Foundations of Nursing in the Community 4th Edition by Marcia Stanhope,Jeanette Lancaster

تمرين 3

Amelia Lewis, a 31-year-old African-American woman with multiple diagnoses, has been followed in the local mental health system for over 10 years. Four years ago, while a client at the local day hospital, she met and married another client, James Wood. She became pregnant and now has Tyesha, who is 3 years old. Multiple agencies have followed Ms. Lewis and her little girl, who live in a sparsely furnished apartment in subsidized housing. Mr. Wood lives separately, and he and his family welcome contact with Tyesha, but the relationship between Ms. Lewis and Mr. Wood has deteriorated. A guardian handles all of Ms. Lewis's financial affairs.
Ms. Lewis has issues of trust, and she is often suspicious of the care providers who come to her home. She does rely on some of the professionals with whom she interacts on a weekly or biweekly basis. Her developmental level places her at a stage at which her own needs are her primary focus, and this is not expected to change; her interaction with Tyesha is perfunctory, involving little outward affection. She is unable to understand that Tyesha is not capable of self-care and that her 3-year-old child will not always obey when Ms. Lewis instructs her to do something. Tyesha's needs, level of functioning, and cognitive development are quickly surpassing her mother's ability to cope. Frustration and misunderstanding ensue when Ms. Lewis thinks that Tyesha does not listen to her, and encouragement and parent education have done little to improve the situation as Tyesha gets older and more assertive. This has made toilet training, provision of an appropriate diet, and other aspects of normal child care problematic.
Many services besides those for mental health are involved to help this family of two cope. There is concern about abuse or neglect because of Ms. Lewis's lack of understanding of how to be a parent. Supplemental Security Income provides monetary support because of her mental disability, and they have Medicaid coverage for their health care needs, as well as food stamps and modest financial assistance through Temporary Assistance for Needy Families (TANF). Ms. Lewis cannot currently work and take care of her child because of her mental disability. Before Tyesha's birth, Ms. Lewis held a job and maintained self-care, but the care of Tyesha has precluded her managing employment at this time. Child Protective Services are also monitoring Ms. Lewis's situation. Ms. Lewis attends a local program to complete her General Education Development (GED), which provides child care during the day. Although Ms. Lewis is not expected to complete her GED, this program provides structured time for Tyesha three times per week. The child is considered developmentally normal at this time, and she is being followed by an infant development program that monitors her progress on developmental issues. The Child Health Partnership, an agency that addresses the needs of challenged families, provides regular visits, family support, and parenting education, and the GED teachers make regular home visits to check on Ms. Lewis and Tyesha. Ms. Lewis thinks things are going just fine.
The Child Health Partnership nurse is concerned about this family, and thinks that some permanent resolution of the situation is inevitable. There is minimal coordination of services and no "lead agency" in the family's care. Choose one of the ethical decision processes or one set of code of ethics discussed in the chapter and discuss and debate these questions:
Whose needs, Ms. Lewis's or Tyesha's, should take precedence