Reference no: EM133261536

Case study:

You are a team of multidisciplinary professionals, including RN case managers, physicians, Advanced Practice Nurses, and RN educators who oversee discharge planning.  Each week, the team meets to discuss patients in the hospital with new diagnosis of a chronic illness to ensure a plan is in place for follow-up and illness management.  The RN case-managers continue to follow families and meet with them in clinic to assist them in navigating the services needed after discharge.  

After you attended a national conference, you heard a speaker talk about the special needs of adolescents with chronic health conditions transitioning to self-care as young adults-and you started thinking about the transition needs of the adolescents you often see in the hospital.  You then returned to your team and proposed a new, theoretical, focus on this population. 

Nate is a young man, 18 years old, newly diagnosed with type I diabetes after being hospitalized with ketoacidosis.  He has a pre-existing diagnosis of anxiety.  His single mother has been raising him and works as a VP of a bank.  He is close with his grandmother, who has been by his side through the entire hospitalization.   He has progressed in managing his anxiety, after years of therapy and finding the right balance of SSRI medication. He and his grandmother say he still gets easily overwhelmed by details and has frequent panic attacks when there is a lot of change in his life.

Nate loves music-and finds it extremely healing.  He has become a gifted pianist and has decided to pursue a college degree in music performance. His mother has been able to support his lessons and also a couple of week-long music camps-which have gone well when Nate attended.  He has been researching programs where he could study piano, and the program he wants to attend most is in Chicago.  He has been accepted to this program as well as a local program that he thinks will not challenge him enough. 

Nate and his mother had decided he should pursue the program in Chicago and he has enrolled there.  It is the spring before his freshman year, and you are working with the family to make plans to ensure his physical and mental health care will be seamless between his stays on campus and when he comes home on breaks; and also to make plans to anticipate challenges that may come up as he moves away from home and pursues this challenging course of study.  Nate says he feels ready to start taking over his own life, but up until now, all of his care has been managed between by his mother and his grandmother.  His mother feels very concerned because Nate's anxiety can often make him avoid tasks and he doesn't have a good track record of meeting due dates, etc without quite a few reminders and support from those around him.  His grandmother is scared that he will have another life-or-death complication from his diabetes because of not caring for himself. She feels he should study in town for a year and then move away after a more progressive transfer of who's responsible for his health management.

Questions:

1. Diagnose and Prescribe:  Design a brief, practical set of questions you can ask to determine "How does Nate's anxiety impact his self-care?" and "What factors impact his self-care agency?"

**Remember to include instructions for the nurse about any notes they would need to use your set of questions correctly**

2. Design and Plan Nate's care

3. Produce and Control (describe implementation and evaluation of this plan of care)

4. Which factors are required for the nurse to demonstrate nursing agency in the care of Nate and his family? (Using Orem's 5 nursing helping methods)

5. How can the community-based nurse case-manager facilitate Nate's movement from the stage he currently is in to a supportive-educative system before entering college? (Using Orem's 5 nursing helping methods)

6. What outcomes would let Nate and the case-manger know that the interventions have been successful? (Using Orem's 5 nursing helping methods)