Strengths Based Approach: Fiona Case Study
Case Study Part 1 (BACKGROUND STORY FOR REFERENCE)
You are a registered nurse (RN) working in an emergency department (ED) of a rural hospital. You have just come on for the afternoon shift and have taken over care from another RN. The RN gives you a handover on Fiona.Fiona, a 3 year old girl, has presented to the ED with her mother, Susanna. Susanna (22 years old) also has her two other children – David (8 months old) and Jason (4 years old) – in attendance with her. David is currently sleeping in the pram, and Jason is playing with his mother’s phone. Susanna states she walked here with her children. You note that neither Fiona nor Jason are wearing shoes.
Susanna brought Fiona into hospital today because she was worried that a burn on her foot was getting infected. She reports Fiona burnt her foot on the heater at home 3 days ago. Susanna cleaned the wound with tap water, applied some paw-paw ointment, and dressed it with an adhesive bandage. Fiona has been reporting a lot of pain from the initial injury, and this has worsened over the past few days. The skin around the wound became red and inflamed about two days ago, and Fiona woke with a fever this morning.
Susanna reports that she wanted to bring Fiona into hospital earlier today, but she had no-one to care for the other children as her partner is currently in prison and she has no support other than her mother-in-law, who works full time. She decided to come with the children this afternoon anyway as Fiona would not stop crying.
Fiona has been triaged, reviewed by the medical officer (MO) and sent to you for a dressing and commencement of IVABs. The triage nurse took down the original dressing. He reported the dressing was dirty and not-well adhered to the skin. He believes it had not been changed since the original injury, and Susanna confirmed this. Fiona has an IVC in her left cubital fossa. She is visibly distressed and crying, hanging onto her mother tightly. She is to be admitted to the paediatric ward once a bed becomes available, which will hopefully be within the next hour or two. Fiona is currently febrile, tachycardic, tachypoenic and hypertensive – likely due to pain, fear and infection. Nil signs of respiratory distress. BGL is normal. Nil signs of dehydration. Fiona is alert and orientated, but clearly distressed.
You examine Fiona’s wound. It covers the dorsal surface of her right foot. The burn covers an area approximately 6x4cms. The burn is partial thickness – penetrating into the dermis – with signs of blistering. The wound edges are ragged, and surrounding skin is red and hot to touch. A small amount of purulent discharge is leaking from the wound.
You administer pain relief to Fiona and dress the wound. You also give the first dose of IVABs as ordered. Fiona now appears more comfortable, waiting on the bed and cuddled up with her mother. She remains febrile, but all other vital signs are Between the Flags. As you are documenting your care, you realise you should complete the mandatory reporter guide (MRG) to see what your obligations are.Case Study Part 2 (LATEST INFO FOR ANSWER)
It is a few days after the events in Case Study – Part 1. You are now working in the paediatric ward where Fiona is an inpatient. Fiona is improving and will likely be discharged in a day or two. Susanna has been staying overnight while her mother-in-law, Maria, looks after her other children. However, as Maria works during the day, David and Jason are dropped off at the ward early in the morning and stay in the ward with their mother and sister all day.
Susanna approaches you at the nurses’ station. She announces that she is annoyed as she has been contacted by the Department of Communities and Justice (DC&J) and wants to speak to the nurse in charge as “you had no right to report me”. While initially angry, Susanna soon becomes teary and discloses that she is having financial difficulties and doesn’t know how she will cope while her partner, Aaron, is in prison for the next 8 months. She discloses that she is worried that she is pregnant again as her period is late. She is also worried her children will be taken away from her. Aaron identifies as an Indigenous man, and thus his and Susanna’s children do too. Susanna is worried this means her children are more likely to be taken away, as she has heard from Aaron and his family about the Stolen Generation.
Susanna states she has a poor relationship with Maria and that Maria blames Susanna for Aaron being in prison. Maria believes that Susanna’s influence caused Aaron to become involved in drugs, as Susanna is known to use marijuana occasionally. Susanna’s family live in Sydney and are not supportive, as they are very religious and are ashamed that she is an unmarried mother. She does not have friends who live locally – she moved here at the behest of Aaron so he could take up an apprenticeship, but then he started using illicit drugs and now he has been sent to prison. Aaron commenced his sentence just over a fortnight ago.
Susanna does not drive. She left school before completing year 12 as she was pregnant, and she has never worked as Aaron has always supported her. Due to his recent conviction and incarceration, Aaron has lost his apprenticeship and will have no job to come back to after he is released. Susanna lives off fortnightly payments from Centrelink, but as she did not declare she was in a de-facto relationship she was overpaid in the past and so part of her payment is withheld to repay her debt. She struggles to pay rent and buy groceries, and does not know how she will be able to cover the next electricity bill.
Using the case study (part 1 and part 2) on the I2 site,
Discuss how the registered nurse would support the family in the case study using a strength-based approach.
In your discussion, you should identify the key issues and risk factors from the case study, and discuss how these might impact the family.
Then, identify one health promotion activity and one health education topic that will improve the health and wellbeing of this family, and discuss how these will be effectively provided to the family.