Scenario Story, Essay Example

David Johnson is a five-year-old African American boy from Chicago.  Prior to his injuries, he resided with his mother, Elaine, and his ten-year-old sister Sharon.  David’s parents are divorced, and his father, Jim, lives out of state.   Elaine works in the housekeeping department at a downtown hotel and Jim is a musician; neither parent has health insurance or any savings.

Two weeks ago, while playing soccer in front of his apartment building with some older boys, David chased the ball out into the street and was struck by a car.  He has a T5 incomplete spinal cord injury with no sensation below the waist.  While the implications of his injuries have yet to fully sink in for David, who has no memory of the accident, his parents are having difficulty coping with the knowledge that their son may be paralysed for life.  This stress is complicated by the fact that Jim has returned to his home in Michigan, leaving Elaine with the sole responsibility for David and Sharon.  She has also had to return to work, or else she would have been fired.  Elaine has no close friends and is estranged from her immediate family.

David is a patient at Children’s Memorial Hospital, and has been referred to the Rehabilitation Department to receive the services of an Occupational Therapist.  Beth has been a pediatric OT for eleven years, and believes strongly that a collaborative relationship with her patients’ parents will increase their level of success.  By placing her intervention within the context of the Johnson’s unique family dynamics, Beth increases the likelihood that David’s rehabilitative process will continue, with his family’s support, once he is released from CMH.  Beth’s goal is to involve Elaine as a client in order to increase her competence and confidence in parenting a child with a spinal cord injury.

Elaine’s primary issue is a fear for David’s future that is linked with a fear of disability.  She believes that David will be left out by his peers and worries that he may have psychological difficulties as a result.  She is also intimidated by the practical details of caring for a child with mobility issues, especially his current lack of bladder and bowel control.  In discussions with the OT, Beth, Elaine admits that she is afraid to bathe David for fear that he might be too heavy to lift in and out of the tub, or may slip in the water and hurt himself.

Beth works with Elaine in a threefold manner:  a) to enable confidence and competence in her parenting skills; b) using scaffolding to promote confidence; and c) reinterpreting the meaning of parenting through confidence building.  To enable confidence, Beth must generate a skill-set in Elaine that promotes competence by demonstrating that Elaine is capable of caring for a child with disabilities.  This involved teaching Elaine how to properly and safely bathe David, while also encouraging Elaine to create a narrative about her relationship with David that recreates the meaning of their family.

In employing scaffolding to promote competence, Beth takes an interactive and instructive role as ‘expert’ to assist the novice Elaine in acquiring skill through learning how to problem solve.  This is accomplished by helping Elaine to understand the outcome of her actions and the steps required to successfully accomplish the task of bathing David.  Beth initially demonstrated bathing techniques while Elaine watched, thereby gaining Beth’s interest and establishing that these tasks aren’t as difficult as she fears.  Tailoring these challenges to Elaine’s skill set and providing a safe environment for making mistakes enables Elaine to control her frustration and build confidence.  Beth also keeps Elaine focused on the objective of safely bathing David while encouraging Beth to take risks while also reading David’s own ‘signs’ (both verbal and non verbal cues).  In the final stage of scaffolding, Beth acts as a validator who confirms Elaine’s competence to care for David’s needs.

In reinterpreting the meaning of parenting and promoting confidence, Beth uses procedural approaches (teaching Elaine how to bathe David) in the therapeutic process to engage Elaine in the details of David’s care while building confidence about her abilities as a mother.  However, Beth’s role went beyond providing information about biomedical care and also gave Elaine opportunities to apply this new knowledge to her relationship with David and his role in their family. Beth emphasized the elements of their family lifestyle that would remain the same, despite David’s disability (such as reminding Elaine of how skillful she once was at bathing the infant David) while giving Elaine a forum to discuss her concerns for their future in a safe and supportive environment.