4.3.3: FRAME 3- Prioritize Hypothesis

Rhys’s wife calls to request the hospice nurse come to the house stating, “Something seems different with Rhys.” The nurse asks Michelle to describe what seems different. Michelle states, “he seems to be having a lot of pain, he is moaning but not responding to me, I am worried.”

When the nurse arrives, Rhys is lying in his hospital bed in the living room with his wife and daughter Liz, by his side. The nurse recognizes there is a change in condition, documents findings, and discusses the transition and comfort care with the family.

Prioritize Hypotheses

QUESTION: Bow-tie

Scoring Rule: 0/1

Identify the condition for Rhys, select three findings, and the three appropriate actions for the nurse.

Finding	Condition	Action
Altered level of consciousness	Infection	Provide emotional support for family
Anxiousness	Poor Pain Management	Administer morphine
Diaphoretic	Transitioning to end-of-life	Suction secretions
Mottled Skin		Apply cool compresses to neck and forehead
Unmanaged Pain		Raise head of bed

Putting It All Together

DEBRIEF

Rhys is transitioning to end-of-life, evident by his altered level of consciousness, diaphoresis, flushed, and mottled skin. Another symptom suggesting end-of-life is a shift in temperature. During the transition through end-of-life, the nurse's primary responsibility is to assess and manage the client's symptoms to optimize comfort. The nurse also provides support, guidance, education, and coordinated care referrals for the family and loved ones. The nurse can encourage the family to participate in providing cares, being actively engaged in care can promote a sense of control and can decrease the sense of helplessness for the family. Communicating with the family about what they can expect may decrease anxiety associated with the unknown trajectory of the end-of-life experience for their loved one.

A therapeutic relationship allows the nurse to apply professional knowledge, skills, abilities, and experiences toward meeting the client's health needs. This relationship is dynamic, goal-oriented, and client - and family-centered because it is designed to meet the needs of the client and family. Regardless of the context or length of interaction, the therapeutic nurse–patient relationship protects the client's (and family's) dignity, autonomy, and privacy and allows for the development of trust and respect (National Council State Board of Nursing, 2018).

RECOGNIZING SOCIAL DETERMINANTS OF HEALTH (SDOH)

The second SDOH domain addressed in this case study is Social and Community Context. The goal of this domain is to increase social and community support. Healthy People 2030 reinforces that a client’s relationships and interactions with family, friends, co-workers, and community members can have a major impact on their health and well-being. Therapeutic communication is an essential component in improving health, health outcomes, and well-being. Two Healthy People 2030 objectives in the Social and Community Context domain are to increase the proportion of adults who talk to friends and family about their health (HC/HIT-04) and increase health literacy (HC/HIT-R01).

What Do You Think About?

1. What are additional actions the nurse can take to encourage participation in care?
2. How can the nurse foster a therapeutic relationship with the family during this time of vulnerability?
3. What are statements and /or observations occurring with Rhys could the nurse address to educate or support Rhys's family regarding end-of-life transition?