CASE STUDY 9

Presented by:
Diana, Daniela
Dichoso, Jennylyn
Navarete, Florcepina
Reyes, Georgie Marie
Talavera, Rose Anne
 STAGE 1
UNFOLDING CASE STUDY

Jean is an 88-year-old widow with four grand sons and numerous grandchildren. She was
living alone, caring for her own home for the past 35 years since her husband died. At home,
Jean could make meals, take care of her hygiene, pay her bills, and use the bathroom on her
own. She had enjoyed being at home and continued to take care of herself and her home.
One day she developed mild abdominal pain. She thought it was related to something she
ate, but it persisted, so she decided to go to her family doctor. She was not concerned about
the cost of seeing a doctor as she had excellent health care coverage under her deceased
husband’s insurance. Jean was taken to the clinic and underwent lab tests and a CT scan,
for which her doctor concluded she had ovarian cancer. Since the treatment would not
provide a cure, she opted to let cancer take its course. The clinic nurse told Jean to call if
she needed anything. Jean was a strong independent woman, as she had to be after
becoming a widow at such a young age. But now, she was facing an unexpected diagnosis of
cancer.
Underline the words in the case study that stands out for you as
important. What is your rationale?
 What aspects of health are included in part I? How are these
aspects related to patient-centered care?
PHYSICAL EMOTIONAL SOCIAL SPIRITUAL INTELLECTUAL
• Age: 88-year- • Enjoyed being
• She opted to let cancer
old at home take its course
• Take care of • She was not • At home, Jean could
herself and concerned make take care of her
her home about the cost • Widow hygiene, pay her bills,
and use the bathroom
• mild of seeing a
on her own
abdominal doctor • She thought it was
pain • She was facing related to something
• a strong an unexpected she ate, but it persisted
independent diagnosis of • She decided to go to
her family doctors
woman cancer

• The nurse may use this aspects to identify which nursing care
plan would be given prioritize and most suited for the client.
What activities of daily living are a part of Jean’s
functional ability in the home setting?
• Since she was living alone, caring for her own home for
the past 35 years since her husband died. At home, Jean
could make meals, take care of her hygiene, pay her bills,
and use the bathroom on her own.
• She had enjoyed being at home and continued to take care
of herself and her home
 STAGE 2

Jean had been living alone at home for two months after her diagnosis.
One day when waking up she developed lightheadedness. She called her
son to help her. Her son insisted on driving her to the emergency room,
where the doctors decided she would be admitted for tests. A CT scan
revealed cancer had metastasized (spread) to her brain. The doctor and
nurse discussed the situation with her four sons. The four sons were
unable to stay with their mother. Although Jean was a very independent
woman who wanted to go home, she would not be allowed to return
home, but instead, the social worker arranged for her to be admitted to a
long-term care facility.
What interventions protect patients from falling in the
long-term care setting?
• Assess furthermore the client capabilities on sensory and physical status
• Instruct the patient to turn side, sit, dangle her feet, wait for a minute,
and hold the side of the bed before standing when she come from a lying
position
• Transfer the patient room near the nurses’ station to be able for the nurse
to response quickly when patient calls ( call light)
• Make sure the family is involved on client’s safety ( making sure that
slippery objects and wet floor is not within the client’s reach)
• Provide assistive device (walker)
• Move items within easy reach by the patient (call light, telephone, water,
urinal)
• Place the bed at lowest position as possible and use side rails
• Encourage the patient to use slippers with nonskid soles when walking
• Familiariaze the patient to the room
 How is the ability to perform activities of daiy living related
to safety?

Due to her age and her condition the client’s ability to

perform her activities of daily living such as providing care to
herself and her home may put the client at risk for fall.
 STAGE 3
Jean wanted nothing more than to live her final days at home. It was disappointing to her
that she went to the hospital for lightheadedness and now would never return home. In long
term care, she secretly hoped she would be able to return home, she thought, if she worked
hard enough. Her mood was uplifted when visited by her grandchildren. One evening, after
her visitors had left, Jean placed her call light on for assistance to use the restroom. She
waited for 20 minutes and nobody came to help. She was worried she would be incontinent
and soil her underclothing, so she got up on her own. Unfortunately, she was too weak and
dizzy and fell on the carpeted floor. Now she was really scared. She thought she certainly
wouldn’t be allowed to return home after falling. Fortunately, she was not injured, but
would not be allowed to leave her bed without the help of others. She became depressed and
sadly, died one week later in the long-term care, surrounded by her family.
 Reflect on your answers to part I of the case study. Did Jean’s
desire for independence stand out to you as important? If the
staff knew Jean valued her independence, how could they have
used this information to promote safety?
Jean’s desire for independence stand out to us as important. If the staff knew Jean valued her
independence (due to being a widow and doing things by herself), they could have used this
information to promote safety by:
• Collabortion intervention between the nurse and patient
• Acknowledge the patient’s feeling and decision (patient’s right)
• Assessing even the smallest details about the client (feelings), can affect a nursing intervention, if
neglected the client condition could be severe.
• Know what to prioritize (client value her independence)
• Pliable when it comes to nursing planning and intervention
• Come up to a plan on how to help the client on doing her activities of daily living without the risk
of injury/fall
• Long-term treatment on the client by having an environment to her home (food she prepares for
herself, schedule time on going to bathroom to defecate, urinate, brush her teeth, and taking bath)
Describe the value of seeing healthcare through the patient’s eyes.
How can nurses have an impact on the lives of patients like Jean?
The patient’s perception, knowledge, feelings about her diagnosis/ disease, and her willingness/unwillingness
to undergo treatment by seeing those value through the patient’s eye, nurses can learn and will be able to:

EMPHATHIZE and NOT SYMPATHIZE on the client.

Establish THERAPEUTIC RELATIONSHIP with the patient. Once we gain her trust we may
educate her on the misconceptions and insufficient knowledge regarding to her conditions.

Encourage her to help herself and motivated to lived

Provide sufficient-centered-care on the client, and MILEU THERAPY

In your opinion, did Jean receive patient-centered-care? Why
or why not?

In our opinion, Jean did not receive patient-centered-care for the reason of:
• She should have lived longer
• Assessment on client’s feelings, perceptions is insufficient
• When patient placed her call light on for assistance to use the restroom, and
waited for 20 minutes nobody came to help. As the patient worried that she
would be incontinent and soil her underclothing, she got up on her own. She
was too weak and dizzy and fell on the carpeted floor.
• Due to fall, the patient thought she would not be allowed to return home.
• She became lonely and depressed as the client unable to do things on her
own.
Thank you for listening!