Setting the scene

Tim Nelson is a 64 year old man who is newly diagnosed with a non malignant condition with an indeterminate prognosis, posing a high degree of uncertainty about the future and care planning. There is a possibility of his being in the last year of life. The condition for the purpose of the case study is pulmonary fibrosis but the trajectory may be similar to other chronic conditions such as cardiac failure or Chronic Obstructive Pulmonary Disease (COPD), therefore similar conversations may take place.

Some things to know about Tim

His personal life:

  • wife died two years ago – killed in car accident
  • recently retired engineer
  • lives alone
  • two daughters – Sasha lives 60 miles away and Laura lives along the road. Both are very caring but have busy lives with full time careers
  • one estranged son from a previous marriage, Kirk
  • five grandchildren – three via his daughters and another two grandchildren via Kirk who do not know him very well at all
  • prior to this diagnosis, his health had been good but he was a smoker and enjoyed a few drinks on a Friday in the local pub
  • he had played bowls since retiring as well as golf
  • he was really struggling with the loss of his wife and guilt over his relationship with his son

He had not visited the GP for many months but in the last eight months of life had:

  • 20 GP contacts (six in his home with four of those OOH)
  • three hospital admissions (died in hospital on final admission)
  • 36 District Nurse (DN) contacts – weekly for two months with initial contact to support home oxygen being put in place as per hospital team advice - then daily for two weeks – twice daily for one week
  • DN also had telephone contact with patient and relatives x six and liaising between teams x eight and a final visit following death as a bereavement visit to family
  • social care package introduced as disability increased – two visits per day for two weeks – increased to four times per day for two days prior to final admission
  • gaps in service overnight.

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