Case Story: The Juan Family
This case story focuses on an older adult, Alicia Juan, who has multiple health challenges. Her husband, Antonio, has been the primary family caregiver for his wife, but he’s had problems taking care of her because of worsening pain from arthritis. The couple’s youngest child has now moved back home to help care for them. This case story will identify challenges faced by older adults and their families and provide opportunities to promote family-centered care.
Alicia Juan is an 80-year wife, mother, and grandmother who has a history of chronic heart failure, diabetes type II, early-stage Alzheimer’s disease, and mild hearing impairment. She lives with her 78-year-old husband, Antonio Juan, and their youngest son and his family, who recently moved in with the parents to help care for them. The family has lived in the US for the last 30 years. Antonio Juan also suffers from hypertension, coronary heart disease, and arthritis. Alicia and Antonio currently receive medical care from the local university hospital. The two have three grown children, all married. Two of them live over 60 miles away but visit regularly, at least twice a month. Miguel, the youngest of the children, is 42 years of age. He and his wife Maria have two daughters, 6 and 10 years old.
For the last two years, Mr. and Ms. Juan have been receiving medical care at the local university hospital from Dr. Smith. One and a half months ago, Alicia was hospitalized for a week due to uncontrolled diabetes and acute exacerbation of her chronic heart condition. Antonio’s blood pressure has also remained uncontrolled, despite his being on antihypertensives, and he always complains that the pain in his joints is getting worse day by day. Despite multiple adjustments of Alicia’s medications, her blood sugar remains high, and she is becoming increasingly forgetful. Her recent renal function tests indicate worsening renal function. During regular visits to the hospital, Mr. and Ms. Juan have been counseled and educated by their physician, the nurse educator, and the dietician on their medications and diet.
The son, Miguel, usually accompanies Mr. and Ms. Juan on these visits. During the doctor’s appointments, Miguel seems withdrawn, frequently defers to his parents for any questions related to their medications and diet, and prefers to act as the translator since the parents have challenges communicating in English.
This time around, Alicia is admitted to hospital in diabetic ketoacidosis. She is brought to the hospital by Miguel and his wife, accompanied by her husband. Her condition continues to improve with treatment. On the second day of hospitalization, the other children, 45-year-old Jose and 47-year-old Elizabeth, visit, along with their spouses and Miguel and Antonio. The physician apprises the children of their mother’s condition. Later in the day, Jose and Elizabeth express concern to the primary nurse that their mother has not been faring well recently and ask if the medication their mother has been receiving may be making her condition worse. The nurse tells them that the medicine is not to blame but suggests that someone needs to pay close attention to how their mother is taking her medications. The nurse also advises them to talk with the physician about their concerns. They meet briefly with the physician who emphasizes the importance of ensuring that Alicia take the medications as prescribed and follow the dietary advice she has been given.
Ms. Juan’s condition improves over the next few days. After extensive discussions with other health care team members who are taking care of her, Dr. Smith recommends to the family that a home health care nurse be assigned to her care. Dr. Smith informs them that the home health care nurse will periodically monitor Alicia’s progress and help guide the family on how to manage Alicia’s medications and help her adopt a healthier diet. The couple insists that they do not need a home health care nurse since the family can handle everything for themselves. The two elder children, however, state that a home health care nurse is a good idea. This leads to a heated argument among the four family members. Eventually, Dr. Smith excuses himself and promises to follow up with the family on the issue the following day.
1. In a classroom or seminar setting, use the following questions as a guide to discuss the use of family-centered communication approaches for the Juan family.
- What challenges are currently being faced by members of the Juan family?
- How is the family as a unit coping with the stress of Ms. Juan’s hospitalization?
- Which communication strategies would facilitate a comprehensive assessment of the needs and strengths of the Juan family?
- From your perspective, was family-centered care reflected in the current care of the Mr. and Ms. Juan?
- What communication strategies would aid in decision-making concerning Ms. Juan’s care and help the family cope effectively with the challenges they are currently experiencing?
2. Family-centered care involves health care professionals, the person receiving care, and the family, working together as a health care team to ensure the best possible outcomes for the person and the family. Effective communication is an essential element in meeting the objectives of family-centered care.
- Ask the students to form a family-centered health care team for the Juan family
- What are the goals of the team?
- Who are the members? What are their specific roles?
- Conduct a role-play, with students acting the roles of Juan family members identified to be essential in family-centered care. Participating students should wear signs indicating the role they are playing. Give the students time to plan their approach while promoting the core principles of family-centered care. Ask students who do not have roles as family members to serve as observers. Have them identify effective family-centered communication strategies, based on the core principles as follows:
- Dignity and respect
- Information sharing