Case study 2 Stanley is 57 years old and has motor neurone disease (MND). Stanle
ID: 128030 • 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 Stanley seems withdrawn and says very little.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.
What roles and responsibilities has Mavis been given?
What is the responsibility of the supervisor in managing the complaint that Stanley has?
What roles could a general practitioner and an occupational therapist play in supporting Stanley to meet his needs?
Explain how the active service model would be used in Stanley’s support.
Give an example of how a person-centred approach has been used to support Stanley so far in the case study
Given what you know about him, give an example of how a strengths-based approach could be used to support Stanley in one of his future goals of catching public transport.
Explanation / Answer
B)The supervisor ,in managing the Stanley’s complaint ahs to explain their colleagues , that the patient with MND , becomes fatigue easily and does their activities in slower pace and need extra time .And they shouldn’t be hastened which may cause distress and their personal space should be respected
A) As Mavis , helps Stanley in preparing his food and nutritional needs , she has to explained about nutritional needs , with soft diet.
Explain about the risk of aspiration can be prevented by upright position and chink –tuk or chin –down technique of eating
Small and frequent meals
Provide warm food, adequate time between each mouth
Consider Stanley favorite food and pudding type food and in small portion
Provide hot or cold drink in between mouthfuls.
Occupational therapist can help Stanley with
An occupational therapist can recommend strategies and equipment to help with personal care.
A occupational therapist would carry out a full assessment to identify the movement and handling needs of the person with MND and their carers. He /She can explain Mavis about
Equipment that may help, such as sliding sheets, hoists, profiling beds, mattress elevators, riser-recliner chairs and turning tables.
safe techniques for handling Stanley if any case of fall
how the limbs, head and neck should be supported during transfers
Patient centred approach is used as we can see,
Adequate introduction and client rapport time was initiated ,
Already prepared daily plan was given to Stanley and his wife Mavis, time was given to them to discuss themselves and come with their pointers to discuss and he talks about his dissatisfaction about the safety workers.
And Stanley wants to attend the local self-advocacy organisation, the health worker and Stanley talk’s together bout the location and transportation needs and options
Strength based approach is emphasize on individual self-determination and strength , in the above scenario we can see Stanley is well determined
1) to attend the local self-advocacy organisation and he was ready to discuss the possibility with the social worker
2) he talked about the location and available transportation needs
3) Stanley is very methodical and loves to use maps and use illustration to finish his daily activities – He is self-motivated and goal achiever.
So these qualities will help to reach the local self advocacy organization by taking train with some monitoring .