Case study of Tom • This assessment is to be presented in essay format. • You may write in the first or third person, however please remember to be consistent (do not swap between the two). • Tom resides in the state in which you are enrolled in the BN - for example if you are enrolled in NSW, Tom lives in NSW. • You may use headings, please ensure they do not disrupt the flow of your writing. • Please read the rubric for this assessment before you start writing and follow rubric. Rubric for this assessment Criterion High distinction Fail 1. Demonstrates and applies legal & ethical principles to clinical decision making, and discusses the important of shared decision making (30%) Demonstrates exceptional critical analysis and exploration of the key principles with seamless integration of literature. Demonstrates little or no insight into the applicable principles Little or no attempt made to correlate literature. 2. Analyses the factors which may impact the provision of palliative care for aboriginal people, and demonstrates culturally safe care (20% Demonstrates a sophisticated understanding of the cultural factors which may impact on the provision of care for Tom and his family, evidence of advocacy is clearly evident. Demonstrate a limited/basic understanding of the cultural factors which may impact on the provision of care for Tom and his family. 3. Demonstrates knowledge of palliative assessment, communication and pharmacology issues (30%) Demonstrates an outstanding knowledge of assessment, communication and pharmacology Demonstrates a poor or limited knowledge of assessment, communication and pharmacology and/or incorrect information presented 4. Writes in an appropriate academic style, substantiating work with scholarly literature and legislation and Harvard referencing (20%) High level of academic writing with strong evidence of planning. Discussion is consistently expressed in a clear and fluent manner. Draws on a judicious selection of literature & legislation to inform and justify writing. Accurately referenced all sources using the Harvard style, without error. The clarity of your paper is hindered by poor structure, poor grammar, and structure (little evidence of planning). Minimal appropriate literature & legislation accessed to support writing. Inaccurate/poor referencing style or does not use the Harvard style. 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 There is a government website, where you can watch movie; which is PCC4U (PALLATIVE CARE CURRICULUM FOR UNDERGRADUATE ) and then go to Home> Learning Modules> Focus topic> Topic2: Aborginal Population>1. Caring for Aborginal People with life limiting Illness> Avtivity 1: Tom’s Story. Task Description :. The aim of the written work is to provide a critical analysis and evaluation of the ethico-legal issues raised in the case study. Your discussion should include the nursing practice in this case relating to complex pain management, pharmacology issues and the patient nurse relationship. Assessment Criteria : Criterion 1: Demonstrates and applies legal & ethical principles to clinical decision making, and discusses the important of shared decision making. Criterion 2: Analyses the factors which may impact the provision of palliative care for aboriginal people, and demonstrates culturally safe care Criterion 3: Demonstrates knowledge of palliative assessment, communication and pharmacology issues. Criterion 4: Writes in an appropriate academic style, substantiating work with scholarly literature and legislation and 8 Harvard referencing. Task length 1500 words Things you need to know... After the commencement of the morphine/midazolam syringe driver to which Tom consented, Tom's daughter Carina arrived at the hospital. Carina 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'. Jimmy denies the power of attorney claim and states that his mother (Cec) is Tom's enduring guardian and he thinks he father did an "advanced care paper, but he is not sure, but that would override the guardian thing anyway". 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 the fact he is not longer drinking or eating. 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. You are the Registered Nurse caring for Tom, you will need to process the information provided to: • identify the issues • establish goals • select a course of action I have also attached the conversation of movie for extra information. Due date of assignment- 27/04/2017 A1: TOM’s story 2.16 mins Cec (Tom’s wife): Tom, Tom the ambulance is coming to take you to hospital! Jimmy (son): Mum, mum what happened? Cec: He couldn’t sleep, he was hot and sweaty, couldn’t keep still, he got up to go to the toilet. I heard a crash. He just fell. Jimmy: Dad, dad you okay old mate? Tom: Yeh! Yeh, I’m alright! Jimmy: Okay, okay everything’s fine dad. The ambulance is coming, we’re all here. In hospital Sarah (Nurse): Hi Tom, what have you been up to then? Having a bit of excitement to start your day? What happened this morning Tom? Tom: I was on the way to the toilet and next thing I knew I was on the floor. Felt I couldn’t get my breath. Sarah: You must’ve both got a fright. What happened just before you fell? Tom: Not sure, just remember being on the floor. Sarah: That’s okay Tom, we’ll have a look at everything and see if we can find out what’s going on. You’ve been coming to the hospital for some time now, haven’t you? How longs it been? Cec: Yeh, it’s been a while now hey, over a year now. Sarah: What’s your biggest worry at the moment? Tom: I’m okay really. I’ve got the family coming around to help Cec, which is a good thing. Sarah: