SW478 Social Work Practice In Health Care

SW478 Social Work Practice In Health Care

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SW478 Social Work Practice In Health Care

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SW478 Social Work Practice In Health Care

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Course Code: SW478
University: Simmons University

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Country: United States

Question:
Case Study 1-The Wates Family

Todd is now age 28 years. He still lives with his parents due to his brittle health. They family moved to a two-bedroom apartment when Todd turned 13 years old so he could have a bedroom of his own. With treatment, Todd was able to attend school fairly regularly. He struggled with math and science classes, but was able to pass them. He did not receive any tutoring. Todd attended the local community college and earned an Associate Degree in Graphic Design. He is able to work from home and does design work for a web-based company whose headquarters are in Seattle, WA. He also learned to play guitar and played in a band with friends in the community. Todd’s health is deteriorating. His lung capacity is severely diminished. He was diagnosed with hypercarbia and now requires supplemental oxygen. Earlier this year he was hospitalized for an exacerbation of his CF. He was placed in an ICU; during this time, he lost 10 pounds and considerable muscle tone. He was transferred to a skilled nursing facility (SNF) for rehabilitation services, and was there for 2 months. One reason that the stay was prolonged was his parents’ hesitance to have him return home. His parents were fearful they couldn’t provide adequate care for him. Todd had to argue with his parents and the professional members of his healthcare team for weeks to get discharged home. Although Sarah would like the family to live on the Nation’s tribal lands again, the family is experiencing disappointment with the tribe and medical services offered by the tribal community. Todd requires more advanced care, so the family must stay closer to the hospital system. Todd is being considered for lung transplant. He is currently on the donor list, but there is considerable uncertainty whether or not a lung is coming. His ancestry, blood type, and genetics severely complicate the chance of finding a donor match. The team has raised the issue of preparing advanced care directives in the past, but Todd’s mother has always interfered and said the family isn’t ready. Consequently, Todd has deferred to his mother’s wishes and has not discussed any advanced care directives with the team. While Todd was in the SNF, the nursing aides on the night shift reported he often asked what it was like for people when they were dying. It was noted by someone on the team that this was the only time that Todd’s mother was not with him. The night nurse did not have time to speak with Todd, but repeatedly  requested a social work consult. When the social worker would go to see Todd, his mother was always present and she said Todd didn’t want to discuss it. Given recent exacerbations of Todd’s CF, his overall diminishing health, and the limited chance of finding a match for a lung transplant, there is a high likelihood that Todd is nearing the end of his life.
Your tasks:
1. What cultural factors related to end-of-life considerations are associated with Native Americans? How might these be influencing the work with Todd and his family? [Limit your response to 1 – 2 pages]
2. Now that Todd is at home, how would you go about engaging him in a discussion about end-oflife? How would you incorporate the family’s cultural narratives into the work? [NOTE: You should write this section as if you were speaking directly to Todd, or another member of his family.]
3. Which of your own biases, values, and beliefs do you anticipate having difficulty with when speaking to a 28 year old about dying? How will you manage these biases in your work with Todd and his family?
Case 2 – Reginald

