write an essay for doug story

 

Task Doug’s story (below) demonstrates a number of issues encountered by patients in the healthcare system. Your task is to explore these issues, specifically: 1. Demonstrate your understanding of the various contextual factors presented in this case. How might these factors be contributing to Doug’s health? 2. Evaluate how the communication processes and methods used between health professionals and institutions affected Doug’s experience and outcomes. 3. Discuss the models of teamwork demonstrated in this scenario, evaluating these for effectiveness. 4. Describe and consider how the clinical reasoning process was implemented in this case and how it could have been improved. 1. Your response will be in the form of a 1,500 word academic essay. 2. This essay will have an introduction, body and conclusion. 3. You will support your information through references from creditable sources. 4. Referencing will be in the APA6 referencing style. 5. There will be a minimum of 7 references. Submission of assessment You will submit your essay through the plagiarism detection software – Turnitin. There will be a link to Turnitin on the Moodle in the Assessment Section You can submit your essay through Turnitin prior to the due date and will receive within 24 hours a Similarity Index rating, which will demonstrate where you may have copied material without due referencing, or where your paraphrasing was not sufficient to demonstrate original content. Each time you submit prior to the due date your essay on file will be replaced (there will not be multiple copies of your submission kept on the system). Subsequent submissions to Turnitin usually results in delayed receipt of the Similarity Index (you might not get a report within 24 hours). Your final submission to Turnitin must be before the due date of Sunday 20th May at 11:59 pm. You will be penalised 5% of your total mark for every day after the due date. After 5 working days your submission will not be marked. 2 | P a g e If you believe you will need an extension of the due date you must do the following: An extension of assignment submission for circumstances in the time leading up to the due date must be applied for in writing (via email) to your teacher at least 48 hours prior to the due date. Your teacher will notify you via email if an extension has been granted. If you require an extension for medical reasons, you will need a medical certificate to cover you from the time the assignment was due until the time it is submitted. The medical certificate must be provided to your lecturer. Information (scenario) for Assessment Task 4 – Essay Doug is a nineteen year old aboriginal man who has had Type I Diabetes Mellitus since he was 13. Doug was born in a small town in a remote area of Victoria. Despite not completing Year 8, he decided to move away from his family to the city. He has not been able to get a job, and has very little income. He misses his family, friends and community, but is determined that they not find out that he is unhappy. Doug has a history of homelessness, but has been living for the past 2 weeks in a share house with people he doesn’t know well. Doug does not see the same doctor for his diabetes, he visits many different clinics, depending on where he is living at the time. One day, while Doug was out walking, he felt lightheaded and then lost consciousness and fell to the ground. He was brought to the Emergency Department of a major hospital by ambulance for assessment and investigation. As a consequence of the fall, he sustained a head injury which resulted in severe and persistent headaches, loss of coordination and difficulty with walking. In the Emergency Department (ED) a number of tests were undertaken (including a CAT scan, blood sugar test and full examination). It was identified department that prior to the fall he had experienced an episode of ‘insulin shock’. Following an 8 hour stay in the Emergency department, Doug was transferred to the Neurology ward for assessment and monitoring. In addition to the medical records available in the central electronic filing system, a member of the ED team provided a ‘handover’ to the Nurse Unit Manager of the Neurology Ward. It was when he was on this ward that the nursing staff identified that Doug has limited knowledge of his diabetes including where to access support and advice, and how to monitor his glucose levels and adjust his insulin dose properly. A team consisting of Nurses, the ward Physiotherapist, a Social Worker, and a Neurologist met on three occasions to discuss Doug’s case. They used the information from the Emergency Department admission, the assessments undertaken by the team of health professionals, and included Doug in all their decisions. They identified his issue with Diabetes management, but as this was a short admission to the Neurology Ward, they did not have the resources to follow this up. After a 4 day stay in the Neurology ward, the healthcare team decided that Doug would benefit from being transferred to a rehabilitation centre. A junior Doctor who had just joined the ward was given the task of writing the discharge summary (see attached). Doug was taken by Patient Transport to a Rehabilitation Centre which was not part of the Acute Hospital, but an independently run organisation. The brief discharge summary was sent with Doug describing the initial head injury and noting the need for ongoing therapy to assist his co-ordination and walking. While in the rehabilitation centre, Doug was assessed by the physiotherapist, occupational therapist, doctor, and of course the nursing staff who monitored Doug daily. They did not seek any additional information from the Acute Hospital, only using the discharge summary as a basis for Doug’s care. They did not formally meet, but they each wrote notes in Doug’s medical record. On day six of his admission to the rehab centre, the Nurse Unit Manager observed Doug confidently walking in the ward corridor by himself. As a very experienced Rehab Nurse she decided that Doug could be discharged home based on his ability to independently toilet and ambulate. In addition, she was under considerable pressure by the Senior Management of the Rehab Centre to discharge patients to free up beds. Without consulting the other staff, 3 | P a g e the Nurse Unit Manager informed Doug that he was to be discharged the following day as he now appeared fine and had no consequences from his “little bump on the head.” Doug was discharged the next day and returned to the house he was sharing. None of his housemates had even realised he had been away. Five days following his discharge home, Doug was again admitted to the ED by ambulance, having suffered a fall at home while trying to descend the stairs from the second floor where his bedroom was located. He fractured his left tibia as a result of the fall. He told the ED staff that he had not been eating well, but that he had still injected his usual insulin dose just prior to the fall. 4 | P a g e La Trobe Assessment Hospital DISCHARGE SUMMARY Patient Name: Doug Woljamiri URN: 10034589 Date of Admission: January 20th, 2018 Date of Discharge/Transfer: January 25th, 2018 Admitting Diagnosis: Head wound from fall, loss of consciousness due to episode of insulin shock. Discharge Diagnosis: Head injury resulting in loss of balance, coordination and difficulties ambulating. Secondary Diagnoses: Type 1 Diabetes Mellitus. Procedures: CAT scan negative for structural damage to skull or brain. Blood sugar monitoring. Consultations: Neurologist, Social Worker, Physiotherapist, ward staff History of Present Illness: First reported occasion of insulin shock. No known prior history of head injuries. Hospital Course: Presented to ED by Ambulance following LOC, repair of small scalp laceration. Transferred to Neurology Ward to follow up loss of balance, coordination and difficulty ambulating. No other cognitive impairment, oriented in time, place and person. Discharge to Rehabilitation Centre to complete rehab for neuro symptoms. Condition: Ambulant with assistance. Discharge Medications: Insulin, self-administered following self-testing of Blood Sugar levels. Discharge Instructions: Discharge to Rehab Centre, suggest discharge home when neuro symptoms resolved. Possible follow up for Type 1 Diabetes.

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