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10 May 2018 7 Respondents
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By Vanessa Peutherer
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DEBATE NURSING : PRACTICE CASE SCENARIO - "NO ENTRY" - VALUES SNAPSHOT

DEBATE NURSING : PRACTICE CASE SCENARIO - "NO ENTRY" - VALUES SNAPSHOT

Joanne, a 23yr old female was admitted to the Medical Assessment Unit 3 days ago due to ongoing vomiting and diarrhoea of unknown origin. She was deydrated on admission and reiceved intravenous fluid replacement as a result. All tests have found no cause for Joanna's symptoms and she has improved a little over the last 24 hours and is due to be discharged in the next day or two, once results of a stool sample have been received.

Although Joanne has capacity, she has some developmental delay and subsequent learning difficulties and appears immature for her age.

Joanne's long term boyfrend Adam has been attending the ward frequently and staying for long periods of time, sometimes out of routine visiting hours. You have noticed that when he is on the ward he tends to speak for Joanne and make her decisions for her. You have also witnessed him looking at her phone when Joanne has been aslepp and using what you percieve to be intimidating remarks to Joanne. Adam has verbalised remarks such as 'Wait till i get you home, you will have your work cut out then' and ' Are you sure you are not just trying to get out of the house work by being in here ?' and 'Hurry up and get bettter as the washing is piling up and no one is there to cook my tea.' He has also inferred to staff that Joanne is lazy and 'she probably poisened herself... to get out of her responsibilities.' Although this is said in jest, you are concerned that Adam displays little compassion and undermines Joanne's confidence frequently. This is evidenced further by Joannes posture and demeanour when Adam is around.  Joanne is also quite withdrawn and appears anxious whenever Adam is due to visit. She also rarely challenges Adam on remarks he makes.

Joanne doesnt receive any other visitors during her stay, from friends or family, and seems heavily dependent on Adam, who descibes Joanne's family as 'misfits' and Joanne is 'better off without them.' Joanne says she fell out with her family and some of her friends whilst living with Adam, because they didnt like him. She rationalises this by claiming they are probably jealous of her close relationship. Joanne gave up her job as a receptionist at her local GP surgery 3 months ago, in order to be a housewife, which Adam has encouraged. Joanne says she misses work but wants to be a perfect housewife for Adam who 'Works very hard.'

While assisiting Joanne to meet her fundamental needs of washing, you notice heavy bruising to upper leg area,  and upper arms of which Joanne quickly covers up, when she sees you have noticed. On questioning Joanne as to how she got these bruises she says that ' it is nothing, I fell on the stairs last week and I bruise easily.'

You are concerned about the bruising to Joanne's body and Adam's behaviour towards Joanne. Adam also seems in a rush to get her home as soon as possible and never strays far from her side. You are concerned that Adam is upsetting and distressing Joanne during his visits, as she often is tearful when he leaves. You have spoken to your team leader about your concerns and she disccusses with you whether it would be in Joanne's best interests to prevent Adam from coming on to the ward, in order to prevent further distress to Joanne and to try and gain more information from Joanne as to how she acquired her bruising. Joanne has not said that she wishes Adam to discontinue his visits stating that 'he loves me very much, he is only joking with his remarks' and when asked whether she would prefer him not to be allowed on to the ward, becomes very agitated and upset and says ' no, he must be able to visit, he will be upset if he cant.'

It is proposed that it is in Joanne's best interests for Adam to be prevented from entering the ward area, whilst the team further investigate the situation

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