Complex Care 1: Assessing And Planning

Module Learning Outcomes:

1. Demonstrate the ability to accurately gather and process all information from the assessment process to identify needs for planning individualised nursing care.
2. Use evidence-based assessment tools and accurately interpret their findings and take appropriate actions when planning care.
3. Compare and contrast the communication skills required to care for people with health problems and their families in complex, challenging and sensitive healthcare situations.
4. Examine the principles of courage, transparency and professional duty of candour within the demands of professional practice for individuals with complex healthcare needs and their families

Case Study Matilda

Stage 1
Matilda is fifteen years old with a profound and multiple learning disability, including postural care issues, respiratory problems and incontinence. She is visually impaired, nonambulant, has cerebral palsy, with some movement in her upper limbs and head. Since birth Matilda has been dependent on others to meet all her needs. However as she grew older Matilda’s body changed a great deal and this has made looking after her more complicated.

She has scoliosis, contractures and because she is growing so fast her wheelchair no longer is suitable, meaning that she spent a period of time bed bound. It also means that Matilda is uncomfortable and in pain some of the time, which affects her sleep.

Stage 2
Matilda has difficulty swallowing and eating and occasionally suffers with constipation. She also suffers from Gastro Oesophageal Reflux Disorder. All her family and school teaching assistants are currently being trained in postural care to help Matilda sit straight and lie straight and her school physiotherapist is working with the family, school, speech and language therapist, wheelchair services, occupational therapist, learning disability nurse and the postural care providers.

Matilda also has just joined a new afterschool group run by the school’s art teacher looking at multi-sensory play (sensory club). The family are currently exploring using a personal health budget to identify and pay for someone to help get Matilda ready for school and accompany her in the taxi.

Stage 3
Matilda is now displaying ‘some challenging behaviour at school’ i.e. grabbing staff at school. It is not known what these behaviours are communicating, however staff are suggesting that this behaviour could be related to her menstrual cycle, or it could be that she is trying to communicate an emotional need, or it could be medical related, or it could be a frustration over needing to rely on others, or a preference over staff that she likes to care for her. A referral has been made to the learning disability nurse for further assessment.