CASE STUDY THE GERAINT FAMILY Richard Geraint is a 42-year-old

CASE STUDY THE GERAINT FAMILY Richard Geraint is a 42-year-old man living in Torrington, a small village about 170 km from Armidale in the Northern Tablelands of NSW. Richard is married to Maureen (age 37 years). Richard and Maureen have 5 children. Jason (21 years) is the eldest, followed by Jill (19 years), Jenny (17 years), Jack (15 years) and Jessica (14 years). • Jill is first in the family to go to University and is studying social work. • Jenny works part-time with a veterinarian, as part of an agribusiness located in Glen Innes, 60 km from home. • Jack and Jessica are in high school and have a one hour bus trip daily to Glen Innes. Maureen works at the Woolworths at Glen Innes but unfortunately her shifts do not often match Jack and Jessica’s school hours. Richard has worked at the local sawmill all his life. He became the foreman about 6 years ago when his predecessor retired but worried about the long-term prospects for work. The sawmill employs 12 people, but in its heyday, it had 60. In those days, the village had 1000 residents and a large school that was a combined primary and high school and thriving commercial sector. As the timber industry gradually declined, so did the village population. Presently, there is only a general store/café/petrol outlet as well as the hotel, which is struggling to keep its doors open. Jason did not like schoolwork but loved sports and was good at rugby league, cricket, athletics, horse riding and just about any other sporting activity. He announced to his parents at barely age 16 that he was quitting school to work full time. Jason had already been working part-time on Saturday mornings and school holidays as a labourer in the sawmill. When he started full time work at the sawmill, he seemed much happier. He started going out with Penny, whose parents own a beef cattle property. Penny is at boarding school, and her parents want her to go on to university after finishing school at the end of the year. She loves the outdoors and she and Jason enjoy bushwalking, camping and playing many sports. JASON HAS AN ACCIDENT Jason was driving home with his dad in the car when a car coming the other way overtook a semi-trailer. This car lost control and side-swiped Jason and Richard’s vehicle before colliding with a tree. Jason swerved to avoid the oncoming vehicle, lost control, and collided with the semi-trailer. The truck then left the road, hitting a tree head-on. The Police, Ambulance, SES, and Fire Service all attended the accident. It took nearly an hour for them to arrive from Glen Innes. Both Richard and Jason had to be cut out of the car wreck. There was concern that the car could ignite due to spilled fuel during the rescue. It was a chaotic scene with Jason unconscious and very badly injured. His father was screaming in pain and also distraught about his son. As it was a rural road, an air ambulance was the quickest on the scene. Jason, who was more seriously injured, was flown to the Armidale Hospital with a doctor and nurse on board. Richard was transported to the same hospital via road ambulance. The truck driver was also critically injured and was transported to the hospital by road ambulance. Upon arrival at Armidale Hospital Jason was attended to by the Emergency Department (ED) staff. Jason’s right arm was almost severed, he had a broken pelvis and both legs were fractured. Jason had internal bleeding along with multiple lacerations and minor injuries to his face and head. He was unconscious and there was uncertainty whether he had a brain injury. Richard arrived at the Armidale Hospital about an hour later; he was also severely injured but conscious. His right tibia (lower leg) was fractured. He has internal bleeding, broken ribs, a suspected spinal injury and a full-thickness laceration on his scalp. The truck driver, Jim, arrived around the same time as Richard and had a severe injury to his chest from hitting the steering wheel, internal injuries as well as a possible fractured neck. The ED team triaged Jason and addressed the most immediate life-threatening injuries. He was sent for radiography and medical imaging of his injuries. He is assessed as being in critical condition. The decision is made to urgently transfer Jason to a larger hospital, the doctors decide that the John Hunter Hospital at Newcastle is the appropriate place for Jason’s ongoing trauma care. Richard and Jim are both assessed as medically serious but stable, can remain in Armidale and are admitted into the Armidale Intensive Care Unit (ICU). The Geraint family is notified of the accident and that Richard and Jason are at the Armidale Hospital. They are informed that Jason is being prepared for retrieval to the much larger John Hunter Hospital nearly 400 km away due to the nature of his trauma, and that the hospital social worker will meet the family at Armidale hospital upon their arrival. JASON IS TRANSFERRED TO GLENAURIE Jason is transferred overnight to the ICU at John Hunter Hospital, and he is still unconscious on arrival. You