Tom, I can see a difference in you since we saw you last and I can see that you’re in pain and that you seem to be having trouble breathing. Tom I’d like to talk to you about some medications we can use to help manage your pain and breathing. How would you feel about having a chat about that? Perhaps there’s someone else you’d like to be here while we talk about these things? Or I can ask Nancy our Aboriginal liaison officer to come in? Tom nods Okay Tom, I’ll let you rest now and I’ll come back in a little while. Here’s your call button, I’m just going to put it right there, if you need me just call, just press it okay. Alright, I’ll be back soon. PCC4U IMPLEMENTATION GUIDE | STUDENT LEARNING RESOURCES | 2014 121 A3: Acknowledging specific needs 1.40 mins Sarah: Tom’s back in with us following a collapse this morning. I started admitting him, but he just wasn’t comfortable talking to me about this last episode. Actually I felt really uncomfortable and I didn’t really know what to say. Nancy (Aboriginal liaison officer): What’s the biggest concern about Tom at the moment? Sarah: He’s in a lot of pain, and he’s having trouble breathing. I mentioned that I’d like to try some tablets to try and help manage his symptoms but he just stopped engaging with me. I don’t know why? Nancy: Well he’s probably worried about a lot of things at the moment. I think first and foremost we need to let him settle in with the family and he’s also likely to be sensing something is really different this time. Sarah: Absolutely, it’s been documented that his condition has been deteriorating by his team. They’ve also mentioned that his prognosis is very poor. That has also been discussed with his family. Nancy: And I’m sure Tom and his family are really aware of that. Nurse: Absolutely, he has definitely deteriorated since I saw him last. I’m really worried about his symptoms; they need to be managed properly. Nancy: Yes, we do need to be mindful though that Tom may want to use a traditional healer or he may want to use some traditional medicines. Sarah: Oh okay, I don’t really know much about that so what would I need to do to arrange for that to happen. Nancy: Importantly we need to take the cues from the family first. They may already be dealing with some traditional medicine or some healers. If not though we can always contact the local Aboriginal medical service and see if they’re dealing with any traditional healers at the moment, but importantly we need to take the cues from the family first. Sarah: Yes. Nancy: Should we go and see him? Communicating with Tom’s family 3.40 mins Nancy: Hey Tom, good to see you. How you doing Cec? Good to see you Jimmy. You been alright Uncle, you been up to country lately? Tom: We was up there a month or two ago, that right Cec, yeh. Cec: Yeh, about that. Nancy: How’s all the mob? Tom: They’re all good. Nancy: Now Uncle, I hear that you’ve been talking to Sarah the nurse and she’s told me that you’re in a little bit of pain, and that you’re breathless. Tom: Yeh, I don’t want them to put me on that morphine. Remember Cec when they gave it to Aunty Joyce. That morphine, made her real drowsy. She couldn’t even speak and then she died the next day. 122 PCC4U IMPLEMENTATION GUIDE | STUDENT LEARNING RESOURCES | 2014 I’m not staying here, we can manage at home. Anyway I want to see Uncle Joe! Jimmy: Yeh that’s okay Dad, I’ll talk to Uncle Joe. I’ll get him to come have a yarn, okay. But let’s listen to what Sarah has to say first hey. Sarah: Tom it’s understandable that your experience with Aunty Joyce would make you cautious about morphine. We would use a small amount to help manage your pain and breathing without making you drowsy. From what you’re saying, it’s really important for you to be awake and not drowsy, is that right? Tom: Yep, not drowsy. I want to be awake so I can have a yarn with everybody, keep in control. That’s what this is all about isn’t it? Sarah: Let me look at this brochure with you, it’s good. It tells you all about morphine and how it might help you. It helps explain the medical jargon. Let’s go through it together. Fades out Okay so Tom does that make a little more sense now about why we’re wanting to use morphine to help control your pain and breathing? Why don’t you have a yarn with your family? I’ll have a chat with the doctors now. I’ll come back and we can talk about anything that you need to. Jimmy: Hey Sarah, I’ll start tracking down Uncle Joe. Sarah: Who’s Uncle Joe? Jimmy: Uncle Joe is an elder back in country; he’s what you call our traditional healer. It’s really important that he’s part of all the decisions that are made. Sarah: Does he need to come down here, or can we get him on the phone? Jimmy: Oh, I can get him on the phone. Sarah: Okay well I can try and set up a family meeting via tele-conference. Would that be okay? Jimmy: Yeh, no worries. Thanks Sarah. Sarah: Jimmy I was wondering if you’d like us to move your dad into a single room, up near the entrance of the ward. There’s a big area there where your whole family can wait and probably visit your dad in larger numbers than just the usual two visitors at a time policy. Jimmy: Sounds great, thank you. Sarah: Okay, is there anything else that you need right now? Jimmy: Dad knows that he’s not going to make it back to country to die. I really do think he needs to share his stories with the folks back home. I think he really needs to say his final goodbyes, it’s really important. http://www.pcc4u.org/learning-modules/focus-topics/topic-2-aboriginal-populations/1-caring-for-aboriginal-people-with-life-limiting-illnesses/activity-1-tom-s-story/