Week 8 Discussion: Case Study or Share an Experience (graded)

Sample Answer for Week 8 Discussion: Case Study or Share an Experience (graded) Included After Question

Discussion

This week you have two options for your initial discussion post. Select the option that is best for you! Please remember to use and credit the lesson or required NIH website (there was not a textbook reading this week), AND one outside scholarly source.

Option #1 – Case Study to Consider

Ann and Michael have been married for 55 years. Ann is 80 years-old, and suffers from lung cancer and advanced Alzheimer’s disease. She currently resides in a nursing home, and often does not recognize Michael when he visits. Last night she was admitted to the hospital with difficulty breathing. Today, you are the nurse caring for Ann, and her physician is suggesting surgery to remove part of her lung to potentially slow the progression of her cancer. Michael is feeling unsure about this course of treatment, and asks for your advice and guidance.

How would you respond to Michael and serve as advocate for your patient?

Option #2 – Share a Related Experience

Share with your classmates a time when you cared for a patient at the end of their life. This may be a time when you assisted the patient (or their support system) with decisions related to end of life care; or a time when you were present for the death of a patient.

What were your observations related to this experience? Do you believe it was a peaceful death? What went well? Can you think of anything that could have made the experience better for the patient and/or family?

This is my area of nursing. I work in hematology/oncology and hospice. I have had a lung cancer patient tell me, “Kelly, I think tonight’s the night”. I said, “Tonight’s the night for what, patient X?” And she said, “Tonight is the night I would like to pass on and see Jesus. I am ready.” And I said, “OK, patient X. Should we call your daughter and have her here with you?” She said, “Yes. Let’s have her come.” Cue the hand holding and smiles. That was that. She passed later that evening by removing her oxygen and being given morphine for comfort.

I have ordered patient’s last meals before sedating them to a comfortable coma-like state. I feel good about what I do when someone is ready to be at peace and be comfortable.

Option #1; Ann & Michael:

I would ask if Michael would mind stepping out of the room and talking to me. Unfortunately, during the pandemic, my hospital has strict end of life visiting policies and I might have to be asked these questions over the phone.

I would ask Michael if Ann had ever mentioned what she would want in this type of situation? Had she ever said things like if I am unable to do xyz, I would want xyz to happen?

What are your reservations to the surgery, Michael? What worries you? Do you feel like you understand the benefits versus the risks fully?

If Michael wanted Ann to just be comfortable in her remaining time on the earth, I would feel comfortable discussing hospice care. Often, in hospice care, we can provide a patient with oxygen for comfort purposes and medicate to make breathing more comfortable and restful. Sometimes we do remove the oxygen and only medicate. We would discuss options of taking Ann home or keeping her under the hospital’s care.

Let us say that Michael wants to understand more about inpatient hospice care, I would discuss all his and his wife’s “physical, psychological, spiritual, and practical” needs could be addressed by the hospice team (Hill & Hacker, 2010). Michael could determine that psychologically, Ann would not have a good recovery after a lobectomy although he does not want her to suffer with dyspnea. Physically he knows that Ann’s dyspnea is exhausting and giving her also sudden anxiety and restlessness. She has become incontinent. Spiritually he believes in God and does not want his wife to suffer, but also does not feel it is right to choose her life or death – chaplain or priest may be asked to step in here. Practically speaking, he feels he has already said goodbye to the Ann that he knew before, but he questions whether hospice is giving up on his wife.

I would reassure that we could really make Ann rest well and relieve her suffering. We could give medications like Ativan for her anxiety, dyspnea, and restlessness. We could also give medications like morphine or dilaudid for dyspnea. We can give robinul and scopolamine patches to dry up lung secretions. We can suction to clear the lung secretions as needed and as comfortable. All the while, we will keep her skin clean and dry, provide oral care and repositioning as tolerated. We will be happy to play spiritual music or biblical readings. We can involve music therapy and chaplains as often as possible. We are here to ensure you have support to through nursing and social and spiritual services.

All these struggles and concerns can be attended to by the right department and nurses play a big role in rounding up those departments as well as communicating with the medical team to relay the patient’s/family’s wishes (Weber & Kelley, 2018).

References

Hill and Hacker (2010). Helping patient with cancer prepare for hospice. Clinical Journal of Oncology Nursing 14(2): 180-188. http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.1188/10.CJON.180-188 

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer.

A Sample Answer for the Assignment: Week 8 Discussion: Case Study or Share an Experience (graded)

Title: Week 8 Discussion: Case Study or Share an Experience (graded)

The first patient who passed away on my shift was the one that made the most impact. I was in my second month out of orientation, working on a Vascular Surgery unit. Most of our patients were post surgical, but we were also one of the few Telemetry floors at the time, so we often had a mix of other specialties. It was Father’s Day, and I had buried my own father two months prior. One of my patients was an elderly woman with metastatic cancer. She was scheduled to go to Hospice the next morning. She was alert and oriented times one or two, but that morning she was more confused than normal. She’d been in our care for about a week, and was getting palliative radiation treatments to help with the pain from her tumors. That morning, she refused. The transporter came out to let me know, and I went in to make sure. She was agitated, and told me she absolutely was not going. None of her family was with her at the time. I believe they were still getting things in order for the move the next day. 