Reginald is a 73 year old cisgender male. He identifies as African-American. He is a veteran of the U.S. Army, receiving an Honorable Discharge after 8 years of service. Reginald was a mechanic in the Army. When he returned to the United States, he married and opened an automobile repair garage in Allentown, Pennsylvania with a former Army friend. The two ran the business together for 15 years until his friend died unexpectedly in a house fire. Reginald ran the entire business himself after that, expanding it to three sites and 14 employees. Reginald was a savvy businessman, and a dedicated husband and father. He and his wife, Elizabeth, were married for 40 years. The couple had 3 children – 2 sons and a daughter. His oldest son took over the business. His middle son moved to Charlotte, NC and is working in the banking industry. Reginald’s daughter lives in your local community, which is four hours from Reginald and Elizabeth’s hometown. Elizabeth died of pneumonia at home 3 years ago. Reginald moved to live with his only daughter 3 years ago, following the death of his wife, Elizabeth. The family was concerned about him living alone, although there were no reported deficits in functioning or ability. His daughter has stated, “We didn’t want him living along. He’s always had mom. I felt better having him come here because it wouldn’t be easy to get to him if he needed something. My brother is busy with the garage and could only check on dad a few times a week.” The relocation was a difficult transition for Reginald on many levels. He was dealing with the death of his wife. He moved away from his church, social network, primary care physician, and the home he and his wife had lived in for over 30 years. Reginald had previously made the following statement: Elizabeth was a rose that never wilted. She was such an extraordinary woman. She was a better wife and mother than I was a husband or father. Everyone loved her. The pastors at our church – we had several over the years, mind you – always came to her when they needed a special event planned. Oh, you should have seen the church when she was in charge of decorating for Christmas! It was like an indoor garden! She knew how to get people organized and working. Especially me! Oh, she Although Reginald is eligible for benefits and services through the Veterans Administration (VA), he is distrustful of most government organizations. He has steadfastly refused to apply for VA benefits, and has no plans to utilize the VA’s healthcare services. “The government has never treated us right. Not in the army, and not out of it. I listened to Dr. Martin Luther King, Jr. in 1963, and I made my dream a reality.” Reginald became a patient in your primary care clinic when he moved to the area. He is generally seen for acute issues (e.g., colds, bronchitis, and an infected cut). Reginald has no chronic illness diagnoses. He does not take any medications other than ibuprofen for occasional headaches; he estimates he does this once everyone two or three weeks. He has not been hospitalized in the past 17 years. His daughter made an appointment for Reginald because she has noticed him becoming very forgetful. She reports he has difficulty remembering the days of the week, why he went into a room, and got lost driving to the grocery store (he drives there regularly). She noticed several overdue bill notices in the mail over the past 3 months. Reginald becomes very irritated when his daughter speaks to him about his memory, so she has avoided bringing it up again. “I am hoping your team has better luck convincing him he has memory problems.” Reginald’s daughter, Candice, called the clinic because the night before he was cooking pasta on the stove, forgot about the boiling pot, and set off the smoke alarm because all the water evaporated and the pasta was burning in the dry pot. During the phone call to the office, his daughter stated, “He must be getting Alzheimer’s. I don’t know what I can do for him. I’m afraid he may need a nursing home.” The primary care team conducted a comprehensive geriatric assessment with Reginald. He agreed to the appointment and the assessment after speaking with the physician on the team. You conducted part of the assessment as a member of the team. You found Reginald to be polite and agreeable. However, he presented with low affect and engagement. He was dressed in slacks, a button-down shirt, socks, and sneakers. He was freshly showered and groomed. Reginald and his daughter both report that Reginald does all his own personal care. Reginald’s bloodwork was all within normal parameters. The physical exam revealed a bruise on his left shin. Reginald reported falling down the back steps when going out to garden 3 weeks ago. “Don’t tell my daughter. She already worries and watches me too much!” There were no concerns noted in the physical examination. A Mini Mental Status Exam (MMSE) and Geriatric Depression Scale (GDS) were completed with Reginald as part of the assessment. Copies of both tests, along with some comments made by Reginald during the GDS, are below. Review the attached materials and respond to the following questions:
1. Based upon the information provided, do you believe Reginald is more likely to be experiencing delirium, depression, or dementia? Provide a rationale for your perspective.
2. What are your treatment recommendations for Reginald? [NOTE: Reginald lives in your local community. You may reference local resources as part of your treatment recommendations. 
3. How would you explain your recommendations to Reginald’s daughter, Candice? [NOTE: Your response should be written as if you are speaking directly to Candice.]

