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Carol is 43 years of age, living on small acreage in the rural hinterland of the Sunshine Coast near Nambour, with her husband Tim (50yo), their son Simon (17yo) and daughter Penny (12yo) who are both secondary school students. Although Carol was born and raised in Brisbane, she settled in the district when she met Tim, a local.
Carol was initially diagnosed with bowel cancer 10 years ago after a sustained period of alternating constipation and diarrhoea, and weight loss after the birth of Penny. A colonoscopy at that time showed that multiple adenomatous polyps had become malignant. At this time, Penny’s mother mentioned that her mother had died many years earlier from ‘something in her bowels’. Carol underwent a partial colectomy and chemotherapy, and has kept good health since, with annual screening.
However, a year ago after some pain and nausea, with breathlessness on exertion, Carol was found to have metastases in her liver and lungs. Further chemotherapy appeared to slow the progress of her disease at that time. Now, Carol is now in the advanced stages of her illness and has been given a prognosis of ‘a few months.’ She reports constant low to medium abdominal pain, especially in the right upper quadrant; she remains breathless with little exertion and generalised weakness. Carol reports erratic bowel habits, where she is mostly constipated.
Tim continues to work at his job in town, as well as maintain the acreage. Simon and Penny have continued to go to school, although both of them have had their parents called to the school following some behavioural incidents with other students.
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Rubric criteria
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- Demonstrate accurate assessment of the holistic needs of a person living with a life-limiting illness and their family.
- Application of the principles and practices of reflective and academic writing and referencing in the style appropriate to the discipline.
- Ethical use of intellectual property.
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Questions
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- What is the likely trajectory of Carol’s illness?
- From your assessment, what type of pain is most likely with Carol’s disease? What are the characteristics of pain that must be included in your assessment?
- What are the elements of assessing Carol’s constipation?
- What are some of the concerns the family might be experiencing? How could you assess these?
Case Study – 2) Managing the impact of illness
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Your assessment of Carol has identified a range of symptom management needs in pain, breathlessness, fatigue and constipation. You are now aware of family dynamics that can impact upon the experience of Carol and her family. As her illness progresses, Carol’s need for support will increase in a range of ways.
Rubric criteria
- Demonstrate critical thinking in the decision making and care planning informed by this assessment.
- Application of the principles and practices of reflective and academic writing and referencing in the style appropriate to the discipline.
- Ethical use of intellectual property.
Questions
What are the domains of care that can be addressed through palliative and end-of-life care?
What pain management plan could be put in place for Carol?
What constipation management plan could be put in place for Carol?
Thinking about the domains of care, which are broader than nursing practice, what kinds of strategies might address the family’s needs?
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Case Study – 3) Challenges in providing care
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Tim is struggling to meet the demands of his job and maintenance of the property, which has chooks and a pair of goats roaming on it, as well as large expanses of lawn. He finds there are just not enough hours in the day given the extra requirements of caring for Carol, going into town for shopping and medication, and running the kids to school and sports.
Tim and Carol are both determined that she should remain at home during her final illness and, if possible, die at home in a place they and the kids love so much. Simon, though, is unhappy at the idea of his mother’s death happening in the house. Penny is alternating between being withdrawn from her mother or fussing over her.
Rubric criteria
- Explore aspects of the case study that might present challenges to care provision.
- Application of the principles and practices of reflective and academic writing and referencing in the style appropriate to the discipline.
- Ethical use of intellectual property.
Questions
Carol and her family would be considered to be subject to an inequity in health care. What is it? How would it impact upon their care and support?
What might the impact of Tim’s experience be on Carol’s illness experience?
What do you think Simon and Penny are experiencing? What could be helpful to support them?
Thinking about the Compassionate Communities model in Week 8, what strategies might help the family as Carol’s illness progresses?
Case Study – 4) Need for self-care
Judy is a 38yo RN providing end-of-life care at home for Carol and supporting her family as her death approaches. At times, Judy finds it difficult to manage Carol’s symptoms; she struggles to figure out the best way to support Tim who looks completely exhausted; Simon has started staying at his friends’ home a lot rather than being at home; and Penny has become very withdrawn and tearful.
Judy has found providing care for Carol quite distressing at times, and often finds herself in tears when she is at home with her own family, including her partner and their three teenage children.
Rubric criteria
- Identify potential stressors on nurses in the context of the case study and explain possible self-care strategies.
- Application of the principles and practices of reflective and academic writing and referencing in the style appropriate to the discipline.
- Ethical use of intellectual property.
Questions
What are some of the most prevalent stressors of PEoLC nursing?
What aspects of this particular caregiving experience might be impacting upon Judy?
How could Judy assess her self-care needs?
What are some evidence-based, self-care strategies that Judy could use? Why are they important in nursing practice?
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