Case study: James

Responding to acute physical risk

• James is a 22 year old injecting drug user who regularly uses the needle exchange facility at a homeless drop-in centre. He is on friendly terms with the non-specialist staff.

• He complains of feeling a bit unwell today and his injection site ‘itches’. On inspection it appears reddened.

• The staff suggest he see the nurse present at the drop-in centre. The nurse takes basic observations. He has a slight temperature, raised pulse and respiration rate.

• The nurse suspects an infection at the injection site due to the reddening around the area. The nurse advises a visit to casualty. James is reluctant to go; it’s just a ‘bad shot’ and it’ll get better.

• The nurse explains to James how infections can be localised or spreading. She outlines what the signs are of a spreading infection: reddening and temperature.

• The nurse says what could happen if it spreads: blood poisoning and serious illness that could be fatal.

• The nurse uses simple language but deals with the information seriously without ‘scare tactics’.

• Given the information, James can see for himself that his symptoms could be serious. He says it is too far to get to hospital and he doesn’t have a GP.

• The nurse offers to transport to the A&E and one of the staff members offers to go with him.

• James agrees. He is a bit worried and likes the idea of company.

• On arrival at hospital, James is assessed promptly.

• James is found to have septicaemia, is admitted and given intravenous antibiotics which save his life.

• Without swift action from the staff at the drop in centre, James could have died of septicaemia or may have had to have a limb amputated to save his life.

• While in hospital, James was screened for Hepatitis B & C, HIV and liver function. He was seen by the drug and alcohol liaison team for assessment of his substance use and given brief intervention and motivational interviewing to engage him in early stage treatment for his addiction.

• He is also seen by the hospital social worker to assess his living conditions and encourage contact with his family.

• Why was it important that James could see for himself what the symptoms were?

• What skills did the drop-in centre staff have that enabled James to get urgent treatment?

Questions

Possible answers• James was ambivalent about seeking help and needed

empowerment to motivate him.

• By helping James understand the risk, James could better understand the situation and make his own decision.

• Further barriers to help seeking were reduced by offering transport and support.

• The staff had knowledge to understand possible risks from injecting, they had the skills to motivate and engage James in seeking help and understood the referral routes for help.