Case Study # 1: Mike
Mike, a 40-year-old former IV drug user, was diagnosed with AIDS 2 years ago. He is admitted from the medical unit for nutritional support and abdominal pain. Three months ago, he moved from his apartment to a nursing facility because of increasing weakness and inability to care for himself. Mike has been unemployed for 6 years. During your interview, Mike appears anxious. He is unshaven. His hair is uncombed and his nails are dirty. The nursing home staff reported that he repeatedly refuses to bathe. He answers questions without making eye contact, frequently commenting “what’s the point”? Mike is divorced and has one teen-aged daughter, who lives with her mother. He has not seen his daughter because he doesn’t want her to see him “like this”. Other family includes an older sister, who helped him move to the nursing home. Mike relates that he no longer sees friends, because he did not tell them he was moving to the nursing facility, and doesn’t want them to know he is living there. When you have finished your interview, he asks you to pull the curtains, shut the door and leave him alone. When you return a short time later for follow up, he screams “I thought I told you to leave me alone”.
1. What are some of the physical, psychological, social, and spiritual concerns that Mike and his family are facing?
2. What members of the interdisciplinary team might be most helpful to contact? Why?
3. What other information would be helpful to assess QOL at the end of life and in planning care for Mike? How are these QOL dimensions interrelated?
4. Discuss the unique role of nursing in caring for Mike. Discuss collaboration with Mike’s physician.
5. What other information would be helpful to assess in planning care for Mike?
6. How do you create a safe environment for Mike?