A Meeting Of An Interdisciplinary Team Paula Has Just Been I ✓ Solved

A Meeting of an Interdisciplinary Team Paula has just been involuntarily

A Meeting of an Interdisciplinary Team Paula has just been involuntarily hospitalized and placed on the psychiatric unit, for a minimum of 72 hours, for observation. Paula was deemed a suicidal risk after an assessment was completed by the social worker. The social worker observed that Paula appeared to be rapidly decompensating, potentially placing herself and her pregnancy at risk. Paula just recently announced to the social worker that she is pregnant. She has been unsure whether she wanted to continue the pregnancy or terminate.

Paula also told the social worker she is fearful of the father of the baby, and she is convinced he will try to hurt her. He has started to harass, stalk, and threaten her at all hours of the day. Paula began to exhibit increased paranoia and reported she started smoking again to calm her nerves. She also stated she stopped taking her psychiatric medications and has been skipping some of her HIV medications. The following is an interdisciplinary team meeting being held in a conference room at the hospital.

Several members of Paula’s team (HIV doctor, psychiatrist, social worker, and OB nurse) have gathered to discuss the precipitating factors to this hospitalization. The intent is to craft a plan of action to address Paula's noncompliance with her medications, increased paranoia, and the pregnancy.

Physician Physician Dialogue 1 Paula is a complicated patient, and she presents with a complicated situation. She is HIV positive, has Hepatitis C, and multiple foot ulcers that can be debilitating at times. Paula has always been inconsistent with her HIV meds—no matter how often I explain the need for consistent compliance in order to maintain her health.

Paula has exhibited a lack of insight into her medical conditions and the need to follow instructions. Frankly, I was astonished and frustrated when she stopped her wound care treatments and started to use chamomile tea on her foot ulcers. Even though we have educated her to the negative consequences of stopping her meds, and trying alternative medications instead, she continues to do so.

Psychiatrist Dialogue 1 As Paula’s psychiatrist for close to 10 years, I have followed her progress in and out of the hospital for quite a while—and I know her very well. She is often non-compliant with her medications, randomly stopping them after she reports she doesn’t like the way they make her feel.

She has been hospitalized to stabilize her medications several times over the last 10 years, although she has managed to stay out of the psychiatric unit for the last three. Recently, she had seemed to appreciate the benefits of taking her medications and her compliance has much improved. She had been seeing her social worker regularly, and her overall mental health and physical health were improving.

This has changed recently, after several stressful life events. We learned that Paula was pregnant by a man she met briefly at a local flower shop. She also reports he has been harassing her with threatening phone calls and unwarranted visits to her home. Paula disclosed to the social worker that she was neither eating nor taking her medication—and she had not gotten out of bed for days. Her decompensation was rapid and extremely worrisome and, therefore, called for a 72-hour hold.

OB Nurse Dialogue 1 I have not known the patient long, but it does appear that she is trying her best to deal with a very difficult situation. Pregnancies are stressful times for even the healthiest of women. For Paula to learn she is pregnant at 43—in addition to her HIV and Hepatitis status and her bipolar diagnosis—must be so overwhelming.

Adding to this, she has come to her two appointments alone and stated she has no one to bring along with her. When I inquired about the father of the child, she said he’s a bad man and he won’t leave her alone. She seemed truly frightened of him and appears convinced he will hurt her.

Social Worker Dialogue 1 When Paula came to me and told me she was pregnant, I was indeed shocked by this announcement. She had never mentioned dating anyone, and with her multiple medical and psychiatric issues, I never thought this would be an issue we would address.

Paula and I have developed a strong working relationship over the last two years, and she has shared many private emotions and thoughts. This relationship has been tested, though, since I suggested she be admitted to the hospital. Paula was furious with me, accusing me of locking her up and not helping her. It will take time to repair our working relationship.

Once I rebuild that rapport, we will need to work together to find a way to address all of her concerns. We will need a plan that will address her medical needs, her psychiatric needs, and the needs of her unborn child.

Paper For Above Instructions

Paula's case is emblematic of the intricate intersection of mental health, medical complications, and the challenges posed by intimate partner violence. This interdisciplinary team meeting elucidates the need for a coordinated approach to manage her acute psychiatric needs while addressing her complex medical history and pregnancy. The following sections will explore the various dimensions affecting Paula's care, challenges in treatment compliance, implications of her pregnancy, and the strategies her care team must consider moving forward.

