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Research a specific health issue (e.g., dementia, depression, cancer, etc). Demonstrate your understanding by including, but not exhaustively, its nature, prevalence, risk factors, illness trajectory, associated impact, and the goal(s) of care. Discuss four main social work interventions that contribute towards a holistic and a good outcome for the patients and their families.

A medical social worker working in an acute or tertiary healthcare setting may encounter scenarios that can be value-laden. For example, in the inter-disciplinary units in terminal / palliative care or emergency departments, patients' choices may differ from their families or healthcare team members. Examine two (2) relevant ethical dilemmas and apply the appropriate ethics and values in order to work to towards a high value team-based health care.

Mr. A, at his prime age of 40, is married with 2 school going children. He is very successful in his career as a property agent while his wife is a homemaker. One morning he collapsed while doing thread mill at his condo gym. A MRI scan result showed he has a major stroke and has temporarily lost his right-sided function. Prior to the onset, Mr A does not have any major health issues or any medical follow up. 

Mr. B is a 78-year-old widowed elderly staying alone in a 1 room HDB rental flat. He does not have children, and relies on social aid. Apart from his thrice monthly follow up at polyclinic for his chronic disease, he does not have any major health issue. One morning he has great difficulty in getting out of bed, found his speech slurred, and realized he may have suffered a stroke. 

The above two scenarios illustrate that a same illness may affect two individuals differently and result in different illness experience. In the context of the ecological approach to sickness, analyse the various considerations in both Mr A's and Mr B's physical, psychological, and environmental conditions. Examine the critical discharge planning skills needed for a social worker in a hospital setting for both gentlemen.

The Nature and Prevalence of Cancer

This question outlines the nature, prevalence, risk factors and many aspects related to a serious health problem, cancer. Cancer is a group of diseases that is caused by the uncontrollable cell growth. It can happen in any part of the body and sometimes comprise of solid tumors. Cancerous cells out number other cells and become invasive in nature (Cancer.gov, 2017).  Some cancers like leukemias do not have solid tumors.

The cell cycle in the human body is highly controlled mechanism. The uncontrolled cell growth results in the increased number of living cell than the dead ones. The abnormal cell growth leads to the formation of the tumor. There are two types of tumors present- benign and malignant. Benign cancers do not spread to the adjacent cells and their growth is local whereas the malignant cancers spread to the adjacent cell and to other body parts (Burman, 2015). The growth of the malignant cells continues in an environment which is usually unfit for its growth and the process is termed as the metastasis (Liberati et al., 2014).

 Cancer is a symptom indicating improper functioning of the body which results from toxin overload and the lack of nutrients (Aktas, 2013).

The growth of the tumor is controlled by oncogenes. The cells start to grow in an uncontrolled manner as soon as the oncogenes are activated.

Cancer is one of the post prevalent diseases and is the cause of the maximum deaths around the world irrespective of age and sex. The percentage of death varies with countries. The low and middle economic countries experience almost 70% death rates from cancer (Siegel, Miller & Jemal, 2015). Human papilloma virus (HPV) and hepatitis are responsible for about 25% of cancer in these countries. A recent study shows that about 8.8 million of deaths occurred in 2015 worldwide. A large population of Africa and America suffer from cancer.

The major risk factors that are responsible for cancer include tobacco smoke, alcohol consumption, irregular and unhealthy diet (Ruiz & Hernández, 2014). Obesity may also be the reason for the cause of cancer. Chronic infections can also cause cancer in the economically backward countries. Cancer is caused by many biological agents that include Helicobacter pylori, HPV, hepatitis and Estein-Barr virus. Some physical factors like ionizing radiations and chemical components like aflatoxin and arsenic are responsible for the cause of cancer (Bower, 2014). The occurance of cancer rises drastically with the age.

According to some studies, a faster trajectory was followed by the surgical patients with cancer and any delay in the treatment is usually avoided by the patients who have an illness trajectory of three months. Cancer infected patients are found to respond properly and remain fit for a long period of time during the period of their treatment but experiences a drastic deterioration before their death. Patients often become tired and feeble and suffer from pain, loss of appetite and weight.

