Case Study: Engaging Diverse Professionals in the Plan of Care
Joseph Kane is a 78-year-old widowed male who lives alone. Two weeks ago, his adult son and daughter-in-law became alarmed when he didn’t come to their home for Sunday brunch as was his routine. His son, Jeff, called Mr. Kane on the phone and got no answer, so he went to Mr. Kane’s home. Jeff found Mr. Kane lying on the floor in the kitchen. Mr. Kane did not seem to understand what was happening and was soaked in urine. Because there were no lights on in the home and because Mr. Kane’s car keys, unopened mail, and a bag of groceries were on the table, it was estimated that he had been lying there for more than 20 hours. Mr. Kane was transported to the trauma center via ambulance, where he was diagnosed as having an acute left-sided cerebrovascular accident (CVA), or stroke. Mr. Kane was admitted to the stroke unit. As a result of his CVA, he is unable to move the right side of his body and has difficulty understanding and expressing verbal communication. He appears confused and frightened at times but is able to cooperate during care. He follows simple commands. His movements are slow and cautious. Mr. Kane does not appear to be in pain. His skin is warm and dry. He has bruises on his left forehead, shoulder, and hip areas, probably as a result of falling. He was dehydrated on admission and has an intravenous line in place. Mr. Kane demonstrated dysphagia (difficulty swallowing). A swallow function test (lateral video fluoroscopic observation) revealed abnormalities in swallowing. The unit’s interprofessional stroke care team meet to plan a comprehensive care plan for Mr. Kane. In addition to the professionals on the team, Mr. Kane’s son, his daughter-in-law, and their two college-aged children come to visit each day and want to be involved in his care. The team’s goal is to return Mr. Kane to his maximum level of independent functioning.
Discussion Questions
- List the members of the group of professionals and others, including Mr. Kane and his family, who should be represented on the stroke care team.
- Identify at least one specific team goal for Mr. Kane’s care. Explain how team members will use their complementary roles and responsibilities, collaboratively, to achieve this goal.
