Running head: case study #1 1

Case Study #1: Case 4: I Need to Advocate for My Client

Joseph A. Cerniglia
University of South Carolina

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Abstract
Case four represents a decision case which centers on social work intern Celia ONeill at
Country Acres Nursing Home in rural Wilson, Texas; just outside of Austin. This nursing care
facility has 129-beds, 14 nurses, and 28 nurse aids. The major participants in this case are:
Jeffrey Allen, Administrator; Connie Bell, RN, Director of Nursing; Betty Williams, Director of
Social Services; Sally Jones, LCSW, contract social work consultant; Celia ONeill, the
protagonist, who serves as both Activity Director and social work intern; and the client, Bobby
Brown, who requires social work intervention to actualize his desire to leave the nursing care
facility as quickly as possible. (Scales & Wolfer, 2006)

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Case Study #1: Case 4: I Need to Advocate for My Client
Problem Statement
Celia is charged with advocating for her client who strongly desires to leave the nursing
care facility as soon as possible but faces several key barriers including, most prevalently,
nursing staff not treating [him] with dignity (Scales & Wolfer, 2006, p. 57). The inhumane
treatment expressed by the nurses at this facility, and the managements ignorance of it, prohibits
the clients self-determination. Client self-determination represents an ethical practice addressed
by the National Association of Social Workers Code of Ethics (2008).
Contextual Analysis
Mr. Brown experiences several factors that limit his full actualization of selfdetermination. Primary of which is his possible alcoholism, which has not, as yet, been addressed
by Celia in her conversations with Mr. Brown. Secondly, Mr. Brown lacks a significant social
support system and appears to have a tenuous relationship with his ex-wife. Finally, Mr. Brown
has no job, and a work history lacking in consistency.
Most relevant to Mr. Browns inability to leave the facility is the hopeless opinion held by
Betty Williams and the unprofessional negative attitudes held by some of the nursing staff at the
facility. Although his medical situation has improved since admission, he is unable to be
discharged without safe and stable housing.
Alternative Strategies
Medical Board Intervention
Celia could circumvent the management of the facility and direct complaints of
maltreatment towards the medical board overseeing nurse and nurses aide licensure.
Management of the facility has, in the past, ignored Celias concerns and this may be the most

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direct way to intervene and advocate on behalf of the clients at the facility. The disadvantages of
this strategy are that it would almost certainly result in a near impossible working climate
between herself and her colleagues. Additionally, this strategy would likely provide short-term
relief to a long-term problem.
Focus Solely on the Client
The pressures and complications of the inadequate political climate within the facility
may prove a distraction from Mr. Browns core issues and Celia could take the tact of focusing
solely on her intervention with him. Recognizing that addressing nurse burnout is outside of her
purview for both her role as an Activities Director and as a Social Work Intern, Celia has the
skills and abilities to effectively intervene with Mr. Brown without the added system intervention
necessary for future clients. This would still allow her to accomplish effective planned change
with Mr. Brown. However, this strategy fails to address Mr. Browns ecosystem for which, at
present, he is confined. Also, this strategy merely pushes the barriers to future client selfactualization to a later time and date.
Holistic, Ecosystems Intervention
Celia could take a holistic approach which address both Mr. Browns core issues, as well
as the issues affecting future clients and other charges within the facility. This holistic approach
would focus on effective planned change with Mr. Brown and general climate improvement at
the facility as a whole. Furthermore, this strategy would allow for more beneficial future client
interventions. The disadvantage of this strategy is that it is much more time consuming and
exhausting than a sole client-focused approach. The potential for Celia burning out is much
greater with this approach.

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Recommendation
Taking into account the multiple biological, psychological, and social factors impacting
Mr. Browns case, the most beneficial approach is for Celia to take over the case from Betty and
implement an empowerment-based planned change process concentrating first on finding stable
and secure housing. In discussions with Mr. Brown, and determining goals, Celia should address
possible alcohol-related addiction and, if Mr. Brown is in agreement, refer him to a recovery
program such as Alcoholics Anonymous which meets with his resource availability. This could
also help develop social relationships for which Mr. Brown is presently lacking. Celia,
recognizing Mr. Browns great potential, and her belief that she can, really help him, should
utilize this strengths-based perspective to contact supporting agencies, such as the United Way,
and state and federal programs to generate housing and living expense, such as Section 8 and
SNAP benefits. Noting Mr. Browns age and medical recovery, Celia should look in to vocational
rehabilitation and/or job training programs that fit with Mr. Browns interests and abilities.
Finally, Celia has an ethical responsibility to address the inhumane treatment the nursing
staff exhibits towards clients at Country Acres. Celia could, utilizing the same empowerment
approach with the nursing staff, develop and implement a support group for the nursing staff who
likely face stressors and complications unmitigated by the current operation of the facility. The
nurses, given the opportunity to vent frustrations with clients and/or management and come up
with mutual aid strategies, would be able to more effectively help clients in their medical care
plans. This strategy meets with the evidence wherein Alvy (2010) implemented just such a
support group for nursing students at a community college in Los Angeles and reduced dropout
rate from 20 percent to just 5 percent. Considering Celias experience as an activities director,
she could leverage her skills in planning, developing, and implementing this new program.

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References
Alvy, D. (2010, May). Nursing student support groups ease stress. American Nurse Today, 5(5),
pp. 46-48.
National Association of Social Workers. (2008). Code of ethics of the National Association of
Social Workers. Washington, DC: NASW Press.
Scales, T. L., & Wolfer, T. A. (2006). Decision cases for generalist social work practice.
Belmont, CA: Thomson Learning.