Case study on Garry
International classification of function (ICF) entails a group of components that stipulate the functioning of disabled as revised by WHO. It deals with the functioning of the body and its structure, the contribution and participation in various tasks and other environmental factors that the handicapped face in their daily activities so that they can come in terms with their condition. ICF takes in consideration such people have to adapt and accept themselves in their new conditions and that they suffer from inferiority complex (Journal 1. Stucki, G. Ewert, T & Cieza, A. 2002) as Value and application of the ICF in rehabilitation medicine: Disability and Rehabilitation states volume 10, (1) 932-938. This means of treatment is advantageous in that it helps to integrate both health and social aspects in treatment. In the case of Garry together with receiving treatment for his brain’s injury he receives social support from both his immediate and extended family.
He is also seen to have a conducive environment where with the family is understanding though he is highly temperament; they have done a diagnosis of his ability since he is seen to work in a machinery shed situated beside their home. This has brought about environmental changes with the brother installing him an airlift since he cannot manage to access some rooms found ten steps ahead in their house such as the bedroom and the bathroom. The aspect of ICF has enabled Garry to be realistic about his current change making it easier for him to adapt though he has faced problems such as dementia and petulance (Journal 2. Ustun, B. Chatterji, S. Bickenbach, J. Kostanjsek, N. and Schneider, M. 2003) The international classification of Functioning, Disability and Health: A new tool for understanding disability and health in Disability and Rehabilitation health states volume 25, 565-571. Though this being the case he needs company so that he does not feel estranged and lacks to communicate enhancing his ability to participate in teamwork activities. This explains the reason why he is highly irritable since he feels as a mockery of the people and does not have enough self esteem.
ICF gives an integrative understanding of the condition an individual is going through other than diverting his attention to the predicament one is experiencing. This is seen by his assessment of how far he can walk before getting fatigue. This shows that his ability to fully accept himself will primarily be dependent on his environment to reduce the impacts which the accident caused him and hence will advance his way of living. ICF has also helped Garry understand his impairments in that he has a damage at the right parietal and frontal robe, quite often fall short of memory, can not do heavy manual activities, is unable to drive and walk for long distances due to his continued body weakness. With these limitations he has continually gotten restrictions to the usual farming he used to do, his ability to walk, play rugby and also his hobby to spend time and help the destitute have been laid off. With this realization he has to fight with these external factors and also the internal factors of not being able to recall, his high temper and also his restriction to work due to his body malaise. In this case he will be following the basic scheme of ICF management as stipulated by WHO ( Journal 3.Heerkens, J. Yvonne, A. Hendricks, D. Erik, C. Ooostendorp, B. & Rob, T., 2006) Assessment instruments and the ICF in rehabilitation and physiotherapy in medical rehabilitation states Volume 10 (3)1-7. Below is an image representing the how the whole process as conducted to help Garry to accept himself with his current condition as explained above (Journal 4.Ustun, B. Chatterji, S. Bickenbach, J. Kostanjsek, N. and Schneider, M. 2003) The international classification of Functioning, Disability and Health: A new tool for understanding disability and health in Disability and Rehabilitation health states volume 25, 565-571.
Figure 1: Scheme on how to conduct ICF.
This method of treatment however has some shortcomings according to this case since there is no clear cut line that measures how much the patient has improved or what effect this kind of treatment has had on him. This is due to concern of his high temperament and irritability. His fast exhaustive nature also acts as a setback not giving him room to work on his ability; he is also shown to be less antisocial with no indications of him mingling with his friends and loved ones though they have provided him with the basic need and support. This would perhaps mitigate his problems of not being of poor memory; reduced duration of concentration and his ability to control his temper. These personal and environmental factors are bound to help him participate in community activities which will directly affect his ability to recover and self esteem. In spite of all these shortcomings he is seen to have a positive attitude towards work by his self discipline while working with machineries beside their house and his exercise while walking despite his fast weariness.
Progress on his realization of goals
According to Gordon’s functional patterns (Book 1. Gordon Marjorie 2002) states the ability for Garry to pursue a TAFE course in farm management shows that his health perception is sound. This is because he will have recovered his strength and control of his brain giving a larger span of concentration thus increased self and environmental perception. This will primarily help him in coping with stress and also being tolerant thus reducing his high temper. He is also able to exercise with his anticipation to join his former rugby club ‘Bushies’. He is seen to have sufficient energy to take a shower by himself; this shows that he is gaining cognitive- perpetual since he can make decisions and set goals by himself. This will help cope with stress and in preventing dejection and perhaps teach him to control his temper. The ability to shower by himself falls under the ability to exercise since he will have regained enough strength and will reduce the cost of the nurse who we are told comes to help him do it thrice a week.
These three anticipations have a degree of being impractical since the first one that involves his anticipation to work as a farm manager on completing his Technical and Further Education (TAFE) course is not possible. In the first place completing the course will be difficult due to his dementia and short attention span thus will mostly fail any test given and not sustain the pressure of reading since he gets tired very fast. Considering his ability to get aggravated fast he will not be ready to accept rebuking from his teacher and the highest probability is he will not fit in the class since we are told he is quite antisocial. The probability of him attending classes on time will be low since he cannot drive and can neither walk for long distances. His ability to be high tempered, memory loss and disability to walk long distances will reduce his competence as a farm manager since he ought’s to enforce policies and manage finances of the farm among other tasks. Joining ‘Bushies’ will also be unrealistic since not only is it a health hazard that can cause further injury he would also not fit due to his physical condition, he can only walk with a stick and his left side of his body is very weak thus can not run a skill required in rugby. His fatigue within a short duration and high temper are against the ethics of rugby playing. However bathing himself is quite practical with frequent practice.
