This writing assignment invites you to reflect on what makes a meeting with a family to
determine treatment goals for a seriously ill patient successful. There is an emphasis on the
importance of what you communicate and your relational skills.
Submit your 4-5-page typed responses to the questions that follow the case
below. You are a nurse practitioner in the neuro ICU.
Angela Smith, a 55-year-old African American female, was brought to the emergency
department four weeks ago for changes in mental status. A neighbor called EMS when she was
found walking shoeless in the snow, unaware of her name or where she lived. She was admitted
to a medical unit with a diagnosis of stroke. A CT scan on admission revealed a subarachnoid
bleed. She has a long history of diabetes and uncontrolled hypertension.
Her social history reveals that she is widowed with two daughters. She lost her husband eight
months ago to a traumatic work accident in which he suffered a head injury and died instantly.
Her religious affiliation is Baptist, and she organizes the pro-life activities at her church. Her
friends and family know her greatest wish is to have a grandchild.
After a two-week stay, Angela was awaiting transfer to a rehab facility when she suffered a
respiratory arrest requiring intubation and mechanical ventilation. A second CT scan showed an
extension of her bleed into the ventricles and brainstem. It is uncertain whether she suffered
irreversible neurological damage.
After two weeks in the ICU, decisions must be made regarding the plan of care for Angela. She
has not regained consciousness and, if she is to remain on the vent, she will need a trach for
long-term ventilation and a PEG for nutrition and hydration. The neuro team does not
recommend trach and PEG, suspecting the damage to her brain is irreversible.
In the absence of an advance directive, the nursing staff reveals that the daughters have stated
they want everything done because that’s what she would want. They verbalized that they can’t
lose both their parents in the same year. The older daughter, who is expecting her first child, is
often overheard saying, “Ma, you need to get better so you can hold the baby when she’s born.”
They believe God will cure her because “she has always believed in miracles.”