Unit 2 Discussion 2

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Question Description

Managing Chronic Diseases

No aspect of aging is more alarming to many of us than the thought of losing our health. Our fears center not only on the pain and inconvenience of illness but also on its social-psychological consequences such as loss of personal independence and economic security. Poor health, more than other changes commonly associated with aging, can reduce a person's competence in mastering his or her environment.

As a human service and public service leader, it is important to learn more about the management of chronic diseases in order to help and improve the well-being and enhance the quality of life of aging adults.

Based on your observation of the aging adult in the Riverbend City simulation and your readings in this course so far, focus on approaches and behaviors that you think have the greatest chance to prevent the loss of quality of life. For your initial post in this discussion, analyze and explain your thoughts on how a multidisciplinary human service and public service leader might help retain quality of life.

  • What behaviors did you observe that would help an aging adult, family, or community organization?
  • What possible interventions might you present for the aging adult, family, or community organization that would prevent the loss of quality of life?
  • What personal experiences can help you provide insight for the aging adult, family, or community organization?

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RIVERBEND CITY: STAGES OF DYING AND STAGES OF GRIEF INTRODUCTION: WELCOME TO RIVERBEND CITY Expository Text Eighty-three year old Sheldon Greenberg has learned that the bone cancer he thought was in remission has come back and is terminal. Sheldon, his family, and his caregivers must now navigate the unique challenges of the end-oflife experience. Instructional Text Regardless of practice setting, human services professionals not only are likely to work with clients facing terminal illness, death, and grief but also are well positioned to meet the needs of individuals and families at this difficult time. Characters in this Mission • Susan Florman - Hospice Social Worker, Compassionate Choice Hospice • Shirley Greenberg - Riverbend City Resident • Sheldon Greenberg - Riverbend City Resident • Bruce Greenberg - Sheldon Greenberg's Son • April Nguyen - Riverbend Senior Services • Charlotte Lambert - Hospice Nurse, Compassionate Choice Hospice • Rabbi Moshe Zimmermann -Senior Rabbi, Beth Shalom Synagogue • Dr. Gavin Murphy - RCMC Oncologist • Mary Ellen Strafford- Community Organizer • Justine Nelson - Hospice Nurse • Chandra Capshaw - Social Worker • Jon Conklin - Hospital Social Worker • Rita Woods - RN-Hospice Nurse, RCMC SCENE 1: RIVERBEND CITY MEDICAL CENTER, DOCTOR'S OFFICE Expository Text Coming Coming to terms with the knowledge that a loved one has a terminal illness can be overwhelming. For Shirley and Bruce Greenberg, the news that Sheldon's cancer has returned aggressively is devastating. As they try to determine the next steps in his treatment, they must also process the loss they are facing. Instructional Prompt Click on all highlighted characters to hear their thoughts and concerns. Dialogue 1: Bruce introduces some ideas about where Sheldon should receive hospice care. Bruce Greenberg I know we have to discuss where Dad is going to spend the end of his life. The doctors think he's going to be with us for another few months. I know he doesn't want to die in the hospital. Justine Nelson You mentioned you were thinking about another hospice. Bruce Greenberg Yes. Our rabbi was talking to us about a Jewish hospice that's very close to my home. I've heard good things about it. But I'm not sure that's what my dad wants either. Shirley Greenberg I want to bring Sheldon home. I know that's what he wants too. But I don't know how I'd be able to take care of him by myself. Chandra Capshaw You wouldn't have to care for him alone, Mrs. Greenberg. If your husband goes home, he'll have home hospice workers assigned. Bruce Greenberg I'd like to bring him home too. But how do we arrange for that kind of care? Chandra Capshaw I can help you with that. Dialogue 2: Shirley describes her life with Sheldon. Shirley Greenberg I feel like this happened so suddenly. I know he had cancer, but he was doing so well, and the doctors said that people with multiple myeloma can live with it for years. Chandra Capshaw I know what a shock this is, Mrs. Greenberg. I understand