The three step procedure (Journal 5. Palese, A. Granzotto, G. Broll, T. and Carlesso, K. 2010) From health organization-centred standardization work process to a personhood-centred care process in an Italian nursing home: effectiveness on bowel elimination model in the International Journal of Older People Nursing, Volume 5, 178-189 to achieve the above goals are; assessment which entails Garry drawing a skeleton diagram with the help of his therapist listing his health problems which include damage of the of right parietal and frontal lobe of his brain accompanied with high irritability, short attention span, dementia and also ability to only walk short distances and get tired fast. This is meant to help access his weakness and how he can work them out to his advantage, he is also supposed to rhyme his abilities with the goals he has set. He is then supposed to formulate a plan to implement and develop the set goals. On completion of this step he should them be evaluated on his ability to proficiently do all the activities in his goals. This is however not supposed to be easy and he to requires the support of his family and therapist since it involves a lot of frustrations.
The intervention including a recognition therapy for Garry to enhance positive attitudes that these goals are achievable if there is determination as this will steer up his urge to do it is crucial. With the help of his therapist he is supposed to partition the goals to small steps and then create an action plan which he should strictly follow within a given time frame, evaluating any step before proceeding to the next is important. Support and a positive attitude from his loved ones will be needed for him to achieve his goals since at a young age of 31 he has so much to offer thus promoting self actualization for his goals, group counseling therapies will also help him know that they are others like him and enhance his skills to socialize (Journal 6.Kennedy, P. Evans, J. Berry, C. and Mullin. J. 2003) in the Comparative analysis of goal achievement during rehabilitation for older and younger adults with spinal cord injury. (International Spinal Cord Society, Volume 41, pp. 354-362). His family should be at the fore front to accept him as he is. This will be done to ensure that Garry receives a measure of independence irrespective of his condition boosting his buoyancy.
Impacts of paternalism on family relationships
Paternalism being the provision of needs one desires without attaching it to any responsibility is a controversial issue particularly if one is undergoing rehabilitation and was previously normal (Journal 7 Brewin, Thurstan, B. 1984) on Who Should Decide? Paternalism in Health Care in the Journal of Medical Ethics, Volume 10 (1) 148-151. As in the case of Garry her domiciliary nurse who should take care of her is following the ethics of ICF so that he can promote Garry to recover and be of use to the community and himself as this will help him to self actualize his dreams and boost his ability to work without getting tired. It is also meant to boost his self confidence with his ability to be functional and productive boosting a feeling of independence. However his brother Ian sees it from a different perspective since he wants what is best for (Journal 8.Garry Gallagher, 1998) Paternalism in healthcare decision making in Ostomy/ Wound Management, journal of medical ethics Volume 44, issue 4, 22-25). This however is deleterious for Garry since he will not remain reliant on his brother to provide him and his family considering he is married and has 3 young children under his care; further this is not encouraging him to face his disability and show he can still make it by doing some work. It is thus going to make him less unable to carry out his duties and when Ian is overburdened with the load of his brother it may lead to family quarrels and eventual disintegration of the family.
The family may not also sustain its needs for long considering they depend on farming and the fact that Garry is an added expense if he does not work. Ian emphasizes the fact that paternalism has not been completely abandoned in rehabilitative health of the handicapped (Book 2.Hann, Harlan. 1981 Disability and Rehabilitation Policy: s Paternalistic Neglect Really Benign? in the Noyes Medical Publication, 740-743). Ian is supposed to understand that the well experienced nurse must have borne witness to ICF principles working. Further he should understand that he is not in a position to decide if Garry is fit to work or not and rather it should be his own initiative. Since he has gone plans to undertake a course in TAFE and join his former rugby team to exercise and managing tasks around the home will help him achieve this. Paternalism will not promote the good effects of therapy on Garry since his ability to recover primarily depends on a joint effort of those around him and also his own effort and it will encourage dormancy leading to other diseases. The issue of paternalism also should be thus a joint effort of his nurse and him and his entire family since it advocates for autonomy (Journal 8. Thurstan, B. 1984) on Who Should Decide? Paternalism in Health Care in the Journal of Medical Ethics, Volume 10 (1) 148-151. On the other had Ian is taking in consideration his brother delicate condition since he has a high temper and gets tired fast thus is an action of safeguarding him. This definitely shows a conflict of opinions which if not solved by continued discussion of the three parties the family, Garry and the nurse to come to a consensus may cost them a sharp division, a family breakup or a further injury to Garry which may result to his death. This will help give a decree on the degree of autonomy Garry should have enhancing a communal participation in the treatment (Journal 9. Moskop, J. & John. C. 1983) in Competence Paternalism and Public Policy for mentally retarded people. (Reidel Publishing Company, Volume 4, (3), 334-341.
Bibliography
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http://www.scribd.com/doc/24159742/Gordon%E2%80%99s-Functional-Health-Patterns
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