Essay On Case Study Nicholas

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Case Study Nicholas

Nicholas, is a 74 year old man who lives in his own home in Enoggera as an immigrant from Greece, and worked as a semi-skilled worker all his life. However, he misses his wife Maria, who died of cancer 15 years ago after a very long and difficult struggle. He had three children with his wife; two daughters and a son. Katherine is the eldest daughter, she is married and lives with her husband around the corner from Nicholas. She is currently making an effort to visit his father on a daily basis. His younger daughter, Anna, and his youngest son both live interstate. Of this two, it’s only Anna that he has visited and has contact through phone calls. His two older brothers live in Sunnybank and Cleveland respectively. Occasionally, he takes a taxi to visit his brother who lives in Sunnybank.

Two years ago, Nicholas had a car accident and broke his sternum. Of late, Nicholas has lost stability and aids his movements using a walking stick. For this reason, her daughters have organized for in-home security service as a precaution. He has also become slightly incontinent, and also, lately losing his directions and getting lost. Anna observes that at times, his father becomes quite aggressive and she has no clue of what to do. Katherine takes him for a full medical check-up, and it is found out that he has a heart abnormality due to a blockage. He is urgently admitted for a heart surgery, and returns to his home after a slow recovery. At home, he is attended to and supported by Katherine, the visiting nurse and a home visitor. When he recovers from the surgery, getting lost on his way to church or the shops becomes more often, forcing Katherine to organize for an ID bracelet and an alarm for his frequently getting lost father.

For the last few years, Nicholas has been suffering from depression. He has become quite volatile, very forgetful, and at times, getting very angry. Sometimes, he becomes a normal, kind and an intelligent person. His personal hygiene and general house cleanliness has deteriorated. Katherine, with her sister Anna asks for a reassessment from Aged Care Assistance Team (ACAT), Department of Health. An occupational therapy and a social worker comes to visit Nicholas, and a decision is made to refer him and the family to a community based organisation (CBO) on the north side. The CBO provides services and activities to families and individuals who experience social isolation, emotional crises and economic hardships. The organization also seeks to build community capacity, building and supporting relationships between the local people and local agencies, and developing new and innovative responses to address local people’s needs and issues. As a case manager worker in the lead organization, I have been appointed by the administration to work with Nicolas and the family and respond to various issues in this particular case. I will be responsible, on behalf of the organization, to ensure that Nicholas is linked to agencies that best meet his needs through case management practices.

Community services that seek to help individuals and families are the main activities that define our organization. Case management is a collaborative process that involves identifying vulnerable situations, assessment of needs, planning, facilitating for referral options and services or implementation, and follow-up to meet the holistic needs of an individual as well as promoting quality and cost-effective outcomes through communication and use of the available resources [1]. Working out Nicholas’ case require a combination of the two practices for a more effective and efficient client need satisfaction.

1.2 Intervention Plan

Intervention strategies have been developed with the help of the family to provide a road map for achieving safety, stability, strengths and well-being of Nicholas and the family. Engagement, safety, stability, strengths and well-being are the key focus areas that drove the development of these strategies. The strategies are matched with the interventions needed for change by addressing the issues raised, and have been carefully selected with a high likelihood of success on implementation. The underpinning principles that guide this intervention strategies include:

i.Proactive approach: Whenever possible, actions will be taken to ensure that Nicholas’ needs are prioritized in advance. Prevention of risks and potential barriers have to be worked out first. The most important priority is medical attention to reinstate Nicholas’ state of health back to normal, particularly his periodic incontinence.

ii.Good rapport: Building a good relationship with Nicholas will offer a good environment for me to discover his needs, and for him to be able to trust me and be talk about his life free of fear.
iii.Client strength and centeredness: Nicholas has his own strengths; he can work and provide for himself without depending on his children only that of late he has been sick and not able to work anymore. He still feels that he can still do most of the daily tasks without help. By building on his capacity, this case management process is dedicated on restoring his strengths. His active involvement in case planning was to ensure that all his medical, social, economic and other personal needs are met.

iv.Inclusion and active involvement of the client and the family: Nicholas and his children Katherine and Anna were involved in the development of his case plan and signed as the agreed plan.
v.Partnerships with various agencies: For a sensitive approach and clarity of purpose, a partnership with Nicholas, his family and agencies such as First Choice Care and Lincs Healthcare were reached upon.

vi.Holistic approach: All psychological, social, physical and cultural considerations were taken into account when dealing with Nicholas. This ensured that all his needs are covered and taken care of.
vii.Dynamic and logical approach: Throughout the process of managing Nicholas’ case, a constant review of goals and outcomes is very necessary after every step. For example, in treating his periodic incontinence, I will be checking for his progress and if the problem is controlled or not.

