Internal Code: MAS5635
Health Care Assignment:
Case Study 1:
Henry has been practising as a physiotherapist for 8 years. He works in an inner-city medical centre along with orthopaedic surgeons, a podiatrist, a rheumatologist, a radiologist, and a massage therapist. Henry has been treating Jim, a 73 year old man, following bilateral knee replacements. After 3 months of therapy, Jim has shown little improvement in mobility; his wife tells you that Jim is not following his
exercise program at home. Henry has a waiting list of patients who need his assistance; for this reason, he decides to discontinue Jim’s treatment. Instead, he suggests that Jim see the massage therapist. Later that week, the practice manager, Sally, calls a meeting with Henry to discuss his decision to discontinue Jim’s treatment as she believes thatsuch measures could undermine the reputation of the practice. She warns Henry that if he discontinues treating patients, they will go elsewhere. Later, Henry raises his concerns with the practice manager over the well-being of one of the surgeons. He tells Sally that the surgeon frequently arrives to work smelling of alcohol, including on those days on which he performs surgery. Sally offers to speak with the surgeon, assuring Henry that he does not need to intervene in this matter. Weeks go by and the surgeon continues to arrive at work in the same condition.
Case Study 2:
Camilla works on a surgical unit in a large, inner-city hospital. One morning shift,she is assigned to care for Sam, a 21 year-old man who was admitted during the night for investigation of acute abdominal pain. His medical history includes multiple admissions to the emergency department for treatment of (among other things) drug-related psychosis. At the beginning of her shift, Camilla attempts to check
Sam’s vital signs but is unable to do so as he is very agitated, attempting to push her away. He is also calling out and unable to answer her questions rationally. Camilla asks the medical team to review Sam as she is concerned about not being able to monitor his condition effectively. She is also concerned for her own safety and that of her colleagues. The medical team arrives to find Sam pulling out his IV
cannula and verbally abusing Camilla. They order that Sam be placed in physical restraints and document as much in the notes. Camilla is concerned that this approach will only exacerbate Sam’s agitation and that, ultimately, he will injure himself and/or other patients and staff. She expresses her concerns to the nurse in charge of the shift (Julia) who advises her to apply the restraints and focus on caring for the other patients she has been assigned. Julia states: “patients like Sam are a waste of our time. Besides, we haven’t got enough staff rostered on today to be worried about him”.
Case Study 3:
Jane works as a midwife in an inner-city hospital where she runs an ante-natal clinic twice a week; on other days, she works in the labour ward. Jane is aware that one of the women attending the antenatal clinic (Tiffany) is alcohol dependent and lives with a physically abusive partner; Tiffany has been admitted to the emergency department on several occasions with multiple injuries, including fractured
ribs, bruising to her face and, on one occasion, a fractured mandible. Jane refers Tiffany to the hospital social worker who, in turn, refers her to the drug and alcohol services; she has attended the D&A clinic only once and continues to abuse alcohol on most days. Eventually, Tiffany gave birth to a seemingly healthy baby. Her partner visited a few hours later and became verbally abusive. Jane became concerned about discharging Tiffany home; in particular, she worried over the well-being of the baby. However, Tiffany insisted that they would be ‘alright’ and discharged herself only a few hoursfollowing delivery.
Case Study 4:
Cindy is a social worker on an adolescent mental health unit. She has been working with a 15 year-old client, Ben, who was admitted as an outpatient following a suicide attempt 3 months ago. On one occasion, Ben tells Cindy that he is involved in a sexual relationship with a 30-year-old man; he explains that he is happy with this arrangement even though he worries that his parents will find out. Cindy continues to see Ben each week but has not mentioned Ben’s situation to other team members; she believes that she will be able to help Ben arrive at a decision, independently, to terminate the relationship. Besides, she finds it rewarding to work with clients like Ben who, she believes, really need her help.
Case Study 5:
Luke is a speech pathologist who specialises in working with patients who have sustained a traumatic brain injury (TBI). He works with a team of healthcare professionals attached to a neurology department of a metropolitan teaching hospital. One of his clients, Tom, suffered a TBI in a motor vehicle accident. He has shown no real progress over the last 9 months; his cognitive function, as well as his speech and language impairments, remain unchanged. Tom’s dysphagia persists such that he continues to need artificial feeding via a PEG tube. Luke believes that weekly treatment visits should stop; he believes that the sessions are exhausting and frustrating for Tom. He also knows that is difficult for his wife to accept Tom’s condition and believes that continuing treatment is deceptive inasmuch as it encourages a ‘false hope’ on her part. The other team members wish to continue treatment even though they agree that Tom is unlikely to improve. While Luke cares about Tom’s well-being, he is also aware that there is a waiting list for his services.
Case Study 6:
Alex, an ‘early career’ epidemiologist, has been employed by the Australian Institute of Health and Welfare (AIHW) to work on a cohortstudy; the project has involved comparing the morbidity rates of the refugee population with the general non-indigenous population. Data was collected from public hospitals and general medical practices where large numbers of refugees attended. The research proposal was approved by the relevant ethics committee in accordance with the NH&MRC guidelines. Towards the completion of the study, it became evident that the use of health services by the refugee population was significantly higher than that of the general population. Moreover, refugees were
significantly more likely to consult health services in relation to mental health conditions, especially post-traumatic stress disorder (PTSD) and psychoses. These findings were discussed on ‘talk back’ radio and other media outlets in ways that alienated and offended refugees; for instance,some commentators were angry that, as taxpayers, they had to pay for medical care of newly-arrived refugees while, at the same time, “our own diggers” were neglected on return from active service. Department heads within the AIHW were considering, in future, to censor research findings they thought likely to undermine social cohesion. However, Alex disagreed; he believes that hiding such evidence is both deceitful and undermining of public health objectives.
Case Study 7:
Ibrahim works in a laboratory on a major cancer research project. The findings of the research are showing great promise; a breakthrough has been reached which will, most likely, produce both reduced mortality rates and improved quality of life for people with prostate cancer. The research project has advanced to the point where trials can commence on human participants. In the course of Ibrahim’s work, however, he discovers that some results have been manipulated. While he hasfull confidence in the effectiveness of the treatment, he suspects that the manipulation has been done in order to ensure that funding continues for the project. Specifically, Ibrahim is aware that the financial and time constraints are placing undue stress on the Principal Researcher to produce positive results. At the same time, he is sure that, with more time, positive results will eventuate anyway.
Case Study 8:
Sam and Natalie, both senior paramedics, attempted to resuscitate a 78 year old man who had suffered a cardiac arrest at home. After 45 minutes, resuscitative efforts were discontinued due to lack of clinical response. Immediately afterwards, a student paramedic, Jim, who had accompanied Sam and Natalie on the call-out, asked if he could re-intubate the patient for practice purposes. Jim argued that, as the
man’s wife would not really understand what he was doing, no-one would be harmed. However, Sam and Natalie thought it inappropriate but were unable to explain to Jim why they objected to his proposal. Jim reluctantly agreed not to re-intubate the man but asked, instead, if he could take a photograph of the deceased man to upload on to his clinical experience portfolio.