Answer:

Case Study #1: The Wates Family:
Cultural factors related to end of life considerations with Native Americans and how it influences Todd and his family:
The cultural perceptions of death vary from culture to culture, each having its unique way to understand death, which are also influenced by their religious beliefs. In the western culture, time and death are considered as linear concepts, which have milestones which are to be passed, as an individual is born, as they live and followed by death, which marks the final milestone (Chapple et al., 2015). However, among several Native American cultures, the perception of time is circular instead of linear. Such a perception implies that time has no specific starting point, and death is only a point on this cycle of birth, life, death and rebirth. Hence death is not considered the absolute end, but instead a passage to the next life or the next world. Even though there exists an incredible diversity among Native American tribes in terms of their beliefs, cultural practices, and lineages, a common perception exists about the time being circular and death being only a point in this infinite journey the soul takes (Irish et al., 2014). Beliefs of reincarnation is also common among several tribes, which considers souls to be eternally present, and only moves from one body to another, after death, and never leaving the world (Griffiths, 2018). Among other tribes, death is considered as the doorway or passage to another world, where the soul moves on and joins the ancestors of the tribe who died before them. Such perspectives lead to death being viewed as a more acceptable concept, compared to the western culture, where death is a source of grief. In Native American cultures, death is not really mourned, but instead celebrated, as the soul of their loved ones becomes free of their earthly bodies, and move on to the next world (Grande, 20915). Todd, who is nearing his end of life, is thinking about death, and how terminal patient death with their own death. His family however did not wish to discuss this matter, showing that they are not fully prepared to give up hope for Todd. This also shows that for Todd’s parents, the importance of Todd’s life is way more important than the safe ‘passage’ of this soul, which is why Todd also refrained from discussing this topic in the presence of his parents. Todd’s mother also prevented the social word consultants to discuss his end of life considerations, stating he didn’t want to discuss about that (Yang, 2018).
Engaging Todd in a discussion about end of life using family’s cultural narratives:
It was evident from Todd’s curiosity that he was actually anxious about what was going to happen when he died, and he needed somebody to talk to regarding his death. It is possible that he avoided the discussion regarding his death in the presence of his family, considering how that though could be hurting them, which is why he chose a moment when his mother was not near to raise such questions. Discussing his family’s cultural narratives, how death is perceived in his culture, and using native storytelling methods to elaborate the native perceptions of death can be a useful strategy to engage Todd in a discussion about his end of life (Bird, 2018; Miller et al., 2018). Storytelling can also be very useful method to bring Todd closer to his cultural roots and heritage. The stories can includes Native American legends about death, such as how death has been portrayed historically in their culture, the origins of those stories, how death and life were considered eternal, stories of afterlife and the passages of soul (Saiyed et al., 2017; Larson, 2017). Such stories can give hope to Todd, giving him something to look forward to, and view death not with grief but with acceptance. Helping Todd to become more acceptable towards his end of life, can  also help to reduce the anxiety towards the uncertainty of the future, and thus any adverse effects such anxiety might be having on his already ailing health (Palacios et al., 2015; Slater et al., 2017). Several authors have suggested that stress and anxiety can have negative impacts on the physical and mental health of people (Liu, 2017; Gerber et al., 2014). It is therefore important that sources of any possible anxiety and stress for Todd be promote addressed and reduced, and help him to be more comfortable as possible to support a peaceful and painless death (Alliance & World Health Organization, 2014; Wiener et al., 2015). It has also been supported that storytelling has very important cultural significance for Native Americans, since they project important ideas, beliefs, and values in a form that is simple, entertaining and engaging. Such methods can be useful to promote wellbeing (both physical and mental) among the Native American Communities, and thus can be used to support Todd’s family as well, to help them accept the eventuality of Todd’s frail health, and discuss Todd’s end of life considerations more openly and freely (Yang, 2018).
