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Question:

Case Story 1

Dora is a 52-year-old woman who lives in a small remote town in south western NSW. Dora has a history of emphysema due to smoking since she was 12 years old and has recently been experiencing a persistent cough and respiratory difficulty.

Dora was referred by her Primary Health Care service to have a series of chest x-rays and a lung biopsy. Dora has refused to undergo these diagnostic procedures as she will have to go to the closest city hospital 50 kilometres away and leave her adolescent family at home without parental guidance as her husband is a 'miner' and is presently working away from home.

Dora’s health deteriorated and she was rushed to the emergency department of the hospital and was given the diagnostic tests and medication to help her breathing. The doctor has ordered for Dora some ongoing chest therapy, respiratory exercise treatment and further diagnostic testing such as blood and sputum specimen collections and recommends she stay in hospital as he suspects she may also have Pertussis. Dora refuses to stay in the hospital and wants to go home to her family.

The doctors are concerned for Dora health as the remote town she lives in does not have a local GP only a visiting GP every fortnight. Dora asks the RN about expenses and necessary trips to the city for ongoing treatment as she does not drive or own a car, the RN states that Dora is free to go home and does not have to comply with treatment.

Dora is concerned about her addition to smoking and deteriorating health as she is no longer able to care for her family. A social worker is asked to speak to Dora about her concerns and family situation.

Provide responses to the following questions based on the case story.

  1. How might the following listed strategies be used to support and manage a person with deteriorating health such as Dora and her family?

  2. How would you raise the issue of Dora wishing to be discharged with the RN; where the nursing intervention of discharge home, is at odds with an already prescribed course of action by multidisciplinary team?

HLT54115 Diploma of Nursing

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