Case studies

The 3 case studies build on one another so you will be required to complete all 3 CASE STUDY 1 you are working in a large regional hospital, and have been rostered to work an afternoon shift in the surgical ward as they are short staffed. There has been an orthopedic list that morning, with several patients recovering from knee and hip replacements. Your handover has been straightforward, everyone is doing well and there have been no post-surgery complications reported. You are looking forward to a great shift You perform the post-op checks and observations, and ask everyone if they have had adequate pain relief. The last name on the handover list is a very elderly Aboriginal lady from a remote community; you decide that you will see her last as she may need some extra time spent with her - she has had a complicated procedure. Her name is Margaret, and she smiles when she sees you, shakes her head and points to the floor. She then pushes the bedcovers away and tries to get out of bed, so you gently push her back down on to the pillows, and draw the covers up around her, explaining that she can’t get out of bed just yet. Margaret doesn’t appear to hear you as she is still shaking her head, so you nod and ask her loudly if she has hearing aids. As there is no response, you start going through the locker to find Margaret’s bag. There is no sign of hearing aids, however, Margaret is looking extremely distressed and grabs your arm. She is shaking her head and pulls her bag away from you then leans forward to push the bed covers away. Your dream shift is fast becoming a nightmare. You are wrestling Margaret for the bed covers again when you realize you are not alone. A young lady is standing in the doorway. She tells you she is Margaret’s granddaughter May. After a swift conversation (that you don’t understand) she tells you that Margaret wants to go to the toilet - urgently. You assist Margaret with a bedpan, and when she is comfortable again ask the granddaughter to go through the patient information leaflet that was sent to Margaret before surgery. You tell them the leaflet explains why Margaret cannot get out of bed, and what to expect following surgery. Both women look at you and begin a conversation between themselves. Margaret’s granddaughter tells you that she has come to interpret for her grandmother as she speaks little English but can understand quite well. You are also informed Margaret is not deaf and did not understand why a nurse would need to go through her personal belongings without permission. If you had read the notes, you would have seen an entry that advised Margaret’s granddaughter would be interpreting for all communications while Margaret was inpatient. You apologize to both and realize you have a lot to think about Questions for Case study 1 1. List the steps you would take to ensure your patient’s needs could be met. 2. Describe how you would feel if you were Margaret   3. What supports are in place for Aboriginal and/or Torres Strait Islander patients at your local hospital? How can you promote culturally safe services and programs to enhance participation? Outline strategies that may encourage self-determination and community control of the services and programs available How can all the elements discussed in this question be evaluated   CASE STUDY 2 You are asked to work a few more shifts on the Orthopedic Ward. In your efforts to provide a better service to your patients and establish respectful relationships, you read the case notes thoroughly for all patients to become informed of their needs. The doctor’s round will also be starting soon so you want to be prepared. Margaret’s granddaughter May has come to the ward quite early in the day and is chatting to some of the women in the shared rooms. You think ‘that’s nice’, and note that she seems to know a lot of the Aboriginal women quite well. Feeling a bit concerned that she is here so early, (because visiting hours don’t start for another hour) you decide to wait for May to finish her conversations to talk to her. You then keep reading. Someone sits down next to you at the desk and picks up the nurse’s station phone. You look up to see May dialing an internal number, and paging a social worker. She begins to read something from a patients file….one if the ladies she had been speaking to earlier. By this time your surprise has given way to panic; this is a breach of confidentiality! Reaching out you remove the file from in front of May and she looks surprised at the other end of the phone to ‘just hold for a minute’. ‘What are you doing?” she asks. You then explain the confidential and privacy policy in great detail, including why she isn’t allowed to read files, use the internal phone and visit outside of the normal hours. You then ask that she go to the other side of the nurse’s station. She tells you she needs to “speak to ‘the aunties’” before the rounds commence so she can report any issues to the doctors and address any needs. You question her about her relationship with these ‘aunties’, and state ‘you can’t be related to all of them”. May doesn’t say anything at all, but stands up and holds out something she is wearing around her neck. Which turns out to be her hospital identification. “Aboriginal Liaison Officer” Another day, another apology. Questions for Case study 2 Provide your answers to the following questions 1. What assumptions did you make about May prior to seeing her identification? 