NUBE 2024

As an ER nurse for twenty years and now a psychiatric nurse practitioner, I have never had a case impact my practice as much as Amanda's. I took care of Amanda as an ED nurse in May 2024. I want to share this fascinating and impactful case with conference attendees. It is a case full of assumptions.

A homeless 40-year-old female, Amanda, comes to the ED via ambulance after people living in a home became worried about "a woman lying in their backyard on a mattress, incontinent to urine and without pants for three days". The patient is severely sunburned (Phoenix in May), has a temperature of 103 degrees, but is alert and oriented. Pt denies mental health and substance abuse. No medical history and takes no medications. No old records are found. Basic labs and UA ordered, fluids hung, and ice packs applied to the neck and groin. Through conversation, it is discovered that Amanda has her master's degree in accounting and lost her job one year ago. She has two children she sees occasionally, and when asked what she does during the day, she replies, "I am a ho on the streets." As the patient's RN, I could not reconcile her situation with her presentation. I left my shift that night with a strong feeling toward this patient. I felt so strongly at one point that I even half-heartedly considered taking her home! I came back to work four days later and learned that Amanda had been admitted to the hospital with Hyponatremia and discharged the day before. She was discharged with a ride home but instead fell asleep on hospital grounds in a bush. I raised concern about her condition to multiple parties, and upon a more extensive review of her medical record, it was discovered that she had been diagnosed with a brain tumor on her front lobe in 2021 and even admitted to our facility in the Neuro ICU in 2021. After being sent to her mother's apartment and trespassed by police there, A "BOLO" is issued for Amanda to all charge nurses in the ED, and amazingly, she appears that same night again via EMS for nausea and vomiting. A head CT is done on her second trip to the ED, and doctors discover that her tumor is now the size of a softball on her frontal lobe, and it is impacting her decision-making. She is taken to the ICU and has a craniotomy four days later. A day after surgery, she is alert, oriented, and trying to rebuild a life with family members who had given up on her. This story has many twists and turns that make it even more compelling. All types of medical professionals (doctors, nurses, social workers) who participated in Amanda's story made assumptions about her in some way. It tells a story of how we can mistakenly view patients in the ED judgmentally and perhaps how changing our mindset can and will save a life just like Amanda's.

Learning Objectives:

Listen to a fantastic and heart warming story from an ED nurse who took care of a homeless patient (5/24) and changed both of their lives forever. This story is extremely relevant to all conference attendees.

Describe educational initiatives related to this case.

Discover how this case was presented to the “ER Behavioral Core team” to inspire participation and ignite a passion for improving the care of behavioral health patients in our ED.