case study
Case Study Part One Use the information in the case study below to complete Assessment Task 2 - Child Protection Case Study (AT2). You may also use this information in your third assessment task (AT3). Roles: • The Registered Nurse (RN) – works in a General Practice as a practice nurse. • Amy – 55-year-old grandmother to baby Rory and mother to Sam. • Clara– 22-year-old first-time mother (primip) to baby Rory. • Rory – 6-week-old male infant. • Sam – 22-year-old female partner to Clara and non-maternal parent (mother) to Rory. Patient History: Rory is Clara and Sam’s first child. Rory was conceived with the assistance of a sperm donor, but otherwise the conception and pregnancy was quite normal. Clara had a very traumatic birth with Rory and had a significant post-partum haemorrhage that resulted in her receiving 3 units of blood and having to have an extended stay in the postnatal ward. There were also difficulties establishing breastfeeding, with Rory losing more than 10% of his birth weight in the first 72 hours postpartum. Despite this, the notes indicate that the first couple of weeks at home seemed to have gone well, with Rory gaining weight and feeding without issue. Scenario: A registered nurse (RN) works in a community general practice and performs immunisations and simple assessments on children referred from their visit with the general practitioner (GP). Today, the GP has asked the RN to weigh and measure 6-week-old baby Rory and has ordered his 6-week immunisations to be administered. Rory has been brought in today by his grandmother, Amy. The RN greets Amy and invites her and Rory into the clinic. Rory is fussing in his grandmother’s arms, but she manages to seat herself and jiggles him to soothe him. Amy hands the RN Rory’s ‘Blue Book’, and the RN notes that the GP has completed Rory’s 6-week check and reported no concerns; however, the ‘Learn the Signs. Act Early’ section and other parent questions have not been filled out. The RN asks Amy if she or anyone else has concerns about Rory. Amy seems hesitant to respond. “A little…” she says warily. “He’s got a bit of nappy rash.” The RN reassures Amy that irritation around the nappy region is quite common, but that they will assess it when they undress Rory for weighing. With the RN’s help, Amy answers most of the parent questions. She is unsure about his feeding routine, however, as he is breastfed. The RN asks about Rory’s mother. Amy replies that Rory’s mother, Clara is waiting in the car. “She’s very tired,” she says, but her face is full of worry. It is not uncommon for parents to forget to complete the Blue Book, but it does seem odd that Rory’s mother chose to stay in the car instead of attending his check-up. In the RN’s experience, most parents are very keen to find out if their baby is progressing well – especially when they are so young. It is time to weigh Rory. Amy undresses him on the clinic bed and the RN notes the extensive nappy rash almost instantly. The rash shows evidence of candida infection. The RN remains calm and asks, “How long has it been like this?” Amy looks uncomfortable. “I’m not sure. Sam told me about it last week, but I don’t think it was new then.” Amy explains that Sam is a ‘fly-in-fly-out’ (FIFO) worker and is often away for 2 weeks at a time. The RN weighs Rory. Rory has gained only 20g since he was last weighed 2 weeks ago. What’s more, Rory was on the 50th percentile at birth, but now his weight is on the 10th percentile. This time, the RN is not able to hide their concern from Amy. Amy starts to cry and tells the RN she is very worried about her daughter-in-law (Rory’s mother, Clara). Amy states that Clara ‘hasn’t been herself’ since Sam went back to work 3 weeks ago. Amy says Clara seems to ignore Rory’s crying and she fears he is left alone in his bassinet for long periods. Amy says she comes over every evening after work, and often finds Rory screaming and in a heavily wet nappy that does not seem to have been changed in some time. When she asks Clara about this, Clara is dismissive and sometimes gets very angry with Amy. The RN is concerned that Clara is now struggling because she does not have her partner’s support at home anymore. Case Study Part Two Use the information below and the documentation attached to complete Assessment Task 3 - Strength-Based Approach Case Study (AT3). You may also refer to information from Part One of the case study in AT3. The information below and the documentation is not relevant for the second assessment