Reference no: EM133220917
Ben is a 28-year-old male who has recently returned to Westtown after serving 10 years in the Australia Defence Force. Ben grew up on a farm in the Westtown area and returned to the region to be close to family and to seek employment in the mining sector.
Prior to returning home Ben's tasks in the Defence Force were primarily office-based following a training accident 3 years ago which resulted in an L4-L5 spinal fusion and associated medical restrictions resulting from chronic lower back pain. Ben was forced to leave the ADF on medical grounds 9 months ago.
Ben does receive assistance with medical costs from The Department of Veteran's Affairs (DVA) in relation to both his PTSD and back injury. Prior to his accident Ben had a very active role in the ADF as an infantry soldier and felt frustrated by the restricted duties due to his injuries. He says he would rather 'work with his hands' than 'drive a desk'.
Ben returned to the care of his childhood GP when he returned to Westtown with whom he has a good rapport. Ben visits the clinic monthly for psychological consultation for PTSD associated with is military service which is paid for by the Department of Veterans Affairs (DVA).
Ben was successful in gaining a job working at the local mine where his role involved driving heavy machinery. Ben enjoyed the role however the long hours of sitting plus the vibration of the heavy earthmoving equipment aggravated his lower back. The mine is above ground and explosives are occasionally used on site. Ben tries to avoid being at work these days as he finds these activities sometimes act as a trigger for his PTSD.
Ben is reluctant to say anything as he was afraid that his medical issues might interfere with his employment. Ben tries to ensure he has a rostered day off when he needs to attend medical appointments so he doesn't draw attention to the same.
For the last 3-4 months Ben's lower back pain has been increasing to the extent that the discomfort was affecting his ability to operate at work and also his ability to get adequate sleep at night. Ben is increasingly relying on pain medications to 'get through the day' and get to sleep at night. Ben has been attending the Youbeaut clinic on a regular basis since he commenced work for pain relief. He is currently prescribed Ibuprofen, Panadeine Forte, and if required Oxycodone, all PRN. Ben's GP has referred him to the local Physiotherapist which is covered by DVA.
Six weeks ago, Ben was forced to take sick leave due to his discomfort. He was unable to operate heavy machinery due to the lower back discomfort and the requirement to take Endone for pain relief. During this time Ben was notified that after being employed at the mine for only 6 months Ben has been laid off due to downsizing associated with lower commodity prices.
Ben has been unable to find employment in town as a result of the economic downturn associated with the ongoing drought in the area. As a result, Ben has had to move back to the family farm with his parents. The farm is located 25km from Westtown and the nearest neighbours are 5km away.
Ben is used to having a close network of friends and has enjoyed living in town particularly socialising with old friends and with the younger members of the mining workforce. Ben likes to unwind with a 'few beers' at the end of the week which he used to relieve the stress and 'help him forget about his problems'. Ben is finding that the amount of alcohol he is consuming during these sessions and the frequency with which he is drinking alcohol is increasing since he was laid off at the mine.
He is reluctant to move back to the farm as all of his siblings have moved away and he has a tenuous relationship with his father (Doug) who is himself struggling with the psychological impacts of the drought. Doug has low health literacy in relation to the benefits of psychological therapy (or a willingness to engage the same). His attitude has always been to 'toughen up and get on with it'. Ben has a good relationship with his mother (Mary) although she is a reserved character who doesn't like conflict and tends to not discuss these issues for fear of Ben or Doug getting upset.
Ben has been receiving psychological treatment focused on cognitive behavioural therapy for several years with good effect. He has a high level of health literacy in relation to these practices and to date he has been happy to engage as he has found it very beneficial.
That said, events over the last 6 months have led to him feeling increasingly depressed. Ben has commenced treatment with a local psychologist in addition to the regular monthly psychiatrist appointments. Despite this, his depression has continued to escalate over the last few months and at his most recent psychiatrist appointment his specialist suggested he commence medication to help control his depression.
Apart from the psychological strategies Ben uses to deal with his PTSD and depression he finds exercise very useful in managing his symptoms. Ben has a membership to one of the Gyms in town however has not been attending regularly lately due to his back discomfort. Now that he is back living with his parents the distance makes it difficult to attend regular.
Task
- Discuss the elements of Ben's medical history that contribute in him being classified as medically complex.
- Consider Ben's situational complexity. Identify and discuss how these factors may create barriers to Nursing management.
- A diagnosis of more than one medical condition (multimorbidity) is a well-documented barrier to effective care delivery. Provide a brief discussion relating to how multimorbidity impact diagnosis and treatment for complex patients.
- Refer to the nursing care management plan for Ben. Identify and discuss any conflicting treatment or management elements of this plan.