Identify Communication Strategies - Identify What May be Perceived as Empathy Gaps - Nursing Assessment Answer

TASK:

Carly Case Study
Carly is an Australian born 27-year-old woman with Greek Macedonian cultural background. Carly presents with a substance use problem. Ice is her principle drug of concern but she has a history of poly substance use (Benzodiazepines, Hallucinogens, Opiates). Carly had been injecting and smoking 3-4 points of Ice daily for 7 years. Carly smokes approximately 15 cigarettes daily. Carly reports the onset of substance use followed her Mother’s death from brain cancer. Carly reports her mother throughout her childhood; experiencing a disorganised attachment and complicated grief abused her. Carly reported past suicidal ideations and two attempted suicides by overdose and cutting wrists. Carly has had 4x mental health hospital admissions.
Carly was a victim of a series of Domestic Violence relationships and experienced emotional, sexual and physical abuse. Carly had been forced to traffic drugs and hold large quantities of drugs and money in her apartment. Carly was a victim of 2 violent home invasions connected to her involvement in drug dealing. Carly had been working a sex worker for many years to pay off drug debts and support her addiction. Carly experiences flashbacks, panic attacks and dissociates when remembering sex work experiences. Carly was affiliated with Sydney gangs through drugs and sex work, who she now fears are “after her” to repay money they accuse her of stealing. Carly attempted to cease methamphetamine herself in 2016 when she developed concerns around her mental health. Carly experienced auditory hallucinations at this time and reported hearing her neighbours calling her a “junkie”, that her “sister was murdered”, talking about “being paedophiles” and “mumbling”. Carly experienced a psychotic episode where she reports hearing 6 voices tell her to kill her neighbours. Carly is now facing trial for home invasion after she broke into her neighbour’s house with a knife threatening to kill them.
After this event Carly received a diagnosis of Acute Drug Induced Psycho Affective Disorder / Schizotypal Disorder. Carly also had prior diagnosis of Complex PTSD and Bipolar. Carly had been prescribed a monthly injection of Abilify but was no longer taking this. Carly is currently taking the following medications to manage her mental health Rispiradone (Anti-Psychotic) Lexapro (Depression/Anxiety).
Carly reported she did not feel safe to return home for fear of endangering her family. Carly also wants to avoid memories of traumatic events that occurred in the house.

Paul Case Study
Paul described himself as a ‘typical teenager’ before he became homeless: ‘I was a fun-loving little kid who drank too much...got into a little bit of trouble...smoked some weed...went to school, bunked off school, had a laugh with my mates – I was just a typical teenager, you know what I mean?’. He reported that, during his teenage years, his relationship with his parents had been characterised by conflict and rebellion: ‘Three or four years of my parents and me not getting on. I guess most of it was typical teenage rebellion. Once it got to the point where my Dad threatened to hit me with his belt, you know. I turned around and told him if he did that I’d fucking kill him’.
For Paul, tensions at home seemed to reach boiling point when, at the age of 16, he discovered that his girlfriend was pregnant: ‘I mean, as far as my parents were concerned, that was the last straw. My mother chased me up the road with a fucking broom swinging at my head...and I didn’t go back’.
Paul recalled feeling rejected by his mother’s reaction to the news that his girlfriend was pregnant: ‘Here was this woman who was supposed to love me no matter what rejecting me...I was feeling quite rejected for a long time but that just put the cherry on the top of the cake, to be honest with you’. From this, it would seem that Paul’s feelings of rejection had been present for some time. When asked to expand upon this, he replied: ‘I felt rejected by my mum, my dad, ostracised by the rest of my family, you know – before all of this actually happened, to be quite honest’.
Being homeless signalled a change in the way Paul was viewed by others: ‘As far as people, most people were concerned, I was a piece of shit on the floor...who did drugs, who did drink,who stole, who mugged, who smelled. Except I wasn’t that person – I was still a fun loving teenager and then the fun loving teenager disappeared and I became what people perceived me to be.

Vicki Case Study
Vicki met Mark at a party when she was 17. He struck her as a fun, passionate and confident guy and was always incredibly charming. They became friends and after a couple of years things developed romantically. From the outset Mark was controlling but Vicki didn’t have much to compare his behaviour to as she was so young when they met. He had previously been in a relationship with a close friend and she had already seen that he could be quite possessive and domineering. Whilst in the first few months they had a lot of fun, going out with friends and partying, Mark's behaviour was confusing. At times, he was loving, passionate and sweet and then he would turn on her belittling and insulting her. As their relationship progressed he became increasingly verbally abusive towards her, routinely insulting her and telling her she had no personality. He dictated what she could wear, sometimes saying he wanted to show her off and then berating her for being a ‘slut’. At other times he would call her ugly. Vicki began to hide herself around men and stopped seeing her male friends in case Mark became angry. Mark also started to smash things and throw things – he said to avoid hitting her. Vicki struggled to keep her friends as they disliked Mark. She felt increasingly isolated and lost a great deal of confidence. Mark assured her that his abuse was her fault and she believed him, trying hard to change her clothes and her behaviour to suit him. Nothing she ever did seemed to have an impact though.
If she was quiet, he'd yell, "Say something, I'm sick of arguing with myself!" If she answered, he'd yell, "Shut up, you stupid cow."
Eventually, it would end up with a beating. Vicki hid the bruises and kept it a secret as she was terribly ashamed and didn’t know who to turn to. She thought her family and friends would think the violence was all her fault. Her parents had taught her that if a man hurt you, you break up with him immediately. But she stayed with Mark out of fear, she was ashamed and thought her parents would be angry for letting them down. She also thought if she went to the police they would laugh at her or that Mark would hurt her even more. The last time however, he really laid into her. One of the kids fled to a neighbour's house, and called the police.
He took a leg off a chair and threatened, "If you say a word, I'll kill you - even if they take me and charge me, I'll come back and find you and you're dead."
He hid behind the door. The police were there, "Are you OK?" "Yes," she said, shaking her head no and frantically signalling behind the door. "Well," said the police, "You don't sound too sure, so we'll stay around for awhile."
Vicki's husband raped her on the lounge room floor. He seemed satisfied then and went to bed. Next day he went to work and sent flowers for her birthday. She waited till she was sure he'd left and then called for a truck. She packed and was gone in with the kids within two hours. Left his flowers
sticking out of the toilet bowl.
A taxi driver said, "You women have really got it good- you cause your man to bash you then you've got a refuge to go to and the government gives you money and a free house...."

Task: Students will be provided with a variety of case studies and a) identify what may be perceived as empathy gaps when caring for such a patient, and b) identify communication strategies that could be utilised in an attempt to better understand the perspective of the person.

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