task (AT2). The GP Clinic RN was able to report their concerns appropriately, and a child and family health nurse (CFHN) performed a home-visit with Clara and Rory. The CFHN completed a psycho-social assessment (PSA) and Edinburgh Postnatal Depression Scale (EPDS) with Clara and her family. Psychosocial Assessment (PSA) Source: NSW Department of Health. (2009). NSW Health/Families NSW Supporting Families Early Package – SAFE START Guidelines: Improving mental health outcomes for parents and infants, p.36. NSW Department of Health. https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2010_004.pdf Risk factors Psychosocial assessment question Client response I. Lack of support 1. Will you be able to get practical support with your baby? 2. Do you have someone you are able to talk to about your feelings or worries? 1. Yes – partner Sam is very hands-on but works FIFO and is only home for 2 weeks, then out for 2 weeks at a time. Mother-in-law (Amy) is very helpful but Clara states she has trouble accepting help from Amy. 2. Yes – partner Sam. Cannot always talk to Sam while away. II. Recent major stressors in the last 12 months 3. Have you had any major stressors, changes or losses recently (i.e. in the last 12 months) such as, financial problems, someone close to you dying, or any other serious worries? 3. Mother died suddenly of cancer when Clara was 10/40 weeks gestation. Clara was very close to her mother and misses her very much. III. Low self- esteem (including lack of self- confidence, high anxiety, and perfectionist traits) 4. Generally, do you consider yourself a confident person? 5. Does it worry you a lot if things get messy or out of place? 4. “Not really.” Clara reports she often experiences self-doubt and has trouble asking for help. 5. No IV. History of anxiety, depression, or other mental health problems. 6 a) Have you ever felt anxious, miserable, worried or depressed for more than a couple of weeks? 6 b) If so, did it seriously interfere with your work and your relationships with friends and family? 7. Are you currently receiving, or have you in the past received, treatment for any emotional problems? 6 a) Yes – History of anxiety since childhood. Clara became pregnant via sperm donor and states she found this extremely stressful and it has caused her to be depressed during pregnancy. b) “Sometimes”. Had a very difficult time in high school. 7. Was on SRRIs prior to pregnancy but stopped when she became pregnant for fear of effects on baby. Has not resumed due to breastfeeding. https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2010_004.pdf V. Couple’s relationship problems or dysfunction (if applicable) 8. How would you describe your relationship with your partner? 9. a) Antenatal: What do you think your relationship will be like after the birth OR b) Postnatal (in Community Health Setting): Has your relationship changed since having the baby? 8. “Great. Sam is amazing with Rory and we are more love than ever.” 9. b). No changes – Clara wishes it had changed so Sam was around more. VI. Adverse childhood experiences 10. Now that you are having a child of your own, you may think more about your own childhood and what it was like. As a child, were you hurt or abused in any way (physically, emotionally, sexually)? 10. Yes, thinks fondly of her childhood and time with her mother. Very sad mother is not here. Sad Rory not able to meet grandmother. No history of childhood abuse. VII. Domestic violence Questions must be asked only when the woman can be interviewed away from partner or family member over the age of 3 years. Staff must undergo training in screening for domestic violence before administering questions 11. Within the last year have you been hit, slapped, or hurt in other ways by your partner or ex-partner? 12. Are you frightened of your partner or ex-partner? (If the response to questions 11 and 12 is “No” then offer the DV information card and omit questions 13–18) 13. Are you safe here at home/to go home when you leave here? 14. Has your child/children been hurt or witnessed violence? 15. Who is/are your children with now? 16. Are they safe? 17. Are you worried about your child/children’s safety? 18. Would you like assistance with this? 11. No 12. No. 13. 14.. 15. 16. 17. 18. Opportunity to disclose further 19. Are there any other issues or worries you would like to mention? 19. Yes – Clara reports that she is having some financial difficulty and has not been able to afford a car seat for Rory. This means she is not