Chose one situation and work on it.  At least two evidence-based, scholarly resources (in addition to required textbooks) support post. You are encourated to use your required texts, but at least two additional resources must be integrated, cited, and referenced per APA style.  See criteria on p. 7 of syllabus) Closely adheres to APA style.

Please post your primary post in both the discussion forum and the assignment box.  Thanks.

Scenario one: Bill and Sue

Bill and Sue are both in their late 80’s, have been married for sixty-five years, and have enjoyed their lives together.  Over the last five years Bill’s health has declined.  He his mobility has become more and more limited by weakness and osteoarthritis. He diagnosed with dementia about three years ago. Although he has significant pain in his knees and hips, he takes no medications as he thinks he is “tough enough to take it”.  Sue has osteoporosis, uses eye drops for the glaucoma, but otherwise is in good health.   They moved from their farm house four years ago when Bill could no longer get up the stairs to get into their farm house. They have four children who live within 10 miles of their small home in a rural town.

Bill has fallen at least six times over the last six months without serious injury.  He has had some skin tears and required stitches on his arm after one of the falls.  When he falls, Sue calls one of the nearby children who come and help Bill from the floor.  One day while Sue was helping Bill with a shower she noticed an open wound on his buttock.  Sue called her daughter who took them both to the local clinic.  Their physician of the last twenty years diagnosed Bill with a stage three wound over his ischial tuberosity. The physician explained that it was probably from sitting in his chair so much of the day.  Since it is difficult for Sue and Bill to get to the clinic, the doctor contacts the home health agency associated with the clinic about a consult for wound care. Both Sue and Bill are hesitant about having the nurse come to their home, but agree to try it.

You are the home care nurse coming for your initial assessment.

1) From the information listed in the scenario, what are some of your initial areas of concern? 

2) List two evidence – based assessment tools that might provide valuable assessment data in this situation?

3) Discuss at least two benefits of utilizing an evidence based assessment tool.

During your interactions, Sue tells you several times that they want to stay in their own home as long as possible.

4) Explore the advantages, disadvantages, and costs of family caregiving on both the family caregiver and on the family member who requires care. 

5) Explore what individual nurses can do to promote improved quality of life for both the family member needing care and the family caregiver? Note: although it is important for nurses to be active politically and be engaged in policy reform, those types of responses will not earn points in this discussion.

6) LeBlanc (in your text edited by Larsen) states ” Self management implies that the individual with chronic condition(s) is motivated, empowered, and engaged” (p. 311). Explore factors that contribute to successful self management.  At a minimum address: 1) motivation, 2) empowerment, and 3) engagement.

7)  Explore at least barriers to effective self management.  

Situation two: Bill and Sue (from first scenario) two years later

After two more years in their own home, Bill forgets that he is weak and falls regularly (at least twice a week) while trying to transfer himself. He has become incontinent, and he sleeps quite a bit during the day (in his chair) and is calling out often during the night. He also has had two more pressure wounds on his ischeal tuberosities.  One day, he falls, breaks his femur, and is admitted to the local hospital for an open reduction and internal fixation. After a family meeting, the very difficult decision is made that Bill will move into the local long term care facility. The facility is only two miles from their current home, so Sue can visit regularly. 

1) You are the nurse admitting Bill to the long term care center three days post operatively, what are four initial areas of concern at this time? 

2) How would you approach patient/resident and family centered care at this time? How would a patient and family centered approach impact the way you conduct your assessment, prioritize concerns, develop goals and formulate interventions to reach those goals?

3) After two weeks in the long term care center, you note that Bill has lost six pounds since admission.  Bill’s wife Sue eats lunch with Bill almost every day and tells you that Bill is ‘not a fan’ of the types of food served.  What approach would you take?

4) Bill’s wife has asked several times regarding a possible move back to his home.  How would you respond?

Bill is restless and his family believes he will be less restless if he could be up walking as he wishes.  Although he ambulates quite safely with assistance, as the nurse you are concerned about fall risk.

5)  Discuss the ethical principles of autonomy and beneficence as they arise in a long term care setting including the following:

           a) How do autonomy and beneficence fit with quality of life?

           b) How might adhering to both principles at the same time create a dilemma?

           c) How might adhering to regulatory requirements in the LTC environment make adhering to both autonomy and beneficence a challenge?