Case study 2 Stanley is 57 years old and has motor neurone disease (MND). Stanle
ID: 127533 • Letter: C
Question
Case study 2 Stanley is 57 years old and has motor neurone disease (MND). Stanley uses a wheelchair and has limited mobility and speech. A case manager has prepared an individualised plan for him. You are meeting with Stanley to introduce yourself and confirm the broad details of the individualised plan. The meeting is taking place in his home. Stanley lives with his wife, Mavis. Prior to visiting Stanley you take the time to read his file and the individualised plan that was prepared by Stanley’s case manager. When you arrive, Mavis opens the door and guides you to where Stanley is waiting for you in the living room. Mavis does most of the talking, and discusses Stanley’s MND in quite a lot of detail. Stanley seems withdrawn and says very little. You spend some time introducing yourself, sharing some of your professional background and listening to Mavis speak, and trying to ask Stanley some questions about himself too. You try and establish rapport with Stanley and Mavis. Stanley and Mavis’ home is quite busy and cluttered, and sometimes when Stanley wants to reach an item or complete a task, he is unable to get very close to the bench or table and has to lean out of his wheelchair. The support worker suggests that an aid could be useful to help him reach across to objects. You ask Stanley if he would like to review the draft individualised plan that was prepared with his case manager. Stanley agrees and, together with Mavis, you and Stanley review the plan. You ensure that you have brought two copies of the plan so that Stanley and Mavis each have a copy. The draft plan includes the goals that Stanley developed with his case manager, but the support activities have not been confirmed. Many of the activities focus on supporting Stanley to maintain as much independence as possible and to remain living at home with Mavis. You allow Mavis and Stanley plenty of time to review the draft plan. Before moving on to prioritising support activities, you ask Stanley if there is anything else he would like included in his plan. Stanley has a complaint about how some of the support workers don’t give him enough time to do things himself and tend to ‘hurry him along’. He seems angry about this, and you note it down so that you can let your supervisor know later. Stanley also says he wants to attend the local self-advocacy organisation but has not caught public transport for over twenty years.Stanley has some cognitive difficulties associated with his MND, but he is very methodical and loves using maps and illustrations to help him with some of his tasks in everyday life. After extensive discussion, it is agreed that the goals of Stanley’s individualised plan should be for: • Stanley to continue to be supported to live at home, and be assisted to maintain his independence • Stanley to attend the weekly self-advocacy group. Together, you work on prioritising the support activities that will assist Stanley to meet these goals. As Stanley has been receiving services from your organisation for some time, a number of services are already in place and just require monitoring. Stanley is accessing daily personal care to help him to get up in the morning and assist him to shower, groom and dress, and then again at night to help him get to bed. Mavis helps Stanley with all his meals and other daily tasks. Stanley’s new goal is to attend his local self-advocacy group. Together you talk about the location of the group and Stanley’s transport needs. Stanley is keen to catch the train to the group, as he says he never gets to do anything or go anywhere independently anymore. Stanley also says if he learns to catch the train that maybe he will be able to go other places independently too.
1) How does the support worker encourage Stanley to take an active role in his own support needs? Give one example of this.
2) Why is so much work put into the planning phase of Stanley’s support, rather than just allowing the workers to get on with meeting his needs of showering and other everyday activities?
3) What monitoring and review processes might take place in future, in relation to Stanley’s plan?
4) If Stanley seems to show signs of depression in the future, is this a problem that the support worker should be able to manage alone? Who else might be able to assist Stanley with depression?
5) Stanley will need to learn some new skills in order to catch public transport to his self-advocacy group, such as buying a ticket. Outline how each of the following skill development processes would be used to teach and maintain this skill
6) If Stanley was to start using an aid to help him with reaching objects, what should you check or be aware of before assembling this equipment? Give two examples.
7) What are three things you can do to create a clean and comfortable environment for Stanley, with the support of Mavis
8) Identify three risks that could occur while following the individualised plan. For each example, explain briefly how you might manage each of these risks.
Explanation / Answer
1. The support worker has to encourage the Stanely and care effectively and training him
She has to note down the progress and important changes in her function. The support worker has to safeguard the patient and maintain dignity in the provision of care. For example, The support worker has to know how to communicate with the Stanely, and to understand the needs of him, as he has difficulty in speech.
2. The caring MND patients not only covering basic needs of the Stanely but also the support activities. Because the environment that may positively or negatively affects the patient condition and the care provided. For example, the support planning phase should include the care plan, risk assessment, the bowel habits, mood changes, skin pressure areas etc.
3. the monitoring and review processes of Stanely's plan:
4. The person with MND may be fearful and worried about his condition. It is important that the primary has to be understood by the Stanely. The support worker has to reassure Stanely and explain about prolonging intervention and control of the system. In addition to the support worker, the occupational therapist, language therapist, can also involve in the management of care in Stanely. For example, the person may experience inappropriate crying and laughing and difficult to control them and may be distressed.
5. The MND causes weakness in the muscle. He can use aids and equipment that help him to mobilize outside the home and socialize with the friends and the communities. An electric chair is designed to help him to move out of the home and to do his leisure activities.
6. The provision of suitable aids with equipment timely is necessary for the independence. Stanely may come across with the different aids and equipment for his personal care and the daily activities. Arrangements of the needed equipment in order minimize the risk of injury. Educate him about the proper use of aid to Stanely and Mavis help him to do better. For example, use of car adaptations and he can drive himself for long distances. Selection of right type of wheelchair to carry the object.
7. 1. The proper positioning of the patient with slings and pillows and provide support to the patient.
2. Home modification of grab rails and ramps are to be secured.
3. While transferring from one place to another make sure that the head and neck muscles are supported.
8. three risks:
1. Stanely may at risk of falls while changing position or while shifting from wheelchair to bed. Place alarm near to his bed so he can call up for an emergency.
2. Risk of development of pressure ulcers. Frequent changing of position and back care reduces the risk.
3. Risk of Bowel incontinence. Give adequate fluid and fiber-rich diet. Establish a daily routine bowel habit.