Case study
Chung is a 35 years-old male who moved to Australia from China five years ago. His parents, older brother and younger sister still live in China. Chung visited his family in China once after a year of moving to Australia. He has not returned to China since, because of his long working hours and need to undertake additional study for promotion.
Chung is a doctor working in Accident and Emergency in a busy inner-city hospital. He is studying for promo- tion to ultimately become an emergency medicine consultant. Two years ago, Chung was under investigation by the hospital Human Resources department due to a drug error. He was very tired and had been on-call over-night with frequent call outs to see patients. The drug error resulted in an eight year-old boy being very sick, requiring intensive care admission. Chung used an intra-muscular medication to treat the boy but administered it intravenously. Chung was subjected to several work-place and medical board investigations and placed on practice supervision for 12 months.
Chung met his wife, Harriett, in Australia four years ago. Harriett is 30 years old. They married two years ago. Unfortunately, Chung’s parents and family could not attend the wedding due to the high costs of travel and his mother has severe arthritis in her hips, making travel very difficult. Chung found their wedding day emotionally difficult. He felt the ceremony lacked reference to his Chinese culture. On reflection, he feels that he wasn’t as involved in the wedding planning as he could have been, due to his long working hours. He simply agreed to the suggestions and plans made by Harriett and her family.
Chung and Harriett now have a three week-old baby girl, Charlotte. Charlotte was born by caesarean section, due to birth complications. Harriett has had an infection in the operation site since the birth, resulting in lots of pain, frequent dressings and difficulties moving around. Chung was off work for one week after the baby’s birth. However, he has now returned to working shifts, often working through the night, where he may go without sleep for 20 – 24 hours. Harriett’s parents are staying with them to support Harriett while Chung is at work. However, he finds that Harriett’s parents are very involved with baby care even when he is home. Given this, Chung finds he gets very little time and space to be with his new daughter.
You are visiting the family in your capacity as a community nurse supporting Harriett with the caesarean section wound care or as a midwife undertaking a post-natal visit. During your visit to the family, you notice Chung looks flat in mood and tearful. His affect is sad and restrictive. He is slumped in his chair, with rounded shoulders and starring at the floor for long periods. You inquire about his health. He has very limited eye to eye contact with you. His speech is slowed and purposeful. On occasions, you need to repeat your question several times to get a reply. However, you do manage to obtain the following information from Chung. He has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte’s birth and his wife’s health. He has been having palpitations, chest pains and breathlessness for six to seven weeks. He asked a colleague at work, another doctor, to assess him for cardiac issues several weeks ago as he had been experiencing thoughts that he was going to have a heart attack and die. Chung has been feeling very low in mood for the past six weeks, experiencing sleeplessness, particularly initial insomnia and early morning wakening at 3am. He has lost five kilos in weight during the past month, due to reduced appetite and missing meals. He feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing fleeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. He states he feels his situation is self-imposed and that treatments will not be of help at this time.
Hints and tips for 401013 – assessment 2
- Please ensure your answers are typed using Word. Your work should not be hand written.
- A reference list with at least 6 different pieces of literature less than 5 years old must be included using APA style.
- You may want to use the table below as a way to structure your work. However, it is not compulsory. You can submit your work with a question number and answer as long as it is very clear which answer relates to which question.
- Please ensure the table and reference list are included in the same word document.
- Please do not submit as landscape paper set up. It should be as portrait.
- If you are using the table, please do not change the side margins and ensure you double check that all your work can be clearly seen when you submit via Turnitin.
- The purpose of the assessment is to assess whether you are able to review the presenting situation for a client and to prioritize their care, in terms of safety management first and less urgent issues later.
Questions 1a and 1b – 200 words in total
1a) Using the case study provided, identify an urgent risk area. Ensure your answer details why you have identified this risk area including specific information about the client and current literature. (2 marks).
1b) Identify one nursing / midwifery intervention you would immediately undertake with your client to address the risk area noted in question 1a and include a rationale for the intervention. (2 marks for the intervention and 2 marks for the rationale)
Ensure the intervention includes who and when you would actually carry out the intervention.
Your rationale should state how and why you would carry out the particular intervention. Ensure literature is included.
- Before you answer questions 1 a and b, consider you are a health professional and have sat with your client to undertake a mental health assessment. You have gathered the information which is offered in the case study. What do you now see as the most urgent risk area to keep your client safe?
- Take care to ensure the risk area is focused on the client. You may identify risk areas for family members or members of the community, but this is not the immediate focus of your actual student assessment here.
- Identify the most urgent concern first in terms of immediate safety concerns.
