you are going to read the paragraph then answer and 5 questions.
Ms. Jones is admitted to the 400-bed community hospital in her city with acute shortness of breath, weakness, and fatigue. She asks her significant other to let Kay know that she is there, and Kay goes to see her. Ms. Jones has pneumonia and congestive heart failure and will be in the hospital for a few days for antibiotic therapy, a cardiac workup, and respiratory therapy. Kay documents the patient’s social history in the chart and asks to be notified when the patient is being discharged. On the day of discharge, Ms. Jones is feeling better but is still weak and is unable go up and down the stairs. She has a split-level home, and there is no bedroom on the same floor as the bathroom. She will also need oxygen and physical therapy. The doctors have assumed that her boyfriend will assist with her care, but he is intoxicated when he arrives to pick her up. He becomes quite belligerent when the doctor confronts him, and Kay is called.
Kay tries to calm the staff and situation a bit and takes the boyfriend aside. She explains that the hospital cannot permit him to drive Ms. Jones home as he appears to have been drinking. He denies this, and Kay points out that there is a smell of alcohol about him, he is slurring his words, and his eyes are bloodshot. She is not confrontational or judgmental. The approach she takes is one of just making observations. Initially, he continues with his denial, but eventually he concedes that he had a “few beers with lunch.” Kay then talks to him about his feelings about having to take care of Ms. Jones. He admits that he does not know how to take care of her, and Kay recognizes that he is ambivalent and anxious about taking care of her. She also asks him about his drinking and whether he is interested in any referrals or information on alcohol abuse, but he declines.
Kay is aware of the DRG for this patient and the financial pressures to avoid extending the admission. Still, she feels that the discharge home is unsafe, and she asks the physician to delay discharge until the next morning. He agrees, and Kay goes back to Ms. Jones, who is quite upset and embarrassed about her boyfriend’s behavior. Kay is reassuring that the staff understand the stress that they are under but is firm that there are problems with her going home without assistance. Kay asks if there are any other options for care and suggests a skilled nursing home facility for rehabilitation for a few weeks, but Ms. Jones declines. Instead, Ms. Jones contacts her daughter, who agrees to have her come to her home. A visiting nurse and outpatient physical therapy are ordered. The daughter is able to drive Ms. Jones to her appointments. A bedside commode and a walker are also arranged to minimize the risk of falling until the patient’s strength returns.
Kay continues to see Ms. Jones in the clinic. Six months later, the boyfriend accompanies Ms. Jones comes to the clinic and asks to see Kay alone. Kay is surprised but talks with him privately. He asks for help with his drinking, which has now reached the point that he is having blackouts. Kay asks one of the doctors in the clinic to see him. The physician concludes that the boyfriend is at risk of severe withdrawal symptoms if he stops drinking suddenly and outlines a detoxification program that includes a prescriiption for a benzodiazepine (tranquillizer), which will be used when withdrawal symptoms emerge. The physician then makes arrangements to see the boyfriend every day for the next week to manage the withdrawal. Kay refers the boyfriend to Alcoholics Anonymous and explains that a group meets regularly at the hospital. She also makes arrangements for the boyfriend to be seen in the mental health clinic for assistance during his recovery.
Questions:
1. Who is the “patient” in this case?
2. Discuss how a doctor might view a situation as a simple discharge while a social worker might view the same situation differently.
3. What does this case demonstrate about the continuum of care and the benefits of social work spanning boundaries across the continuum of care?
4. What skills and abilities does Kay demonstrate in this situation?