The cost of cancer treatment rises to a great extent and becomes less effective when it is diagnosed at an advanced stage (Kauvar et al., 2015). The cost of the treatment amounts to almost billions worldwide. Cancer has become a great economic burden due to the high cost that involves in its treatment. The site of the cancer makes a great impact on the increased cost of the treatment. The treatment of the cancer of lung and colorectal are very expensive followed by the cancer of prostate and breast.

Risk Factors for Cancer

Oncologists should be optimistic in their approach while discussing the illness with the patient’s family. The members of the family should discuss various goals that they may take for the treatment with the oncologist. The goals should be identified and executed with special care when the patients become unresponsive. The oncologist should help the patient and his family to understand the benefits that they would get and the harm that may cause during the treatment. The last stage of cancer involves the goal of pain relief, proper functioning of the organs rather than cure and avoidance of death. Oncologist should sustain hope to the patient and his family.

The first main social work intervention may be the psychological care provided to the patient and his family. A support is given to the patients and the aim of the oncogenic social worker is the reduction of the depression and the anxiety that the patients are facing, overcoming the difficult situation and to response to the treatments that are being provided to them. The professionals associated with the healthcare should be involved in it and recognize the need of the psychological back up to the patients. Compassionate interaction with the patient and his family and the optimistic information would help them overcome their anxiety. Oncology social workers may also take up the role of supervisors or administrators and give them the training to work as a group supervisor and case consultant (Werner, Mills & Ram, 2014). The workers get a close interaction with the patient inspite of having the risk of acquiring the infection.  

The workers develop a board, plans a management program and focus on the palliative care. A research program is carried out on psychological intervention and training on this program is conducted. A planning of the supportive care starting from the diagnosis of the infection through the treatment procedures is considered as the important part of the care (Zimmermann et al., 2014). The social workers attend different conferences and also support their own education. They publish several peer reviewed journals and various professional meetings are attended by them. A multidisciplinary team of researchers have been formed by the social workers who would help in the development and evaluation of the innovative programs. These programs help in the screening of the distress and the support given to the patient family when they take decision regarding their treatment. They help to provide education regarding the issues related to psychology, cancer and treatment to the patient and the professionals associated with him.  Cancer infected patients should get extreme cares from the home, hospice or hospitals. The workers carry out programs of palliative care and establish home health agencies which help to support the patients from the time of the diagnosis till the end of his life (Zimmermann et al., 2014). The skills of the palliative workers provides help in the reduction of the pain, stress, physical and psychological suffering of both the patient and his family. The palliative care workers provide screening of the distress that they face, by carrying out a group counseling that is essential for them during the phase of their treatment.  

Illness Trajectory and Impact of Cancer

The clinical social workers have a huge responsibility and the recommendations that they give have a great significance in the life of others associated with the clinic (Dorfman, 2013). They continue to practice within their genre and enhance their professional development. The clinical workers do not violate their professional code of ethics by exploiting their professional relationship financially or some personal issues and they maintain this relationship with everyone associated. They often work as employees in the clinics and hospital and identify and modify different policies that conflict with their profession. They have the responsibility of putting forward the code of ethics of their profession.

 The clinical social workers also possess responsibility relating to their profession both for themselves and for the new comers as their teachers or supervisors (Fernando Chang-Muy & Congress, 2015). They maintain a high standard of their objective and continue to try to expand their knowledge so that they can apply it in practical purposes. The clinical worker always tries to safeguard the well being of their client. It is their responsibility to influence the patient and make him aware of the effect the treatment procedures have when a conflict arises. The social worker associated with a clinic must be employed and task should be given based on their qualification and they must maintain a better private conduct. The misinterpretation regarding qualification competence and other policies should be avoided by a social worker.

The dilemma faced by a social worker is that to decide between two solutions that should have the same ethical value (Reamer, 2013). They face this dilemma in order to protect their client’s interest as well as meeting the social demands. A clinical social worker must follow the ‘ethics work up four’ which includes the following four points- medical indications, patient preferences, quality of life and contextual features. Medical social workers face a wide variety of dilemmas.