you've been married for 60 years? Shirley Greenberg Yes. We started dating when I was sixteen. I can't even imagine living my life without Sheldon there. He's been around so long he's like a part of my body. Justine Nelson I can only imagine, Mrs. Greenberg. Shirley Greenberg Sheldon does so many things for me. He pays the bills, he fixes things. He does all the driving when we leave town. I don't like to drive on freeways. How am I going to cope without Sheldon? Bruce Greenberg Mom, Terri and I and the girls will always be there for you. You'll never be alone. Chandra Capshaw Bruce, how are you coping? Bruce Greenberg I'm doing the best I can. One step at a time. (sighs) My youngest daughter just got engaged, and we're all really sad he's not going to be there for the wedding. I'm an only child, so my dad and I have always been close. He's the kind of dad who never missed one of my ballgames. Chandra Capshaw We have support groups at the hospital for families of terminally ill patients. Would the two of you like more information about them? Bruce Greenberg That sounds like a good idea. SCENE 2: RIVERBEND CITY MEDICAL CENTER, MEETING ROOM Expository Text Having met with the Greenberg's, the RCMC social workers now need to explore the various options available for in-home hospice care. One such option is Riverbend Senior Services — RSS. April Nguyen, a liaison worker for RSS, has come to meet with John Conklin and Rita Wilson to discuss the case. Instructional Prompt Click on all highlighted characters to hear their input to the meeting. Dialogue 3: April asks some questions about the Greenbergs and their needs. April Nguyen It's good to see you both again. How have you been? Jon Conklin Busy, but good. Yourself? It seems like RSS is always in the news. You've been expanding your outreach, haven't you? April Nguyen We sure have. Of course, that means we're all busier than ever, but it's good knowing that we're making a difference. Jon Conklin Well, I am hoping that you can help here. Let me give you the digest version of the Greenberg's situation. Sheldon presented with respiratory issues after exposure to the chemical spill the other day. On examination, though, it was determined that his bone cancer, which had been thought to be in remission, had metastasized to multiple locations. His wife, Shirley, is having a very difficult time accepting this and has been in conflict with the nursing staff over his treatment - particularly in terms of pain management. The family would like to take Sheldon home and receive in-home hospice care - preferably aligned to their Jewish faith. Rita Woods Normally, that's exactly what we'd be encouraging the family to do. But the wife's inability to accept that her husband is dying concerns us. I just wonder - will she be able to care for him? She would definitely need in-home help, but can hospice provide enough help to ensure that Sheldon receives appropriate palliative care throughout the process of dying? April Nguyen These are good questions and I can help with some of them. We're going to want to tap more than one source of help. Let's start at the beginning, though. Here, I'm going to take notes on the whiteboard while we talk. Jon Conklin Sure ... let me grab my laptop from my office, too. I'll be right back. SCENE 3: RONDO NEIGHBORHOOD, GREENBERG HOME Expository Text Having explored several options, the Greenberg family has settled on bringing Sheldon home for hospice care. Susan Florman, the social worker from Compassionate Choice Hospice, has arranged an initial meeting at the Greenberg home to discuss the family's needs and concerns. She has arranged that the Greenberg's rabbi be present for this initial meeting as well as the hospice nurse, Charlotte Lambert, who will be providing much of Sheldon's care. Instructional Prompt: Click on highlighted characters to hear their concerns about providing for Sheldon during this last stage of his life. Dialogue 4: Susan sets the context for the meeting. Susan Florman One of the first things I learned in this job is how difficult it can be to set up meetings with busy professionals, so let me start by saying how much I appreciate all of you putting Mr. Greenberg's needs first and making time for this meeting. I know this is a difficult time for you, Mrs. Greenberg ... Mr. Greenberg. I hope we'll be able to help provide the tools and support you need. A lot of people believe that when you begin hospice care, it means giving up on the person - giving in to death. We don't look at it this way. We like to think that