Case Study or Share an Experience – End of Life Care- A Related Experience

Case Study or Share an Experience – End of Life Care- A Related Experience

Stephanie was a 65 year old who was enrolled to hospice after a difficult and prolonged admission in hospital. She had spent most of her time in the rural areas managing rural property and race horses. At first, Stephanie was admitted in a NSW hospital secondary to a basal cell carcinoma, which had spread, to the brain tissue despite surgical intervention. This was followed by a long duration in the ICU where she experienced seizures and was intubated. She was later discharged following successful management with anti-convulsants and intubation. Unfortunately, she thereafter developed a deep intracranial infection as a secondary complication from the surgery whose chances of resolving were minimal.

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As the health status of Stephanie deteriorated, Stephanie’s sister requested to consult on palliative care. Since she had become unresponsive to treatment, it was unanimously decided that she was to be referred to the hospice center for end-of life care. Stephanie had a number of symptoms which significantly contributed to a deteriorating health status. The most serious symptoms were that of a hyperactive delirium, on and off headaches and seizures. Severally, Stephanie’s seizure, depression, anxiety and seizure medications were revised. Although she became very weak, symptomatic and largely dependent, she stabilized. Case Study or Share an Experience – End of Life Care- A Related Experience.

Stephanie’s family  was her  power of attorney and   were precise that she was not to receive further interventions that would burden her such as being transferred to another facility, cannulation, resuscitation  and surgical interventions (Chan, Webster & Bowers, 2016). Her preferred place of death was hospice. Nursing care for this patient involved: continuous management of her mobility which was worsening and issues related to a high fall risk. Regularly, her mobility was reviewed by the hospitals occupational therapist and physiotherapist. Stephanie also had issues with the integrity of her skin and continence. This needed some modification in her care needs as her health status continued to deteriorate. Since the wound on her scalp was purulent and foul-smelling, her care needs had to include wound care and aesthetic matters. Since she was confused most of the time, she severally attempted to remove the dressing. Therefore, in order to suit her needs, nursing care utilized a variety of head gears.

As her condition improved, in collaboration with the senior nursing staff and the clinical nursing counselor, we became more actively involved in her care for it to be effective such as by genuinely desiring to link with Stephanie’s love for dogs and horses. It was undeniable that Stephanie had a lot of sense of humor which made it easy and possible to positively connect with her. In order to ensure that staff had clinical and emotional support regarding her care, several education sessions were held. Despite the fact that most staff were surprised on how her condition had generally stabilized, others were concerned that a short-term special unit was not the most appropriate strategy for her in the long term.

As recommended by Kisorio & Langley (2016), Stephanie’s care revolved in the entire nursing team for the purpose of ensuring that staff not only cared for their own health but also upheld a positive and compassionate outlook on her overall health status. A pastoral team was also contacted which provided her with the audience to discuss all her fears and other stressing issues. The hospitals social worker, who was also a highly trained counselor spent time with both the family and Stephanie discussing complex issues. After quite a long period of stability, Stephanie eventually deteriorated. Her end-of-life care was immediately initiated six days before a peaceful death in hospice. In the moths that preceded, Stephanie had developed a lot of trust in the staff working in the hospice while her friends and family came to terms that she would die in the long run. Whenever they could, the often visited and when she finally died, everyone was happy to go console and comfort Stephanie. Our mission as the care team was to ensure that Stephanie smiled which she actually did. Case Study or Share an Experience – End of Life Care- A Related Experience

References

Chan, R. J., Webster, J., & Bowers, A. (2016). End‐of‐life care pathways for improving outcomes in caring for the dying. Cochrane Database of Systematic Reviews, (2).

Kisorio, L. C., & Langley, G. C. (2016). Intensive care nurses’ experiences of end-of-life care. Intensive and Critical Care Nursing, 33, 30-38.