Model Case Study: 41-Year-Old Patient

Model Case and Analysis
P. Y. is a 41-year-old patient, a Native American who lives in a reservation area in New Mexico. Five years ago, she was diagnosed with a rare, long term skin condition called Hidradenitis suppurativa. This condition is characterized by small, painful lumps under the skin and it can persist for years and worsens overtime, with serious effects on patient’s daily life and emotional well-being. She goes to surgery regularly, every 3-4 weeks to remove the painful lumps. She developed chronic pain, rates her pain at 8-9/10 constantly and medicate herself with high doses of Morphine tablets and Hydrocodone at home for breakthrough pain. She is totally dependent with pain medications. Talking to her one day, noticed that she
S. is 25-year-old female, a practicing RN in the perioperative area. She got married recently after a devastating divorce. M. S. had a history of teenage depression and refused to take any treatment in the past. She is having chronic pain in her right hip area from unknown pathology and taking pain medications regularly. Despite her atrocious personal experiences, she never showed any ill-mannered attitude to everyone, she manifests consistency in providing compassionate care to her patients, and she gets along very well with her co-workers. She is highly motivated to get well from her chronic condition. She goes to the gym every day, watches her diet and performs relaxation techniques to be more empowered in controlling her pain. During her tour of duty, she was taken to emergency room for extreme and intolerable pain in her hip. History was taken and revealed that she missed her dose of pain medication due to alcohol intake in the past few days. She was medicated and discharged home afterwards.
This a good example of a borderline case. Two out of four defining attributes were exhibited. She manifested caring relationships with her patients and her co-workers despite her debilitating condition. Her motivation to take care of herself by exercising and modifying her diet to prevent obesity, which is a contributing factor in chronic pain, is a sign of hope and willingness to recover from her
E. C’s behavior and his attitude towards himself and to the people around him reflect poor coping mechanism and a demonstration of unresolved internal crisis through performance of unhealthy practices. There was no manifestation of any of the four defining attributes. This case proposed a challenging intervention for health care providers.
Implication for Nursing Practice Management of chronic pain is complicated and involves integration of multidisciplinary approaches to deliver adequate and effective therapy to patient. Nursing knowledge requires empiric evidences to understand the complexity of this condition and to address the problem appropriately. This concept provides a general view to increase nurse’s power to analyze diverse situation and to formulate solutions that are tailored to the needs of the patients. As evidence-based practices are emerging and growing, this concept furnishes accessory information to develop more future research.
Peplau’s Interpersonal Theory in