2.0 Initial Contact and access to the service

The client was referred to our community based organization by the Aged Care Assistance Team (ACAT), Department of Health, after they visited the client in his home to reassess him. Normally, a person with special social needs has to be assisted by their family members to access help from our community organization in case we are not able to reach them. Therefore, a part from this referral mode of access, there is the outreach access mode where the organization extends into the community to search for inaccessible clients and encourage them to join our service system. Engagement with the client and the family on matters of mutual concern is an ongoing process, beginning from the life of the case to the follow-up and closure [12].

3.0 Intake, Assessment and Setting Goals

Intake

The services offered by our organization attends the motel to meet the client and his family to provide the intake, with a focus on authentic engagement with the family. After the access function, the organization administration established that Nicholas needed help out of his problem and situation. There was also a strong match between our organization services and the client needs. As a person handling the case, I had to provide the client and the family with an understanding of what services our organization can offer so that together, we can assess their needs and safety issues. After a mutual understanding and gathering of the required information, and filling out some administration forms as a normal routine, Nicholas was approved and formally admitted.

Assessment

The assessment process involved holding further discussions with Nicholas and his family, and making observations, to further examine the situation and understand causes and dynamics of the problem. The assessment approach was built on various principles of practice, such as client centeredness, openness, mutual respect, trust, cooperation, client strengths, confidentiality, partnership and cultural responsiveness [6]. Psychological, social and medical assessments were carried out.

During the discussions, I was in a position to acknowledge my client’s strengths, including his willingness to do things for himself and sort out his own issues, and also help him to identify his objectives around his needs. It provided an opportunity to talk to any other service that the client has accessed previously as involvement in trying to help him. This made my assessment more informed. Nicholas has presented his views, as well as Katherine. As an intelligent and articulated man, Nicholas had clear views of what he wanted, and recognized his priority needs. The major issue of concern was his periodic incontinence that had kept him indoors most of the time. After a car accident, he can’t do much of the home duties and needs some assistance with personal care, cooking etc. As a result of the accident, he is now suffering from vascular dementia.

After the car accident, Nicholas developed vascular dementia, a condition that requires a proper medical attention. The disease is caused by reduced blood flow in the brain vessels, usually one a person suffers from a stroke [14]. It leads to loss of memory, slow thinking, difficulty in following a series of steps e.g. cooking etc. Such behavioral and physical symptoms were observed from the client. Nicholas had initially developed some erratic thoughts, like the assumption that everyone hates him because of his poor hygiene or because he is mad. That is why he is even accusing Katherine of wanting to poison his meals. However, his biggest concerns is periodic incontinence, a condition in which one cannot hold back their urine until they reach a bathroom due to involuntary contraction of bladder muscles. After assessing this health needs, it was important to seek the services of a professional medical practitioner to assess what treatments Nicholas would require.

A further assessment on his social needs found out that since the client left working, he had been so dependent on his daughter Katherine, a situation he is not happy about at all. He wants to stay financially independent. Living all alone in his home makes him lonely and needs someone to reconnect with, especially his other children and members of his extended family. He is not yet over the loss of his wife, Maria and gets upset at times. He has no friend that he can trust and converse with, a situation that makes him crave for companionship from his people in his home country, with whom he can reminisce and speak his native language. The result of all these social life is depression, an illness that impacts the brain [10]. Some of the symptoms associated with depression, such as irritability, agitation, sadness and helplessness were observed from the client. This approach of assessment was found to be relevant to Nicholas’ situation as it incorporated all his needs, making it easier to address them at implementation stage.

Setting the Goals

The setting of service goals was based on the client’s views and perceptions, and agency resources and capability.
Immediate goals
i.The case manager will advocate and coordinate service delivery for the client within systems. Nicholas and his family agreed to provide all the cooperation that will be required. I will introduce Nicholas on the first meeting, and accompany him during service delivery as will be scheduled by the agencies.
ii.By navigating within available care channels, the case manager will restore client health, function and psychosocial outcomes. Nicholas and his family agreed that the client will be linked to the available treatment options for his medical check-up and treatment. Initially, I will introduce Nicholas to various agencies and with the company of Katherine and Anna.

Short-term goals

i.Reducing hospital recidivism for Nicholas. The client agreed to attend all treatments services as will be directed by the medical experts in time.
ii.The community organization will put a maintenance program in place that will enable Nicholas to function in the community. Nicholas agreed to keep the home assistant and home security, but insisted that he will be able to do most of the duties on his own when he gets well, therefore, he will not need a home assistant. We came to an agreement that the home assistant and security will be maintained until we evaluate that he is fit on his own.