hospice is for life. We strive to help you and your loved one live all the moments left to him. Bruce Greenberg That's a very nice way to put it. Thank you. Rabbi Moshe Zimmermann It is a good way to put it. I'm sure you know that Jewish tradition holds that Pikuach Nefesh is perhaps our greatest mitzvah - commandment. Charlotte Lambert Peek-oo-ach neffesh? Rabbi Moshe Zimmermann The obligation to save a life. It is the most important commandment. If someone is dying of starvation and the only thing to eat is a cheeseburger ... he should eat that cheeseburger! Susan Florman Forgive my ignorance, but what would be wrong with a cheeseburger if a person wasn't starving? Shirley Greenberg It's not kosher. You don't mix dairy and meat if you keep kosher. Though ... we don't really keep strict kosher here. We don't eat pork or seafood, but I admit that I'm not as careful as my mother was. Rabbi Moshe Zimmermann People work out for themselves how to observe halacha. I'm not telling you what to do. But it may be that you and Sheldon will find comfort in becoming more observant. Susan Florman That's often the case for people. Hospice care is by its nature very multidisciplinary. The hospice team consists of a social worker - in our case, me - a hospice nurse - Charlotte - a chaplain for spiritual needs - that would be Mark Bachmann, who couldn't make it today - as well as home health aids, volunteers, and your primary physician - that's Dr. Murphy - Sheldon's oncologist? Shirley Greenberg (distressed) Yes, but who is this Bachmann person? A chaplain? Rabbi Moshe Zimmermann Miss Florman, there are very specific teachings in Judaism when it comes to this time in a person's life. I don't wish to appear rude, but will your chaplain be familiar with our customs and beliefs? Charlotte Lambert I've worked with him before and I believe he takes a non-denominational approach. Susan Florman This is actually a good point to talk about what I hope to accomplish today. We need to determine what the plan of care is - for Sheldon, but also for you, Shirley and you, Bruce. Hospice care extends to the whole family and we need to make sure we understand what everyone's needs are. But... often in a situation like this, people want to go straight to what they call problem-solving. What I'd like to propose is that we begin by talking about the facts. What do we know about this situation? That should take about half the time we have available, so 30 minutes at least for this discovery work. Then, the next 20 minutes of our time should be spent on talking about what these facts mean. This is the interpretation of the facts and this is where we're likely to see disagreement and a lot of different perspectives. Finally, the last part is talking about solutions and we should reserve about ten or fifteen minutes for that part of the discussion, though it's possible that we won't finish that work today. How does this sound to the rest of you? Bruce Greenberg I'll be honest - it doesn't sound very efficient. It seems like we could start with the big issues and get an idea of what everyone sees as possible solutions and then discuss them. Susan Florman Most people would agree with you, Bruce, but it's my experience that when I'm working with a multidisciplinary team, it's important to try to find a solution that will stick. The model you suggested is more familiar to most people, but what often happens is that people come in with their own ideas about what should be done and they argue for those ideas rather than working collaboratively. The solutions that sort of group arrives at are often not as good as ones that come from an open discussion of all the options. Rabbi Moshe Zimmermann I am interested to see how this model works. It's always good to learn new ways of problem-solving. What did you say this model is called? Susan Florman The Hourglass Model. The basic idea is that you have two parts - the top part is all about gathering the facts about the situation and the second part is for interpretation and finding a solution. So, you have half your time going into data gathering and then the second half is split - discussing the interpretations and then working on a solution. So ... let's give it a shot. What are our facts? How about the issue that started this (...) Sensitivity to and understanding of the Greenberg's Jewish faith is very important. Dialogue 5: Shirley tries her hand at describing the facts of the situation. Susan Florman Well ... it's a fact that I don't know if I can do all the things Sheldon will need me to do. When he