Problem
Scenario:
Tom is a 79-year-old gentleman who has recently been transferred to permanent care at a residential aged care facility where you work. He was previously at home living independently and without community services with his wife of 55 years Beryl. They have 3 sons Craig, Barry and Robert who live locally and provide support as required.
Tom has had a recent hospital admission due to increasing dyspnoea, confusion and frailty, leading to a subsequent fall at home. Following investigations, Tom and Beryl were informed that he has Metastatic lung cancer with brain and bone metastases to his spine. They have been informed that there are no treatment options available to Tom and his prognosis is poor. His symptoms of pain (headaches and back pain) with intermittent nausea have been adequately controlled as an inpatient. He requires assistance x 1 with all ADL's and Mobility, and remains a high falls risk. Tom would like to return home, however Beryl feels she will not be able to care for Tom at home, hence why he has moved in to a residential aged care facility near their home where she can visit daily.
On arrival at the residential aged care facility both Tom and Beryl are teary. Beryl feels she has let Tom down by not being able to care for him at home. You discover there have been limited discussions about prognosis, what to expect during his illness, including any end of life care planning with Tom or Beryl at the hospital.
Beryl mentions in your initial interactions that Tom is catholic and this is very important to him. She also mentions he has a dog 'Lucy' at home that he is very fond of and misses dearly. A few weeks after he arrives Tom begins to deteriorate. Beryl has had a negative experience of death as a young child, when she witnessed her father die with poorly controlled pain. She is concerned this will also happen to Tom.
A. Identifies when it would be appropriate to refer to a specialist palliative care team.
B. Shows appropriate communication strategies when discussing end of life care, and provides clinical indicators that would indicate Tom is entering the terminal stage of his illness.
C. Identifies what is important to Tom spiritually and provides discussion on how this could be addressed.
D. Provides knowledge of what is required legally post death and how continued respect can be shown to both Tom and his family in regards to his preparation.
E. Identifies if Tom is a suitable organ donor. And, the nursing procedure if an autopsy was requested.