Case Study

You are a new graduate Registered Nurse who recently started working at your first job in a long-term care facility. You oversee 25 patients and delegate to a few Registered Practical Nurses and Personal Support Workers. In the last month, you have been noticing some strange behaviour between a patient and their family member. Mr. Joshua Cordova is a 78-year-old resident that recently came to the long-term care (LTC) facility. His daughter used to be his main caregiver at home however, she brought him in because she stated she could no longer care for him. Mr. Cordova has multiple sclerosis and is quadriplegic. He requires total care with all his activities of daily living, including incontinence care, feeding, bathing, dressing, physiotherapy exercises and mental stimulation. Mr. Cordova is unable to communicate his needs verbally. Sometimes the staff can communicate with him through his blinking. When he arrived at the facility, he was malnourished, covered in bedsores and had incontinence dermatitis. Some staff members suspected that he was not properly taken care of at home. When you approached Mr. Cordova’s daughter and questioned her about the bedsores and dermatitis, she stated that “He was too much to care for”, and “I couldn’t do it anymore”.

Mr. Cordova’s daughter visits her dad once or twice a month. You notice that each time Mr. Cordova’s daughter visits, he seems frightened, withdrawn and emotional. You notice that his daughter stands over him, and always speaks to him in a loud and forceful tone. Her visits are often very short. One day, as you are making your way through the unit when you overhear Mr. Cordova’s daughter yelling at her father about finances. In anger, she slams her hand down on his bedrail and pinches the skin on her father’s arm. His arm instantly starts to bleed and the daughter, in frustration, grabs some Kleenex very firmly and holds her father’s arm to stop the bleeding. Mr. Cordova grimaces in pain. You interrupt the scene and replace the Kleenex with some clean gauze. You also ask Mr. Cordova’s daughter to step out of the room as you call your manager in to help you. When your manager arrives, you explain what happened and dress the wound on Mr. Cordova’s arm. You ask the daughter to leave the facility and indicate that Mr. Cordova should get some rest as he was quite upset. You also bring this information to the healthcare team to discuss the situation that transpired and the next steps.