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Stress Vulnerability Model: Case study on Chung

Case Study

Note: your student assessment work must focus on Chung, regardless of your status as a nursing or midwifery student.

Chung is a 35 years-old male who moved to Australia from China five years ago. His parents, older brother and younger sister still live in China. Chung visited his family in China once after a year of moving to Australia. He has not returned to China since, because of his long working hours and need to undertake additional study for promotion. Chung is a doctor working in Accident and Emergency in a busy inner-city hospital. He is studying for promo-tion to ultimately become an emergency medicine consultant. Two years ago, Chung was under investigation by the hospital Human Resources department due to a drug error. He was very tired and had been on-call over-night with frequent call outs to see patients. The drug error resulted in an eight year-old boy being very sick, requiring intensive care admission. Chung used an intra-muscular medication to treat the boy but administered it intravenously. Chung was subjected to several work-place and medical board investigations and placed on practice supervision for 12 months. Chung met his wife, Harriett, in Australia four years ago. Harriett is 30 years old. They married two years ago. Unfortunately, Chung's parents and family could not attend the wedding due to the high costs of travel and his mother has severe arthritis in her hips, making travel very difficult. Chung found their wedding day emotionally difficult. He felt the ceremony lacked reference to his Chinese culture. On reflection, he feels that he wasn't as involved in the wedding planning as he could have been, due to his long working hours. He simply agreed to the suggestions and plans made by Harriett and her family. Chung and Harriett now have a three week-old baby girl, Charlotte. Charlotte was born by caesarean section, due to birth complications. Harriett has had an infection in the operation site since the birth, resulting in lots of pain, frequent dressings and difficulties moving around. Chung was off work for one week after the baby's birth. However, he has now returned to working shifts, often working through the night, where he may go without sleep for 20 - 24 hours. Harriett's parents are staying with them to support Harriett while Chung is at work. However, he finds that Harriett's parents are very involved with baby care even when he is home. Given this, Chung finds he gets very little time and space to be with his new daughter. You are visiting the family in your capacity as a community nurse supporting Harriett with the caesarean section wound care or as a midwife undertaking a post-natal visit. During your visit to the family, you notice Chung looks flat in mood and tearful. His affect is sad and restrictive. He is slumped in his chair, with rounded shoulders and starring at the floor for long periods. You inquire about his health. He has very limited eye to eye contact with you. His speech is slowed and purposeful. On occasions, you need to repeat your question several times to get a reply. However, you do manage to obtain the following information from Chung. He has been feeling increasingly anxious during the past two months, given his continuing long hours, shift work, the high pressure of an Accident and Emergency department, Charlotte's birth and his wife's health. He has been having palpitations, chest pains and breathlessness for six to seven weeks. He asked a colleague at work, another doctor, to assess him for cardiac issues several weeks ago as he had been experiencing thoughts that he was going to have a heart attack and die. Chung has been feeling very low in mood for the past six weeks, experiencing sleeplessness, particularly initial insomnia and early morning wakening at 3am. He has lost five kilos in weight during the past month, due to reduced appetite and missing meals. He feels he is worthless and a failure at work within his medical role and he is letting his wife and new daughter down. He has been experiencing fleeting thoughts of suicide for the last week. He is aware of high lethality medications which he could take to overdose. Currently, he is hopeless and helpless and wants to die. He states he feels his situation is self-imposed and that treatments will not be of help at this time.

Question:

Critically discuss two factors that have contributed to the development of the client's current mental health status. You should demonstrate your knowledge of the Stress vulnerability model.  

Answer


Case Study Assessment

In a given case, it is found that Chung is under heavy stress due to increasing work responsibilities and also additional family responsibilities, which he is not able to fulfill as per his expectations. The given case describes that Chung is living in Australia for the last five years. His parents, older brother and younger sister still live in China. He has visited China only once during this period as he is focusing on his study for promoting. 

He is working as a doctor assistant in Accident and Emergency in a busy inter-city hospital. However, he faced one of the major issues when he prescribed wrong drug to a young child of eight years old. The boy was required to be immediately admitted to the hospital; there were several investigations made on Chung regarding this issue. 

Further, on a similar note, he married to Harriett in Australia four years ago and today they have three-week old young baby girl named Charlotte. However, Chung felt that his marriage did not reflect the Chinese culture as he was not able to share his inputs in the preparations. Further, his parents and other relatives were not able to attend the marriage due to high travelling costs and medical issues of his family.

In the present situation, Chung is heavily occupied in his workplace to such an extent that he is working for nearly 20-24 hours. He is not able to sleep properly, not able to take meals on time, and also not able to spend time properly with his family. He lacks motivation to live the life and seems completely worthless. 

His failure at the medical role and his inappropriate approach to take care of his family is depressing him further in given circumstances. He feels that his situation is self-imposed and he is experiencing fleeting thoughts such as of suicide. Under given cases, it is important to analyze this case from the Stress Vulnerability Model perspective. 

As per this model, there are different factors that can effect on the biological vulnerability of an individual, which can further lead to stress among the individual. In a given case, the two major factors that are leading to such an issue include - lack of social support from both the families and heavy working stress in given working conditions (Addington, Piskulic, & Marshall, 2010). 

He is thereby not able to cope up with those issues and subsequently lacks motivation to live a normal life. He has several expectations such as to become an efficient doctor, to take care of his family in China, and to look after his wife and new-born daughter and spend quality time with them. He wants to improve this present life conditions by overcoming the present challenges and thereby deploying coping strategies through which he can cope with these issues (Jobe & Harrow, 2010). 

It is important for the medical professional to understand each and every factor in greater detail and first motivate him to live the life. He needs to have support of both the families so that his emotional quotient can increase and he will be able to overcome the stated challenges in this case. Further, he needs to change his work organization and find another similar organization that can reduce his work stress at the workplace (Alloy & Abramson, 2010). 

He further needs to focus on his meals and sleeping habits and ensure that both are taken properly and on time. Only then he will be able to overcome with these challenges and live a peaceful life as per these expectations. The role of the parents and his wife are important as they will be working as important supporting members in this case. The healthcare professional needs to inform them and suggest them to consult with Chung and help him to come out of this situation. It is important to reduce stress in such situations to help Chung overcome his problems and subsequently assist him to live a better life. 

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