Managing Conflict

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.

Attention 

• 1- Please      write your paper in the first person.
• 2- You      may use headings, images, tables and dot points to convey information.
• 3- For the purpose of this assessment      task Tom lives in Tasmania.
• 4- Please      read the rubric for this assessment before you start writing.
• 5- use references in text and list (Harvard style) 8 references at least.

Just follow Tasmanian legislation.

 

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.

Just follow Tasmanian legislations

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 no 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.

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 for this assessment before you start writing.

Just follow Tasmanian legislations.

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-making-what-do-clinicians-need-know-and-why-should-they-bother

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

CASE STUDY RUBRIC

Criterion	High Distinction (HD
1. Applies legal & ethical principles to decision making (20%)	Demonstrates exceptional critical analysis and exploration of the key principles and applies these to the case context.
2. Demonstrates the principles of effective communication when interacting with Tom and his family (30%)	Selects specific communication strategies, which address the needs of Tom and his family given the current context of care (on multiple levels, for example physical, cultural, spiritual and psychological). Demonstrates an excellent understanding of conflict resolution.
3. Demonstrates knowledge of palliative assessment and symptom management (30%)	Demonstrates an outstanding knowledge of assessment and management (including pharmacology).
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.

1- Start with patient context 3-4 sentences

 

 

 

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