Holistic Health and Healing N



Group Case Study: Holistic Health and Healing in Nursing Care

Scenario:

You are a newly graduated nurse, and will be working in the Emergency Department (ED).
As the ED serves patients with a wide variety of medical issues, your orientation program includes several one-week rotations to different specialty units within your hospital.
During each of these rotations you get to work alongside an experienced staff RN.

This week you are assigned to a Labor and Delivery (L&D) unit, and your mentor is Jane.

Shortly after you and Jane begin your shift, you are alerted that a pregnant patient, Anna, is being brought to the L&D unit from the ED for further evaluation. Anna is pregnant for the first time. She is at 24 weeks gestation and has had several routine prenatal checkups; however, she has only had one ultrasound, very early in her pregnancy, and she has not had any special testing performed.

Anna has been concerned as she has been feeling less movement of her fetus. After arriving to the ED, Anna was brought to the L&D unit for further evaluation. You and Jane receive Anna and her spouse in the OB Triage area of the L&D unit. You connect her to fetal monitoring, confirm the fetus has a heartbeat, and ask a set of intake questions that are used for every patient.

As part of the patient intake process you learn that Anna’s main spiritual/religious practice is:
[THIS WILL DIFFER BY GROUP].

Fast forward one hour:

The on-call Obstetrician has examined Anna and performed an ultrasound. You learn that Anna’s fetus has been diagnosed with Anencephaly. As you discuss this congenital defect with Jane, you are reminded that Anencephaly is a neural tube disorder that results in the absence of a large portion of the brain, and that it is always fatal. Approximately 75% of fetuses are stillborn, while those that are born alive typically die shortly afterward (usually within a couple of hours). In very rare cases, an infant born with Anencephaly may survive for a few days or a week.

Describe how you would approach the care of this patient, based on the identification of Anna’s spiritual or religious background.

Your case study presentation must include a thorough description of how Anna is likely to respond to her diagnosis, including reactions and decisions at key points as the situation unfolds. You must also address specific strategies you would take in providing nursing care, including how you would assess Anna’s spiritual or religious needs, what interventions you might consider, and how you would evaluate whether your care was helping Anna address her health needs from a holistic standpoint.

Specific sections that you must address when working up your case study:

(1) HEARING THE NEWS

Anna and her spouse are given the diagnosis of Anencephaly by the on-call Obstetrician. They learn their infant’s condition is fatal.

Describe how you would provide nursing care and support as Anna and her spouse are given the diagnosis.

(2) DECISION POINT

Anna and her spouse are told they have a decision to make:

They could choose to be induced and deliver the baby now, which would terminate the pregnancy early, or;

They could choose to carry the pregnancy to full term, knowing they will deliver an infant that may have already died (or that will die shortly after birth).

Anna and her spouse know the fetus currently has a heartbeat. Describe how you believe Anna and her spouse would choose to proceed, as guided by their spiritual or religious practice. How might they face this decision, and what factors would influence which way they decide to proceed? Would Anna be likely to induce delivery now, or, would Anna be more likely to carry the pregnancy to term?

Explain your conclusions.

(3) CARING FOR ANNA’S NEXT STAGE OF HER JOURNEY

Describe how you would provide holistic care to Anna for ONE of the following scenarios (whichever route you decided she is most likely to follow):

Option A: INDUCTION and LABOR NOW:
If Anna induces delivery now, describe what you would do to provide holistic care to her as she faces the unexpected end of her pregnancy four months before her due date. How would you prepare her to face early induction and labor?
(Do not discuss the actual birth/delivery at this point, only the induction/labor).

Option B: CARRY THE PREGNANCY TO TERM:
If Anna chooses to carry the pregnancy to term, describe how you would provide holistic care to her as she is readied for discharge, to continue a pregnancy she knows will end with the death of her infant. How would you prepare her to face the next four months of pregnancy?

(4) DELIVERY OF ANNA’S INFANT

Whether Anna delivers now, or four months from now, she will face the loss of a wanted child. Describe the holistic care that might be appropriate for Anna at the point of the delivery of her infant.