2. What are your actions immediately following this incident? 3. a. How could you engage with May to promote a more culturally safe workplace for her? b. List some things you could do to develop a good interpersonal working relationship 4. Think about the places you have completed your semester 1 vocational placement in and evaluate the extent of how cultural safety is integrated into that workplace (you can also refer to other workplaces you have experienced if you wish)   CASE STUDY 3 You are required to submit your responses to the following case study scenario, which builds on the previous 2 scenarios about ‘Margaret’ There are 2 discharges this morning, and it is your role to ensure that all goes well. Your clients will need for you to ensure they have transport organized, understand the post-discharge plan and instructions, and complete all paperwork Margaret is an elderly Aboriginal lady (who is known to you) is being discharged from hospital following her orthopedic surgery. You are assisting Margaret to pack her belongings and await her granddaughter to one to attend for a discussion around exercise, follow up appointments and contacts for any problems that Margaret may have. You are aware that other members of her family will be collecting her to take her home soon. Your second patient to be discharged this morning is unknown to you. They had minor orthopedic surgery a few days ago, and only need minimal instructions before they can leave. As you have learned a recent lesson about appropriate care for your patients, you read the notes thoroughly and note they have a small amount of English, but will need translation for more detailed information. There are no notes around transport home, and the next of kin contact number is not picking up. You then make a point of introducing yourself as best you can and let them know through hand gestures that you can assist them to pack their bag if they would like. As Margaret’s granddaughter is one of the Aboriginal liaison officers, you decide to wait for her to ask for her assistance. You need to know who will be transporting them to home (noting they are from an island off the northern coast, to where transport can be quite difficult). May arrives and asks you if everything is ready for Margaret to be discharged. You reply that you need to talk about the discharge plan before Margaret leaves but ask if they could quickly help you with another matter, and ask them to follow you to the other patient’s room. ….is hesitating, saying that she needs to know who is in the other room. You tell her ‘it’s ok’ because this is another Aboriginal person The patient sees May and quickly averts his eyes, struggling to turn around on the bed. May also becomes visibly upset and runs out of the room. You follow her and find she is distressed and says ‘you shouldn’t have done that!’ She explained she cannot speak with or look at this patient, and that she will be ‘in trouble’ because of this. When you ask why she just says ‘culture, and that’s all I can say‘ Once again, you feel that you need to apologize, however you don’t know what you have done. Where did you go wrong? Provide your answers to the following questions. Questions for Case study 3 1. List any potential cultural reasons for May’s and the patient’s reactions. 2. Describe how you would approach May and the patient to apologize, and what you would say to them both that will bring healing to the situation 3. What strategies could you now put into place for promoting cultural safety for Aboriginal and/or Torres Strait Islander patients at your workplace and their communities? 4. How can you involve Margaret and May in the planning and delivery of services and programs when she is discharged 5. Reflecting on how these 3 case studies have affected Margaret, how would you prevent this from happening to someone else? 6. As part of the discharge process, Margaret is to attend an outpatient’s rehabilitation program at her local community health center. Discuss the following points How can you as a nurse promote this program to Margaret and May? Who would you involve to ensure that Margaret participates?   How can you assess if Margaret has the confidence to participate in this community program when she is discharged What follow up strategies can you put into place to assess and evaluate the effectiveness of the rehabilitation program? Margaret has missed a few days of her rehabilitation, who would you communicate within the healthcare setting and Aboriginal Islander people to devise strategies to ensure that Margaret completes her rehabilitation How can you promote culturally safe services and programs to enhance participation?      

Sample Solution