A person dies from coroner’s case requires post mortem and his family do not want it, a pediatric patient’s parents who are economically backward want his discharge against medical advice, some relatives of a comatose person wants to remove the life supporting system and others do not, a severely burnt or injured patient wants to get an anodyne to get rid of his pain but that may cause damage to any of his body organs, a patient suffering from any kind of psychological illness refuses to take medicine. These are some of the dilemmas, among many, faced by a medical social worker during the period of their work. These issues are very sensitive and so the ethics associated with the clinics which require a thorough and careful identification and the issues are analyzed and resolved. A medical social worker must always maintain his loyalty towards his profession, clients and the society in a broad way.

A comatose person was given a life support system and some of his family members want this to be removed while others do not as he was observed to be in a persistent vegetative state. The social worker, in this situation, provides support to the family and the patients and helps the family members to communicate with the attending physician and become an important part of the interdisciplinary team in terms of decision making and care giver (Upenn.edu, 2017). A set of question arises in this situation regarding the effectiveness of the medical therapy, whether it impose any burden to the patient and the intention of the caregiver in the removal of the life support.

Goals of Cancer Care

A person in this vegetative state does not possess the capability to identify or reason out the goods of life because of the cerebral cortex dysfunction. He is not capable to eat, chew or swallow and talk properly. The removal of the life support system from this patient is a act of mercy killing and relieving him of the pain from which he was suffering. He should also be relieved from the medical burden. The social worker in this situation would aware the patient’s family that the removal of the life support is not unethical and that the patient would be freed from psychological or social burden because it is ineffective and is the cause of burden to the patient.

A medical social worker has a responsibility of a manager, investigator of the patient and a therapist. A child is suffering from a severe illness and is admitted to a hospital for a prolonged period. The child’s parents are not from a good economic background and are incapable of bearing the increased cost of the treatment and the hospital cost. The child’s parents now want to discharge him against medical suggestion and continue the treatment from home (Berry et al., 2013).

 The matter is brought to the medical social workers notice. The patient’s family should discuss about the changes that may occur to the patient after the discharge, the adjustments required to care the patient and the various needs of the care givers and the ways taken to reduce the stress during the entire period of care giving (Dorfman, 2013). The social workers along with the attending professionals and family would take the consent from the patient and arrange home care services such as the visiting nurses. The patient’s family should keep a stock of medical equipments that the patient might require during his stay at home after discharge. They should make a schedule for the follow up appointments. The social worker would conduct a training program for the family members of the patient and train them the techniques such as the transfer of the patient from the bed to the chair, how the equipments should be used, recognize the symptoms and tackling difficult situations. They should also be given the medication list referring instruction and the dosage of the medicines and aware of the side affects that may happen with the application of the different medicines. The social worker must make the child’s parents aware of the diet that should be given to him after his discharge (Berry et al., 2014).

The medical social worker adapts these ethics and values when they face the dilemma and provide support to their clients.

Mr. A’s right side was paralyzed temporarily which is a important physical condition of the stroke that he experienced. The physical conditions include headache, nausea, vertigo, limb ataxia and many more. The systolic blood pressure becomes greater than 220 mm Hg during the onset of the stroke.

The psychological conditions that follow the stroke include depression, anxiety and pseudo- bulbar affect or PBA. The symptoms of depression in a stroke experienced person includes prevailing sadness, unwillingness of performing works that were once enjoyed and the eating and sleeping habits (Campbell Burton et al., 2013). Anxiety often accompanies worries whereas PBA is characterized by mismatched reaction and feelings. Concentration of the pollutants present in the air is one of the major factors that are responsible for the stroke experienced by Mr. A.

Psychological Care for Cancer Patients

A quick discharge of the patients of hemorrhagic stroke is forced by the budget cuts. The medical social worker would inform the family about various symptoms that would help to identify the stroke that is drooping face, weakness in the arm and slurry speech. This is the time when they should consult a doctor immediately. They should give the family a proper diet chart that the patient should follow after his discharge. The diet includes the intake of fresh fruits and vegetables, low-fat dairy products, limited oils, sweets and preserved foods and prevents the intake of high fat and salt containing foods.

