Summary of Jenna’s Case
Jenna’s case highlights the relational nature of resource allocation and decision making thereof in the phase of complexity. The information contained in this section is exclusively drawn from Fraser et al (2010). The case manger, Rosie exemplifies the intricate relational experience as she tries to balance and weigh the interests of the family, Jenna’s condition and the reports from physicians and the care team in the hospital and at home. Although Jenna’s condition was not aggravated before the prognosis, the outcomes thereafter proved an uphill task and required the competence in relational ethics and, decision making and resource allocation proficiencies of the case manager, Rosie. Rosie was caught up in an intricate web of weighing and balancing existent and emerging issues. Jenna had to go home after 11 months’ stay in the hospital after the prognosis (Fraser et al., 2010).
However, the issue of home-based care was different from hospital care. A lot of resources were needed in terms of funding, time, understanding, commitment and tolerance. Resources in need were scarce including money and equipment. Time was also scarce for Martin and Becky, Jenna’s parents (Fraser et al., 2010). There were conflicting issues that would potentially juxtapose the case manager and others involved at crossroads and serious relational ethics dilemma. The story of Jenna as detailed below provides a salient picture of how complex, iterative and multi-dimensional resource allocation decision making is.
Essentially, Jenna’s medical condition is paraplegic. In an attempt to repair her scoliosis several years ago, Jenna who is 12 became paraplegic (Fraser et al., 2010). The scoliosis was secondary to a seldom disorder that causes tumors to grow around the myelin sheath on her spine. Her lower parts were paralyzed and the mobility of her upper body is limited (Fraser et al., 2010). She could however manage basic tasks including taking care of herself and communication. However, in 2006, Jenna developed complications and when she was hospitalized, the prognosis indicated abdominal sepsis. This led to her hospitalization. According to Fraser et al (2010), Jenna developed complete gastrectomy, tracheostomy, and mechanical ventilation. The prognosis was poor. Nevertheless, “she survived, attained a stable health status and was ready to go home” (Fraser et al., 2010, p.152).
It was important for her to go home because her condition had stabilized significantly despite the prior poor prognosis. She had also stayed in the hospital for 11 months and was thus ready to go home, having stabilized. She could also get home based care. Fraser et al (2010) however, do not give details about whether she went home eventually or not but asserts that there were many complex/difficult medical decisions that delayed her discharge several times. However, of importance is that there is a detailed coverage of the requirements and resources for going home as organized by the case manager, Rosie. Jenna needed several resources for her to go home. Her condition by the time she attained stability necessitated these resources. According to Fraser et al (2010), the care manager, Rosie had to make resource allocation decision making and improve relational terms with the family, physicians and other healthcare professionals dealing with Jenna’s case. This is why the multi-faceted and complex nature of resource allocation decision making surfaces.
Apparently, before hospitalization, Jenna did not require a lot of resources for home care because she was fairly independent. Thus, she was expected to be independent and there was no arrangement for home-based care. However, her condition after hospitalization required special attention and allocation of resources. Although Jenna had even performed her own catheterizations, she could no longer perform such tasks after the sepsis prognosis and the resultant complications. She required a ventilator for about 20 hours a day. She had a jeujenostomy tube for feeding and a gastronomy tube for draining (Fraser et al., 2010). In addition, she had an esophagostomy that drained to the outside of her neck. She also required urinary catheterization every 4 hours, a bowel routine, assistance with mobility (Fraser et al., 2010). She also wore a back brace and braces on both legs. The equipment needed daily care, cleaning and maintenance. She needed a ventilator (and external battery). This facilitated the need for another wheel-chair. There was need for a catheter. There was need for a licensed practical nurse and health care aide for 10 hours per night (Fraser et al., 2010).
The care manager however, encountered barriers in acquiring these resources. Jenna required physical assistance as her needs were predominantly physical. Her parents were working and did not get some time off (sick leave). This meant that the decision to organize parental care was difficult for Rosie. Further, the Jenna’s family was lower-income family. Jenna had four younger siblings whose needs were to be considered by the parents. Rosie saw the difficulty Martin and Becky had in handling Jenna’s care. The issue of acquiring new ventilator was another barrier.
Apparently, Jenna did not qualify for the ventilator that the family wanted because of its small size. The need for ventilator posed another need for new wheel chair. Jenna was adding weight as she grew up and the weight was also added by other required equipment (such as the external battery for the ventilator), hence need for a new wheelchair. The case manager also faced the problem of the Jenna’s parent’s beliefs. Essentially, Martin and Becky believed that healthcare in Canada is free. However, this is as long as care takes place in the hospital. When at home, it is not as free but the parents could not understand/take this. This showed the communication barrier. The relationship between Rosie and Jenna’s parents would have gotten worse were it not for the excellent relational ethics of the former. Another barrier is that there was need for a catheter that was a closed system and completely sterile. Jenna’s previous urinary tract infection was believed to have been caused by not using sterile techniques. The choice that the family wanted was not however, covered under the Ministry of Health program.
Fraser, K., Estabrooks, C., Allen, M. & Strang, V. (2010). The Relational Nature of Case Manager Resource Allocation Decision Making: An Illustrated Case. Care Management Journals, 11(3): 151-156.