n preparation for this case study, please take a few

n preparation for this case study, please take a few moments to play the Syrian Journey serious game: https://www.gamesforchange.org/game/syrian-journey/Links to an external site. 36 yo female Amira Mohamed is a Syrian refugee. She arrived in Canada with her 5-year-old daughter 3 months ago. She and her daughter survived an illegal chlorine gas bombing by the Syrian government in a suburb of Damascus in 2018, in which her husband and infant son were killed. Following the bombing, which destroyed her neighbourhood, Amira made her way with her daughter to a refugee camp in Turkey, where she lived for 3 years. At the time of the bombing, Amira was taken to hospital and diagnosed with pulmonary edema from inhalation of the gas. She was critically ill but recovered from this initial episode. Over the last 3 years in the refugee camp she experienced episodic SOB, increasing in frequency. Because of the limited resources in the camp, she was not able to access medical treatment, either for herself or her daughter. She speaks very limited English and a translation service was used in the ER, but has not been used since arrival on your unit. Amira has been admitted to your unit for investigation of increasing SOB over the last 7 days. Admission X-ray reveals lung scarring likely attributable to her inhalation of chlorine gas. She has been admitted for further investigation of her increasing shortness of breath. While afebrile in admission, she was slightly tachypneic (RR 22) with a SaO2 95% on room air. Vital signs are otherwise stable. Repeated chest x-rays suggest right lower lobe pneumonia for which she is ordered IV antibiotics. 15 min into the infusion of Unasyn 1.5g IV, she rings the bell to indicate she is itchy all over. You observed that she is rubbing her mouth as she states “mouth is itchy”. You call for help and you and the team engage in life-saving intervention for suspected anaphylactic reaction to antibiotics. Approximately 10 minutes into the treatment, Amira becomes even more SOB and tries to climb out of bed. As the physician moves toward her to stop her, Amira screams and looks panicked. The physician instead has a female nurse move to assist Amira, indicating that “none of us know what she experienced in war and in the camp as a woman”. Amira is successfully treated for her anaphylactic reaction and spends 24 hours on a step-down unit. When she is transferred back to your care the following day, she is accompanied by a friend who speaks English. Amira recognizes you and reaches for your hand, sadly smiling. You ask through her friend how Amira is now feeling, and she says “breathing much better” before she buries her face in her hands crying. Her friend shares with you that during the anaphylactic reaction, she felt as though she was suffocating and it brought back the chlorine bombing where her husband and son died and where she almost died. Her friend looks to Amira questioningly and Amira nods. Her friend shares “everything else flooded back for her… all of the viciousness, the brutality she experienced that the enemy uses against women, but she shared with no one, not even her husband” *Reminder: As you reflect on this case study consider using John’s model of reflection before answering the question* Reflective Questions: What stands out for you from this case study? Consider the basis of Peplau’s Theory and Trauma Informed Care. How are both relevant to the care of Amira? Peplau’s theory is often used in the context of mental health, but Amira is admitted to a medical unit. Does that mean you should consider using another theory instead? Johnsmodelofreflection.pdf

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