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Posted: February 6th, 2020

Print/Download this page Assessment 2: Case Study

Print/Download this page
Assessment 2: Case Study
Introduction
In this case study you will meet Tom, a 55 year old man who has advanced lung cancer and multiple metastases.
To start you need to watch Tom’s story to provide background and context.
Video
Video source: https://echo360.org.au/media/81dbf602-de8e-4787-aaa6-a31f28bfa732/public?
autoplay=false&automute=false
Tom’s Story
Tom’s Story 
Things you need to know…
Tom was able to discuss his end of life decisions with Uncle Joe, however his condition continued to deteriorate
and he is now receiving end of life care (terminal phase).
Following on from the end of the video, Tom’s daughter Carina arrived at the hospital. Carina is clearly angry (she
is raising her voice and she is clenching her fists), she tells you that she has power of attorney for her father and
she wants the morphine stopped and changed to ‘something better’. She explains she wants ‘everything done to
save her father’ and that only she has the capacity to make decisions for her father.
Jimmy confirms the power of attorney claim however states that his mother Cec is Tom’s enduring guardian
and he thinks his father did “some advanced care planning with his GP, but he is not sure, but that would
override the guardian thing anyway – wouldn’t it?”.
While reviewing the progress notes, you also note an entry from Tom’s last admission, the page is tagged with a
red dot and a medical registrar has written “Following discussion with team – NFR, not for CPR, not for ICU
admission”. The entry is signed and dated. He current medication order is for Morphine 2.5mg – 5mg SC every 2
hours PRN. All other medications have been ceased.
Carina’s arrival and comments are causing obvious distress to the rest of Tom’s family, who are aware of Tom’s
wishes and are supportive of the palliative approach currently being undertaken, however they are concerned
about Tom’s increasing agitation and pain. Tom is not longer eating but is taking small sips of fluid, Carina wants
the nursing staff ‘make sure Dad drinks or get the doctors to put a drip in’.
You are the Registered Nurse caring for Tom, you will need to process the information provided to:
identify the issues
establish goals (what do you want to happen)
select a course of action (what are you going to do)
A good starting point is to ensure you research and understand the terms above which are in bold.
Module three will provide you with a range of resources to assist you with your case study.
Word count is 1500.
You may also like to refer to this document: Death and Dying in Aboriginal and Torres Strait Islander
Culture_Sorry Business 
Attention
Please write your paper in the first person.
You may use headings, images, tables and dot points to convey information.
For the purpose of this assessment task Tom lives in Tasmania.
Please read the rubric
(../Rubrics/CNA254%20Case%20Study%20Rubric%20Sem%202%202018.pdf?
_&d2lSessionVal=FToH1iJ4Cg7vWbWrvsOLSdfRc&ou=347841)for this assessment before you
start writing.
What is Shared Decision Making?
According to Australian Commission on Safety and Quality in Health Care ‘shared decision making involves
the integration of a patient’s values, goals and concerns with the best available evidence about the benefits,
risks and uncertainties of treatment, in order to achieve appropriate health care decisions’. Shared decision
making is an ethical imperative and the hallmark of good clinical practice (Hoffman et al. 2014). As a
Registered Nurse shared decision making fits well with our values and standards around patient advocacy.
Working together with patients/clients rather than an approach whereby we dictate care is a far more
mutually satisfying relationship.
Hoffman, T. Legare, F. Simmons, M. McNamara, K. McCafferty, K. Trevena, L. Hudson, B. Glasziou, P. Del
Mar, C. 2014, Shared decision making: what do clinocians need to know and why should they bother?, Med
J Aust, vol. 201, no. 1, pp. 35-39. https://www.mja.com.au/journal/2014/201/1/shared-decision-makingwhat-
do-clinicians-need-know-and-why-should-they-bother

Communication
You will note on the rubric that communication is one of the criteria. As a Registered nurse (and as a
student) you will need to speak up and advocate for patients receiving end of life care. Some of the reasons
you may need to speak up and advocate for patients/residents is when they are not being included in the
decision making, or they are not receiving adequate pain or symptom control. There are also times when
patients/residents and their families are not receiving adequate information regarding goals of care and the
prognosis.
Managing Conflict
This video is a good starting point to get you thinking about managing conflict.
Managing con

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