and I now have zerotolerance for careless drivers and sometimes I just want to drivestraight into them to teach them a lesson, and that’s not like me.My kids are becoming my only reason for going on, andthat’snot goodfor them. I think they can see it, and it scares them. They’retrying to be super-good…”

Thinking ofhow her despair is affecting her children, Emma bursts intouncontrollable sobs.

1.The psychiatric nurse takes Emma into an examining room immediatelyto interview her. Based only on what you’ve just read, what in your opinion is the likelihood of Emma beingadmitted for short-term inpatient care? Give at least two admissioncriteria that may apply to her situation. Offer (a) a possiblecausative factor and (b) symptomatic evidence.

2.Further assessments lead the psychiatric mental health team torecommend that Emma agree to a 72-hour inpatient visit to stabilizeher current condition. The team would work with her to ensure thather and her children’s needs are being met and to explore ongoingtreatment options as well as social, psychiatric, and otherservices. Emma agrees and arranges for a church member to keep herchildren during that time.

Later that night, though, she changes her mind and approaches thenight nursing staff about checking herself out. The nurse on dutydiscourages her; when Emma then asks to take her cell phone back toher room to call her brother, the nurse says, “Why don’t you stayhere 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 thephone in that condition. The nurse tries to give her an oralsedative to help her calm down awhile before making her call, butEmma pushes it angrily away and says, “I’m not leaving this spotuntil I can talk to my brother!”

What should the nurse do in this situation? What recourse does shehave when this patient will not comply with requests and, moresignificantly, refuses her medication?