The Unfolding Case Scenario

Instructor’s Overview:

Julia Morales and Lucy Grey Part 1

Scenario Overview

Patient: Julia Morales

Diagnosis: Lung cancer, stage 4

This scenario is part of the Julia Morales and Lucy Grey Unfolding Case. The scenario can be used as a standalone scenario or as part 1 of the case.

The Unfolding Case

Julia Morales, age 65, and Lucy Grey, age 73, are partners who have been together for more than 25 years. They are retired and have spent the past several years traveling together. Julia has lung cancer, which has been treated with chemotherapy and radiation, and now she wishes to stop treatment. Lucy is supportive and feels she will be able to care for Julia in their home. Lucy’s past medical history includes a knee replacement. Their support system includes Julia’s son, Neil.

The simulation scenarios begin with the home health nurse evaluating Julia after she has decided to stop treatment for her lung cancer. Her partner Lucy wishes to care for her in their home. In the second scenario, the end of Julia’s life is near and she is surrounded by her loved ones and the hospice nurses. Julia dies during this scenario. The learners are introduced to supportive measures for both the patient and the family during this process. The final scenario concentrates on Lucy and the difficulties she has adjusting to her new life after Julia is gone. The objectives focus on the students’ assessment of Lucy’s grieving process, how well she is coping, and the physical changes that she has experienced over the past few months.

Brief Summary of Present Scenario

This scenario involves a visit by the home health agency nurse. The students are expected to do a physical and functional assessment of Julia and her nursing care needs. Julia inquires about hospice services, but her son Neil urges her to try one more round of chemotherapy. Lucy is supportive of Julia’s decision and tries to comfort Neil. The students should assess Lucy’s caregiver preparedness, and articulate what hospice care means for the patient and family. The assessment tools recommended for this scenario include the Katz Index of Independence in Activities of Daily Living (ADL), and Informal Caregivers of Older Adults at Home: Let’s PREPARE!

Learning Objectives

Upon completion of the scenario, the student should be able to:

· Provide care for the terminally ill older adult and her family in the home setting

· Perform physical and functional assessments of the older adult, using standardized tools, to include:

· Katz Index of Independence in Activities of Daily Living (ADL)

· Assess caregiver preparedness using the Informal Caregivers of Older Adults at Home: Let’s PREPARE! assessment tool

· Identify purpose of hospice care and services provided

· Explain advance directives and durable power of attorney

· Relate the importance of providing individualized care unique to each individual and family

Patient Case Introduction to Students

Time: 1400

Report from home health agency manager:

Julia Morales is a 65-year-old woman who has stage 4 lung cancer. She has been treated with chemotherapy and radiation but now wishes to forgo further treatment. She is living together with her partner, Lucy Grey, age 73. They have been together for more than 25 years. Julia and Lucy both want Julia to spend her remaining days in their home, and Lucy wishes to care for Julia. The oncologist nurse practitioner has asked the home health agency to do a home visit to assess client needs for comfort, safety, and other support. Julia has questions about hospice care and what that comprises, especially related to pain treatment. Lucy and Julia’s son, Neil, will also be present at the visit. Please make sure to assess Lucy’s preparedness to care for Julia. I think she has some questions related to the caregiver role.

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