NURS 6914 Week 2 role analysis example

Seven Views of One Patient: An Interdisciplinary Role Analysis for a 53-Year-Old Woman With Advanced Progressive Multiple Sclerosis

Student Name

College of Nursing, Walden University

NURS 6914: Advanced Palliative Concepts and Interdisciplinary Perspectives

Instructor Name

Month Day, Year

Seven Views of One Patient: An Interdisciplinary Role Analysis for a 53-Year-Old Woman With Advanced Progressive Multiple Sclerosis

Case Summary

Twenty-two years after her first symptoms, a 53-year-old former bank loan officer is living with secondary progressive multiple sclerosis that has left her bedbound. She can no longer move her legs, has limited use of her arms and has begun to cough during meals. Over the past year her thinking has slowed, and her husband describes new irritability and flat moods as "living with a stranger in the house." She has had two urinary infections this year and a pressure injury over her sacrum that is slow to heal. Her husband, 55, works full time and provides most of her care at night; their 15-year-old son has missed school to stay with her when the aide cancels. The home palliative team was consulted after her second hospital stay.

Guidance on palliative care for people with severe, progressive multiple sclerosis recommends interdisciplinary care addressing symptoms, psychological and cognitive change, caregiver support and advance care planning (Solari et al., 2020). This paper analyzes what each of seven team members contributes, using a common format: what the role assesses, what it alone tends to see and where it collides with another view.

Palliative Advanced Practice Registered Nurse

Assesses. Symptoms, prognosis in general terms, goals of care and the medical plan across settings. The palliative APRN practices within the scope and standards defined for palliative nursing, which include advanced assessment, prescribing where state law allows and leading goals-of-care conversations (Dahlin, 2021).

Alone sees. That her coughing at meals and two infections suggest a trajectory the family has not been told about, and that a conversation about goals is overdue.

Collides with. The home health nurse, who wants to focus on wound healing, which the APRN suspects may not be achievable.

Home Health Registered Nurse

Assesses. Skin, continence, nutrition, medications and daily function.

Alone sees. Daily change: she sees the wound each visit, notices when intake falls and knows which days the aide does not come.

Collides with. The APRN, over whether wound healing remains a realistic goal or whether comfort and prevention of further breakdown should come first.

Social Worker

Assesses. Family functioning, finances, caregiving capacity and community resources.

Alone sees. A husband near collapse, sleeping four hours a night, and a son whose missed school is a warning sign no one else has recorded. Also that the family may qualify for more paid care hours through a waiver program.

Collides with. The husband himself, who says he is managing and resists outside help in the house.

Chaplain

Assesses. Spiritual distress, meaning and sources of hope.

Alone sees. The husband's anger at God, voiced only to the chaplain, and her own quiet question about whether her life still matters now that she cannot work or care for her son.

Collides with. No one directly, but the chaplain's findings are often left out of team discussions when time runs short.

Pharmacist

Assesses. Medications, interactions and safety.

Alone sees. That several of her medicines for spasticity, bladder symptoms and mood can each cause drowsiness or confusion, and together may be adding to the cognitive change her husband describes.

Collides with. The neurologist's plan, which added medicines one at a time over years without a combined review.

Home Health Aide

Assesses. Bathing, positioning, skin and comfort during personal care.

Alone sees. What she is like during intimate care, when she is most vulnerable: that she winces when turned onto her left side and is more alert in the morning. The aide spends more hands-on time with her than any other team member.

Collides with. Scheduling, since visits called off at short notice leave gaps the son fills.

Volunteer

Assesses. Companionship needs, informally.

Alone sees. What she talks about when no one is assessing her: her garden, her old work friends and her wish to see her son finish high school.

Collides with. No one, but the volunteer is rarely asked what she has heard.

Where the Views Meet

The Interprofessional Education Collaborative organizes collaborative practice into four competency areas, one of which concerns knowing your own role and the roles of others well enough to use them (Interprofessional Education Collaborative, 2023). This case shows why the second matters. Each role holds a piece: the pharmacist's medication finding may explain part of the husband's stranger, the aide's observation of pain on turning bears on the wound plan, and the volunteer has heard the goal, seeing her son graduate, that could organize everything else.

Three collisions need resolving. First, wound healing versus comfort requires a goals conversation led by the APRN with her and her husband. Second, the medication burden requires a combined review by the pharmacist, APRN and neurologist. Third, the husband's resistance to help requires the social worker and chaplain together, since his exhaustion and his anger may be linked. The team will hold a meeting in which every role, including the aide and volunteer, reports what it has seen.

The case also shows that the roles with the least formal authority often hold the most personal knowledge. The aide and the volunteer spend hours with her in ordinary moments and hear what she says when she is not being assessed. Teams that include only licensed professionals in their meetings lose that knowledge, and teams that include the aide and volunteer but never ask them to speak lose it just as surely. In this plan, both will be asked a specific question at the team meeting: what has she said or shown you this week that we should know?

Recommendations

Four recommendations follow from the analysis. First, the APRN should lead a goals-of-care conversation with her and her husband within the week, before the next infection or a choking episode forces decisions in an emergency department. The conversation should include her wish to see her son graduate, which the volunteer heard, and should address her swallowing and what she would want if it worsens. Second, the pharmacist should complete a full medication review with the neurologist, aiming to reduce the number of sedating medicines where symptoms allow. Third, the social worker should apply for additional paid care hours and discuss with the husband and son how the son's school attendance can be protected, including a back-up plan for missed aide visits that does not rely on him. Fourth, the team should agree on a shared goal for the wound, whether healing or comfort, after the goals conversation, so that the nurse and APRN are working toward the same end.

References

Dahlin, C. (Ed.). (2021). Palliative nursing: Scope and standards of practice (6th ed.). Hospice and Palliative Nurses Association.

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3.

Solari, A., Giordano, A., Sastre-Garriga, J., Köpke, S., Rahn, A. C., Kleiter, I., Aleksovska, K., Battaglia, M. A., Bay, J., Copetti, M., Drulovic, J., Kooij, L., Mens, J. M., Meza Murillo, E. R., Milanov, I., Milo, R., Pekmezovic, T., Vosburgh, J., Silber, E., ... Oliver, D. (2020). EAN guideline on palliative care of people with severe, progressive multiple sclerosis. European Journal of Neurology, 27(8), 1510-1529. https://doi.org/10.1111/ene.14248