Case Study of a Patient with Sickle Cell Anaemia

Scenario 1:

Julian Jenson is a 35year old man who has sickle cell disease. He is manged at a sickle cell centre, at hospital in a neighbouring town. Generally, his sickle cell has been managed really well and he is reviewed every six months. Recently he has become very tired and is struggling to undertake any of his usual activities outside of work. Julian has 2 young kids and thinks that this is the cause of his tiredness. This morning Julian was admitted to his local hospital with uncontrolled pain. Any ongoing  pain relating to his sickle cell is usually controlled with paracetamol and co-codamol, but he has taken this, and the pain is still severe. Julian thinks he is having a sickle cell crisis. He has flair ups usually once a year and this sometimes results in admission to hospital for symptom control.

Julian was at work when the pain became uncontrollable and his boss sent him to hospital. Julian did not have any of his management plan documents with him when he arrived.

The local hospital where Julian went to did not have a sickle cell centre and there was no local guidelines on management of this. He was initially reviewed; bloods were taken to confirm sickle cell crisis and morphine was prescribed for pain relief. Julian told the doctor and the nurse that this has no effect on his pain relief, and he needs to be given an infusion of morphine. He was given the morphine and they said they would review his pain again. After 1 hour of being in A&E, Simon a student nurse approached Julian and did a pain assessment on him. His score was 9/10. He spoke to Julian about what his usual plan of care was and escalated this to his mentor. It was confirmed shortly after that he had sickle cell and was in sickle cell crisis. His usual plan of care was identified from the sickle cell centre where he usually attends, and his pain was manged with the appropriate dose of morphine.

Things to consider for the seminar:

The decisions that were made and the reason why.

The importance of service user involvement in their care.

The ethical considerations around management of pain

Clinical Decision-Making Assessment: A report into the clinical decisions made for a clinical care scenario.

You have to write a report on a clinical care scenario that involves clinical decision making.

Consider any clinical placements recent or one that you can remember. Think of an episode of care that was undertaken. This does not have to be good or bad. Please avoid anything that may be personal, emotive or considered poor practice and needs escalating. We are using this as an opportunity to learn why something happened in a particular way or why it may be best for it to be undertaken differently. You are also able to frame this on one of the case studies if you choose to.

The clinical care scenario care will provide the framework for the report and the critical discussions and therefore ensure that it has sufficient content to be able to explore, and not too much that it is hard to cover.

Tasks to undertake in order to write the report:

1. Identify an episode of care. Write down the details.
2. Consider the clinical decisions made and the processes involved getting to that decision. By doing this you may uncover elements that you will explore within your clinical care scenario. For instance, experience, ethical or professional aspects may influence the decision-making process.
3. Write down the key clinical decisions made. Break these down so that they can be explored. You may not choose to write all of these down. Focus on the important aspects

The report has to cover the following aspects

1. A brief summary of the clinical decisions made.
2. A discussion of the pathophysiology and pharmacology relevant to the episode of care
3. The importance of person-centred care and involving patients in their decisions around the planning and implementation of their care.
4. Discuss the relevance of health policy in relation to the episode of care.
5. Critical discussion and evidence to support or refute the decisions that were made
6. Evaluating the effect of the decision

Included in the report there must be consideration towards:

Ethical issues and professionalism.

Systematic approaches to care, for instance the Nursing process.

There must be critical discussion and evidence to support your writing from a wide range of sources.

Word count 2500+/- 10%

You will be offered the opportunity to undertake a formative to support you with your assignment.

The formative will consist of 500 words on section 2: Explore the relevant pathophysiology and pharmacology relevant to this clinical care scenario. Include in the appendix your clinical care scenario and an outline of your report (bullet points).

Appendix 1: Clinical Care Scenario

Appendix 2: References and bibliography