julia toolkit monologue

Instructor’s Toolkit for Julia Morales’ Monologue

Julia's introductory monologue can be used in a variety of ways. Here are a few to consider:
ƒ large class discussion
ƒ small group discussion during class or clinical
ƒ reflective journaling assignment
ƒ web-based assignment: listen to the audio or read the script, then discuss and summarize the group’s conclusions.
1.
2.
3.
4.
5.
6.

What are Julia’s strengths?
What are your concerns for this patient?
What is the cause of your concern?
What information do you need?
What are you going to do about it?
What is Julia experiencing?

These questions were adapted from the following publication: Benner, P., Sutphen, M.,
Leonard, V., Day, L., & Shulman, L. (2010). Paradigm case: Lisa Day, classroom and clinical instructor. In Educating nurses: A call for radical transformation (p. 133). San Francisco: JosseyBass.
Possible answers to questions:
1. Strengths: Julia is in a committed relationship and has support from her partner and other family members. She has no financial concerns. Julia has good memories of her childhood and her life in general. She seems to have a feeling of accomplishment with what she has done. She seems to have come to terms with her disease and prognosis.
Julia believes she has done everything she could to fight her disease.

2. Concerns: pain (current and future), respiratory status, weakness, son Neil’s acceptance of Julia’s choices, end-of-life planning and decision-making, legal issues related to Julia and Lucy’s relationship, Lucy’s health issues
3. Causes of concerns: Julia has had side effects from her treatment all along. She says she is weak. Her prognosis is poor. Lucy may have physical issues that make it difficult to provide all of Julia’s physical care. Conflict is possible between Lucy, Julia, and Julia’s son. SJulia’s death will leave her partner Lucy alone.

4 & 5. Needed information and next steps:
ƒ Assess Julia’s functional status.
ƒ Explore Julia and Lucy’s knowledge base regarding disease progression and management. ƒ Obtain legal information related to advance directives, durable power of attorney, and other issues related to end-of-life care.
ƒ Find out if they’re ready to discuss legal matters and end-of-life care?
ƒ Find out specific names of medications to check for possible side effects or interactions. ƒ Find out what services are available to them.
ƒ Explore their understanding of the role of hospice and the services it provides?
6. Julia is experiencing the physical discomfort related to her lung cancer: primarily pain and weakness. She has concerns for her partner and her son. She regrets her past smoking history. She seems to be willing to stop all treatment even though she knows her death will result.
Other ideas:
ƒ Have students listen to the Julia audio and respond to questions before coming to class. ƒ Create a Facebook page for Julia (or have students do this) with pictures of her family, the various trips she took with Julia, and her nursery business.
ƒ Create a memory book for Julia with photographs from her life that she can review with her family before she dies.
We encourage you to be creative and add to the monologue or create new monologues that match the content in your curriculum. You might consider expanding the case until you have monologues and simulation scenarios that can be used throughout the entire curriculum.
The ACES Essential Nursing Actions can serve as a guide to learners when deciding what interventions may be appropriate for the older adult in this situation.

ACES Framework
Essential Nursing Actions

Assess

ƒ

Function and Expectations

ƒ

Coordinate

ƒ

and
Manage
Care

ƒ

Use

ƒ

Evolving
Knowledge

ƒ

ƒ

ƒ
ƒ

Make

Situational
Decisions

ƒ
ƒ
ƒ

Assess the older adult’s individual aging pattern and functional status using standardized assessment tools.
Use effective communication techniques to recognize, respond to, and respect an older adult’s strengths, wishes, and expectations.
Include findings of assessment of older adult’s cognition, mood, physical function, and comfort to fully assess the individual aging pattern.
Manage chronic conditions, including atypical presentations, in daily life and during life transitions to maximize function and maintain independence.
Assist older adults and families/caregivers to access knowledge and evaluate resources. Advocate during acute exacerbations of chronic conditions to prevent complications. Understand geriatric syndromes and unique presentations of common diseases in older adults.
Access and use emerging information and research evidence about the special care needs of older adults and appropriate treatment options.
Interpret findings and evaluate clinical situations in order to provide high quality nursing care based on current knowledge and best practices.
Analyze risks and benefits of care decisions in collaboration with the interdisciplinary team and the older adult and family/caregivers.
Evaluate situations where standard treatment recommendations need to be modified to manage care in the context of the older adult’s needs and life transitions. Consider the older adult’s wishes, expectations, resources, cultural traditions, and strengths when modifying care approaches.