Effect of my biases on the discussion and ways to manage those biases:
My cultural beliefs biased my views and perceptions about death quite differently than what is believed by the Native Americans. I believed that death is the end of the existence of a person, and after death the soul either goes to heaven or hell, or leaves this plane of existence. In essence the person who dies is forever gone, and thus is a source of grief, morning and unhappiness (Shiraev & Levy, 2016). This also led to me feeling sad for Todd, since he was a young person, nearing his end of life due to his frail health and the faint chance of him ever getting the right donor for lung transplantation. Such bias have also led to me trying not to have the discussion about death with Todd or his family, and thus when Todd wanted to discuss about the subject, I did not know how to respond, as I did not want my perceptions about death to make Todd more anxious and afraid than he already was (Norenzayan et al,, 2016). I also was unable to console Todd or his family effectively, since I believed in the eventuality of Todd’s condition, and due to my perception of death as the final outcome. I also did not believe in re incarnation, and that the souls take up another body and stays in this world, which was a common belief among the Native American Tribes. All such perceptions prevented me from having an effective discussion about end of life with either Todd or his family. However, such biases can be overcome through storytelling that included Native American legends, folklores and philophies about life and death, telling stories about passages of souls and eternal existence of life. Involving these storytelling sessions can also increase the cultural competencies of the end of life care, and help to engage both Todd and his family in the discussion apart from helping to overcome my own bias and how it affected the discussion (Tan, 2016). I could also reduce the bias by learning more about Native American cultures and views about life, death and reincarnations, comparing it to my own beliefs and appreciating the diversities in how death is perceived in different culture, thereby helping to understand how differently we think about death (Slater et al., 2017).
Case study 2: Reginald:
Whether Reginald is experiencing delirium, depression or dementia:
Reginald is 74 years old male, an army veteran who was honorably discharged and had his own business in automobile repairing, which was later handled by his son. He suffered bereavement of his wife, with whom he was happily wed for 40 years, and they both were very close to each other, and very active in the community. After his wife’s death, his daughter, Candice did not want him to stay alone, and Reginald moved in to life with Candice and her family. Due to this, Reginald had to give up his social interactions, as he relocated to a new place, leaving the place where he stayed for 30 years. Reginald have shown signs of memory issues, as he stopped remembering the days of the week, entering the room and forgetting why he entered there, getting lost while driving to the grocery store and forgetting to put water into the pot while cooking pasta. These are significant symptoms of dementia and memory problems. However, the Mini Metal State Examination (MMSE) showed a score of 23/30, which showed that Reginald has mild to no cognitive impairment or construction problems and thus suggests that Reginald does not have dementia (Creavin et al., 2016). It should however be noted that the signs of memory problems should not be taken lightly, as it clearly indicates the early warning signs of dementia.
The Geriatric Depression Scale on the other hand showed a value of 8, which shows that Reginald might be significantly depressed. Interview with Reginald also suggested that he might be depressed, since he mentioned that he feels sad as he is not longer able to talk to his wife anymore and did not get enough time with his children either. Moreover, moving to a different city, he had to five up his social circle and friends, and spends most of time alone, not doing anything. He felt that he was wasting his time by being idle all the day, which might be adding to his depression. This can be supported by the views of several authors who suggested that lack of physical activities, isolation from social circles or social life , being alone, and episodes of bereavement can significantly increase the risks of depression, as well as dementia at an old age (DiNapoli & Scogin, 2017; Pocklington et al., 2016).
Recommendations for treatment: (including local resources that can be used):
Considering that Reginald is showing the signs of depression as well as the early warning signs of dementia, it is vital that both the conditions are addressed in his treatment plan. It is important that Reginald be helped to cope up with the bereavement of his wife, helping him to accept and move on with such an adverse life experience (She & Prigerson, 2018). He can also be supported to build his social circle, and be involved more in social interactions and with the community, the way he used to be engaged in his previous community. He can be recommended to increase his physical activities such as walking, gardening, playing board games or visiting relatives, and avoid sitting at home idle (Morris & Blocks, 2015).
