1. Present a brief overview of the presenting issues as outlined in the case scenario.
Then briefly describe how you would manage Janet, yourself and the other staff.
You need to consider in your answer issues of risk, safety, consumer focus and self-efficacy.
Discuss how you would engage Janet and give your reasons supported by evidence from academic sources.
(1000 word limit)
this is the case:
You are working as one of a two person paramedic team and you attend a call to assess Janet Smith at 18.00 hours on a Saturday evening. Prior to your arrival at her premises, Janet’s parents had phoned the police, as they were concerned for her safety. Janet had locked herself in her bedroom and refused to open the door. Her parents could hear loud banging, breaking glass and shouting coming from Janet’s room. Janet refused to open the door to her parents. The police arrived to assess the situation and were able to persuade Janet to open the door to her room. On entering the bedroom, Janet was sitting on her bed with her arms wrapped around her, eyes closed, rocking and crying loudly. They found that Janet had smashed a mirror in her room and there was glass all over the floor. Police observed a lot of blood in the room that appeared to be coming from cuts on Janet’s arms. They then called Paramedics to assess and assist the transportation of Janet to the local hospital for treatment.
On arrival you found out the following information about the patient. Janet is a 160cm, 54kg, 18 year old Caucasian woman who lives with her parents and 2 younger siblings in a house in a suburb of Mandurah (WA). Janet’s family reported to you that over the past few months Janet’s appearance and behaviour has changed. She has become socially withdrawn, some days in the past fortnight even refusing to leave her room. Janet’s personal care has suffered, often not showering or changing her clothes for several days. Today her hair is tangled and greasy and she is dressed in a dirty singlet, mini skirt and thongs despite the fact that it is winter. This is out of character for Janet who was previously appropriately dressed and well groomed.
Janet no longer eats meals with the family and she has lost several kilos in the past few weeks and appears pale. Janet is often irritable and angry especially when approached by her family about her appearance and behaviour. Her parents tried to talk with Janet this afternoon and persuade her to see their GP for help. Janet screamed at her parents “no one understands, I feel so rotten, there is no help for me…I just want it all to end”
then ran out of the house. When she returned home several hours later, her family stated that she looked dishevelled, smelled of alcohol and refused to talk and locked herself in her room. Concerns for Janet’s safety led her parents to contact police. Janet had a blood alcohol content (BAC) of 0.05g/100ml when breathalysed. Janet is silent when you try and intervene with her but compliant with interventions.
Janet has her head lowered and will only make intermittent eye contact.
You transport Janet to hospital and have to wait with her until nursing staff are available as the Emergency Department is very busy that evening responding to a major road traffic accident. You are taken to a waiting area, where Janet lies on her stretcher sobbing quietly. The psychiatric liaison nurse is unavailable due to several other presentations that evening and the bed coordinator asks you to stay with Janet until further assistance can be found.
Janet’s parents are in the ED waiting room; you invite them in and speak quietly whilst observing Janet and they give you the following information. Her parents have been concerned for some months about the decline in Janet’s mood and change in behaviour. Janet was a happy, outgoing and active child and teenager who enjoyed playing netball, jazz ballet and going out with friends. Janet’s parents report that their niece died in a car accident a year ago. Janet was close to her cousin and took this very hard at the time. Her mother reports “she never really got over it and has been taking about her cousin a lot lately; I think that might be because it will be a year ago next week that we lost Ally”. Janet was an average student in primary school, but her studies declined rapidly midway through year 11 and Janet left school shortly after starting year 12 as she was failing all of her subjects. Since leaving school four months ago, Janet has become much less social, keeping in contact with only a handful of friends and has stopped dancing and playing sport. She has told her family that she doesn’t feel relaxed around people anymore and will often start to shake when meeting new people. Janet was in a relationship with Liam, who she met at school and they had been talking of moving in together. Liam ended the relationship 2 months ago as he felt Janet was becoming ‘nervy’ and distant, however they still remain friends.
Janet’s parents own an air conditioning business that is not currently doing well and the family have been discussing closing the business. Her parents have been under a great deal of stress around their reduced income and future employment. Janet has been working at the family business part time since leaving high school. Due to the downturn in the business, there has been less work for Janet in the past month. When Janet is at work, her parents have noticed that she becomes easily distracted, has been forgetful and has been making many mistakes. The family have encouraged Janet to consider attending TAFE or going to Centrelink for job seeking and income support, but Janet has lacked motivation and has not done either. Her parents report that Janet will have an occasional glass of wine at a social event but does not drink regularly or take any drugs.
When you approach Janet to ask her some questions and take her observations, she is standing by the side of her stretcher putting on her thongs and has removed her dressings. Janet bursts into tears when she sees you starts shaking and sits on the bed. Janet looks briefly at you, scowls and yells “what can you do for me, how can you possibly help, I just don’t want to be here” and throws her dressings across the cubicle.
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