Case Scenarios

CASE 1 (Role of Interdisciplinary Team & Communication)

Patsy, 89 years old, was diagnosed with lung cancer recently. She was taken cared by her daughter Mary at home. Due to her age and health status, Patsy’s doctor had advised for no active treatment to be commenced. A family conference has been planned to discuss further on Patsy’s care management.

Guiding questions:

In your write-up, included the following details:

1. Explain what palliative care is.
– Definition
– Different model of care
– Principles palliative care practices
– Palliative care services

2. Discuss how palliative care can add meaning and value to one’s life
– Physical
– Psychosocial
– Spiritual

3. Who should be involved in a family conference?
– identify the rightful healthcare professionals

4. What is the role of every member in the interdisciplinary team?
– State the importance of their presence

5. What are the issues to be included in the discussion/ family conference?
– List out the topics and explain why

CASE 2 (Pain Management)

Madam Yan, 48 years old, was diagnosed with terminal (stage 4) breast cancer six months ago. She appears depressed and verbalised that she has been experiencing generalized weakness and constant bone pain. She verbalised fear of being a burden to the family. She has stopped attending her weekly dancing classes which she enjoyed most. She mumbled that she has no value in life and has lost her will power to move on. She was admitted to Clementi hospice for total pain management.

Guiding questions:

1. Identify the facts/ evidences that indicate Madam Yan is experiencing symptoms of “Total pain”.
– Define the type of pains
– Include definition of total pain
– State your justification and relate to the case

2. Does dying have to be painful?
– State reasons for your thoughts
– Cite other examples

3. What are the effective ways to handle pain at the end of life?
– Pharmacological interventions
– Non-pharmacological interventions (include complementary therapies)

4. What could be barriers to pain relief for Madam Yan, such as her pain is not well controlled, or returns before expected?
– Patient and family related factors
– Environmental factors
– Medical related factors
– Other factors

5. What are some issues around opiate/opioid use?
– Common effects of opiate/opioid use

CASE 3 (Caregivers Support)

Asmah, 88 years old, has recently admitted for left Cerebral Vascular Accident (CVA) with righthemiplegia and slurred speech. As a result, she was bed bound and required 4-hourly feeding via the nasogastric tube. Asmah was being cared by her only daughter, Aisyah (65 years old retired teacher). As a palliative care nurse, you have identified that Aisyah would benefitted from a caregiver
training before discharge.

Guiding questions:

1. Explore the caregiver training programme for Aisyah.
– Duration
– Topics
– Assessment of learning

2. Discuss the caregiver support in palliative care services.
– In-patient setting
– Within the community
– Voluntary welfare organisations

3. How can we prevent caregiver burnout?
– Physical assistance
– Financial aspects

4. What can be done to reach out to the caregivers?
– Communication and connection
– How often?

5. Discuss on respite care in palliative care.
– What is respite care?
– How do you refer the patient?
– Is this case appropriate to receive respite care? Sate reasons.

CASE 4 (Advance Care Planning & Good Death)

Jamie is at end stage of her terminal illness. Recently, she has spoken extensively with her husband and daughter about what is to happen with her in her final hours before dying. She shared that she wants no interventions to extend her life. However, she has agreed to pain and symptom relief if
required.

Guiding questions:

1. Discuss advance care planning and its ethical consideration.
– Define ACP and when it started in Singapore
– What is the process?
– Who are involved in the decision-making process?
2. When should be the best time to initiate an advance care planning?
– Indicate the most appropriate time for discussion.
– State why and how.
3. What can be done to ensure Jamie has an option to participate in planning and being addressed
to her informed palliative treatment and care preferences?
– What are some questions/ queries from patient?
– How do you ensure that he is involved in the discussion?
4. Discuss on dignity care and good dying.
– Explain what dignity care is
– Give examples of dignity care
– How do you know/ measure good death?
5. What can be done to provide quality end-of-life care to patients to ensure good death and dying
with dignity?
– Link to the aspects of care for palliative care patients (i.e., physical, psychosocial,
spiritual)

CASE 5 (Dealing with Grief and Loss)

Mrs. Teo, 52 years old woman with metastatic breast cancer, has undergone a bilateral mastectomy, chemotherapy, and radiation. She is well known to the palliative care team from her several prior hospitalizations related to treatment complications and uncontrolled symptoms. She has a husband and a 10 years old child. Mrs. Teo’s oncologist revealed a new finding of brain metastasis and the lack of further treatment options available and then leaves the room. As you enter her room, you found both Mr. and Mrs. Teo were crying.
Guiding questions:

1. What type of grief are Mr. and Mrs. Teo having?
– What are the types of griefs?
– Explain why you identify the case with the type of grief

2. What is the process of grieving?
– Kübler-Ross stages of grief (link to the case)
– Identify which stage is the patient in now

3. How would you approach and convey empathy to them?
– SOLER framework
– N.U.R.S.E framework

4. What support services are available in palliative care?
– Who provides the services for grief and bereavement?
– Give examples on the services within the palliative care settings (i.e., community, hospice, voluntary welfare organisations)

5. As a nurse, how do you ‘protect yourself’ from grief and loss?
– Include self-care tips for nurses