For this final, you will read through the example scenario below and go through the critical thinking and problem-solving steps that follow.

Erin is a single parent with an 8-year-old daughter and shares custody with her ex-husband. Erin works as a case manager for a local non-profit. She works long hours (8 am to 6:30 pm) and receives just enough money to pay her bills. After visiting the doctor recently, she was diagnosed with stage 1 hypertension. The doctor discussed a diet and exercise regimen with her to lower her blood pressure numbers; he said that he would like her to try this before he prescribes her medication. He told her to schedule an appointment with you, the community health worker to have her numbers checked.

When Erin arrives in your office, you check her blood pressure with the automated blood pressure cuff and see that her reading was high; her blood pressure was 145/90. After talking with her for a while, she opens to you and says that she has not been following the diet plan and exercise regimen that her doctor prescribed. She says that she has no time to cook when she gets home and usually picks up fast food on the way home from work. She says she doesn’t really understand why eating fast food is a problem, “it doesn’t taste salty to me.” She also stated that she doesn’t have money to join a gym to exercise and it is just too cold outside to walk. Plus, “I have so many things to do around the house like laundry and dishes when I get home from work.”

You discuss with Erin what the doctor prescribed for her to do. She says that the doctor said that she should not eat out and should cook at home. She should read the labels and cut salt down to ½ of what she is currently doing. He also stated that she should be walking for 30 minutes each day and try to lose weight. You ask if he discussed any recipes of ways that she could cut salt in her diet and she said, “no.”

You go on to ask her how she has been feeling since her last doctor visit and she said that she has been feeling ok. She states, “I have been a little bit dizzy from time to time but I usually just sit down for a minute and it goes away.” You ask her if she has been having any headaches and she says, “yes, but that isn’t anything new, that is the reason I went to the doctor in the first place.” “I also feel out of breath sometimes, but I have asthma.” You ask her if her doctor discussed her asthma with her and she says “yes, and I use an inhaler.” You then ask if she has a current prescription for an inhaler and she said, “well, no not at this very moment because I forgot to go pick it up at the pharmacy. “Plus, my asthma hasn’t really been bothering me that much.”

Doctors Notes:

Weight: 200

Height: 5’7

BMI: 31.32

BP reading at last visit: 148/92

Age: 38

Step 1: Contextual Awareness

• Provide a paragraph discussing/summarizing the context of the situation.

Step 2: Identify the problem and/or problems

Step 3: Symptoms

• Identify the symptoms

Step 4: Exploring and Imagining Alternatives

• Identify the possible reasons for the problems. These will include your ideas and assumptions which is what you really would not record if you had the client in front of you. You would just ask the client. Write all possibilities that you can come up with based on what is said in the above scenario.

Step 5: Assumption recognition and evidence

• Go through each of the assumptions and alternatives above and discuss what evidence you have to support each. Identify the questions you would need to ask to get at more evidence (these should be pretty simple questions).

Step 6 Reflective skepticism/what am I going to do?

• After going through each assumption and question above, what did you find out (you will have to use hypotheticals here since the patient is not in front of you).

Step 7: Stages of Change

• Identify what stage the client is in for each of the items you discussed in question 6. While it may not be realistic when working with the client, for this exercise, you should make at least one of the items an action item.

Step 8: Goal/action

• Help the client write one goal for the action item that you identified in stage 7. The goal should be written in the following format:

What:

When:

How much:

How many:

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