CMCT01_Case_Studies 2015

CASE STUDY 20 – KATRINA

Katrina is a 49 year old Registered Nurse who injured her back 4 weeks ago whilst trying to assist a patient who fell in the shower on the medical ward of her workplace (public hospital). She has previously suffered from back problems but had not disclosed this information to her employer upon her appointment 6 years ago. The injury she incurred resulted in Katrina’s admission to the local private hospital where she was diagnosed with multiple herniated discs and associated nerve root compression. Katrina admitted to her General Practitioner that the patient was morbidly obese and that she had not sought assistance from her colleagues as the ward was short staffed and she did not want to create any further work to her already overworked and stressed peers. Katrina’s General Practitioner issued her with a medical certificate for 8 weeks leave and instructed Katrina to limit any lifting to no more than 5 kg and abstain from any activities that required any repetitive bending, twisting or raising of her arms above shoulder height. She was told to call the medical centre and book a follow up appointment to see him in 5 days time and was provided with a written referral to a Occupational Physician. Contrary to her General Practitioners instructions Katrina, as the sole provider for 3 children, returned to the workplace having only taken 3 days leave. With her symptoms worsening and fearful of her medical condition being disclosed to her employer and/or a referral to WorkCover Katrina has not booked any follow up appointments with her General Practitioner nor the Occupational Physician. Katrina is exceeding her prescribed dosage of Oxycontin and combining it with alcohol in an endeavour to mask the constant pain. Consequently her motor skills are compromised, her mood is labile, she is emotional stunted and her cognition is compromised. Katrina suffers from a pre-existing condition of sleep apnoea (untreated) which is exacerbated by her present issues. She has a suppressed appetite and is not eating resulting in a weight loss of over 12 kilos since the injury. Today Katrina administered the incorrect dosage of Morphine to an elderly frail patient in palliation resulting in a cardiac arrest and their immediate transfer to the Intensive Care Unit. You have been urgently summoned to the ward by the Nurse Unit Manager following an emotional disclosure by Katrina, during a disciplinary investigation meeting, that she has recently injured herself at work and has not been coping. ►► Katrina has mounting financial stressors as her husband of 20 years committed suicide 3 months ago leaving her with debts of over $250,000. ►► Katrina has become reclusive and isolative consequent upon increasing feelings of guilt in relation to her husband’s suicide. ►► Katrina is estranged from her family and friends. ►► Katrina lives on an isolated rural property and commutes to and from work via public transport (40 minutes one way). ►► Katrina’s phone and internet have been disconnected following arrears in payment. Questions: 1. What guidelines from each of the CMSA National Standards of Practice for Case Management would you utilise in this case? 2. How does your proposed case management provide evidence of: A. Facilitating the personal development of Katrina? (i.e. her individual, diverse and special needs, including her aspirations, choices, expectations, motivations, preferences and values) B. Advocating for Katrina’s rights? (including developing Katrina’s strengths to advocate for herself) C. Addressing Katrina’s needs? (i.e. purposeful case management) D. Promoting sustainable solutions for Katrina? (i.e. balances Katrina’s needs with the available resources and any of your possible limitations as a case manager) E. Effective communication? (i.e. with Katrina and all other Key Stakeholders Additional information Instructions: 1. Please answer each of the questions below. 2. Please complete this activity with reference to the resource materials provided. 3. Please document and report your findings back to the group.

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