Details

Using the case study details provided – Choose One of the Three Scenarios. Apply the theory, terms and concepts encountered throughout NURS11157 to analyse and discuss the behaviours of Either Bill, Ahmed or Ella. An essay format is required including an abstract, table of content, introduction, discussion, conclusion and a reference list. Resources have been provided in the unit Moodle site to assist with preparing this assessment.

Scenario 1: Bill

Bill who is 65 years of age, lives with chronic hypertension. Bill lives in a small coastal town and describes himself as 'semi-retired'.  He works part-time at the local golf course as a grounds man. Bill is married however; the marriage has experienced extreme difficulties over the past 5 years following his diagnosis. His wife Betty describes him as 'a crabby old man' who is constantly complaining about 'everything'.  Bill has two grown children and 5 grandchildren who all live in distant states. 

He loves to go fishing in his spare time and is a keen gardener however, is finding it increasingly difficult to perform heavy manual labour due to his age and declining health.  Bill is also extremely overweight (98kg and 168cm tall) and avoids going to see his GP as much as possible. He likes to eat take away food and makes many poor life style choices such as drinking too much red wine and not exercising enough. Betty is now threatening to leave Bill and is seeking counselling in relation to the unhappy state of this marriage and the consequent stress and anxiety it is causing her. Bill is in denial that there is a problem with the marriage and has started spending a large amount of time at the local Hotel playing the 'pokies'. Consequently, the family's financial status is not solid as money seems to keep disappearing at a rapid rate. Recently, they have not had enough money to pay the rates and are rapidly slipping behind in home loan repayments. Bill has also recently been experiencing problems with his vision, but refuses to seek help to rectify this choosing to buy cheap five dollar spectacles from the local chemist. 

Bill is worried that if his health declines further his wife will put him in a nursing home. 'That will be the end of me to go into one of those dog box homes' he told his next-door neighbour. Bill also frequently indicates 'it's my life and no one is going to tell me what to do- those young quack doctors think they know it all and just want to pump me with pills'.  At the doctor's office last week, Bill stated to the registered nurse that since he had been taking the blood pressure pills he was feeling a little better and had been able to work in the garden more on the weekend and did not need to take a 'breather' so often at work, He requested a repeat prescription from the doctor. In relation to his weight he also indicated that he'd heard about Dr Slims new weight loss program that was advertised on the TV and wanted to know if 'those shakes really work'? He then admitted he was only trying to lose weight due to his wife's nagging. 'If she could learn to cook better I'd eat at home more,' he said.

Scenario 2: Ahmed

Ahmed is a 13 year old youth who lives with his Mother and two younger siblings in the town of Littlemore. Littlemore has a population of 2500 people. Littlemore has a small 6 bed local hospital staffed by n Registered Nurse with Telemedicine link up facilities to a major hospital in the city of Packmore – some 600 km away. The closest Children's specialist hospital is also located in Packmore. The Royal Flying Doctor Service assists in transporting patients between these hospitals in emergency situations. Ahmed often flies alone during these transports as his mother must drive with his two siblings to Packmore. He remains very frightened of flying however tries to be brave so his mother is not too anxious.

Ahmed lives with haemophilia. His condition requires daily treatment using a synthetic blood product that his mother administers at home by having to set up an intravenous line to deliver the medication which costs $600 per month out of pocket expenses.  Ahmed's mother has no family support in the area however; they do have access to a social worker through the Haemophilia unit at Packmore Hospital. Ahmed's father works abroad and is waiting for a visa to come to Australia. Ahmed sees himself as the head of the household in his father's absence but feels inadequate, as he cannot always mow the lawn nor do the outside work due to his health condition. When he last spoke with the registered nurse, Ahmed was indicating he felt guilty because his mother had to do the jobs he should be doing and she also has to work to be able to pay for his additional needs such as equipment and medicine.  He has asked the nurse on many occasions 'why me?' Ahmed sometimes cries at night when he is alone as he feels he has no control over his body or choices about his health. He does find prayer a source of comfort.

Ahmed misses out on school for weeks at a time when he experiences a significant bleed into his joints. At these times, Ahmed remains at home and is in a wheel chair. The school is has 800 students and the buildings are demountable units with stairs. Ahmed sometimes requires treatment at the hospital when his routine 'at home' protocol is not effective. He misses his friends at school when he is away but he tries to keep up with his schoolwork, as he wants to become a doctor one day.