Long term goals

i.The community organization will ensure long-term management of functional, medical and social problems for Nicholas. Nicholas wants to stay in his home and be independent by working for himself as he used to. The organization will assist him in finding a semi-skilled job in Enoggera.
ii.The client should achieve optimal functional, medical and social outcomes. This is the long term goal for this case management which require a pull of all available resources.

4.0 Intervention Planning and Resource Identification

Intervention Planning

An intervention plan was put together within a clear timeframe based on a balance of my assessed priorities, the client’s views and the goals of the intervention. Discussing with Nicholas about his priorities and the importance of connecting him to other support services that will help achieve the intervention goals was very important. Initially, he seemed reluctant to engage with me, but I assured him that we will attend the initial meetings together with him to assist him in connecting with other required supports. The entire process was based on principles of cooperation and mutual respect [13]. From here, we drew a time frame and at some point Nicholas felt that it was too distant to him, but I assured him that we shall be reviewing the progress regularly to ensure that we can work towards his success. The following is the case management action plan that we agreed upon with Nicholas and his family

Case Management Action Plan

Issue and GoalsPlan/strategy Responsible Person/ Agency Time Frame

1. Periodic incontinence, vascular dementia and depression.
Goal: Meet client health needs.
-Referral to Elder Care Clinician for further medical assessment and treatment. First Choice Care 2 weeks
2. Nicholas requires assistance with laundry, bathing, housework and personal care.
-Maintaining a home assistant to help the client in cleaning, cooking chores, going to church etc.Lincs Healthcare/House assistant 1 week
3. He has no people to socialize with at home
-Finding his children who live interstate, including the youngest boy and bring the family together.Katherine/ Anna/ Youngest son 2 weeks

4. Nicholas wants to stay at his own home
-Maintaining his home security Lincs Healthcare 1 week

5. He wants to be independent of Katherine
Help him to find a semi- skilled employment after full recoveryNicholas 3 weeks
6. Katherine is afraid that his father may fall off and be hurt, or may get lost.Maintain the home assistant and home security.Home security 1 week
7. Katherine is concerned that tending for her father, beside her daughter and a part-time job has stressed her significantly.Facilitate for a psychologist, social worker or a mental health doctor to assist Katherine in stress management. Healthcall Nursing Agency/ Katherine3 weeks
8. She is also feels some resentment that she is the only one to deal with her father, with her siblings living interstate.
Contact her siblings who live interstate and inform them of what is going on.Katherine/ Anna/ Youngest son 2 weeks

9. Katherine does not want her father to be admitted under a residential care Provide a home-based care program with nutritious meals. Lincs Healthcare 1 week

Resource Identification

The resources that will be used in obtaining and organizing all the required information include office resource files and directory to find contacts for the agencies that we have identified to work with. Information will also be gathered regarding other service providers, their level and purpose to find if they can offer better services.
Every individual have their own cultural and religious beliefs, values and preferences. An Individual is likely to more open to a person they share the same beliefs, values and preferences [5]. Since Nicholas is a migrant from Greece, there is need to access a good interpreter to ensure that he feels comfortable, and that the entire engagement process takes place in a safe and comfortable

5.0 Linking the client to formal and informal supports

The linking process will involve clarification of service need and careful matching of the client to the service providers [9]. As a case manager, I will make the initial telephone contacts to the agencies, prepare the required papers and visit the agencies before orienting the client and his family. Where travelling is required, our organization will facilitate for this as provided in its policies, and as a person in charge of Nicholas’ case, I will be his travelling companion in the first visits and also follow up on any actions decided upon. This process will provide a solid and emotional support to the client that will in turn facilitate a more productive connection [4]. Connecting to new developing services that are in existence and the legislative policies applicable to these services may be a potential challenge for this process. However, through organizational and community oriented skills, this challenge can be addressed in order to optimize connection to services. The client will also be connected to his children who live interstate and extended family through telephone contacts and visits, and if possible, bring his younger son to his home in Enoggera. As the person in charge of Nicholas’ case, I will be responsible for the follow up on any actions decided upon.

6.0 Monitoring and reassessment

A collective input from all the stakeholders, including the organization responsible for this case management that I am responsible on its behalf, will monitor the progress and respond to any changes. My responsibility will be to hold regular meetings with the client, his family and the agencies responsible to discuss the progress and review of the intervention plan to find out if there is need for critical changes. This will require a high level of communication, especially with the client and the family [3]. As a case manager linking the client and service providers, I will play a central role of communication and monitoring of service delivery. As engagement continues the client should maintain his real situation and be encouraged to focus on his strengths. Nicholas need to manage his personal hygiene, community function and cooking etc. and be praised for his efforts. Through these, I will be able to know if the intervention plan has been helpful for the client.

