case study: Susan Frank is an advanced practice nurse in a home care agency and
case study: Susan Frank is an advanced practice nurse in a home care agency and she is making her initial visit to a new patient. The patient’s name, Jay Gold, looks familiar, and when she enters his home, she finds she knew him in her former job. Susan had first met Mr. Gold more than a decade ago when she was working on a medical unit at the local community hospital. At that time, Mr. Gold had been admitted to the hospital for diabetes with ketoacidosis. It was at this time that he discovered he had insulin-dependent diabetes. During his initial hospitalization, he was started on insulin and had to learn to care for his diabetes. In the weeks that followed his hospitalization, Mr. Gold returned to the medical unit to see the nurses who cared for him each time he had a visit with his dietitian and diabetes educator. As his diabetes came under control, Mr. Gold returned to his outgoing, energetic baseline. He talked to the nurses about his sales job, his wife, and his two daughters and told them how much he had learned in caring for his disorder. The reason for the home visit was that Mr. Gold was found to have osteomyelitis, requiring 6 weeks of intravenous antibiotics. Susan was shocked to see Mr. Gold’s appearance now. He was lying in his bed with his back to her and did not look up when she entered the room. She introduced herself and reminded Mr. Gold that she had cared for him ten years before this visit. She spoke to him softly and held out her hand. When Mr. Gold looked up at her, he put out his hand, she gently held his hand and noted that his color was ashen. His voice was weak as he spoke, and Susan thought that he appeared depressed and lethargic. He had had a right above the knee amputation (AKA), and Susan noted a large scar on his chest. Susan asked Mr. Gold if he was comfortable or if she could help him get more comfortable before she reviewed his medical record. He stated that he would like to turn in his bed and Susan took time to rub his back with the repositioning, while talking to him about his family. He tells Susan that he and his wife live in a 2-story condo in in a quiet retirement area. His two grown daughters are married but visit often. Susan also learns that Mr. Gold has not been able to work for several years and is relying on Social Security disability and his wife’s part-time job. During the dialog, Mr. Gold’s eyes fill up with tears and he tells Susan that he does not want any antibiotics, because he wants to die so he isn’t a burden to his family any longer. Susan sits down on a chair beside Mr. Gold and sits quietly, holding his hand for a few moments of silence and then asked him to tell her more about his feelings. He described how much he loves his family and doesn’t want to use up all of the money for caring for him, as he wishes to leave his wife comfortable. Susan thanked Mr. Gold for sharing his feelings with her and rubbed his back and shoulders gently until he closed his eyes. After Susan was sure Mr. Gold was comfortable, she reviewed his record and found that Mr. Gold’s diabetes had progressed rapidly and that he had multiple complications. He had had a coronary artery bypass graft (CABG) 2 years ago and was also being monitored for decreased renal function. He had vascular problems and neuropathy, which led to the AKA. Susan knows that antibiotics will further damage Mr. Gold’s renal function, but without antibiotics the osteomyelitis will progress and could also be life-threatening. She also feels conflicted with knowing Mr. Gold’s current wishes to decline treatment. Answer each of these questions in your initial post: Discuss the actions in the scenario related to Susan’s empirical knowing (science of nursing). Why do these actions relate to empirical knowing? Describe the actions related to Susan’s esthetic knowing (art of nursing). Would you have done something different in this scenario based on your esthetic knowing? What actions did Susan take that related to her personal knowing (therapeutic use of self)? Would you change any action that Susan took related to your own personal knowing in this scenario? What information in this scenario will require Susan to engage her ethical knowing (moral component of nursing)? What do you think she should do first based on your own ethical knowing? You have examined the nursing metaparadigm concepts in your readings and in the multimedia activity this week. If you were to examine this scenario through the lens of Nightingale’s theory, can you identify the four recognized nursing metaparadigm concepts in this scenario? Explain if you think that caring and social justice should be part of the nursing metaparadigm, and whether these concepts would fit in the scenario. Your initial post should Be between 350 and 400 words in length. Points will be deducted if posts are less than or greater than the recommended word range. Have clear and well-thought-out responses to questions, written in a scholarly manner. Do not repeat the questions your responses. You are encouraged to write in a scholarly manner. If you want to specify which question you are responding to, use headings consistent with APA (7th edition) format rather than repeating the questions themselves. Be supported with at least two scholarly sources other than, or in addition to, your textbook, cited both in the body of the initial post and in the reference list, using APA (7th edition) format.

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