PowerPoint presentation to analyze a specific ethical dilemma faced by

Based on the case study below: What factors do medical social workers need to consider to promote just experiences for their patients? Use an example from one of the case studies you examined previously in the course to support your perspective. What does anti oppressive practice look like in a system that is highly regulated and prescriptive? Use another example from case studies you examined previously in the course to support your perspective. How do you plan to apply your knowledge and skills to better serve vulnerable populations in your future work? What additional skills, knowledge, or resources do you need to achieve these goals? Case study of Phyllis Robinson Phyllis Robinson (a pseudonym) was a 78-year-old Black female who was born and raised in a middle-class, Christian family in New York City. She was a retired educator with a master’s degree in educational leadership who spent her career teaching at an independent day school in the city. She maintained a home in NY but was visiting her daughter in Delaware for the Thanksgiving holiday when she experienced shortness of breath and shooting pain around her rib cage. Her daughter Janice rushed her to the hospital emergency department where a comprehensive workup revealed metastatic cancer of unknown primary origin with evident lung lesions. When her mother had arrived for the holiday visit, Janice noticed that Phyllis seemed thinner and weaker, however she attributed this to the isolation and resultant depression imposed by COVID-19 lockdowns. Phyllis was admitted to the hospital for management of dyspnea (shortness of breath) and further workup, and ultimately was given a terminal prognosis of “days to weeks” and referred to the hospital’s inpatient hospice center for ongoing symptom stabilization. Phyllis had divorced Janice’s father when their daughter was in junior high school. Phyllis had remained single since then which suited her fiercely independent personality. Janice had been born into a lineage of family caregivers and watched as Phyllis cared for her own mother at the end of life. Having grown up with this experience helped Janice to embrace being both a daughter and a caregiver, though not without some hesitation. One major source of anxiety for Janice was the heavy responsibility of healthcare decision-making for her mother during times when Phyllis was too consumed by pain or foggy from dyspnea. Under Title 16 of the Delaware Code, important healthcare decisions default to a surrogate decision maker when a patient is deemed to lack capacity. Prior to this hospitalization, Phyllis had not discussed her care wishes with her daughter and had not completed an advanced healthcare directive. Thus, Janice was forced to make important decisions in a crisis situation which added to her apprehension. Upon learning about the hospice inpatient unit and feeling overwhelmed by the enormity of responsibility heaped upon her, Janice consented to having her mother admitted into the care of the hospice agency. This was the family’s first experience with hospice care and the fact that Phyllis was being transferred to an inpatient unit reinforced the misconception that hospice care is only delivered in a placed-based setting. Given all of the other information Janice was trying to wrap her mind around, she did not immediately understand that her mother might have to be discharged home at some point with home-based hospice care. A clinical liaison from the team informed Janice that the IPU was for “short-term symptom management” only, but she still did not realize what this meant. Janice thought of hospice as a place you go to die, and she had just signed her mother “into a hospice.” This decision also created a sense of guilt as she felt she was going against her fundamental values by turning her mother’s care over to a group of strangers. To be admitted to the hospice IPU, a patient must agree to “being a DNR,” (i.e., they must agree to a physician order instructing that if the patient’s heart stops, they do not desire resuscitation, and CPR will not be administered). Phyllis and Janice felt pressured to make this decision in the midst of adjusting to the recent terminal prognosis. Phyllis was faced with two choices: leave from the hospital with little support because there was “nothing more that could be done,” or approve admission to the hospice IPU for short-term symptom management and stabilization. Goals The primary goal of hospice is to provide each patient with their conception of a good death experience. Collectively, we hoped to support Phyllis’ autonomy to define a good death for herself, then to collaborate with the interdisciplinary team to help curate a plan of care that met with her definition. This “goals of care” conversation is usually facilitated by the HSW, and it centers each patient’s identity and helps them bridge the divide between who they were and who they can still be. Together, we considered Phyllis’ life experiences, skepticism about the healthcare system, and the multiple losses she had faced throughout her life. We explored what she understood about her prognosis and the implications of that prognosis on her care needs for the remainder of her life. Phyllis desperately longed to return home to New York. However, the acuity of her medical needs coupled with her extreme weakness and increasing disorientation rendered this impossible since she did not have a stable caregiving system in New York. With all her assumptions shattered, we collaborated with Phyllis and Janice to build a new hope for compassionate care and support during this time of agonizing loss.

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