Steven Hawks 55 year old male with mid stage ALS Diagnosed 2 years ago

Nursing Care
1. Relational Practice
  1. Respect
  2. Compassion
  3. Empowers client
  4. Empathy
  5. Active listening
  6. Self-Awareness of own beliefs, values, and practices
  7. Therapeutic Nurse-Client Relationship
  8. Genuiness
2. Health Teaching
  1. Call for assistance during ambulation
  2. Catheter care
  3. Signs and symptoms of infection
  4. Medications
  5. Diet & Nutrition
  6. Hygeine
  7. ALS overview education
3. Collaborative Practice / Interprofessional Team
  1. Neurologist
  2. Dietician/Nutritionist
  3. Nurse/Nurse practitioner
  4. Occupational therapist
  5. Assistive technologist
  6. Physical therapist
  7. Speech pathologist
  8. Social worker
  9. PSW
4. Safety
  1. Safe eating
    1. Risk of aspiration
  2. Breathing exercises
  3. Ambulation
  4. Proximity of personal items
  5. Home hazards
5. Tanner's Model
  1. Noticing
    1. Progression of symptoms
    2. Health deterioration
    3. Increased susceptibility to co-morbidities
  2. Interpreting
    1. Patient and family are struggling to cope
    2. Need for ALS education
    3. Provide resources
    4. assess need for medication
  3. Responding
    1. Provide ALS education
    2. Provide external resources
      1. Support group for patient
      2. Support group for family
      3. counselling
      4. Financial assistance
      5. mobility devices
    3. arrange for home care (PSW)
    4. pharmacological intervention
  4. Reflection
    1. effectiveness of medication
    2. family coping well
    3. patient mental health is stable
      1. is more informed about about ALS
    4. interprofessional consultations
    5. Mobility devices are beneficial
Social Determinants of Health
1. Culture
  1. Caucasian
  2. Catholic
  3. ALS Support Group
2. Housing/Physical environment
  1. 2 story house
    1. Ramps
    2. Renovate first floor
      1. Wheelchair accessible bathroom
      2. Bedroom
      3. No carpets
      4. Wider hallways
  2. Rural Area
    1. Extended Family located neighbouring town
    2. Access to Groceries 10 km away
    3. less pollution
    4. Population 800 people
3. Income/Employment
  1. Treatment and equipment expenses
  2. Single source of income (as Steven can not work)
    1. Wife works and earns less than $30,000 annually
  3. Ontario Disability Support Program [ODSP]
4. Social Exclusion/Inclusion
  1. ALS Support group
  2. Most social interaction is only with family
  3. Interacts with healthcare providers
  4. Spends time alone with PSW while wife works and kids are at school
5. Health Services
  1. Doctor located 30 km away
  2. Nearest hospital located 30 km away
  3. Limited access to home care due to rural location
Amyotrophic Lateral Sclerosis [ALS]
1. Progression
  1. Symptoms
    1. Difficulty breathing
    2. Dysphagia
    3. Weight loss
    4. Loss of mobility
    5. Loss of cognitive function
    6. Insomnia
    7. Progressive loss of the ability to speak
    8. Fatigue
2. Treatment
  1. Feeding tube (Late Stage)
  2. Catheterization
  3. Oxygen/Ventilation
    1. Later stages, when breathing muscles are affected
  4. Medication
    1. Does not treat disease, treats symptoms only
    2. Lengthens the appearance of symptoms
3. Prognosis
  1. Death after 2-3 years
4. Diagnosis
  1. Diagnosed between 40-70 Years old (Average age of 55)
  2. Less common in younger people
Personal Meaning
1. Vision of the future
  1. Care and treatment preferences
  2. Do not resuscitate
  3. Euthanasia
  4. End of life wishes
  5. Palliative care plan
2. Experience with Disease
  1. Loss of independence
  2. Coping with grief
  3. Depression
  4. Loneliness
  5. Self perceived burden
3. Experience with Diagnosis
  1. Anxiety
  2. Fear
  3. Stress
  4. Sadness
Quality of Life
1. Facilitators
  1. Church
    1. Catholic
    2. Supportive Community
    3. Bible study
    4. Prayer
  2. Support from family and friends
  3. Hobbies
    1. Watching sports
    2. Reading
    3. Listening to music
  4. Equipmments
    1. Ramps
    2. Wheelchair
    3. Bathlifts
    4. Hospital bed
  5. ODSP
  6. Access to hospital
2. Barriers
  1. No cure for ALS
  2. Dysrathia
  3. Low income
  4. Social Isolation
  5. Limited Mobility
  6. Home environment
  7. Limited insurance coverage
  8. Health worsens as Disease progresses

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Steven Hawks 55 year old male with mid stage ALS Diagnosed 2 years ago

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