This assignment focuses on vignette analysis and direct application of course concepts to the persons and situations
Vignette Analysis I
This assignment focuses on vignette analysis and direct application of course concepts to the persons and situations presented in the vignette for each question. All discussions must take into account the legal and ethical considerations, as well as issues of culture and human diversity that may pertain to the situations presented below.
Use the reading assignments thoroughly in an integrative discussion. Remember to reference all work cited or quoted by the text authors. You should be doing this often in your responses
Please keep your responses focused on what is presented in the vignette. Do not add information but use your creativity to support what you see in the vignette as written. Avoid elaborations and assumptions. This assignment MUST be typed, double-spaced, in APA style, and must be written in graduate level English.
Your assignment should be 3-4 pages in length per vignette PLUS a title and reference page
Vignette One (3-4 page response)
Janie is a 42-year-old African American, wife of Jake, and mother of 12-year-old Stacy. Once a vibrant business office manager, Janie is now on disability and rarely leaves the house. She was diagnosed with major depressive disorder at age 20 when she reported feelings of worthlessness, fatigue, insomnia, and loss of concentration to doctor at her college health services. Janie stated that she had felt “blue and emotionally needy.” She had a relationship with a guy who “deceived me and physically and emotionally abused me for two years. I lost interest and respect for myself and others.” She was prescribed an antidepressant medication and referred to a counselor and support group.
Janie’s therapist stated that Janie’s depression is a chronic condition and Janie is at risk for recurrent episodes of depression. She asked Janie to identity triggers that might precipitate those episodes. Janie stated these triggers: (1) fear that I might return to my “lowest low” depression state, (2) anxiety that I want to spare my daughter the pains that I have endured, (3) periodic “sense of dread” for Stacy’s future in an uncertain world, and (4) wonder about what my “hormonal change” menopause will look like.
- How would you apply the “impaired-at-risk role” to Janie’s situation and chronic condition? Illness behavior is shaped by sociocultural and social-psychologic factors. What are demographic and past experiences that shape Janie’s illness behaviors? What are some examples of Janie’s statements to support your responses?
- Caring for a client with chronic illness requires a framework or model for practice that differs from that of caring for those with acute, episodic disease. Illness frameworks and models address the illness experience of the individual and family that occurs as a result of changing health status. How can you use the chronic illness and quality of life, the trajectory framework, and the shifting perspectives model of chronic illness with Janie and her family?
- Chronic illness is fraught with unpredictable dilemmas. Dependency in chronic illness may link with a sense of powerlessness. How can you incorporate strategies to decrease Janie’s/her family’s feelings of powerlessness? How do you think that Janie would describe self-management? How can her healthcare team foster Janie’s sense of order and other themes associated with self-management?
Vignette Two (3-4 page response)
Tom is a 62-year-old Italian-American man who was diagnosed with Diabetes Mellitus Type II about 10 years ago. He has chosen to live with little diet control, weight gain, weekly elevated blood sugars of over 300, sedentary lifestyle, and non-adherence to prescribed diabetes medications. He freely admits that this disease “gets in the way of my life.” “I like to eat whenever and whatever I please, especially while I watch TV. You know, finger-sticks and doctors’ visits are not in my game plan. Maybe all of that later.” Tom now faces increasing blood pressure, increasing vision problems, unrelenting skin ulcers that will not heal, and insulin therapy. His wife, Gilda, describes Tom as, “he’s always been self-indulgent and does what he wants regardless of the consequences. When we first met, he was smoking marijuana daily, but he grew out of that”. Gilda does not understand Tom’s decisions and says, “If I had diabetes, I’d take care of myself by eating well, exercising, and taking my medicines.”
- Use Stanton and Revenson’s five attributes of adjustment to conceptualize adjustment for Tom and his family. Discuss Engel’s Biopsychosocial Model in regard to Tom’s situation.
- Coping is a complex, multidimensional process. It is sensitive both to the environment and its demands and resources, to personality traits that influence the appraisal of stress (such as a chronic illness), and to resources for coping. Project how Tom, his family, and his support systems might use 4 of the 8 categories of coping skills that Moos and Holahan identify.
- Perhaps a blend of cognitive-behavioral, self-management, emotional intelligence, and self-help/support strategies might be helpful to the client and family’s adjustment/adaptation. How might you facilitate Tom’s cognitive processing of the implications and meaning of his condition(s)? Describe two interventions to address Tom’s coping effectiveness, individual-level change, self-efficacy, self-management, and decision-making. Suggest interventions to bridge the gap between Tom and Gilda’s thinking and approaches to adjustment/adaptation of living with Diabetes Mellitus Type II.
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