Assessment 1a, 1b, and 1c: Case study of Joi Anderson with sickle cell pain crisis and Jehovah's Wit

Joi's Medical History

Joi Anderson, a 16-year-old female, is admitted to the medical ward with a sickle cell pain crisis secondary to a urinary tract infection.

Joi was diagnosed with sickle cell anaemia at age 4, she has an annual review with a haematologist and has not required any ongoing treatment.

She lives with her parents, Ben, and Chloe, as well as her grandmother, Sharyn. Ben is a fly-in-fly-out (FIFO) worker and Joi’s mother, Chloe, works two jobs, 6 days per week. As Ben and Chloe work long hours, Sharyn has moved in with the family to help care for Joi.

On admission, Joi’s vital signs are within normal limits. She is complaining of bilateral hip and thigh pain, rated at 5/10. She is also complaining of dysuria, frequency, shortness of breath and lethargy.

Joi is placed on bed rest, ordered regular analgesia, oxygen therapy, intravenous therapy and antibiotics. The haematologist reviews Joi and suggests a blood transfusion to decrease symptoms and prevent complications.

Sharyn’s response to this suggestions is as follows:

“No, Joi can’t have a blood transfusion, it is against our religion. We belong to the Jehovah Witness faith”.

The haematologist explains to Sharyn the positives of having this blood transfusion if needed but

Sharyn continues to state “no, she will not have a blood transfusion. I will never give consent to this”

Sharyn confides in the Registered Nurse that she knows Ben and Chloe need to work long hours in order to meet the mortgage repayments. She enjoys spending time with Joi but she sometimes finds caring for her exhausting. She has hypertension and Type 1 diabetes mellitus and feels that her health is deteriorating and she misses spending time with her friends.

Sharyn explains that the family belong to the Jehovah’s Witness faith and all hold strong traditional beliefs. Sharyn talks passionately about her religious beliefs and explains that ‘she will not allow anyone to do anything to Joi against these beliefs’. Joi and Sharyn attend church meetings twice a week and attend mass on Sundays. Joi enjoys going to church and has made many friends in the congregation. Sharyn is pleased that Joi enjoys these church activities as the family cannot afford for her to participate in other activities. Sharyn is concerned that Joi’s current condition will impact on their involvement in church activities, further caregiving roles and additional expenses.

Joi has been hospitalised for 3 days and her condition has improved. The intravenous therapy has been removed and she is requiring less analgesia. As a result, she is scheduled for discharge tomorrow.

As part of the discharge planning, you meet with Joi, Sharyn & Chloe to develop a family centred care plan for Joi when she goes home.

Chloe has many questions regarding sickle cell disease. She is very concerned about her daughter and what will happen in the future, asking:

• “Does Joi need to be taking any medications for her condition”

• “What should we do if Joi gets this pain again?”

• “Where can we get more information about sickle cell anaemia?”

• “I wish I knew somebody else who was going through this. It would be good to talk to someone”

• “What can we do to ease the pressure on mum?”

• “Is there anything we can do to prevent this from happening again?”

Joi asks

• “Can I still go to church and school?”

• “ What can I do to have fun”

Sharyn asks

• “How will I know if Joi is unwell in the future?”

• “ I am so worried about Joi, will she be able to live a normal life”

• “ Will Joi require more care when she goes home?”