Competency Assessment: The Case of Mr. Bale


Background of Mr. Bale

Mr. Bale is an 85 years old American who lives with his son, daughter-in-law, two grandchildren, and his wife. He has been recently diagnosed with COPD making him oxygen dependent. He also has Congestive heart failure and hearing loss. Mr. Bale has smoked two packs per day for the last 50 years as noted by . He has a limited understanding of English and depends on translation to comprehend details. Apart from receiving western health services, he also uses alternative remedies from Mexican culture.

Mr. Bales Three Comorbid Conditions and Risk Factors

Health problems identifiable are Chronic Obstructive Pulmonary Disorder (COPD), Congestive Heart Failure (CHF), and hearing loss. The primary risk factor with Mr. Bale is smoking two packs for fifty years and continuing smoking even after signing an agreement to stop the behaviors once he became dependent on oxygen. The other risk factor is that he lives with his wife independently. Also, he uses alternative remedies instead of the ones directed by the doctors. Lastly, there is the risk factor of limited knowledge of the English language.

COPD threatens Mr. Bale because it puts him at risk of other conditions that can lead to disability. COPD can lead to osteoporosis and increase fall risk factors (TS et al., 2020). This increases the risk of hip fractures, leading to disability among senior citizens like Mr. Bale. COPD is also very expensive to manage since oxygen is expensive, and this puts his family at the risk of using their finances to cater to his health. On the other hand, the CHF issue will impact his health by triggering a lack of appetite and nausea (TS et al., 2020). This can impact his nutritional intake, which can lead to other conditions. Also, it increases risk conditions such as high blood pressure, which can be risky to his health. The condition also impacts ones emotions (TS et al., 2020). This can impact his physical abilities and socialization capacity.

On the other hand, hearing loss can impact the patients life. According to TS et al. (2020), hearing can lead to stress when one cannot understand what is being said. This means that he will become dependent on other family members for assistance.

The behavior of smoking is the leading cause of COPD. Failure to quit smoking will put Mr. Bale at the risk of triggering COPD flare-ups. When patients with COPD smoke, their lungs get irritated and inflamed, causing the lung tissues to thicken (TS et al., 2020). This causes the breathing to become complicated, resulting in shortness of breath and more lung infections. Living independently with his wife causes a risk of isolation from one of his closest persons. This puts him at the risk of depression. Limited knowledge of the English language can put him at the risk of inefficient diagnosis, especially if there is no one to trans late. 

Application of 6 Components of The Chronic Care Model to Mr. Bales Case

Health System support. This component relates to the organizational support that the healthcare system should give (Silva et al., 2018; In Mrs Bales case, the organizations support should be given to ensure that he has the technical support. For instance, availability of oxygen and timely refill. The second component is clinical information systems. This component organizes data from patients and populations to enhance care delivery (Silva et al., 2018). Using this component, the nurses should facilitate individualized care planning for Mr. Bale. Also, he should be given timely reminders about when to refill his oxygen and medications. Using this component, information between care providers and the patients should be shared to enhance care delivery.

The third component is Delivery System Design. This system ensures that care is delivered effectively with self-management support (Silva et al., 2018). To achieve this, roles are defined between the care teams. For Mr. Bales case, the care team should ensure regular follow-ups and give him the care that fits his cultural background. The fourth component is decision support. This ensures that clinical care nurses promote for the patient to follow scientific evidence and patient preferences (Sendall et al., 2017). In Mr. Bales case, the nurses have fully supported her decision to use alternative medications. This means they honored the patients decisions. They should ensure that they educate the patient about the effectiveness of the primary therapy compared to alternative therapies.

The fifth component is self-management support. This component ensures that patients are empowered to manage their conditions at home (Sendall et al., 2017). In Mr. Bales case, this component has been achieved through the provision of oxygen administered without the nurses help. The model would further achieve self-management support by ensuring that nurses set goals with the patients and families and follow up to see how the patient is adhering to the goals (Sendall et al., 2017). With this component, nurses should advocate for policies that will enhance care delivery among patients with comorbid conditions such as Mr. Bale. For example, they should follow up and ensure that the patient quit smoking. The last component is community resources which should be mobilized to meet the patients needs (Sendall et al., 2017).

Approach to Mr. Bales Situation

As a home health nurse, I suggest evidence-based interventions for COPD, CHF, and hearing loss. For COPD, I would use combination therapy with long-acting bronchodilators (Vitacca & Paneroni, 2018). This will ensure that the symptoms and frequency of exacerbations are reduced. For Congestive Heart Failure, I would administer supplemental oxygen as needed and diuretics (Vitacca & Paneroni, 2018). In addition, I would use ACE inhibitors or ARB drugs for CHF. These drugs strengthen the heart muscles and prevent blood clotting (Vitacca & Paneroni, 2018). For hearing loss, I would suggest assistive devices such as a hearing aid (Holman et al., 20121). This device undoubtedly amplifies the sound to help the patients make sense of sounds.

For this case, I would employ verbal communication. Excellent verbal communications are essential since they maintain clarity, accuracy, and honesty (Arnold & Boggs, 2019). However, I would use this method when communicating with the patients relatives since Mr. Bale has hearing loss. When talking to Mr. Bale, I would use non-verbal communication. This includes facial expressions, eye contact, and smiling (Arnold & Boggs, 2019). I would use this technique on Mr. Bale since he has hearing loss to create a good rapport.

Ethical Dilemma

One ethical dilemma in the case is the choice between using modern medications provided by the hospital and cultural medication from Mexico. The ethical principle that originates from this dilemma is autonomy. Patients with autonomy can make informed choices (Rainer et al., 2018). This implies that nurses must ensure clients have all the information needed to make an informed choice concerning their medical treatment. The nurses have no control over the patients decision.

Two possible solutions for this ethical issue are respecting patients autonomy and educating the patient about the importance of using modern medicines over traditional ones. For this case, I would choose the latter. Modern medicine is evidence-based (Rainer et al., 2018). These medications have been tried in various cases and tested to be effective (Rainer et al., 2018). This means they have been proved to treat or manage connections they are intended to treat. Upon educating the patient, I would expect him to stop using cultural medications, and if he refuses, I will respect his autonomy as a home health nurse.


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Holman, J. A., Drummond, A., & Naylor, G. (2021). The effect of hearing loss and hearing device fitting on fatigue in adults: A systematic review. Ear and hearing, 42(1), 1.

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Sendall, M., McCosker, L., Crossley, K., & Bonner, A. (2017). A structured review of chronic care model components supporting transition between healthcare service delivery types for older people with multiple chronic diseases. Health Information Management Journal, 46(2), 58-68.  

Silva, L. B., Soares, S. M., Silva, P. A. B., Santos, J. F. G., Miranda, L. C. V., & Santos, R. M. (2018). Assessment of the quality of primary care for the elderly according to the Chronic Care Model. Revista Latino-Americana de Enfermagem, 26.

TS, W., Karl, J. L., Bhattarai, G. R., Nickels, L. D., & Yeh, C. S. (2020). Geriatric Medicine and Gerontology.

Vitacca, M., & Paneroni, M. (2018). Rehabilitation of patients with coexisting COPD and heart failure. COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(3), 231-237.