Critical care nursing quarterly
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Review
Munchausen by proxy syndrome: the forensic challenge of recognition, diagnosis, and reporting.
Munchausen by Proxy Syndrome (MBPS) is a rare form of abuse in which a caregiver fabricates or produces symptoms of an illness in a child, elder, or disabled person. The deception is usually repeated on numerous occasions, resulting in many hospitalizations, considerable morbidity, and sometimes death. MBPS is a factitious disorder in which caregivers injure their victims in order to gain sympathy or attention for themselves. ⋯ Unwillingness or the inability to recognize this abuse deprives the victim of the opportunity to be shielded from future harm. There is a need for strategic protocols and a multidisciplinary approach to this baffling problem. Discussing the clinical profile of the perpetrator, the victim, and the family may help nurses distinguish medical fact from fiction.
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Triage nurses in the emergency department are in a unique position to screen for domestic violence. This study, using Orlando's theory with a focus on two of her five major concepts, identifies barriers that prevent effective screening for domestic violence. ⋯ Education on abuse and resources should be essential in nursing school curricula. Policy development and review should be part of an annual, mandatory inservice for all emergency nurses.
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Critical care nurses learn early in their careers that patient confidentiality is to be respected. Challenges to this belief come when public safety or justice seems to outweigh any individual's privacy. The resolution of the problem caused by such competing values may not be easy for a nurse and will necessarily demand examination of legal, ethical, and professional responsibilities.