Ahmed is a happy young boy who enjoys going to school and has several interests including the chess club and drama classes. He has fewer male friends, as he is unable to participate in the popular contact sports such as basketball and football that his schoolmates play most lunch times and on the weekend. Sometimes Ahmed is teased at school and called a 'drug addict' as he has to carry supplies of injectable and a sharps container to school in case he requires additional medication. This makes him feel hurt as it is against his religion to use drugs. Ahmed wants to be able to administer his own medication now that he is in high school. 

 Scenario 3: Ella

Ella is 7 years of age and started year 2 at the local primary school a few months ago. She lives with her mum in a rented NAS (National Affordability Scheme) town house in the outer suburbs of Cityscape. Ella is usually a happy child and she accompanies her mum everywhere. They are very close as it is just the two of them in the household. Ella's father does not have any contact with the family.  Ella's mother works part time at a café during the day and as a cleaner when extra work is available. She also helps out at the school in the class room listening to the children's reading in the mornings. Ella likes her mum coming to the school.  They are a low income family and receive some government support.  Ella's mum considers her situation to be OK as she has a job, a house and a lovely daughter. The family have been in the area for five months and have located some community based services that are proving very useful. They have a goal to purchase a small town house next year. Ella's mum adheres to a strict budget and has been saving a small amount each week since Ella was born. With her savings and the first homeowners grant, she expects they will reach their goal and purchase a place of their own December next year. 

One place they frequent each week is the Food Bank. Over the last few weeks their shopping experiences have taken a different turn for example, last Saturday, at the food bank Ella wanted her Mum to purchase a packet of brand name chocolate biscuits. Her mother only had enough credit vouchers for her basic supplies. They had selected standard items such as toilet paper, bread, rice, some vegetables, cordial, cheese and washing powder.  Most of their intended purchases were brand names. The mother was using a calculator to help her work out her costs for the order and selecting things and then replacing them on the shelf after considering if they were necessary or not. 

The little girl kept running up and asking if he could have a number of other items and had selected some cream cheese and biscuit prepacked snacks, crisps, juice boxes and flavoured milk.  She kept insisting that all her friends had these biscuits and she wanted some too. She stated 'I don't want the yucky sandwiches from home or the bikkies we wrap in plastic… everyone just laughs at me. I want the flavoured milk like they have too…' The mother was trying to explain to Ella that she didn't have enough money for the biscuits and these other convenience foods but the little girl was insistent.  She said, 'all my friends get these. Why can't I? I don't want to be different all the time. What's wrong with you… Why can't I have normal food like the other kids?'  As fast as Ella put the items into the trolley, the Mother removed them.

The situation became very tense. The mother ended up shouting at Ella and she began to cry. The mother then crouched down and hugged her daughter and said she was sorry for shouting.  Ella pushed her mother away and stomped off to the end of the aisle and sat down on the floor.  She was crying and calling out 'I hate you'. The mother was very embarrassed. Another lady who was shopping suggested Ella needed a good spanking to 'get that attitude out of her… fancy speaking to her mother like that!' This upset Ella's mother even more and she was also crying and fumbling in her bag for a tissue.

The volunteer at the centre had observed the goings on and came over and asked if she could help because the mother and Ella both seemed upset. The mother appeared ashamed.  The volunteer said 'I remember when my kids were the same age … so I get it'. She smiled at the mother and handed her a tissue. 'Nothing I haven't experienced myself' she said.' Right- so let's see what we can do to fix this…'

The volunteer called Ella over and she then suggested to both of them 'what if we swap the toilet paper and washing powder for the one that's on special and then you can get the no name chocolate biscuits as it will be much the same price?'  Ella's mum asked Ella if that would be ok. She asked 'do they still look the same as the other kids' ones?' The volunteer said well if you wrap them in plastic they will. Ok said Ella. Now for the milk- what if we put these ones back – she handed Ella the small pre-packaged bottles – 'What's your favourite flavour?' she asked … Both Mother and Daughter said 'Strawberry'.  If we get one strawberry topping and two litres of milk you can make your own and freeze it each night. 'That sounds like fun' said Ella.  After some further adjustments a compromise has been reached however, the budget did not stretch to the packet of mini chocolates Ella was eyeing off. 'Sorry' said her mother, 'we have no more money for those.' 'OOOk' moaned Ella less than enthusiastically, placing them back on the shelf anyway.

They went to the checkout where Ella was busily 'beeping' the items through the scanner. Ella's mum was smiling again and the happily set out to catch the bus back home.

