The care should not be confined to the physical aliment but also the psychological and spiritual needs. Thus, patient care should have a patient centered approach considering the patients as still active dignified individuals, who can plan, manage and create some meaning out of their end life situation. Understanding of these facts helps in better nursing care. The patients seem to know better (than the past) about health care and they demand more knowledge on their end of life options today. Most of the patients want to discuss their treatment options and have a Right to refuse as per existing laws in UK. Problems pertaining to 'End-of -life' care and care for the aged are on the rise especially when concepts of euthanasia and physician assisted death are trying to find legitimate positions in the society. The present case study is that of an eighty-year-old Mr.X in a care home in London. He is dependant on the staff for most of his daily activities. He has complaints of constant pain and it has been becoming increasingly difficult to move this man as his bones have become very contracted although he is being made to sit on his chair as often as possible. He is also encouraged to eat with the other residents in the dinning room in spite of his spine becoming so twisted that eating at the table is difficult. Patient X is a Retired School Master, widowed with 7 children all off whom visit him on a regular basis and although he is confused at times his Religion and faith are very important to him and still attends Mass every day in the care home. He has a medical history of Myocardial infarction, chronic heart failure, pacemaker, Paget's disease, depression and Type 2 diabetes. He is a classic example of an aged individual with multiple complications. Any further development in these complications will result in the patient being shifted to Intensive care with the possible outcome of death. Thus, it is an excellent case of a patient where managing patient care is vital rather than just assessment and interventions.
The Nurse care for the case study should be based on Roper Logan and Tierney model of nursing (1980) which is a care model based on activities of daily living. Unlike Virginia Henderson (1966) model, which recognizes 14 activities, Roper model recognizes only 12 activities. This includes, maintaining a safe environment, communication, breathing, eating/drinking, elimination, washing/dressing, thermoregulation, mobility, work/play, sexual expressions, sleep and dying.
Three problems in nurse care for Mr.X:
1.Chronic pain: Chronic pain of the bones is an unpleasant sensory and emotional experience in the patients with Paget's disease and Mr.X has been diagnosed with Paget's disease. Pain management in patients with Paget's disease helps in the improvement of quality of the patient care. Understanding pain needs specific communication skills based on perception. This is true because many of the terminally ill patients may not be able to verbally communicate their pain. Chronic pain is a pain, which lasts for more than six months. Chronic pain is further classified based on its etiology as 'non-malignant' and 'malignant pain'. Non - malignant is non-cancer related pain and malignant pain is cancer related. Chronic pain depresses, debilates and affects the quality of life (Cole, 2002) .A study by Green et.al (2002) on chronic pain management has revealed a need for further educational insights of physicians. A recent study