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Case Study: Ladder of Influence

Please read the following case study. Use the attached ladder of inference worksheet to complete the case study.

Mia is the oldest of six children from a two-parent family. She was diagnosed with Osteosarcoma of the left leg and was experiencing intractable pain. She received her diagnosis at 15 years of age under the care of a pediatric oncologist at a local hospital. Mia underwent months of radiation and intensive chemotherapy. Mia's community nursing team was struggling to meet her needs and referred her for palliative care services through a local home care agency.

Her parents had a complex history of substance abuse and domestic violence, and Mia had a difficult relationship with both, although recently she has become close to her mother who has attended most of her chemotherapy treatments.

During one episode of severe uncontrolled pain which required that Mia be transferred by ambulance to the emergency department, she noticed all of the nurses except for one being attentive and kind. Mia overheard the nurse saying:

"I don't know why her parents bring her here... We can't meet her needs and we are short-staffed..."

The conversation Mia overheard was incomplete, which left her to draw her own conclusions. The whispering nurse was actually the charge nurse who was in the midst of planning staffing for a pending snowstorm. Her complete statement is as follows:

"I don't know why her parents bring her here. The home care nurses should be addressing pain management issues with her oncologist in a timelier manner so that Mia can remain in her home for treatment. If we had available resources to address Mia's pain, we could plan to make her stays in the emergency room more comfortable. I wish that we could meet her needs better and in a timelier manner. I feel frustrated that once again we can't meet her needs more effectively. We are short-staffed, and that shortchanges Mia."

Upon Mia's mother's return to the bedside, Mia begs her to take her home, even though the pain medication has had little effect in relieving her pain. Throughout the ride home, Mia becomes increasingly sullen and tells her mother she doesn't ever want to go back to the emergency room for care.

*Please see attached Ladder of Inference to complete the inference worksheet*

Using the Ladder of Inference Worksheet fill in the information on Mia's Ladder of Inference.


Solution Preview

The ladder of influence in this scenario is represented by the child's erroneous belief that the nurses don't want to provide her the treatment that is desired by her or can't provide it based off an offhand comment misconstrued by the child. Based off this erroneous belief, the child has requested that she not go back to this hospital, which shouldn't be her decision if the treatment has been effective. The case scenario states that it hasn't been entirely effective; therefore, the child has some valid input into the scenario but should still receive a more nuanced approach from her parents who should seek more information about the scenario. The child has reached a conclusion without all the pertinent facts necessary for an optimal conclusion that would result in her being treated with the most effective care for her disease. The meanings that she has added to her conclusion will negatively impact her ability to receive the most quality treatment for her disability. From her erroneous observation, the child has selected bits and pieces of the data that was heard instead of the whole picture, which is recorded in her mind frame and negatively impacting her approach to the scenario. If she was privy to the entire conversation, she wouldn't have the same disposition that she does in this case.

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Solution Summary

8-1 Case Study: Ladder of Influence