Reference no: EM133622671

Assignment:

Joe, a 35-year-old homeless Iroquois veteran, with no recent family contact and a history of alcohol abuse, receives care in a large urban clinic in the Pacific Northwest. Joe was diagnosed with HIV four years ago. He presents at the clinic, as a walk-in client and asks to see Maggie Hernandez, the nurse he usually sees in the clinic for his "appointments." After about an hour, Ms. Hernandez escorts Joe to an exam room and asks, "What brings you in today?" Joe likes Ms. Hernandez and seeks her out at the clinic, refusing to receive care from other available staff. He tells Ms. Hernandez that he "just thought it was time to come in."

During the clinic visit, Ms. Hernandez notes that Joe is forgetful and exhibits mental slowing and language finding problems. He appears disheveled and in need of a shower. His last CD4+ T cell count was 620 cells/mm3 and his viral load was 45,000 copies/mL. Joe says he has difficulty taking his medications; he forgets his schedule, often loses medications, and is generally ambivalent about his need for non-Native drugs. He believes that a traditional Native healer could help him feel more comfortable with his illness. He lives in street camps and continues to drink alcohol on a daily basis.

Joe and Ms. Hernandez discuss an occasion when he received services from a traditional Native healer. The healer refused to continue helping Joe unless he stopped drinking. Joe told the traditional Native healer that he didn't drink and was offended by what he considered the healer's disrespectful behavior. Ms. Hernandez attempts to talk with Joe about his drinking but he becomes very upset. She shifts her approach and asks if he would consider a referral for a neuropsychiatric assessment. She also presents the possibility of finding a case manager to help Joe with medication adherence and housing. Joe asks, "what type of assessment is that and why do I need a case manager?"

Based on the above case, answer the following questions:

1. A summary of the case.

2. Who are the stakeholders involved in the case?

3. Describe the dilemmas evident in the case. What are the key problems and why do they exist? Describe the religious elements that come into play. What considerations have to be balanced?

4. What are the possible solutions to the case study dilemma?

5. Of the possible solutions, what solution do you think is best overall, and why? Of the possible solutions, which do you think offers the most religious autonomy?