Case sharing
Ms Liu , 82 years old
Ms Liu had multiple chronic diseases, including diabetes, hypertension, heart disease. She had to rely on insulin injections to control her blood sugar level. However, Ms Liu had difficulties adhering to her medication regimen due to her declining memory. Ms.Liu had a son who was worried that he might not be able to spend a lot of time taking care of her mother because he was a stranger to Hong Kong and he had to secure a job to make a living.
Although Ms. Liu lived alone, she would invite her friends to her home to play Mahjong. After assessing Ms Liu’s health status and living habits, the service team created a "large", easy-to-read poster for Ms. Liu, designed as a visual reminder that can help remind her to take her medications. The team explained Ms. Liu's situation to Ms. Liu's son and her friends. Eight weeks later, there were improvements in Ms.Liu's blood pressure and glucose control measures. She also showed significant improvement in her memory and cognitive function.。
Since Ms Liu’s son was a stranger to Hong Kong, he was not familiar with the health care system in Hong Kong and he had difficulties finding support and assistance. After introducing the community services that were available to him, our team's social workers were able to refer him to an appropriate social welfare organization for case discussion.
Team Nurse, Katy Fung
Ms Wong, 81 years old
Ms. Wong , a stroke survivor, suffered from sciatica over the past year, which had made her feel ill at ease. She also developed mild depressive symptoms. Since she had trouble walking, she was spending most of her time staying at home. When we first met Ms. Wong, her feeling of distress was so intense that she had cried multiple times throughout the session.
Given that Ms. Wong had chronic pain, our team conducted a pain assessment for her. I taught her some leg raise and stretching exercises to help strengthen her leg muscles. After communicating with her family, a suitable walking aid was purchased for Ms. Wong. During subsequent follow-up visits, I accompanied Ms. Wong to the supermarket to purchase groceries while assessing the risk of falls throughout the process.
With a walking aid that suits her needs and through weeks of exercise training, Ms. Wong gradually built her confidence of going out. After twelve weeks of intervention, she could purchase groceries by herself, make her own food choices, and choose foods with low glycemic index. Being able to go out for a walk again had helped ease the pain that Ms. Wong was experiencing. Most importantly, the process of going from staying at home most of the time to going to the park everyday, had made Ms. Wong become more cheerful; it had also allowed her to rebuild her social network with her old neighbours.
Team Nurse, Sherming Kwan
Mr. Cheung, 83 years old Mrs. Cheung, 82 years old
Mr. Cheung lives with his wife, both of whom had diabetes and hypertension. In particular, Mrs. Cheung had pooly controlled diabetes, with an average blood glucose level of 16-18 mmol/L.
According to the couple, their diet usually consists of mostly light-flavoured food, so logically speaking it was difficult to understand why their blood glucose levesl were out of control. During the home visit, we learned that Mr. Cheung, who was a "tender lover", often bought egg tarts and other snacks such as steamed rice roll for his wife. We also learned that Mrs. Cheung could eat four egg tarts in the morning, and she would also snack on unhealthy foods such as sandwich cookies when she watched the television. These food choices were the major contributors to Mrs. Cheung’s consistently elevated blood glucose levels.
Throughout the program, Mr. Cheung was highly motivated to improve his health with exercise, and in 12 weeks he had successfully built a habit of exercising on a daily basis. His blood glucose was well controlled, and he was even able to reduce the dose of his diabetes medications. As for Mrs. Cheung, she was not motivated to control her diabetes through regular exercise, but with support from Mr. Cheung and their children, her snacks had been replaced with a healthier option: tree nuts. It was noted that Mr. Cheung had reduced the amount of snacks purchased each time (for instance, he would only buy two egg tarts instead of six). As a result, Mrs. Cheung's blood glucose levels had successfully been lowered, with an average of around 10 to 12 mmol/L.
Team Nurse, Hera Leung
Mr. Leung, 80 years old
Caregiver, Mrs. Leung , 72 years old
Mr. Leung had hypertension, heart disease and prostate enlargement. Since he was discharged from the hospital in April of last year, his cognitive ability began to deteriorate and his ability to provide self-care was also on the decline. Consequently, his lifestyle habits had changed and he had stopped reading the newspaper, which used to be his favourite past time activity.
The first two sessons of home visits were full of challenges. The caregiver Mrs. Leung was very stressed, and she dominated the conversation while expressing her anger and helplessness throughout the session. We formed an inter-disciplinary team to tackle the complex problems faced by the client and his caregiver. During the third home visit, the team's counsellor was mainly responsible for talking to Mrs.Leung, and I, as a nurse, focused on assessing Mr. Leung's cognitive ability and mobility.
During this visit, the counsellor provided emotional support for Mrs. Leung and learned more about the assistance that she needed the most -- she hoped that Mr. Leung could do a cognitive health assessment and attend a day-care centre, which would alleviate caregiver burden and allow her to have several hours of resting time each week. Therefore, we referred Mr. Leung to a geriatrician and provided him with assistance over several months, which was the time it took to obtain the results of the cognitive health assessment. Four months later, Mr. Leung was able to formally participated in the training at a day-care centre. I also created a simple cognitive training exercise and physical activity plan for Mr. Leung to follow when he was waiting for his assessment result and during his time spent at the day-care centre.
After the completion of the program, Mrs. Leung was able to receive the support that she needed, which had greatly relieved her stress, and Mr. Leung’s mobility also showed improvement. Mrs. Leung went from feeling angry and frustrated at first to feeling grateful for all the support that the team had provided. Caregiver stress was evident in this case sharing. As the emotional and physical demands involved in caregiving can lead to caregiver burnout, it takes time to relieve caregiver stress and resolve problems that caregivers are facing on a daily basis.
Team Nurse, Ella Li
