The heart failure nurse checks that she understands what Molly has told her about her current condition. Molly’s symptoms have improved and she is now less oedematous but her breathlessness is still problematic. The HF nurse reminds Molly that previously the cardiologist had decided that surgery was not an option for Molly and that her symptoms should be managed by medication. She tells her that discussions should perhaps take place between Molly and the multi disciplinary team regarding her future care. The nurse then discusses aspects of this care in more detail, including discussing with Molly her thoughts about her preferred place of care. Molly tells the HF nurse she really wants to stay in her own house if she can.
Q. Which of these options should be considered for Molly?
- Surgery – wrong
This has already been established within her cardiology review. Her valve disease is terminal and an operation cannot help. These decisions are made taking a number of factors in to consideration including age, physical abilities, anaesthetic risk, other co-morbidities, degree of concomitant heart failure. - Hospital – wrong
At this stage, Molly has requested not to go into hospital and this must be respected as she has capacity to make decisions. This decision, however should be routinely reviewed as patients will often change their minds and this should be discussed as an option. - Nursing home – wrong
At present Molly appears to be coping at home with support to be arranged if required. This again is her own decision and should be reviewed if her condition worsens or if Molly expresses this as a preferred option. - Hospice – wrong
but may become an option that the HF Nurse will explore as she assesses Molly. She is being treated with a palliative approach at the moment and at present may not require specialist palliative care input but often joint working at this stage within these teams can promote seamless care for patients with incurable disease processes such as Molly. Holistic, patient centred care is the aim of all patients´ care management. (These issues are discussed further within Module 7.) Hospice care should be considered if symptomatic management of deteriorating symptoms is becoming unmanageable within an out-patient scenario - Community palliative care – CORRECT
This may be an option that the HF Nurse will explore as she assesses Molly. She is being treated with a palliative approach at the moment and at present may not require specialist palliative care input but often joint working at this stage within these teams can promote seamless care for patients with incurable disease processes such as Molly. Holistic, patient centred care is the aim of all patients care management.(these issues are discussed further within Module 7) - Home support – CORRECT
This is an area that should be explored initially whilst the HF Nurse is holistically assessing Molly. This is Molly’s preference at this time and requires respect and further exploration of realistic options. This may include aids and home assessment, ability to cook and make meals effectively and any help with home care.
Pulse point
Although health professionals should always consider the patients choice, it may be that further comprehensive assessment of cognitive function and physical ability is required. Cognitive impairment is often an additional factor to consider in heart failure. This may not routinely be done but should always be a consideration during assessment.
Page last reviewed: 28 Jul 2020