What rituals or behaviors might Anna and her spouse/family engage in once the infant has been born?What might their needs be if the infant is stillborn? What might their needs be if the infant is born with signs of life, and then dies a short time later?

(5) GRIEF AND BEREAVEMENT

Address how somebody of Anna’s background might experience parental grief and bereavement, including the role of her spouse and family.
What burial or death rituals might they wish to follow? How might they cope with the loss? What follow-up care or mental health services or support might they wish to receive?

(6) NURSE SELF-CARE

Consider your own self-care as an RN that cared for a patient experiencing a significant loss.

What are some ways that the nurse might cope with the sorrow, grief, and loss of this type of patient care situation?

General guidance to keep in mind, as you develop responses to the case study:

Remember to consider the patient’s spiritual health in the context of our human need for meaning, purpose, relationships, and connectedness.

Consider what spiritual distress cues might be present.

Keep spiritual assessment techniques in mind to guide the process of determining Anna’s needs.

Remember to consider collaborating with other resources or disciplines when appropriate. Consider the self-care needs of RNs that take care of patients during difficult diagnoses and experiences such as the loss of a child

REMINDERS:

You will prepare a presentation that covers the above sections (1 – 6).

You will separately prepare a summary paper (two pages or so), that documents an overview of the spiritual/religious background, selected for the case study. The paper is NOT meant to address the case study prompts – you will do that through your presentation. The paper is intended to summarize the general information you discovered about the spiritual/religious practice you selected.

FINAL NOTE: You absolutely must research the spiritual or religious practice you chose, in order to support your decisions with appropriate evidence. This means finding information from textbooks, articles from Library databases, or other reputable/reliable sources such as educational websites, to support your conclusions.


Purpose
Working in small groups, students will explore how a patient’s spiritual, cultural, or religious background changes the way that a nurse approaches the patient’s plan of care. This will be done by addressing a case study.
Process
The instructor will divide the class into small groups of up to five students. Each group will have the opportunity to choose a spiritual or religious practice, as a ‘variable’ to apply to their exploration of a case study. The entire class will address the same core case study and guiding prompts, with the only differences being that each group will have a different variable.
Groups will assemble a PowerPoint presentation consisting of no more than 1 title slide, 10 content slides, and 1 slide for references.
Each group will be allowed 15 minutes to present their case study findings to the class, followed by 5 minutes for a Q&A session afterward.*
*This format may change when the course is offered in a fully online format. Sharing may occur in a discussion forum instead.
Groups will submit their PowerPoint presentation for grading, along with a 1-2 page summary paper that describes the key tenets of the variable they applied to the case study.
Instructions
(1) Groups will select one spiritual or religious practice from a list of approved options provided by the instructor. The instructor will take steps to ensure that no two groups have the same variable. Sign-up will be managed through Canvas.
(2) Groups will be provided with the case study and a set of prompts to be addressed. Groups should discuss and thoroughly explore how the chosen variable would influence the way the fictional patient might respond to the health crisis described in the case study.
(3) As groups explore the case study, they will research their variable first, to understand the core tenets of the spiritual or religious practice and its general influences. The group will document these findings in a brief summary paper (2 pages maximum) to demonstrate their baseline knowledge of the variable. This paper only needs minimal formatting (double-spacing, 1” margins, correct citations where applicable); however, sources MUST also be cited properly using APA format.
(4) Groups will then apply their knowledge to the case study, preparing a PowerPoint to be shared with the class. The PowerPoint should follow this format/flow:
– Slide 1: title slide
– Slides 2 and 3: slide about their spiritual or religious practice
– Up to 8 additional slides that address their conclusions about the assigned case study prompts
– Final slide: a list of any/all references used
(5) One group member may submit the PowerPoint and summary paper to the submission link in Canvas on behalf of the entire group.
(6) ALL group members MUST contribute toward the group project, including delivery of the presentation.

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