was in the hospital, it seemed like there were all these nurses doing things all the time. I won't be able to do all the things a nurse can do. Susan Florman (writing and talking) Shirley will need help with caregiving. Rabbi Moshe Zimmermann Another fact is that the teachings are very clear that no action can be taken that will hasten death - even in the name of comfort. Bruce Greenberg But we don't want Dad to suffer. There's no justification for that, Rabbi. Susan Florman Let's keep talking about the facts - I'm hearing two here. First, that we need to be clear about the purpose of what we're doing. Rabbi, I'm guessing that you're thinking about medications and morphine specifically? Rabbi Moshe Zimmermann Exactly. Susan Florman Alright - so how about I put down "Concern that morphine could hasten Sheldon's death." And also "Bruce wants Sheldon to be comfortable and as pain-free as possible." Charlotte Lambert Well, if we're just pulling information together, you could put down that I'll coordinate with the doctor to get all of Mr. Greenberg's medication prescriptions set up through Compassionate Choice. There's a pharmacy service that will deliver everything you need right to the home. Bruce Greenberg That's very convenient. Shirley Greenberg You all seem so concerned about medications. I don't want this to be like when Sheldon was in the hospital. Bruce Greenberg No, that would be bad. But, mom, you need to trust the people we have helping us. Susan Florman How about I put down something like this "There is concern and distrust around the area of medication (specifically use of morphine)"? Shirley Greenberg That's exactly right. There *is* distrust. Susan Florman And it's important that we acknowledge that if we're going to be able to find a real solution. Dialogue 6: Bruce describes his concerns for his father's care and his worries about his mother's needs. Bruce Greenberg For me, the biggest issue is that Dad be kept comfortable and as pain free as possible. And that mom get the support she needs. We promised her that if Dad came home, she'd have help with caring for him. Susan Florman Can you describe what these things look like to you? What does it mean when you say you want your father to be comfortable and pain free? Shirley Greenberg I want the same thing. But when he was in the hospital, I thought they were going to give him so much morphine he'd go into a coma and never wake up again. He doesn't want to be so drugged up that he can't even be with us anymore. What kind of life is that? Charlotte Lambert It is a goal of hospice nursing that the patient not have to suffer needlessly. Shirley Greenberg Sheldon and I have talked about this. He wants to be able to talk to his granddaughters and to Bruce and to me. Can't we make him comfortable with Tylenol or some other pain killers that aren't so strong? Susan Florman This is definitely an issue that we're going to need to discuss thoroughly. Does anyone have any other issues that need to be addressed? Alright... let me take a minute to summarize what we have and then we can talk about our perspectives on each of these issues. Shirley Greenberg Can I get anything for anyone...? Some coffee or tea? Bruce Greenberg I wouldn't mind some coffee. I'll go with you and help you get everything together. SCENE 4: SUSAN FLORMAN'S OFFICE, COMPASSIONATE CHOICE HOSPICE Expository Text: Back in her office at the compassionate choice hospice, Susan Florman is making calls to coordinate services for Sheldon's care and Shirley's support. Instructional Prompt Click on the characters in the circles to hear their conversations with Susan. Dialogue 7: Rabbi Zimmermann calls Susan to further discuss some of his concerns about the Greenbergs' cultural and religious needs. Susan Florman Compassionate Choice Hospice, this is Susan. Rabbi Moshe Zimmermann Good morning, Miss Florman, this is Rabbi Zimmermann. Susan Florman Oh, good morning, Rabbi. It's nice to hear from you again. How are you, today? Rabbi Moshe Zimmermann Oh, I can't complain. Well, I suppose I could but what's the point? Susan Florman I know some people who make it their only point. How can I help you? Rabbi Moshe Zimmermann I wanted to talk to you about the Greenbergs. I must say that I appreciated the way you facilitated the meeting the other day. You really helped ensure that everyone contributed to finding solutions to the issues we were discussing. I know that Shirley and Bruce feel more confident about the future. Susan Florman I'm glad. Hospice care is a very multidisciplinary field, but