Strategies to reduce depressive symptoms can include the involving of daily exercise routines (such as walking, or gardening or oriental techniques such as yoga, tai chi or qi gong), ensuring healthy diet and dishes that Reginald likes to eat, ensuring that Reginald gets sufficient amounts of sleep, picking up new hobbies or activities or engagements and getting out of the house more often (Karlsson et al., 2016). Also, Reginald can be assisted to deal with the negative emotions and his sadness caused by his wife’s death, helping him to deal with it in a better manner. This suggestion is mainly supported by Reginald’s avoidance to engage in this topic with anyone. If the depression is significantly affecting Reginald’s life and mental well being, consultation with a psychologist is also recommended as well as a pharmacologic intervention, which can help to alleviate any clinical signs of depression (Davenhill, 2018).
Many of the strategies to reduce depression can also be useful to prevent the onset of dementia and reduce the early warning signs. Researchers have shown that social interactions, games, physical activities and healthy diet can be useful to treat the symptoms of dementia and alleviate the effects. It is also important that hazards of falling be assessed in Reginald’s home, considering that he already experienced a fall and the nature of attire he wears at home, which can increase fall risks. Physical activities and exercise can also help to increase his sense of balance and reduce fall risks, while engaging in social interactions and playing board games with friends and community members can help in the better retention of memories, which has been supported by many studies (Jahn et al., 2015; Groot et al., 2016).
Explaining the recommendations to Reginald’s daughter, Candice:
Considering how Reginald mental health might be getting affected since moving away from his home, to relocate to a different state, it is important that he either finds a way to renew or re develop his social ties in the new community, or moves back to his old home, where he was social active, and can revert back to old lifestyle. Reginald also might need community assistance, which can help him and support his engagement in the community, assist him to increase his physical; activities such as going for a walk, visiting friends or playing board games with them. Through community services, trainers can be appointed who can provide classes on yoga, tai chi or qu gong, all of which can help to improve balance, cardiovascular functions and also improve the mental well being (Bunn et al., 2016). Healthy diet recommendations can also be used to help Reginald select healthier diet options and avoid unhealthy ones. It is also important to highlight the fact that moving away from his community and not being able to socialize with his friends have also affected Reginald’s depression, as he feels that he is wasting his time away, and feeling miserable about it. Reginald understands though that his daughter is worried about him, and for good reasons, but being at the position where he is not really helping Reginald’s health, and might be even adversely affecting him. Relocating back might therefore be the best option for him, and f such is not possible or feasible, the nest best thing would be to help Reginald to build his social ties anew, and also helping him to engage his time in a more meaningful manner, that would keep him mentally and physically engaged (Kilmova & Kuca, 2018). Also, environmental hazards of falling at home should be assessed and minimized, and necessary modifications be made to his home, to reduce the risks of falling and thus prevent any avoidable injuries (Booth et al., 2015).
References:
Alliance, W. P. C., & World Health Organization. (2014). Global atlas of palliative care at the end of life. London: Worldwide Palliative Care Alliance.
Bird, S. E. (2018). Dressing in feathers: The construction of the Indian in American popular culture. Routledge.
Booth, V., Logan, P., Harwood, R., & Hood, V. (2015). Falls prevention interventions in older adults with cognitive impairment: a systematic review of reviews. International Journal of Therapy and Rehabilitation, 22(6), 289-296.
Bunn, F., Goodman, C., Pinkney, E., & Drennan, V. M. (2016). Specialist nursing and community support for the carers of people with dementia
Chapple, A., Ziebland, S., & Hawton, K. (2015). Taboo and the different death? Perceptions of those bereaved by suicide or other traumatic death. Sociology of health & illness, 37(4), 610-625.
Creavin, S. T., Wisniewski, S., Noel-Storr, A. H., Trevelyan, C. M., Hampton, T., Rayment, D., … & Patel, A. S. (2016). Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev, 1.