In hindsight, I probably should have seen some of the signs, and asked more questions. She was more agitated than usual, and  it was in my head that she was Hospice, and end of life, but I had no idea that she was actively dying until one of the palliative doctors came out to find me later that afternoon. He told me that I should call her family and get them to the hospital as soon as possible. I hadn’t noticed in the morning, but her hands were mottling, she hadn’t eaten, and by the afternoon her blood pressure was dropping. (Signs and Symptoms of Approaching Death, n.d.) I called her family, and calmly asked them to come up. They were surprisingly calm, given the circumstances, but I assume it was because the Hospice plan was already in place. The palliative doctor called pastoral care to consult, and I was to call when they arrived. We moved the patient’s roommate out of the room, and I attempted to make her comfortable with pillows. At that point, the patient was no longer speaking. She didn’t appear to be agitated or in pain. When the family came, I called Pastoral care to come to the bedside. He gave her last rites and spoke with the family. Shortly after he left, a family member came out to ask me if she had passed. Her breathing had stopped. When I walked in the room, it had become more of a death rattle type breathing pattern. (Providing Care and Comfort at the End of Life | National Institute on Aging, n.d.) I knew what this was. I stroked her forehead and started to cry. I explained what the breathing pattern meant. They asked me if I’d had a chance to speak with her that day, and I told them how feisty she had been about not going to radiation. This put smiles on their faces, because she was a small woman, with a big personality. A few minutes later, she passed away. I excused myself and gave the family time to themselves. 

If the same situation happened today, I don’t know that I would have done anything differently. I might have called the family sooner had I been more aware of what to look for. I might have offered to get a radio, or tune in to a music station for some calming music. (Providing Care and Comfort at the End of Life | National Institute on Aging, n.d.) I felt like the family appreciated what we were able to do to give them time, and comfort. I think that my father’s recent passing helped me to be more empathetic to their situation. They actually told me that they were touched to see me cry, and hugged me as they left. 

References

Providing care and comfort at the end of life | national institute on aging. (n.d.). National Institute on Aging. Retrieved August 21, 2020, from https://www.nia.nih.gov/health/providing-comfort-end-lifeLinks to an external site.

Signs and Symptoms of Approaching Death. (n.d.). Hospice Patients Alliance. Retrieved August 21, 2020, from https://hospicepatients.org/hospic60.htmlLinks to an external site.

5. Grading Rubric

Discussion Criteria	A (100%) Outstanding or highest level of performance	B (87%) Very good or high level of performance	C (76%) Competent or satisfactory level of performance	F (0) Poor or failing or unsatisfactory level of performance
Answers the initial graded threaded discussion question(s)/topic(s), demonstrating knowledge and understanding of concepts for the week. 16 points	Addresses all aspects of the initial discussion question(s) applying experiences, knowledge, and understanding regarding all weekly concepts.16 points	Addresses most aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of most of the weekly concepts.14 points	Addresses some aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of some of the weekly concepts.12 points	Minimally addresses the initial discussion question(s) or does not address the initial question(s).0 points
Integrates evidence to support discussion. Sources are credited.* ( APA format not required) 12 points	Integrates evidence to support your discussion from:assigned readings** OR online lessons, ANDat least one outside scholarly source.***Sources are credited.*12 points	Integrates evidence to support discussion from:assigned readings OR online lesson.Sources are credited.*10 points	Integrates evidence to support discussion only from an outside source with no mention of assigned reading or lesson.Sources are credited.*9 points	Does not integrate any evidence.0 points
Engages in meaningful dialogue with classmates or instructor before the end of the week. 14 points	Responds to a classmate and/or instructor’s post furthering the dialogue by providing more information and clarification, thereby adding much depth to the discussion.14 points	Responds to a classmate and/or instructor furthering the dialogue by adding some depth to the discussion.12 points	Responds to a classmate and/or instructor but does not further the discussion.10 points	No response post to another student or instructor.0 points
Communicates in a professional manner. 8 points	Presents information using clear and concise language in an organized manner (minimal errors in English grammar, spelling, syntax, and punctuation).8 points	Presents information in an organized manner (few errors in English grammar, spelling, syntax, and punctuation).7 points	Presents information using understandable language but is somewhat disorganized (some errors in English grammar, spelling, syntax, and punctuation).6 points	Presents information that is not clear, logical, professional or organized to the point that the reader has difficulty understanding the message (numerous errors in English grammar, spelling, syntax, and/or punctuation).0 points
PARTICIPATION: Response to initial question: Responds to initial discussion question(s) by Wednesday, 11:59 p.m. M.T.	0 points lostStudent posts an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.		-5 pointsStudent does not post an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.
PARTICIPATION Total posts: Participates in the discussion thread at least three times on at least two different days.	0 points lostPosts in the discussion at least three times AND on two different days.		-5 pointsPosts fewer than three times OR does not participate on at least two different days.