A change in the life style should also be brought (Larsson, Åkesson & Wolk, 2015). The patient should be careful and regular in taking the medicines exactly as prescribed and is not supposed to skip the doses mentioned. The social worker should help them and advice them to obtain an exercise program and give the knowledge of the steps to start it. He should make the patient and his family aware of the facts that they should have a regular check up and monitor the level of cholesterol and the ways to keep it under control. He should strictly follow the advice of the social worker regarding the quitting of consumption of alcohol and smoking (Peter & Justus, 2016). He should be aware of various management techniques relating to stress which would help him to deal with the everyday stress both in his house and in his work place.  He should also bring about changes in his daily activities like showering, bathing and getting dressed. The social worker should advice the patient that he should be careful not to catch any urinary tract infection which may lead to bacterial infections like sepsis, bacteremia or dehydration. These may compromise with the recovery as hypertension may be the outcome of these complications.   

The symptoms of the stroke experienced by Mr. B are dizziness, balance loss, trouble in walking, and drastic loss of the capability to move arms and legs and slurry speech (Kernan et al., 2014). Loss of vision is another common physical condition observed in this type of stroke. The patient with this type of stroke may also experience disturbances in the sleep and convulsions which are termed as the seizures.

The stroke affected patients often suffer from psychological problems such as depression, mania, anxiety, apathy, catastrophic reactions, psychosis and many more (Mierlo et al., 2014). Post stroke depression can be identified by irrelevant speech and the difficulty that the patients face in order to comprehend the languages. This psychological disorder has a large impact on the recovery of the illness. The social worker meets with the patient and his family to discuss the discharge planning and visits his house to ensure that the environment is suitable for the patient to stay there. The social worker then tries to assess the psychological and social needs of the patient.

The social worker along with the doctor decides a suitable time for the patients discharge. It was advised by the social worker to arrange a proper transportation to the patient after his discharge. The social worker would make Mr. B aware of his daily routine. They should have healthy food in his regular diet which would consist of low fat containing dairy products, whole grain breads and many others. He should be selective in choosing food and have foods containing less salt, potassium containing fruits and vegetables (Paquereau et al.,  2014). The social worker would also advice him to consult a dietician for his diet chart. He should also be informed that he is prohibited of smoking, drinking and taking of any kinds of drugs that would affect his health (Deijle et al., 2017).

Oncology Social Work Interventions

He should keep himself in rest and avoid any kind of stress that may have an adverse effect on his health. The social worker along with the attending physician would make him aware of the various symptoms that would indicate of stroke and advice him to keep all the necessary medicines with him and take accordingly in an emergency situation. He must be informed to take his medications strictly as directed by the physician and should not skip any.

Mr. B must visit to a rehab for speech therapy in order to improve his speech and the capability to swallow (Daemen et al., 2014). They may also help him to regain his strength and self confidence. Mr. B would gradually be able to control his balance and walk properly and would also learn new techniques to carry out daily activities like being dressed, bathing and eating. The therapists associated with the rehabilitation thus play an important role in the recovery of the patients suffering from this kind of stroke (Clarke & Forster, 2015).

Mr. B must keep his house safe and keep his path clear so that he would not topple over. The floor must not be slippery and any electrical cord or appliances must be kept out of reach. Mr. B must use a walking stick while walking which would help him to maintain his balance. He must know different aspects of depression as informed by the medical social worker. Mr. B must make follow-up appointments after discharge and must undergo a thorough check up of everything that he needs. He should discuss his fears or any queries that he may have regarding his physical condition after his discharge.  

References

Aktas, A. (2013). Cancer symptom clusters: current concepts and controversies. Current opinion in supportive and palliative care, 7(1), 38-44.

Berry, J. G., Blaine, K., Rogers, J., McBride, S., Schor, E., Birmingham, J., ... & Feudtner, C. (2014). A framework of pediatric hospital discharge care informed by legislation, research, and practice. JAMA pediatrics, 168(10), 955-962.

Berry, J. G., Ziniel, S. I., Freeman, L., Kaplan, W., Antonelli, R., Gay, J., ... & Goldmann, D. (2013). Hospital readmission and parent perceptions of their child's hospital discharge. International Journal for Quality in Health Care, 25(5), 573-581.

Bower, J. E. (2014). Cancer-related fatigue [mdash] mechanisms, risk factors, and treatments. Nature Reviews Clinical Oncology, 11(10), 597-609.

Burman, K. D. (2015). Introduction. In A Case-Based Guide to Clinical Endocrinology (pp. 121-125). Springer New York.

