Reference no: EM133396605

Case Study Description

First, review the case study:

Lacey is a 28-year-old patient admitted to your inpatient rehabilitation unit after a 1-week hospital stay following a fall while rock-climbing up the bluffs at Devil's Lake. Her injury included being pinned between 2 rocks and she had a crush injury of her lower leg and required a below the knee amputation (BKA) on the right side. The surgical incision on her stump is healing well but must heal even more before she can be fitted for a prosthesis. For the time being, she is using a combination of wheelchair and crutches to transfer to a bedside commode or to get to the bathroom. She has had a very limited amount of physical therapy while on the unit because of pain during healing.

During her stay on your unit, she will get 2 hours a day of physical therapy-to regain strength and flexibility-- and 1 hour per day of occupational therapy-to re-learn how to everyday tasks. The goals for her nursing care include working with her to move toward adaptation to her new situation, emotional healing, ensuring that she has resources necessary to be discharged, and assessing/intervening for family involved in her care.

Lacey has been married for 2 years and she and her husband, Tyler, had been planning to start a family in the next year. They were taking the chance to go on as many adventures as possible before they settled down. The couple have always been extremely active-running marathons, playing tennis, sailing, playing ultimate Frisbee. They had already thought they might have to scale some of those back to raise a family, but this injury will require a huge, immediate adjustment.

Lacey is extremely concerned about gaining weight, about losing her husband if they aren't able to keep doing the same things they were doing together before, whether he is going to be responsible for intimate things like helping her shower and go to the bathroom. She has also made comments about losing friends-they all have in common being very active and traveling a lot. She's embarrassed about her physical appearance now and can't even imagine how she'll feel attractive. She doesn't even know if it's ok to still think about having a baby now that she has this injury. She tells you she just feels like her whole world has been turned upside down. Her husband is diligent about visiting every evening after work and on weekends and behaves very lovingly toward his wife-but he also appears stressed and distant at times.

The nursing staff recognize the unique needs that this couple might face and want to assess the husband's current level of coping, and to figure out what anticipatory guidance and support they can provide to prepare them to go home as physically, mentally, and spiritually well as possible.

You decide to invite Tyler to have a cup of coffee with you in the family kitchen area, so you can have a private conversation and assess how he is adjusting. After you ask a few open-ended questions, and he responds with some expected responses ("everything will be fine. We love each other". . .etc.), you ask some more probing questions. He then shares with you that this has really made him upset. He feels totally guilty even being upset, but he has struggled with what this means for their future. He takes his vows seriously and loves Lacey, but never really considered that this big a "for worse" could happen. He was really excited to start having children and they wanted a big family, but now he feels like that's not ever going to happen. He really doesn't want to back off the hobbies they shared together but wants to keep spending lots of time together. He even admits that she's still beautiful and attractive to him, but he can't imagine how their sex life might change. He's afraid he'll react in a way that makes Lacey feel undesirable-and yet, he just feels overwhelmed and doesn't want to hurt her. He just feels like he does not know how to be her husband now that this has happened.

After viewing/reading the case study scenario, review the case study question prompts. In 5-7-minute, individual video, answer the prompts based on assigned module readings and other supporting evidence to apply the HEC theory principal concepts. Remember to base your responses on the assigned module readings and other supporting evidence and include citations and references in your video and posts.

Case Study Prompts:

1. After reviewing the things that Tyler said, examine the themes found by Macleod (2011).
   • Which themes resonate with Tyler's experience (and by extension, the young, male caregiver experience)?
   • Provide quotes from Tyler that support that theme.
   • Which themes do not resonate with the experience he is describing?
   • How does the phenomenon of a young, male caregiver differ from the older caregiver dyads included in Macleod's (2011) article?
2. In this situation, what would be the ultimate goal of the nurse's work with Tyler in HEC?
   • In other words, what would it mean for Tyler to develop expanded consciousness as described by Newman?
3. In 2 weeks', time (a realistic length of stay for Lacey), what interventions could a nurse use to help Tyler recognize both adaptive and maladaptive patterns and move toward expanding consciousness?
   • What kinds of behaviors or statements might indicate that Tyler or the couple will require more extensive support after discharge?
   • What kinds of behaviors or statements might indicate that they have made enough progress toward expanded consciousness to cope on their own after discharge?