Discuss the holistic assessment strategy for Gavin and comment on the implications of the institutional context, guiding the team in their planning of Gavin’s care,
Topic: Advanced care planning, nursing decision making framework
1. Discuss the holistic assessment strategy for Gavin and comment on the implications of the institutional context, guiding the team in their planning of Gavin’s care,
2. Discuss the triggers for advanced care planning and your role in this process including the discussion with patients and family/guardian,
3. Examine the issues arising out of Gavin’s social, medical and mental health history and how this might impact on the decision-making process in relation to advanced-care planning. Include and justify the options that might have been available for Gavin.
4. Apply the Nursing and Midwifery Board of Australia (2013) Nursing Decision Making Framework (DMF) to Gavin’s care including everyone in the multi-disciplinary team the MD team to manage Gavin’s complex health and social problems.
Assessment 2: Case study Analysis – Innovative nursing practices for people with chronic/complex conditions and advanced care planning
Course Objectives being assessed:
4. Explain the role of advanced care planning in contemporary society.
5. Explore innovative practices to support the older person living with chronic and complex conditions and their families/support networks.
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CASE STUDY: This assignment is based on the case study of Gavin outlined below:
You are working in ED when Gavin (aged 60) arrives at the ED via ambulance, experiencing moderate dyspnoea, lethargy and decreased responsiveness (GCS 13-14). He was initially saturating in the high 80’s when picked up by the ambulance, and with high flow oxygen was reaching 93-94% only. An ECG is conducted and is reviewed by the medical officer in charge of the shift. Regular observations are taken and Gavin also has IV antibiotics administered as required. He is observed closely to ascertain whether the treatment being conducted is effective.
Gavin’s saturation level slowly decreases and after a chest x-ray it is discovered that he has a poor prognosis given his diagnosis of severe pneumonia compounded by his other conditions: lung metastases and co-morbidities related to COPD.
Gavin has a long history of chain smoking and he also has been diagnosed with Schizoaffective disorder. He has also not taken good care of himself for many years and he has previously discharged himself numerous times refusing treatment for other serious illnesses. He has lost contact with his family many years ago and subsequently a guardian was appointed for him under the SA Guardianship and Administration Act 1993, to make health, accommodation and lifestyle decisions for him.
The medical team is discussing his case and a high priority is the need for his guardian to be contacted so the team can be directed as to the type care that Gavin would choose at this time.
The team decide to continue with the current treatment while they wait for a phone-call from the guardian. In the meantime they decide to set up a Bi-Pap machine for Gavin.
The Bi-Pap has been in place for 2 hours and Gavin is saying continually that he does not want the mask and is constantly trying to remove it. The team is now meeting to determine whether or not Gavin condition is such that intubation is indicated. The team all agree that given the current state of his health he is not a good candidate for intubation and even if he receive ongoing Bi-Pap in the High Dependency Unit, he may not have much longer to live.
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