Introduction

The case scenario – 1 describes the psychosocial condition of a 65 years old man (named Bill) experiencing a pattern of chronic hypertension. The patient is affected with irritability and undergoing stressful circumstances related to his unhealthy lifestyle and marital conflict. The pattern of overweight in the patient is substantiated by the absence of healthcare interventions and excessive consumption of junk food and wine. Bill is overburdened by financial constraints, influenced with blurred vision and dominated by the pattern of distrust and insecurity in relation to his deteriorating health and wellness outcomes. The patient is entirely dependent of antihypertensive medicines for controlling his blood pressure. He remains stressed because of his marital complications and impulsively shares his desire of losing weight under the influence of familial pressure. Apparently, the systematic implementation of the chronic care model is the best approach warranted for the enhancement of quality of life and the pattern of self-management of the affected patient (Lewanczuk, 2008). The preliminary objective of chronic care model attributes to the execution of multidisciplinary coordination between healthcare professionals for the systematic promotion of culturally appropriate and qualitative continuity of care in the context of elevating the wellness outcomes of the treated patient. Proactive administration of healthcare approaches, implementation of evidence-based decision support/clinical information systems, promotion of self-management strategies and administration of community based, person-centred and holistic interventions is highly warranted for effectively improving the patient's overall health and wellness outcomes.

Evidence-Based Discussion

The case scenario indicates the requirement of undertaking evidence-based health decisions for reducing the mental manifestations of the chronically ill patient. Evidence-based findings indicate the pattern of the relationship between psychological distress and hypertensive manifestations. The adverse psychosocial implications might influence psycho-physiological state of the patient under the adverse influence of depression and anxiety symptoms (Hamer, Batty, Stamatakis, & Kivimaki, 2012). The administration of labelled-hypertensives increases the risk of consciously experiencing stressful state among the treated patients. This case scenario evidently advocates this fact as the patient shares his irritability in relation to the requirement of administration of antihypertensive medication for blood pressure management. The experience of negative emotions by the hypertensive patient predisposes toward the development of mental health complications and associated co-morbid states (Kretchy, Owusu-Daaku, & Danquah, 2014). Indeed, the psychological pressure of experiencing the state of chronic hypertension increases his risk of non-compliance with the recommended treatment regimen. Medication non-compliance further increases his risk of acquiring cardiovascular complications. The concomitant development of mental health complications with hypertension elevates the predisposition of the patient towards experiencing cardiovascular mortality (Aaron, et al., 2015). In the presented case study, the mental stress experienced by the patient might unnecessarily intensify his antihypertension therapy, thereby leading to the development of drug related toxicity. The psychophysiological state of the patient in the presented clinical scenario might provide prognostic information regarding the pattern of his hypertension and risk of developing cardiovascular disease (Hamer & Malan, 2010). The elevated BMI pattern of the patient, because of his nutritional and behavioural inadequacies elevates his risk towards the acquisition of cardiovascular, cerebrovascular as well as metabolic complications. The presented case scenario indicates the low socioeconomic status of the hypertensive patient that evidentially elevates his healthcare cost, thereby leading to the establishment of psychosocial manifestations. The research analysis by (Fateh, Emamian, Asgari, Alami, & Fotouhi, 2014) indicates the increased prevalence of elevated blood pressure among the impoverished individuals. The healthcare inequalities experienced by the underprivileged individuals elevate their vulnerability towards the acquisition of chronic disease states (including hypertension and associated clinical complications). In the presented case scenario, the treatment methodology followed by the physician and nurse for treating the pattern of patient's hypertension does not effectively address his opinion, perceptions as well as level of uncertainties experienced by him in the community environment. The type of clinical decision-making utilized in the case scenario-1 lacks the pattern of patient follow-ups and his systematic involvement in care-planning and assessment of healthcare outcomes (Hajjaj, Salek, Basra, & Finlay, 2010). Resultantly, the patient experiences consistent deterioration in his quality of life, level of self-dependence and associated wellness outcomes. The patient's somatic as well as psychosocial outcomes indicate the requirement of customization of healthcare interventions in accordance with his individual needs, treatment challenges and psychosocial circumstances. Understanding and assessment of patient's preferences is highly required with the objective of implementing effective dietary strategy and healthcare plan for the systematic improvement in the psycho-socio-somatic health outcomes of the treated patient. The greatest factor affecting the health behaviour and medical-decision making in the presented case study includes the absence of the pattern of self-evaluation and healthcare awareness in the treated patient. Therefore, the nurse professional and physicians need to administer self-directed approaches in the context of improving the coping skills of the patient to effectively overcome his psychosocial circumstances.

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