discussion 1594

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Mr. Ahmed is a 49-year-old with a recurrent brain tumor currently hospitalized after experiencing seizures. Mr. Ahmed was diagnosed at age 44 and has had extensive surgery, chemotherapy, and radiation therapy. Three months ago, his oncology team advised him and his family that there were no further treatment options and recommended palliative care. The family was not interested in palliative care, they requested that “everything be done.” He has experienced weight loss, increasing severe headaches, nausea and now seizures. Following a severe seizure last week, his wife brought him back to the cancer center seeking possible new treatments and wonders if he can receive palliative care, too. As Mr. Ahmed waits in radiology for a scan, you, the oncology nurse, come to see him as you heard he was in radiology. He tells you he is so tired of treatment and being taken far away and just wishes his family would “give up and just let me be at home so I can play with my dog and be with my friends.”

Discussion Questions:

a. How would you respond to Mr. Ahmed?

b. Is it possible for Mr. Ahmed to receive treatment and palliative care at the same time? If so, how would you describe this to Mr. and Mrs. Ahmed?

c. How could you use attentive listening and presence with this patient and his wife?

d. How you would respond to Mr. Ahmed’s last statement?

Thomas, a new nurse graduate, is assigned to practice on a unit where practices are physician centered. He is working on the night shift and knows that eventually he will have to call a physician for advice about a patient. He dreads this experience because he has heard so many tales about how much physicians dislike being awakened in the middle of their sleep. He asks a more experienced nurse how to present information, how to convey the importance of needing an answer, how to remain calm if the physician is disturbed with him, how to document his oral interchange with the physician, and what the nurse’s first experience was like.

a. Is it true that physicians dislike being awakened at night?

b. Is asking a more experienced nurse about how to present information a good strategy?

c. What systematic approach could be used for communication (Hint: Describe SBAR).

d. How could Thomas use the IOM competencies to practice his communication in advance of actually needing to call a physician?


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