Case Studies

Case Study #5

Rehabilitation challenges post heart-attack

Amy Mullens, Clinical & Health Psychologist, University of Southern Queensland

This case study discusses a range of individual and contextual vulnerabilities associated with rehabilitation post-hospitalisation for a middle-aged man with limited protective factors.

‘Jon’ is a 53-year-old male of Eastern European background. He has lived in Australia since the age 13. He is single and lives alone, and works as a labourer with casual employment contracts. He has many friends (socially, but no close friends); however he has no children and his parents and siblings are deceased.

Jon is 2 weeks post-heart attack, and is currently an in-patient at a public hospital. Jon has been recently advised that he will require 3–6 months rehabilitation and lifestyle modification; and describes some ambivalence regarding this. Pre-morbidly, Jon reports he was ‘a very active guy’ who ‘didn’t let anything slow me down’.

Jon was an avid golfer prior to the heart attack, and he stated that he enjoys ‘having beers with the boys’ and his primary social contacts are workmates. Jon reported that he is uncertain regarding future work prospects and whether his casual role will still be available once he is able to work again, ‘whenever that is’.

Jon has had few visitors whilst in hospital and he is getting ‘very bored and agro’.

Jon is a long-term heavy smoker (nil smoking since heart attack, using Champix but having difficulties with side effects). He has long-term high cholesterol – he uses statins but his adherence is not 100%. Further, Jon was raised on a cattle property where his parents were labourers, and he loves meat and is highly reluctant to make significant dietary changes.

There is a family history of maternal depression, and his maternal aunt was reportedly treated long term in a ‘psychiatric ward’. Jon reported that he had witnessed trauma during childhood in country of origin.

The hospital nurses report he is very tearful and increasingly less conversive and more withdrawn during rehab appointments. They report that Jon seems increasingly hopeless regarding his recovering and prospects of returning to pre-morbid functioning and vitality.

Discussion questions

  • What are some ways you can work with inter-professional staff members at the hospital to work towards collaborative goals with Jon?
  • What are some possible targets for intervention?
  • What other allied health staff and community services could potentially provide support towards these goals?
  • As a health psychologist, what are some ways you could support Jon and his treating medical team whilst he is an in-patient?