Question

Pamela is a patient of Muslim faith, living in Boston MA, with late stage melanoma. She is experiencing a variety of issues that impact her health. When you meet 45 year-old Pamela, she informs you that she is a lesbian and has been in a committed relationship with Elizabeth for 15 years. Pamela and Elizabeth are the primary parents for two children, George who is 20 and Laura who is 18 from Pamela's previous marriage, both whom are living at home with Pam and Elizabeth when they are not in college. Pamela is an owner of a restaurant, very active in her religious community, and enjoyed dancing prior to the onset of her illness. She enjoys walking her Labrador retriever along the Charles River with Elizabeth.

Pamela’s illness has now progressed at a rapid rate and it appears that she is entering into a stage that will require extensive treatment and therapy. Pamela and Elizabeth have discussed together the type of treatment and care that Pamela wants and will agree to. The children strongly disagree with what Pamela and Elizabeth have decided regarding future treatment (to terminate treatment if there is not a positive result within three months and to only receive medication and care that will minimize pain and discomfort in Pamela’s final days.) The children feel that Pamela has been persuaded by Elizabeth to terminate treatment rather than making the decision herself. They do not want Elizabeth to be involved with Pamela's medical care or decisions and are seeking legal help in order to get this accomplished.

It appears that there is not a written medical directive about her wishes and she has not designated her healthcare proxy. Pamela remains aware of the medical issues facing her and appears to be competent to make medical decisions at this time but this could change at any given moment.

Pamela’s case is being discussed by a multidisciplinary team at your hospital. She is currently receiving chemotherapy and radiation therapy to combat the melanoma.

Pamela’s case is being discussed by a multidisciplinary team at your hospital. She is currently receiving chemotherapy and radiation therapy to combat the melanoma. The team consists of a primary care doctor, an oncology physician assistant, a nurse, a physical therapist, a social worker, an occupational therapist, a recreational therapist, exercise physiologist, dietitian, and a psychologist.

5) Where could disagreements between your profession and the other professionals arise? How would you handle those disagreements? 6) Describe any additional types of care the patient might need.

6) Describe any additional types of care the patient might need.

Answer 1

Q5

Answer: The disagreement that can arise between my profession and the other professional is regarding the decision of treatment taken by the patient. As a nurse in the profession, respect the decision of the patient is the first priority for nurses but counseling should be done to the patient becuase within 3 months the result can not be seen, it will take time. For other professional they might just follow what the decision of the patient regarding the termination of the treatment.

The disagreement can be handle first by acknowledging the disagreement and discuss again with all the staff regarding the best solution to resolve the problem and take a best decision that will help the patient.

Q6

Answer: The additional types of care that need by the patient include

-proper education regarding the disease condition and treatment.

-Provide psychological support and medical advices

- Encourage to take decision by own, not influence by other

- Relaxation therapy to reduce stress and emotional issue.

- Pain management should be included