- We want to see your understanding of the client’s issue, so avoid writing brief details about the client such as: ‘the client has self-harm thoughts’. Expand on the detail of the concern ie. the client has presented with daily self-harm thoughts for 3 months, with intermittent / regular thoughts to cut his wrists using a razor blade. The client reports family contact as a possible cause of distress triggering self-harm thoughts which last for one hour daily immediately after seeing his family.
- You should then add in some literature about self-harm which has relevance to the case study ie. males and self-harm, incidence of self-harm. Remember 1a is only 2 marks, so the literature here doesn’t need to be expansive, but do make sure you provide some literature and provide details of the client’s main concern ie. safety concern.
- Identify one nursing or midwifery which you would undertake to address the concern you have noted in answer 1a. The intervention must be suitable for the concern you note otherwise it will not be awarded marks. For example: building a therapeutic relationship with your client; maintaining a safe environment; risk assessment; observations. You need to state exactly what you would undertake and how to gain marks. Ie. how would you build a therapeutic relationship with your client exactly? What approach would you take? What kind of language might you use? Who would be undertaken the activity ie. nurse / midwife on duty? Ie. the nurse / midwife will build a positive relationship with the client by meeting with them daily for 30 minutes using positive and recovery-based language to establish trust and rapport.
- Another example of a nursing / midwifery intervention: primary nurse / midwife to undertake a self-harm / suicide risk assessment with the client on initial contact and review on a continuous basis as new information is obtained or the client’s presentation changes.
- It must be a direct health professionals and client intervention not a referral to another service or practitioner.
- You should include a rationale with your intervention using literature and making reference back to the case study. Ie. why would you use recovery-based language when building a relationship with your client? Why would you undertake a risk assessment with your client?
Questions 2a and 2b – 200 words in total
2a) Using the case study provided, identify a mental health concern. Ensure your answer details why this is an area of concern. Include specific information about the client and current literature. (2 marks)
2b) Identify one nursing / midwifery intervention you would undertake with your client to address the mental health concern noted in question 2a and include a rationale for the intervention. (2 marks for the intervention and 2 marks for the rationale)
Ensure the interventions includes how, who and when you would actually carry out the intervention. Your rationale should state how and why you would carry out the particular intervention.
Ensure literature is included when you discuss the rationale.
- Question 2 a and b helps us to assess that you understand the difference between an urgent client concern ie. safety and a mental health concern. Question one was concerned with safety identification whereas question 2 is about mental health concerns ie. possibly low mood or anxiety.
- Again, avoid simply identifying the actual concern and writing in brief. You need to say something about the details of the client’s experiences using literature. Ie. the client has been experiencing low mood for one month, with thoughts of reduced self- esteem, worthlessness, hopelessness and suicide ideation. You should add in some literature in relation to low mood in males; anxiety in males for example. Again, it’s only 2 marks so doesn’t need to be lots of literature here.
- Try to avoid highlighting depression in your answer to 1a, as depression is an actual diagnosis with a collection of experiences as opposed to one concern. Better to term this as low mood as opposed to depression.
- Next identify an intervention which is suitable for the mental health concern in your answer to question 2a. Ie if you have identified low mood, what intervention can you do directly with your client to help / support them with low mood. Again, when writing the intervention think about who would carry out the intervention, when, how often, how exactly with details, actually describe what you would do.
- Again, a referral to another professional is not a direct face to face intervention, so please avoid this.
- You should include a rationale for the intervention you have offered in 2b. ie. why have you decided to carry out the intervention making reference to literature and your client?
Question 3 – 100 words in total
3) Using current literature, identify and discuss (2) two legal, ethical or professional issues a nurse / midwife may need to consider when working with the client in the case study (4 marks).
- Question 3 helps us to determine your understanding of some of the wider issues in relation to a person’s presentation and care.
- Re-read the case study to identify possible legal, ethical or professional issues.
- For example: you might want to discuss the client’s presentation in terms of
legal issues such as: Mental Health Act; Privacy Act; Health Records Act;
ethical issues such as: the ethical principles such as building a relationship while undertaking risk assessment which may result in a client being scheduled under the Mental Health Act; asking the client lots of questions for mental health assessment knowing the client may find the actual questions distressing;
professional issues such as: confidentiality and maintaining public safety; being involved with a clinical relationship with a fellow health professional who may work within your place of work ie. hospital.
- Clearly identify each issue in your work and then relate to the case study and use literature. If you are highlighting legal issues, you should relate to the Act directly and not secondary sourced literature.
- Make sure you refer back to the client in the case study and literature.