Understanding Paula's Mental Health Challenges

Paula's history of bipolar disorder and the recent decompensation underscore the necessity for ongoing psychiatric evaluations and adjustments to her treatment plan. The psychiatrist's insights reveal a pattern of non-compliance that has persisted over a decade. The changes in her mental state following stressful life events, particularly the revelation of her pregnancy and subsequent threats from the baby's father, have exacerbated her condition. Addressing her fear and the implications of being a victim of potential domestic violence is critical. According to the American Psychiatric Association (2013), untreated mental illness can severely undermine a patient's coping mechanisms, leading to chaotic lifestyles and increased risk of harm.

Impact of Noncompliance with Medications

Noncompliance poses a significant challenge in managing Paula's health, both mentally and physically. The physician's concern over her lack of adherence to HIV medication, alongside her psychiatric treatments, creates a precarious situation for her health. The World Health Organization (2003) emphasizes that consistent medication adherence is vital for individuals with chronic conditions, especially those like Paula, whose health is interconnected with fear and mental health crises.

In Paula's case, alternative treatments, such as chamomile tea for her wounds, exhibit her struggle to find control over her condition but simultaneously highlight a lack of understanding of the seriousness of her ailments. Collaborative education efforts are necessary, aiming to foster insight into the importance of medication compliance and the risks associated with her chronic health conditions.

Considerations of Pregnancy in High-Risk Populations

Paula’s unexpected pregnancy complicates her treatment significantly, particularly at her advanced maternal age and medical history. The obstetric nurse's observations about the physical and emotional stress of a pregnancy under these conditions invite a thoughtful response from the healthcare team. Prenatal care must carefully consider Paula’s mental health, potential exposure to domestic violence, and the well-being of the fetus. Research indicates that women with HIV who become pregnant have increased risks of complications (Esposito et al., 2004). The care plan needs to include comprehensive prenatal care, psychiatric support, and strategies to mitigate potential violence from the father.

Addressing the Dangers of Domestic Violence

Paula's reported fear of the father of her baby presents a primary concern for her safety and well-being. The interdisciplinary team must prioritize creating a safety plan. The National Domestic Violence Hotline (2020) suggests that safety planning should be tailored to individual circumstances and needs, enabling victims to navigate potentially dangerous situations more effectively. This may include legal advocacy, emergency resources, and social support systems.

Furthermore, the social worker's commitment to rebuilding trust with Paula and addressing her multifaceted needs is crucial. As they work towards restoring the therapeutic alliance, they can incorporate additional support mechanisms, such as providing resources for domestic violence shelters and legal assistance.

Integrative Care Plan Development

In crafting a comprehensive care plan, the interdisciplinary team must incorporate input from all disciplines to facilitate a holistic approach. This includes ensuring consistent medication management, thoughtful medical oversight of her pregnancy, psychological intervention to stabilize her mental health, and proactive measures against intimate partner violence.

An effective care plan will integrate psychiatric treatment strategies while enhancing her support network. Patients exhibiting complex needs often benefit significantly from case management approaches that offer coordinated services (Chamberlain et al., 2008). The team may also consider employing motivational interviewing techniques to engage Paula in her treatment, fostering a collaborative process that encourages her compliance.

Conclusion

Paula's case highlights the complexities of caring for individuals facing the confluence of mental health disorders, chronic diseases, and domestic violence. The interdisciplinary team’s approach must be comprehensive and flexible, aligning with her evolving needs. As they convene to develop a robust care plan, the overarching goal remains to enhance Paula's safety, health, and long-term well-being, recognizing her right to make informed choices regarding her life and pregnancy.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
• Chamberlain, C., et al. (2008). A systematic review of healthcare interventions for people with multiple health and social care needs. Health Services and Outcomes Research Methodology, 8(1), 32-51.
• Esposito, A., et al. (2004). The impact of pregnancy on the progression of maternal HIV disease: A review. AIDS, 18(Suppl 2), S47-S54.
• National Domestic Violence Hotline. (2020). Safety planning. https://www.thehotline.org/resources/safety-planning/
• World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. Geneva, Switzerland: World Health Organization.