Nina the New Nurse is working as a homecare nurse. She is meeting with the case manager about a client with end-stage heart failure. She tells the case manager, “I am so frustrated with Mr. Partyguy and his family. I visit the home three times a week. Each visit I reinforce Mr. Partyguy’s fluid and sodium restrictions, and we discuss ways to maintain his weight; I’ve brought information on how to quit smoking and drinking. I share, review, and reinforce all of this with Mr. Partyguy and his family. Do you know what I walk into every visit? Cigarette smoke, overflowing ashtrays, and empty beer bottles! Mr. Partyguy shows no interest in changing his behaviors; his family’s position is if smoking and drinking make him happy, with very little time left, they are unwilling to confront him. If Mr. Partyguy doesn’t choose to accept the help, and the family is unwilling to support behavioral change, shouldn’t my role be to accept their choice, and leave it at that?” What is the case manager’s best response?
