Case Studies

THE FIRST SCENARIO ~ A Case Study

Levine’s Conservation Model will provide integrated theoretical aspects to the facts of this case. (Remember, theories are described on Introduction 2 page.)

“Nursing can exceed only when it recognizes that the person is not summarized by the immediate present, but is burdened by a lifetime of experience—recorded not only on the tissues of the body, but on the spirit and mind as well” (Levine, 1990, p. 197).

CLAIRE

Claire sits by her bed, hearing the irregular rhythm and declining quality of Victoria’s breathing.  An adult son and his wife huddle around the makeshift bed in the humble living room where she has been lingering between life and death for 3 days, suffering in the unfortunate final stage of a battle with AIDS complicated by pneumonia, comforted and cared for by the community-based hospice staff.  Claire has been her case manager and now she is remembering when she first met Victoria in this same community 25 years ago . . .

Claire began her nursing career on a Med-Surgical unit in a general hospital of a middle-size town.  She worked full time, during that time, married and with her husband, Jason, began working toward the purchase of their own home. Claire had many challenging and interesting patients over this time (the ‘80s).  One of whom was Victoria, who was 22 years of age.

Six days before Victoria was discharged to home after a cholescystectomy with a 4-inch incision and an adjacent stab wound with a T-tube draining into a grenade-like collection unit (this was before laparoscopy procedures). She returned in 3 days with a fever of 1040 and abdominal pain.  Her surgical wound had eviscerated 10 cms producing foul drainage.   She was assigned to Claire.

In the immediate hours cultures were taken, IV antibiotics begun, pain med ordered and given, diet limited to clear liquids, and activity restricted to bedrest for 24 hours.  A male visitor of a different ethnicity than the patient had accompanied her to the Emergency Department, but never returned throughout her hospitalization.  It was 3 days before Victoria gained the courage to relate what brought about this setback: a male “friend” had handled her roughly, threatened her, and punched her in the abdomen.  Claire learned more about the environmental and social aspects of her living circumstances and, with her permission, arranged for the Social Worker to meet with her.  Today she was discharged with new living arrangements made and continuance of the SW support.

Discussion . . .

What are the conservation principles applied here?  What values are expressed?

Today, what assessment measures are in place to discover need for intervention earlier?
What support structure do you have in your community to assist a person like Victoria?

It is a year later now . . .

Victoria has arrived again on Claire’s unit.  This time she sustained a comminuted tibial fracture that has been surgically repaired.  She states she tripped over her child’s toys.  Bruises on her arms and face were also noted.  During the admission assessment Claire discovered a foul odor from vaginal drainage.  Victoria admitted to multiple-partner sexual activities.  During the next few days of her treatment, Victoria and Claire bonded a friendship in spite of their many differences.  It was clear that Claire’s care and concern won her heart.  When Victoria was discharged 5 days later she was referred to the Public Health Nurse who covered her neighborhood.

Discussion . . .

The primary/ultimate goal of Conservation:  To defend, sustain, maintain, define, the integrity of the system.  It acknowledges the effort the individual makes to receive recognition, respect, self-awareness, humanness, holiness, independence, freedom, self-hood, and self-determination. (Alligood & Toomey, p. 201)

How did Claire honor this goal and what more could be done if it happened today?
What care will the PHN presumably plan for Victoria and her child?

Though Claire enjoyed working on her Med-Surg unit and had progressed in responsibility to a relief Assistant Nurse Manager, she had a yearning to do something different in nursing—to take her perceptive caring skills into the home of patients in order to teach them methods of prevention.  Claire began to think of a broader mission of mercy outside the hospital that would aid in preventing these unfortunate circumstances.  So she left her hospital job for a position in a Home Health Care agency. Over the ensuing years she encountered many unique and challenging situations.  For instance:

  • Lem, the 65 year-old dairy farmer who developed peripheral artery disease as a result of hypercholesterolemia, obesity, and hypertension.  After femoral-popliteal bypass surgery, Claire managed his recovery and rehabilitation at home, monitoring wound healing and improvement of circulation and teaching Lem and his wife a healthier lifestyle.
  • Sarah, an 82 year-old widow, living alone in a small apartment of an old renovated warehouse, who had iron-deficiency anemia and rheumatoid arthritis. Contacting Sarah’s only surviving son in a state 600 miles away, Claire was able to aid them through community resources in resolving a fractured relationship and living together for the benefit of both.
  • Denzel, an African-American 13 year-old boy with sickle-cell anemia and a passion to play basket ball.
  • Marina, an obese 17 year-old mother of twins and her newly-diagnosed diabetes.

Discussion. . .

Comment on the above cases in the context of Levine’s theory model.  If you wish, you may enhance any of them to create another working case study using either Watson or Levine that we can then be added to this course 🙂

Claire, now in her late 50s considers retiring soon.  She has worked full time most of her career, with a 6-month break to take care of her dying mother last year.  Fortunately, she was able to return to the job she loved so much in home health.  But she is noticing a lessening of stamina, though she has managed her health well.  As she plans for her future she ponders what she will do with her time and how she will continue to serve the needs of others.

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