Davenhill, R. (2018). Looking into later life: A psychoanalytic approach to depression and dementia in old age. Routledge.
DiNapoli, E. A., & Scogin, F. (2017). Geriatric Depression Scale. Handbook of Psychological Assessment in Primary Care Settings, 277.
Gerber, M., Jonsdottir, I. H., Lindwall, M., & Ahlborg Jr, G. (2014). Physical activity in employees with differing occupational stress and mental health profiles: A latent profile analysis. Psychology of Sport and Exercise, 15(6), 649-658.
Grande, S. (2015). Red pedagogy: Native American social and political thought. Rowman & Littlefield.
Griffiths, A. (2018). Science and spectacle: Native American representation in early cinema. In Dressing in Feathers (pp. 79-95). Routledge.
Groot, C., Hooghiemstra, A. M., Raijmakers, P. G. H. M., Van Berckel, B. N. M., Scheltens, P., Scherder, E. J. A., … & Ossenkoppele, R. (2016). The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Ageing research reviews, 25, 13-23.
Irish, D. P., Lundquist, K. F., & Nelsen, V. J. (2014). Ethnic variations in dying, death and grief: Diversity in universality. Taylor & Francis.
Jahn, K., Kressig, R. W., Bridenbaugh, S. A., Brandt, T., & Schniepp, R. (2015). Dizziness and unstable gait in old age: Etiology, diagnosis and treatment. Deutsches Ärzteblatt International, 112(23), 387.
Karlsson, B., Johnell, K., Sigström, R., Sjöberg, L., & Fratiglioni, L. (2016). Depression and depression treatment in a population-based study of individuals over 60 years old without dementia. The American Journal of Geriatric Psychiatry, 24(8), 615-623.
Klimova, B., & Kuca, K. (2018). Multinutrient Intervention in the Prevention and Treatment of Dementia. In Role of the Mediterranean Diet in the Brain and Neurodegenerative Diseases (pp. 341-351).
Larson, S. (2017). Native American aesthetics: An attitude of relationship. In Contemporary American Women Writers (pp. 99-113). Routledge.
Liu, R. T. (2017). The microbiome as a novel paradigm in studying stress and mental health. American Psychologist, 72(7), 655.
Miller, A. L., Berlo, J. C., Wolf, B. J., & Roberts, J. L. (2018). American Encounters: Art, History, and Cultural Identity.
Morris, S. E., & Block, S. D. (2015). Adding value to palliative care services: the development of an institutional bereavement program. Journal of palliative medicine, 18(11), 915-922.
Norenzayan, A., Shariff, A. F., Gervais, W. M., Willard, A. K., McNamara, R. A., Slingerland, E., & Henrich, J. (2016). The cultural evolution of prosocial religions. Behavioral and brain sciences, 39.
Palacios, J. F., Salem, B., Hodge, F. S., Albarrán, C. R., Anaebere, A., & Hayes-Bautista, T. M. (2015). Storytelling: A qualitative tool to promote health among vulnerable populations. Journal of Transcultural Nursing, 26(4), 346-353.
Pocklington, C., Gilbody, S., Manea, L., & McMillan, D. (2016). The diagnostic accuracy of brief versions of the Geriatric Depression Scale: a systematic review and meta?analysis. International journal of geriatric psychiatry, 31(8), 837-857.
Saiyed, Z., & Irwin, P. D. (2017). Native American storytelling toward symbiosis and sustainable design. Energy Research & Social Science, 31, 249-252.
She, W. J., & Prigerson, H. G. (2018). ” Caregrieving” in palliative care: Opportunities to improve bereavement services. Palliative medicine, 269216318780587.
Shiraev, E. B., & Levy, D. A. (2016). Cross-cultural psychology: Critical thinking and contemporary applications. Routledge.
Slater, M. D., Oliver, M. B., Appel, M., Tchernev, J. M., & Silver, N. A. (2017). Mediated Wisdom of Experience Revisited: Delay Discounting, Acceptance of Death, and Closeness to Future Self. Human Communication Research, 44(1), 80-101.
Tan, C. H. P. (2016). Investigator bias and theory-ladenness in cross-cultural research: Insights from Wittgenstein.
Wiener, L., Weaver, M. S., Bell, C. J., & Sansom-Daly, U. M. (2015). Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer. Clinical oncology in adolescents and young adults, 5, 1.
Yang, J. (2018). Storytelling and Cross-Cultural Communication

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Course Code: MN506
University: Melbourne Institute Of Technology

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Country: Australia

Answer:
Introduction
An operating system (OS) is defined as a system software that is installed in the systems for the management of the hardware along with the other software resources. Every computer system and mobile device requires an operating system for functioning and execution of operations. There is a great use of mobile devices such as tablets and Smartphones that has increased. One of the widely used and implemented operating syste…
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Australia Cheltenham Computer Science Litigation and Dispute Management University of New South Wales Information Technology 

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