Question

Julia Morales, age 65, and Lucy Grey, age 73, are partners who have been together for more than 25 years. They are retired and have spent the past several years traveling together. Julia has lung cancer, which has been treated with chemotherapy and radiation, and now she wishes to stop treatment. Lucy is supportive and feels she will be able to care for Julia in their home. Lucy's past medical history includes a knee replacement. Their support system includes Julia's son, Neil, and Lucy's niece, Nora.
The introductory monologue takes place in Julia's home prior to an initial home health nurse visit. In the monologue, Julia discusses her life, including raising a son to adulthood, then meeting Lucy. She reviews her history with cancer and relates her understanding of home hospice care and her desire to die at home. She expresses concern about leaving Lucy alone.
The scenarios begin with the home health nurse evaluating Julia after she has decided to stop treatment for her lung cancer. Her partner Lucy wishes to care for her in their home. In the second scenario the end of Julia's life is near and she is surrounded by her loved ones and the hospice nurses. Julia dies during this scenario. The learners are introduced to supportive measures for both the patient and the family during this process. The final scenario concentrates on Lucy and the difficulties she has adjusting to her new life after Julia is gone. The objectives focus on the students' assessment of Lucy's grieving process, how well she is coping, and the physical changes that she has experienced over the past few months.
Scenario 1 involves a visit by the home health agency nurse. Learners are expected to complete a physical and functional assessment of Julia and her nursing care needs, as well as an assessment of the home with a focus on safety. Julia inquires about hospice services, but her son, Neil, urges her to try one more round of chemotherapy. Lucy is supportive of Julia's decision and tries to comfort Neil. Learners will assess Lucy's caregiver strain, and articulate what hospice care means for the patient and family. The assessment tools recommended for this scenario include SPICES: An Overall Assessment Tool of Older Adults, the Katz Index in Activities of Daily Living, and Informal Caregivers of Older Adults at Home: Let's PREPARE!
Scenario 2 takes place in the home two months later. Julia is barely responsive and has Fentanyl patches for pain. Nursing care consists primarily of performing an appropriate patient assessment and ensuring patient comfort. Julia dies during this scenario and the learner provides support for the family. During debriefing, discussions may include how nurses manage their own emotions and self-care after the death of a patient.
A second monologue occurs three months after Julia's death. Lucy is in the emergency room. She is grieving and wants to talk about Julia and their life together. She feels very lonely, but has had some contact with her neighbor, Adele, and her niece, Nora. There have been other instances where she has become anxious, dizzy, and slightly confused, stating that her heart was pounding and she felt like she "can't walk or do anything." Lucy thinks she has called 911 "about once a month since Julia died" and was transported by ambulance to the emergency department.
Scenario 3 takes place in the emergency department. Lucy called 911 once again after another fall at home. Her blood pressure is slightly elevated. Otherwise, Lucy is found to be in good health. Objectives relate to assessing her safety, her fears, the grieving process, and her need for assistance at home. The assessment tools recommended for this scenario include SPICES, The Hendrich II Fall Risk Model, the Geriatric Depression Scale, and the Generalized Anxiety Disorder 7 (GAD-7).

Finish the Story:
Learners have now seen Lucy at four snapshots in time. What do they think her life will be like three months from now?

Answer 1

Lucy's life since 3 months:

Scenario 4:

A Counsellor from Social support services for elderly, Ms. Mariya Jones is meeting Lucy at her home and helps her to ventilate her feelings. Lucy's niece Nora arranged the meeting as she got to know that Lucy is suffering with GAD ( Generalized Anxiety Disorder) since from Julia's death and now she wants the Counsellor , to help Lucy to overcome her Anxiety Disorder and to talk about an ' Asssisted living facility ' as Lucy has certain doubts regarding the facility after Nora suggesting her aunt to stay in such facility, that may reduce her loneliness.  

( Generalized Anxiety Disorder : Common anxiety disorder found in Elderly is GAD. It may occur associated with falls , accidents or traumatic events. It is characterised by excessive and persistent worry about different things like possible disaster, health issues , money etc. )

Assisted living facility: It is a housing facility for the elderly or adults , who decides not to live or cannot live   independently.

Scenario 5 : An Assisted living living facility, where many elderly people at different age is sitting; some are playing Chess , some are reading novels or news papers, some are sitting in round and chatting and Lucy is there in the group, happily conversing with another resident.  

Scenario 6: The counsellor Mrs. Maria Jones arrived for the follow up session and both Lucy and Maria is sitting in the Counselling room of The facility. When Mariya, enquired, Lucy is happily responding with the experience in The facility. She tells that , Once Julia left , she felt so lonely and she thought that she will never get a company or friend again. Even though nobody can replace Julia , but she found many friends here in the Assisted living facility. Now her feelings of hopelessness and helplessness flow away and she is appointed for the team leader of the 'farming ' session of the organisation. On their back yard there is huge Kitchen garden , where many plants and trees of vegetables and fruits are planted. Lucy has to supervise the workers and should give instructions for it everyday one hour . This post she has choose voluntarily from many other posts. Now she is happy , even though minor body alignments and knee pain exists , she engages with many activities and getting adequate rest , sleep and good food.

Asssesment with The GAD scale shows absence of GAD and significant reduction in the symptoms and finally Lucy thanks Maria Jones for helping her to get rid of depressive feelings , encouraging her through counselling sessions and for helping her the choose the Assisted living facility.