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James is a 50-year-old man with HIV. His first AIDS-defining illness caused his weight to drop from 85 kg to 60 kg due to intractable diarrhoea. The doctor thought caloric intake was of primary importance and urged James to eat whatever he wanted. The doctor also prescribed opium for the diarrhoea, but James hated the opium because it made him feel out of control. Since James was getting worse, his nurse argued that he needed intravenous nutrition and should eat only bananas, rice, apple sauce and weak tea until the diarrhoea stopped. The nurse suggested adding other foods one at a time and only as tolerated. James’s family and friends offered to take control of James’s food preparation.

 

The doctor compared AIDS to advanced cancer and argued he would not prescribe intravenous nutrition for advanced cancer. The nurse argued that this was James’s first AIDS infection and that his prognosis was better than someone with advanced cancer. The nurse’s primary focus was on stopping the diarrhoea, and supplementing nutrition with intravenous therapy. James’s friends preferred the nurse’s approach, but James and his doctor were not as easily convinced.

 

1.    What concepts are present in this case?

2.    What appear to be the perspectives or views represented by the doctor and the nurse (how might you say they are defining the metaparadigm)?

3.    How might Florence Nightingale analyse this situation?

4.    Which of the nursing models in this chapter best supports the nurse’s plan of care?

 

SCIENCE
HEALTH SCIENCE
NURSING

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