even in hospice, people don't always think about what it means to work collaboratively. It's kind of my thing, though. I take it very seriously. Rabbi Moshe Zimmermann I think you should. The work you do and the different people you are assembling for a team; they all have their own perspective. Collaborating may not necessarily come naturally to them. But... the issue I wanted to discuss is actually a little more sensitive. There are requirements in the Jewish tradition for how one treats the person who is a goses - this is a person whose death is imminent - and what must be done with the body when death occurs. I know that you will have more than one person who will be helping the Greenbergs. Susan Florman Yes... Charlotte is the nurse, but we're also helping Mrs. Greenberg and Bruce arrange for a home health aid to help with basic care such as bathing. I was also hoping to arrange for a volunteer who would simply provide companionship and support for Shirley. Rabbi Moshe Zimmermann Well, there are resources available that talk about our beliefs and what is expected in terms of the people who are with the dying person. Could I send you some articles and other materials? Susan Florman That would be wonderful. I can read through them myself and also share them with the people providing care to the Greenbergs. Rabbi Moshe Zimmermann Thank you so much. I'll get those materials together and send them to you by email. Your email address is on the business card you gave me? Susan Florman Yes, it is. Is there anything else I can do for you today, then? Rabbi Moshe Zimmermann No, no ... that was all I wanted to talk about. Thank you, Miss Florman. Good bye for now. Susan Florman Goodbye, Rabbi Zimmermann. Dialogue 8: Mary Ellen Stafford, a volunteer with Compassionate Caring Hospice, returns a call from Susan. Mary Ellen Strafford Hi, Susan ... this is Mary Stafford. How are you doing? Susan Florman Not bad, yourself? Mary Ellen Strafford Good. I hear you have a new client for me? Susan Florman If you're interested. Mary Ellen Strafford Yes. I was just thinking the other day that it has been a while since I did any work with you and I realized I missed it. What can you tell me about the case you have for me? Susan Florman The patient is an 83year-old gentleman with terminal cancer. He and his wife have been married for over 60 years and she's really struggling with the thought of being without him. Also, the family is Jewish and they are a little concerned that we might be pushing Christian ideas on them. Mary Ellen Strafford Interesting. I haven't ever worked with anyone who was Jewish ... in a hospice situation, that is. Is it going to affect how I engage with the family or the patient? Susan Florman I don't really think so. We've met with the family and the rabbi once already. I think we just need to be sure to ask questions if it seems like there's a miscommunication. Mary Ellen Strafford Alright. Why don't I come by tomorrow afternoon to review the file and talk about how I can help in more specific detail? Susan Florman That sounds great. I'll talk to you then. Goodbye for now. Mary Ellen Strafford Go ...
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Tutor Answer

ephykam
School: Boston College

Attached.

Unit 2 Discussion Post
I.
II.
III.

Behaviors observed
Interventions
Personal experience


Running head: UNIT 2 DISCUSSION POST

Unit 2 Discussion Post
Student’s Name
Institutional Affiliation

1

UNIT 2 DISCUSSION POST

2
Unit 2 Discussion Post

What behaviors did you observe that would help an aging adult, family, or community
organization?
One can observe various behaviors in the prompt as Greenberg’s family tries to cope with
the expected loss of their loved one. For example, the family expresses denial for the fact that
their 83-year-old Sheldon Greenberg who is a husband, a father, a grandpa, and a friend is
suffering from a chronic illness and has a very limited time to live. Particularly, Shirley,
Sheldon’s wife expresses the behavior of denial when she states, “I can't even imagine living my
life without Sheldon”. Additionally, Sheldon depicts denial of his terminal illness when he states,
“Who'd have thought that I'd be spending the end of ...

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Tutor went the extra mile to help me with this essay. Citations were a bit shaky but I appreciated how well he handled APA styles and how ok he was to change them even though I didnt specify. Got a B+ which is believable and acceptable.

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