3011OL Palliative Care Nursing

Students are required to read through the case review and respond to the questions in each section. This case review has a 2250 word limit and students are required to substantiate the responses with peer-reviewed literature.

The School of Nursing Harvard Referencing style is to be used in accordance with the School Academic Manual.

Please use subheadings to clearly identify section 1, 2 and 3.

A separate introduction and conclusion is not necessary.

Section 1. (1000 words)

Sharon is a 57year old woman who was diagnosed with motor neurone disease, amyotrophic lateral sclerosis (ALS) type 18 months ago.  She is married to George and they have 2 children; Tom aged 17 and Sophie aged 23. George runs a small business from home and has been able to provide some support for Sharon in the past 12 months. Tom, 17, is preparing for year 12 next year and Sophie has recently married and has announced that she is pregnant.

Sharon was working as a primary school teacher, but has been forced to take leave due to a progression of her disease. Sharon identified as being a Buddhist on admission.

Sharon was admitted to a general medical ward following increasing falls at home, speech distortion, swallowing difficulties and shortness of breath. During the admission process Sharon talks openly about how she has had to adjust to being diagnosed with ALS.

• Describe the pathophysiology of Motor Neurone disease and identify if this disease could be classified as a ‘life-limiting illness’.
• Identify which illness trajectory is the best model for this illness and justify your choice.
• Discuss the impact of this disease on Sharon including current symptoms and losses she will face as the illness progresses.
• Identify some issues that George might need to consider in the near future.
• Identify and outline the roles of the multidisciplinary team members that would be necessary to be involved in Sharon’s care?

Sharon is discharged home one week later with some community services in place to provide equipment and supportive care.

Section 2 (700 words)

Four months later, Sharon is readmitted to a medical ward with a significant progression of her disease. Her speech is slurred and difficult to understand, she has developed significant weakness in her legs, arms and neck and she is reporting muscle spasm and pain in her legs. Sharon now requires feeding but has had distressing coughing episodes after eating certain foods. You have a discussion with Sharon and George around referral to a palliative care service. The social worker arranges for a ‘family meeting’ to discuss ‘goals of care’.

• Describe how you would prepare for a discussion with Sharon and George about introducing palliative care?
• Describe how you would introduce and explain what the palliative care team can offer Sharon and George?
• Explain the purpose of a family meeting? Describe the nurse’s role in a family meeting.
• Define the ‘goals of care’ and discuss what specific areas need to be considered in Advance Care Planning for Sharon?

Section 3 (550 words)

Six weeks later Sharon is admitted to a hospice with a chest infection for end-of-life care. She can now only move her head slightly and is fully dependent for all care needs. Sharon has brought with her an Advance Care Directive stating:

‘I do not want to be artificially ventilated via intubation; I do not want to be transferred to an Intensive Care Unit; I do not want cardio-pulmonary resuscitation; I do not want medically assisted feeding or hydration; Treatment should focus on relief of discomfort and symptoms rather than prolonging life.’

• Describe how you would prepare George, Tom and Sophie for Sharon’s impending death?
• Outline any spiritual considerations you need to be aware of.

Sharon dies with her husband, son and daughter present three days after admission.

• Describe what care of the family involves at this time.

NB: Word count for each section is a suggestion only.