Forensic Nursing in the Emergency Department

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Many patients treat the emergency department as a doctor’s office for various reasons.  I believe the top two reasons are lack of insurance and the patients know that the emergency department can’t turn them away for inability to pay. The other reason is that if they are medicine shopping or trying to hide certain things such as domestic or child abuse then they can go to various emergency departments without a true paper trail. The likelihood that a doctor or nurse is going to remember a particular patient in a crazy setting such as the emergency department is rare unless it is a rural emergency department.

Unfortunately many staff members of the emergency department have grown calloused to the “repeat offenders” and don’t actually look for issues.  I can think of a time when I was working midnights in an emergency room in a small town hospital in South Carolina when we had the same drunks and druggies come in almost religiously every Friday and Saturday nights.  However, we also had this one woman who came in with various complaints that ranged from becoming dizzy and falling down stairs to playing with her kids and the ball striking her.  Being a new nurse I had just had the equivalent to a forensic nursing class prior to graduation and I questioned her repeat visits and the fact that the husband would never leave the room for us to examine or question her.  The more experienced nurses just shrugged their shoulders and said “well, at least he brings her in for treatment.”  I was appalled.  Not really knowing what to do I just ignored it also.  Then one night she came in by herself via ambulance in critical condition from what the EMS gathered was a stranger altercation.  Knowing that she came in regularly and for various injuries I grabbed the police officer investigating the complaint and told him my suspicions.  Like everyone else he started to ignore my concerns when I asked him how he would feel if this were his mother or sister and people ignored possible serious signs of abuse.  He talked with the husband and various family members who had shown up and then he called in a social worker who pulled the lady’s medical records. She had been seen somewhere around 100 times in that year for various injuries most were minor. 

This case has stuck with me over the years because I never found out what became of the lady after I moved away. My guess is she either stayed in the relationship and continues to visit the ER or she is dead.   Either way the shame of it all is that because most of the staff was calloused to seeing such things and they had never had a proper forensic nursing class to know the obvious and hidden signs of abuse this lady was continually placed back into harms way. 

The emergency department is sometimes the only place a person has to go for help.  This means that we must work as our patient’s advocate to ensure they receive the care they need.

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