Critical Appraisal Practice Part II Assignment Purpose: Practice appraising the

The Case of Wohali Wohali is a 38 year old Native American male. He self identifies as a Cherokee Indian and reports growing up in a traditional Cherokee Indian home. Wohali recently suffered a stroke as result of uncontrolled blood pressure and diabetes. In addition, Wohali tested positive for heroin. Wohali is currently unemployed, uninsured, and has no monetary income. Wohali reports that he has struggled to maintain steady employment since leaving Cherokee, North Carolina. Wohali was born and raised in Cherokee North Carolina and at the age of 21 started working at the Harrah’s Cherokee Casino and Hotel. Wohali reported that he wanted to do “more” with his life so he decided to quit his job and move to TN. Wohali stated that he moved to TN approximately 6 years ago and that he has had nothing but “bad luck” since being in TN. Wohali reported that he moved here to be with his girlfriend (Lisa), whom he met online, and because he want to do “more” with his life. Wohali futher reported that his relationship with Lisa did not last although he has remained close friends with her. Wohali states that he was once married and that he and his ex-wife have two children, a son (10 y/o) and a daughter (8 y/o). He reports that he has not had any contact with them since moving to TN because his ex-wife refuses to accept his calls. Wohali further explains that he has not had contact with his family in Cherokee North Carolina because he does not feel that he will be well received by them because he is “such a disappointment”. Wohali reports that he did not know that his blood pressure was high, and he has no idea what “hypertension” is or means. He also states that he is not familiar with diabetes although he thinks that he knows what it is because he remembers his grandmother healing herself of diabetes when he was younger. Wohali has not had a physical nor has he been to a medical professional since he was teenager. Wohali states that he does not “like” doctors and that whenever he would go to the doctor as a child “they treated him like he was weird”. Wohali also reports that if he wanted to go to the doctor as an adult he could not afford to go the doctor, because he has never had health insurance as an adult. Wohali admits to using heroin and states that he has been using heroin for approximately two years, and that he used heroin occasionally when he lived in North Carolina. Wohali further reports that he attempted drug and alcohol counseling through his previous employer’s EPA program although treatment was not successful. Wohali insists that due to his strenuous work schedule and the need to hide the counseling from his family and friends he was not able to attend counseling as needed. Wohali reported that Harrah’s Cherokee Casino and Hotel has a strict point system, for missing days, and that he could not afford to “point out” (get fired), therefore he gave up on the counseling and figured that he could “heal” himself of the heroine and alcohol use. Wohali’s future is very uncertain. He is currently residing at an extended stay hotel in TN that is paid through the end of next week. Although, he does not understand his diagnosis of hypertension and diabetes, and he will not able to afford his medications due to being uninsured and having no monetary income; in addition he is currently not eligible for substance abuse treatment as a result of being uninsured. You are the healthcare/medical social worker assigned to work with Wohali. He is scheduled for discharge from the hospital in 2-3 days. Introduces the purpose of the assignment—to identify, assess, and apply appropriate practice knowledge to assist with interventions to support clients impacted various psychosocial issues and cultural beliefs of health and healthcare. 1. Describe what factors/issues are evident as it relates to assessing this patient (Wohali) from a biopsychosocial- spiritual perspective. Thoroughly evaluate the identified factors/issues and identify how those factors/issues impact the patient’s decision making. 2. Describe what other theories may be applicable in assessing this patient (i.e. Eric Erikson’s Theory of Human Development). 3. Identify what basic medical knowledge the medical social worker will need to have as it relates to hypertension and diabetes. Thoroughly explain why this medical knowledge is necessary. 4. Use the Behavioral Model for Vulnerable Populations to assess Wohali’s health behavior as it relates to larger systems and to address the impact of determinants of health service use such as (demographics, health beliefs and attitudes, insurance coverage, social support, income, healthcare policy and resources, and customer satisfaction) on Wohali and his health outcomes. 5. Identify the most appropriate strategy/intervention for Wohali and thoroughly explain how this strategy/intervention will be utilized with him. 6. Identify the most appropriate strategies/interventions to address the public health issues associated with hypertension, diabetes, and substance abuse. Thoroughly explain how the strategies/interventions will improve public health outcomes and reduce associated disparities. 7.Identifies how the NASW Code of Ethics and NASW Standards for Practice in Healthcare will be used to guide the medical social. Provide all sources that require citations and in-text citations.

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