SOCW 400: Introduction to Social Work in the Health Care Context Practice
Examples for Assignment #3:
(See Assignment 3 for requirements and due date)
Students will be expected to choose from ONE of the four practice examples
provided below:
Practice Example 1:
You are a social worker in a community health center where you work with
individuals and families and also facilitate groups. Edna has been referred to you
by one of the physicians at the health centre. Edna is a 51-year-old woman who
was diagnosed with Rheumatoid Arthritis 15 years ago. She had not seen a
physician for several years but six months ago made an appointment with a
physician at the centre because she had been having joint pain so severe she
had been having trouble walking.
A year ago, Edna quit her job at the dry cleaners where she had been working 45
– 50 hours per week. She was now living on a very low income through social
assistance. Eight months ago Edna’s relationship of 10 years also ended. She
told her physician she had given up on men since ‘they are such liars’ and ‘didn’t
care about anyone but themselves.’ Edna says she is lonely – she lives alone in
a small one-room apartment, she does not have friends or family nearby, and her
grown-up children live in other cities.
Edna’s physician indicated to you she is frustrated with Edna because other than
taking her medication she doesn’t follow through on any other recommendations
that would improve her health – exercise, diet changes to lose weight, smoking
cessation, etc - and although there has been some improvement in her pain
level, unless Edna follows through on other recommendations, her health will
deteriorate. To add to it, for the last four months Edna’s blood pressure has been
high so these recommendations have become more urgent.
Edna is willing to see a social worker but doesn’t really understand what a social
worker could do to help her with her problems or her arthritis.
Practice Example 2:
You are a social worker with a home and community health care program. It is a
multi-disciplinary program that provides healthcare to adults living in the
community. You have received a call from a distraught woman from a remote
First Nation’s community; she expresses to you that she is concerned about the
well being of Mary, her 82-year-old mother. She tells you that Mary and her
husband Charles moved to the city with their grandson and his girlfriend. Mary
has several chronic health conditions, including diabetes, arthritis, and high blood
pressure, along with some cognitive impairment. Charles is healthier than Mary;
he walks every day, but is slowing down noticeably and has hearing loss in both
SOCW 400: Introduction to Social Work in the Health Care Context Practice
ears. They have never lived away from their community. Jane, Mary’s daughter,
does not believe that the grandson will take proper care of Mary and Charlie; she
also believes that the grandson’s girlfriend is more interested in Mary and
Charles’ money than concerned for their health.
Mary and Charles are known to you. You have made contact before, when they
first arrived in the city. They originally reached out and were welcoming of
information about the services available through the community health program.
After Jane’s call expressing concern, you make contact with Mary and Charles,
the grandson and his girlfriend. They are happy to hear from you and welcome
the opportunity to meet with you. You meet with Mary and Charles regularly to
check in and discuss the supports that might be most helpful. As you become
more engaged, it is clear that Mary has some significant cognitive deficits, her
diabetes is not being well managed (as evident by the mostly fast food wrappers
and containers around her chair in the living room), and she is having increased
difficulty getting up out of her chair. Over subsequent visits, as you ask more
about Mary’s cognition, you begin to notice a shift. The girlfriend is more vocal
about not needing support and uses outdated, inflammatory language to tell Mary
that you think she is “senile” and that you are going to take her away and put her
in a home. Charles becomes noticeably more withdrawn and sad as well. They
no longer want you to visit, saying that they are being looked after fine by the
grandson and his girlfriend. You stop by after a month to check in; they agree
that you can come in – but only for a short time. Mary won’t look at you in the
eye. After awhile Charles says out loud that he will not allow Mary to go into
residential care. He tells you that they grew up in the same small coastal
community, from which they were taken and re-located by the government to a
reserve community. They have been married 65 years and neither of them drink
or smoke. They both spent 9 years in residential school. They raised their
grandson and he is and will continue to look after them just fine. They tell you
that there is no need for your further involvement. You still have significant
concerns about Mary’s health and well-being. Other family members have
expressed concerns. Jane, the daughter who originally called with concerns,
continues to call and believes that you should be doing more.
Practice Example 3:
You are a hospital social worker and have been called to the Emergency Room
to attend to a 13- year-old boy who is ‘hysterical and agitated’. Upon your arrival,
the ER nurse tells you that the boy must leave the emergency room because he
is a disruption to the other patients; he must wait for his father in the waiting
room. Cody is angry and demands that he be allowed to stay by his father’s side.
He asserts that he is his father’s primary caregiver along with his sister Sara, and
he has a right to be treated as such. As you accompany Cody to the waiting
room, one of the community home care nurses and the community care social
worker arrives at the ER. The community care social worker takes Cody to the
SOCW 400: Introduction to Social Work in the Health Care Context Practice
cafeteria while the community nurse fills you in on what has been happening.
Mark, Cody’s father is 45 yrs. old and has an inoperable brain tumor. He moved
to your community recently with Cody and Sara because he always wanted to
live here before he died. He does not have family or friends in the community. He
does not work. He is supported by the Community Palliative Care team, who
provides nursing and psycho-social support to him in his home. Cody and Sara
are in temporary custody of MCFD, because of the family history and recognition
of Mark’s inability to provided parenting, given his health care status. It was a
mutually agreed upon plan. Cody and Sara’s mother is living in a different
community, is a prostitute and has addiction issues, which is why Mark has
custody of the children. She showed up last week in the community for the
weekend, threating to take the kids home with her. However, as quickly as she
arrived, she left three days later without notice, after having stolen all of Mark’s
powerful pain medication.
Cody does not go to school regularly, instead often chooses to stay at home with
his dad, making sure that he is eating, taking his medication and is safe. He
knows the care workers, the nurses, and the social worker by name and knows
their visiting schedules. He knows his dad’s condition and the daily treatment
regime. This behaviour is at odds with what MCFD would like, yet they admittedly
do not know how to support the family under these special and unique
circumstances. The community palliative care team attends to the family’s needs
from a healthcare perspective, although also admit to not knowing quite how to
fully support all the complex and diverse needs.
Mark’s prognosis is not good and the community nurse tells you that he does not
have long to live. The size of the tumor is increasing, the impact of which is
increased pain and significant functional decline, especially with respect to
balance, vision and cognition. He will likely continue to have seizures, which is
what precipitated this visit to the ER. Mark does not want to be admitted to
hospital and wants to die, if he’s going to die, at home. He is hopeful about his
prognosis, believing that he will find a surgeon who will remove the tumor; he is
confident that he will see his kids graduate from high-school. He does not
acknowledge his own cognitive and functional decline and the increased risk he
lives with at home. Cody is vocal about his support for his dad, though he has
shared with the team his biggest fear: that his dad will have a seizure and die
without him present. He is increasingly reluctant to leave his father’s side.
Cody returns with the community social worker to the ER waiting room. He has
calmed down but is angry that the paramedic put his father in restraints to
transport him to the hospital. He is furious that the ER nurse and physician will
not talk to him or share information about Mark’s status. They keep telling him
that he is too young to understand. All he wants is to sit by his father’s side.