Case Study 7.2: The Case of Mr. Davis

Jim Davis is an 85-year-old home-care patient with a long history of congestive heart failure. He has been a widower for 10 years and lives on his own. Janetta Crosby has been his visiting nurse on and off for five years. Ms. Crosby has become aware of a chronic decline in his condition recently. He has been hospitalized three times in the last two months for increasing extremity edema and worsening shortness of breath. His hygiene has deteriorated and from their interactions she has noted that he does not eat well and is becoming more forgetful. He has stopped driving his car because of worsening cataracts and is dependent upon neighbors for grocery shopping. Although he has a daughter who lives a few miles away, his daughter's husband is paraplegic from an automobile accident and she is unable to spend as much time with Mr. Davis as she would like.

Ms. Crosby and Mr. Davis have a good relationship. He credits her with having been able to "keep him out of the hospital" on more than one occasion due to accurate assessments and prompt interventions. As a result of ongoing discussions with Ms. Crosby about the meaning and purposes of resuscitation and how this fits in with his life-long beliefs and values, he has made a "living will" detailing his decision not to be resuscitated in the event of a cardiac arrest. He feels has lived a full and satisfying life until recently and is resigned to what the next day will bring.

Ms. Crosby is concerned that Mr. Davis has decreasing abilities to adequately take care of himself. Based on her nursing judgments and her knowledge of Mr. Davis, she thinks he will soon need placement in a nursing home. How should she approach this topic?