are a healthcare professional at John Hunter Hospital ICU. When you start work, you are advised that Jason is a new admission via an inter-hospital transfer from Armidale Hospital, where he received initial treatment following a motor vehicle accident. You examine the medical records and become aware that Jason and his father were involved in the accident. Jason’s father remains in a serious condition at Armidale with significant trauma. At the morning ’rounds’ with the ICU team you are acquainted with Jason’s medical condition. You see that there are ongoing investigations to determine the precise extent of his injuries. Jason’s injuries include: • Fractured skull • Subdural haematoma and significant swelling on the brain • Catastrophic trauma to the right arm • Ruptured spleen • Bruised kidney • Minor fractures of the left hand and fingers, He has continued Loss of consciousness and is breathing with the support of a ventilator. The most serious is the head injury, requiring an immediate operation to relieve swelling on the brain, the swelling likely resulting in an acquired brain injury of yet indeterminate impact. In addition, the injuries to his right arm reveal that injuries are so serious that the arm cannot be repaired. The decision is made to amputate the arm, to alleviate further complications such as significant infection and further delay Jasons recovery pathway. Maureen and the children regularly visit Richard in the Armidale Hospital. They are trying to organise one family member to travel to John Hunter Hospital to be with Jason. However, they find that getting information from the ICU staff over the phone is difficult, if not impossible. Although some of the doctors and nurses have tried ringing Maureen’s mobile phone she is cannot receive the calls when she is at work. Her employer is supportive, but there are rules against staff carrying their mobiles, so all she is getting is short messages. She has tried to talk to the Armidale Hospital social workers. However, she has found that they not often in their office but are instead in other parts of the hospital attending to other patients and their families. Money is very tight for the family. Although the accident occurred during their return from work which is covered by the WorkCover NSW scheme, there are nonetheless considerable delays accessing payment as there are a many forms to be completed. Maureen makes a decision to go to see the social worker in the Armidale Hospital about her situation. She is worried about her son and has been finding it hard to sleep. JASON’S SURGERY AND RECOVERY The Armidale Hospital social worker contacts the social worker at John Hunter Hospital about Jason Geraint. The two social workers work together to see what assistance is available to Jason’s mother Maureen for travel to Newcastle to be with her son. They identify the Isolated Patient’s Travel Assistance Scheme (IPTAS) run by EnableNSW to see whether it will help non-patients who have travel away to be with an ill or injured loved one in a NSW Health hospital. A week passes, and Jason has several operations to address the swelling on his brain, including a shunt to release fluid. His right arm is amputated, and some work is done on his internal injuries. He is a young man and recovers from these quickly, and he regains consciousness. However, he is nonetheless suffering from the impacts of his injuries. He is in pain, and his acquired brain injury is leaving him confused and dazed. Jason is transferred to the John Hunter Hospital Orthopaedic Ward from the ICU. He is most pleased to see that his mother is there to stay for a while but remains confused and disorientated. Over the next two months he begins the long journey for his recovery and rehabilitation. A variety of healthcare professionals are engaged in this healing process. Over time Jason receives help from the physiotherapists regarding his physical injuries and physical movement. Speech therapists work with him on re-learning to talk. He also sees a clinical psychologist who assists with determining the extent of his mental impairment. An occupational therapist assesses his injuries and likely rehabilitation requirements. Pharmacists are closely involved with his medication and the possible side effects and reactions when different drugs are combined. Dieticians work on his food intake to make sure that he is eating healthily. For Jason, their work has been truly lifesaving. However, as he prepares to be discharged from hospital, his journey to recovery has only started. QUESTIONS (a) Identify and justify with examples, and critically analyze four social determinants of health that will impact on the Geraint family as Jason recovers from his accident. (b) Critically analyse how your 4 selected social determinants of health will impact on the Geraint family as Jason recovers from his accident (c) Present the findings in essay format. Use academic tone and language, and APA 7th edition referencing style including in-text citations and References list

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