7.0 Outcomes

On implementation of this strategies as specified in the case management plan, it is expected that the client will achieve optimal medical, functional and social outcomes [2]. Nicholas’ state of health should be back to normal after treatment of periodic incontinence, vascular dementia, depression and any other illnesses as may be found by a medical practitioner. He should be able to function well in the community, and be able to perform his semi-skilled work that will see him sustain himself financially without necessarily depending on his children. Having a home assistant will ensure that he has someone to talk to and keep him company. I am also hopeful that Nicholas will be drawn closer to his children and relatives who live interstate, and they should be having regular contacts and visits. Achieving this will be in line with the organization’s most important objectives which are to develop their client and giving them resources to grow, inspire, motivate and empower them to realize their full potential through a self-driven change process. A case management in the context of our organization should be a means through which a client’s health, wellness and autonomy are promoted through advocacy, education, communication, identification and facilitation of service delivery, guided by the principles of non-maleficence, autonomy, beneficence and justice. The clients deserve a first duty – a good coordination of care delivery that is safe, timely, equitable, effective, efficient and client-centered [8].

8.0 Evaluation and Critique

An evaluation process will be done with a collaborative approach, i.e. involvement of all the organizations providing support services to the client and his family. It will be a measure of the results achieved after implementing the case management intervention plan discussed in section 4 of this report. These include the effect of goals, objectives, treatment and interventions on the client’s condition. The main focus of the evaluation process will be on the types of care outcomes, specifically clinical, physical functioning, emotional, psychological, self-care management ability, quality of life, knowledge of his health condition, plan of care, financial, and service experience and satisfaction. Outcome reports will be generated based on these measurements and send to key stakeholders, including the client. Inter-agency collaboration improves service coordination [7]. However, an issue that has been identified that may be a barrier to collaborative service delivery is the fear of loss of organization’s identity. This issue will be resolved by informing all the organizations involved that they have specific roles to play, and act at equal level.

The intervention plan drawn is client centered and sets the scene for activities to be undertaken between the client, the case manager and the support service providers. It is a reflection of the client’s situation, needs and goals [15]. Nicholas is suffering from periodic incontinence, vascular dementia and depression. All these medical needs have been well addressed in the intervention plan. He is also lonely and cannot sustain himself financially, a situation that makes him socially and economically unstable. Strategies have been drawn in the intervention plan that can help in solving all this issues.

References

[1] Arthur J. Frankel, S. G. (2012). Case Management: An Introduction to Concepts and Skills. London: Lyceum Books.
[2] Di Gursansky;Judy Harvey;Rosemary Kennedy (2003). Case Management: Policy, Practice and Professional Business. New York: Columbia University Press.
[3] Cohen, E. L. (1996). Nurse Case Management in the 21st Century. Missouri: Mosby.
[4] Cohen, E. L., & Cesta, T. G. (2005). Nursing Case Management: From Essentials to Advanced Practice Applications. U.K: Elsevier Health Sciences.
[5] Cox, C. (2010). A Guide for Nurse Case Managers. Bloomington: iUniverse.
[6] Department for Communities and Social Inclusion . (2013). Case Management Framework:Specialist Homelessness and Domestic and Aboriginal Family Violence Services (SHS). Australia: Government of South Australia, Department of communities and Social Inclusion.
[7] Guzys, D., & Petrie, E. (2013). An Introduction to Community and Primary Health Care in Australia. United Kingdom: Cambridge University Press.
[8] Laird, E., & Holcomb, P. (2011). Effective Case Management: Key Elements and Practices from the field. United States.
[9] Martin, D. E. (2007). Principles and Practices of Case Management in Rehabilitation Counseling. Springfield: Charles C Thomas Publisher.
[10] Powell, S. K. (2000). Advanced Case Management: Outcomes and Beyond. New York: Lippincott Williams & Wilkins.
[11] Powell, S. K. (2000). Case Management: A Practical Guide to Success in Managed Care. New York: Lippincott Williams & Wilkins.
[12] Roberts, A. R., & Watkins, J. M. (2009). Social Workers' Desk Reference. United Kingdom: Oxford University Press.
[13] Rothman, J., & Sager, J. S. (1998). Case Management: Integrating Individual and Community Practice. Boston: Allyn and Bacon.
[14] Turner, F. J. (1999). Adult Psychopathology, Second Edition: A Social Work Perspective. New York : Simon and Schuster.
[15] Vourlekis, B. S., & Greene, R. R. (n.d.). Social Work Case Management. New Jersey: Transaction Publishers.