CASE

PRESENTATION
M EAG HAN M C DONAL D
MEET THE PATIENT

• Patient is a 34 year old male with a traumatic brain injury (TBI) due to a motor vehicle
accident which he has had for 15 years. Leaving him unable to care for hisself at times. Both of
his parents have passed away, therefor the S.C. DSS has custody of him, but he lives in a group
home in Tabor City.
• He was brought to SRMC hospital after an outburst at his grouphome where he ”threw a
computer, and punched a wall” he no longer is welcome back at the grouphome.
• He is a talkative young man, but gets agitated when things are not going his way. He likes to get
out of bed and walk around in the ER and that is not allowed, so nurses talk with him about
staying in bed and he gets agitated quickly.
• TV does not entertain him long, nor does coloring. He enjoys company more than anything.
MORE ABOUT THE PATIENT

• His case worker was extremely hard to get in touch with. For the first two weeks we were leaving
her voicemails. She finally returned our calls and made a visit. She gave us more information on his
situation, and basically told us it was our problem now.
• We reported this to our Attorney of the hospital.
• We were now doing everything we could to let S.C. court know that this case worker was
neglecting her case.
• Meanwhile, He was having 3-4 outburst a day and he was being chemically restrained AND
physically restrained all while being in seclusion. He was not a happy camper in our ER. Taking him
outside in our fenced in area was always a nice way to calm him down.
• Dumping someone in a hospital who does not have the mental capacity is immoral and unethical.
CONTINUED..

• After 37 days in the ER and several phone calls, emails, and even text messages the case
worker for him faxed over the guardianship papers.
• When he began having 3-4 outburst a day we met with the psychiatrist and he agreed that no
more medication can sedate him, he will wake up and do it all over again. An ER is not a place
to live. So it was either admit him to psychiatry, which he doesn’t have a need for psychiatry or
transfer him to Cherry hospital.
• Cherry hospital can better provide for him there, and now that we have the guardianship
papers we can send him.
• 45 days later he is being transported to Cherry hospital, and he seemed very excited.
STRENGTHS/LIMITATIONS

• Strengths: He his able to do things on his own at times, but he will refuse to do things when he
is agitated. When it comes to his case in general having the Attorney advocating for the patient
and being so proactive with his situation is a huge strength
• Limitations: Not having the guardianship papers, leaving us unable to transfer him anywhere, or
finding him placement anywhere. Causing him to remain living in the ER.
CONCEPTUAL FRAMEWORK
WHY?

• I chose this framework due to his traumatic brain injury causing him to be almost child like
forever. He may be 34 years old, but acts like a 7 or 8 year old.You say something, he copies
what you say, you do something he will do exactly the same thing.
• He imitates the the things he sees or hears. Makes me wonder what he may have heard or
seen at the group home as to why he threw a computer and punched a wall.
• He has temper tantrums like a child would too.
• But he is also very easy to get along with too.
QUESTIONS

1. Biases: If he would understand what was going on, and if he was capable of doing this with me.
2. Value differences: Family, because he has none left he feels they are not important. Says no one
cares about him, and does not believe in friends or a higher power.
3. Events or life experiences have shaped them into the person they are: Motorvehicle
accident was a major event, and his parents passing away.
4. Staff recommendation about diagnosis, Interventions or treatment: Because he was
primarily a placement issue the interventions as far as placing him somewhere was to go an assisted
living. He needs to 24/7 care for his TBI. And keeping him drugged up all the time is not ethical.
Transferring him to Cherry was a short term goal, to offer him better care while waiting for
acceptance at an appropriate assisted living facility.
QUESTIONS

5. What does research say on their diagnosis/problem/treatment? TBI Patients recover better in
homes with their family, but in this case with no family assisted living is more helpful compared to
a group home.
6. What changes do recommend for the agency or service (Needs of agency, changes, and rights
issues)? Demanding the guardianship paperwork from caseworker upon arrival of patient. Have
staff read out our Return to residence “no dumping” policy to case worker. Therefor patient
could have avoided living in the hospital for 45 days.
COMPETENCIES

• 1.3 Demonstrate professional demeanor in behavior; appearance; oral, written, and electronic, communication.
• 1.5 Use supervision and consultation to guide professional judgement and behavior
• 2.3 Apply self-awareness and self-regulation to manage the influence of personal biases and values in working
with diverse clients an constituencies.
• 3.1 Apply understanding of social, economic, and environmental justice to advocate for human rights at the
individual and system levels.
• 4.3 Use and translate research evidence to inform and improve practice, policy and service delivery.
• 6.2 Use empathy, reflection, and interpersonal skills to effectively engage diverse clients and constituencies.
• 7.3 Develop mutually agreed on intervention goals and objectives based on the critical assessment of strengths,
needs, and challenges within clients and constituencies.