Campbell Burton, C., Murray, J., Holmes, J., Astin, F., Greenwood, D., & Knapp, P. (2013). Frequency of anxiety after stroke: a systematic review and meta?analysis of observational studies. International Journal of Stroke, 8(7), 545-559.

Cancer.gov. (2017). What Is Cancer?. National Cancer Institute. Retrieved 18 August 2017, from https://www.cancer.gov/about-cancer/understanding/what-is-cancer

Clarke, D. J., & Forster, A. (2015). Improving post-stroke recovery: the role of the multidisciplinary health care team. Journal of multidisciplinary healthcare, 8, 433.

Daemen, E. M. L., Flinsenberg, I. C. M., Van Loenen, E. J., Cuppen, R. P. G., & Rajae-Joordens, R. J. E. (2014). Adaptable healing patient room for stroke patients. Methods of information in medicine, 53(5), 406-415.

Deijle, I. A., Van Schaik, S. M., Van Wegen, E. E., Weinstein, H. C., Kwakkel, G., & Van den Berg-Vos, R. M. (2017). Lifestyle Interventions to Prevent Cardiovascular Events After Stroke and Transient Ischemic Attack. Stroke, 48(1), 174-179.

Dorfman, R. A. (2013). Clinical social work: Definition, practice and vision(Vol. 9). Routledge.

Fernando Chang-Muy, J. D., & Congress, E. P. (Eds.). (2015). Social work with immigrants and refugees: Legal issues, clinical skills, and advocacy. Springer Publishing Company.

Kauvar, A. N., Cronin Jr, T., Roenigk, R., Hruza, G., & Bennett, R. (2015). Consensus for nonmelanoma skin cancer treatment: basal cell carcinoma, including a cost analysis of treatment methods. Dermatologic Surgery, 41(5), 550-571.

Kernan, W. N., Ovbiagele, B., Black, H. R., Bravata, D. M., Chimowitz, M. I., Ezekowitz, M. D., ... & Johnston, S. C. C. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke, STR-0000000000000024.

Larsson, S. C., Åkesson, A., & Wolk, A. (2015). Primary prevention of stroke by a healthy lifestyle in a high-risk group. Neurology, 84(22), 2224-2228.

Liberati, S., B Morelli, M., Amantini, C., Santoni, M., Nabissi, M., Cardinali, C., & Santoni, G. (2014). Advances in transient receptor potential vanilloid-2 channel expression and function in tumor growth and progression. Current Protein and Peptide Science, 15(7), 732-737.

Mierlo, M. L., Schröder, C., Heugten, C. M., Post, M. W., Kort, P. L., & Visser?Meily, J. (2014). The influence of psychological factors on Health?Related Quality of Life after stroke: a systematic review. International journal of stroke, 9(3), 341-348.

Paquereau, J., Allart, E., Romon, M., & Rousseaux, M. (2014). The long-term nutritional status in stroke patients and its predictive factors. Journal of Stroke and Cerebrovascular Diseases, 23(6), 1628-1633.

Peter, J., & Justus, A. H. (2016). Knowledge and Practices of Stroke Survivors Regarding Secondary Stroke Prevention, Khomas Region, Namibia. Journal of Medical Biomedical and Applied Sciences.

Reamer, F. G. (2013). Social work values and ethics. Columbia University Press.

Ruiz, R. B., & Hernández, P. S. (2014). Diet and cancer: risk factors and epidemiological evidence. Maturitas, 77(3), 202-208.

Siegel, R. L., Miller, K. D., & Jemal, A. (2015). Cancer statistics, 2015. CA: a cancer journal for clinicians, 65(1), 5-29.

Upenn.edu. (2017). Cite a Website - Cite This For Me. Repository.upenn.edu. Retrieved 18 August 2017, from https://repository.upenn.edu/cgi/viewcontent.cgi?article=1049&context=edissertations_sp2

Werner, H. M., Mills, G. B., & Ram, P. T. (2014). Cancer systems biology: a peek into the future of patient care?. Nature reviews Clinical oncology, 11(3), 167-176.

Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., ... & Donner, A. (2014). Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. The Lancet, 383(9930), 1721-1730.

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