Task
Jenny’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 Jenny’s health?
2. Discuss the models of teamwork demonstrated in this scenario, evaluating these for effectiveness.
3. Describe and consider how the clinical reasoning process was implemented in this case and how it could have been improved.
4. Evaluate how the communication processes and methods used between health professionals and institutions affected Jenny’s experience and outcomes.
5. Identify and describe community supports and health and human services professionals that could assist Jenny on discharge
The Scenario – Jenny’s story
Jenny is a nineteen year old aboriginal female who has had Type I Diabetes Mellitus since she was 13. Jenny was born in a small town in a remote area of Western Australia. Despite not completing
Year 8, she decided to move away from her family to the city. She has not been able to get a job, and has very little income. She misses her family, but does not want them to know that she is
unhappy. Jenny has a history of homelessness, but has been living for the past 2 weeks in a Boarding House which is run down and dirty. Jenny does not see the same doctor for her diabetes, she
visits many different clinics, depending on where she is living at the time.
One day, while Jenny was walking to the shops, she felt lightheaded and then lost consciousness and fell to the ground. She was brought to the Emergency Department of a major hospital by ambulance
for assessment and investigation.
As a consequence of the fall, she sustained a head injury which resulted in severe and persistent headaches, loss of coordination and difficulty with walking. It was identified in the Emergency
department that prior to the fall she had experienced an episode of ‘insulin shock’.
Following an 8 hour stay in the Emergency department, Jenny was transferred to the Neurology ward for assessment and monitoring. It was when she was on this ward that the nursing staff identified
that Jenny has limited knowledge of her diabetes including where to access support and advice, and how to monitor her glucose levels and adjust her insulin dose properly. A team consisting of
Nurses, the ward Physiotherapist, a Social Worker, a Neurologist and a diabetes educator met on three occasions to discuss Jenny’s case. After a 4 day stay in the Neurology ward, the healthcare
team decided that Jenny would benefit from being transferred to a rehabilitation centre.
Jenny was taken by Patient Transport to a Rehabilitation Centre 20 kms from the hospital and 30 kms from the Boarding house which she had been staying in. A brief discharge summary was sent with
Jenny (see attached), describing the initial head injury and noting the need for ongoing therapy to assist her co-ordination and walking. While in the rehabilitation centre, Jenny was assessed by
the physiotherapist, occupational therapist, rehabilitation medical consultant, and of course the nursing staff who monitored Jenny daily. Although they did not formally meet, they each wrote
notes in Jenny’s medical record.
On day six of her admission to the rehab centre, the Nurse Unit Manager observed Jenny confidently walking in the ward corridor by herself. She rang the Rehab Consultant, who agreed that Jenny
could be discharged home given her ability to independently toilet and ambulate. When the physiotherapist was on the ward, she read Jenny’s medical file and noted the entry by the Nurse Unit
manager that Jenny was able to walk without support. Without consulting the other staff, the Nurse Unit Manager informed Jenny that she was to be discharged the following day as she now appeared
fine and had no consequences from her “little bump on the head.”
Jenny was discharged home to the boarding house after a seven day admission in the rehab centre.
Five days following her discharge home, Jenny 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 her bedroom is
located. She fractured her left tibia as a result of the fall. Jenny informed treating staff that she had injected insulin moments prior to her fall.