• Observe a human person, using the knowledge gained in class and from readings.
• Analyze what was observed using the assigned growth and development theory appropriate for the person observed.

Observation:

• Select a person between the age of 12 months and older age (over 65yrs).
• Observe the subject in their natural environment. The observation can be done at a day care center, nursery school, playground, school, recreation center, job setting, senior center, or in the home.
• The observer should not be responsible for the individual’s care at the time of the observation.

Guidelines for the observation:

• Prior to the observation, read about growth and development of the age group you will be observing focusing on one specific aspect of development.
• Use the Denver Developmental Screening Test or other standardized measures appropriate for the person you have selected to observe to help focus your observation.
• Take paper, pen and a watch with you for making notes and timing activities during the observation. .
• Do not join in the activities. You are an observer.
• Describe what you observe. Be as objective as possible.
• Write a rough draft of your observations immediately from your notes in order to be accurate and comprehensive.

Guidelines for Written Assignment- Description:

• Based on the observation of the person, write an eight to ten page, typed paper which describes the person’s behavior.
• You should describe all aspects of the behaviors for the following developmental areas:
physical, psychosocial, emotional, moral and cognitive.
• You should analyze your subject’s behaviors according to developmental theorists discussed in class and assigned readings from text, as appropriate for subject’s developmental level e.g. Erickson, Gesell, Kohlberg, Mahler, Maslow, Neugarten, and Piaget
Guidelines for written assignment:

1. Start with an introduction that describes the setting in which the observation took place and individuals interacting with the subject.
2. The first part of the paper should begin with a description of what the individual did during your observation.

3. Include the subject’s exact age, height, weight, physical appearance, actions, verbalizations, emotions, type of play/activity and the way in which the subject related to others and to objects in the environment.

4. The second part of the paper should analyze the observations of the subject. Compare specific examples of the person’s behavior with the expected “norms” for that age group from readings (text and/or other references).

Include in the analysis:

1. Physical (Gesell or Growth Charts and Textbook References)
a. What is the child’s level of physical development?
b. Are there any development spurts or delays, declining ability?
c. How does the physical development influence play, school, work other activities?

2. Psychosocial (Erickson)
a. What stage of psychosocial development was observed:
b. What is the critical task for the stage and how was it expressed in play and
interpersonal relationships?

3. Cognitive (Piaget)
a. What is the subject’s stage of cognitive development?
b. How does level of cognitive development influence the individual’s
behavior in: play, language, relations with others, etc. ?

4. Object Relations (Mahler)
a. Where is the child in the separation-individuation process?

5. Hierarchy of Needs (Maslow)
a. Describe level of need from pyramid.

6. Moral Development (Kohlberg, Piaget)
a. Describe value systems and any behaviors observed related to this area.

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Topic 1—Preparing to understand our patients
Each piece of information tells you about the patient, their pathophysiology and the pharmacology used to manage this case. By using the signs and symptoms we begin a process of elimination and confirmation.
Case studies are mainly not straightforward ‘textbook’ answers. Sometimes we have to ask lots of questions and explore each fact before we really understand the case.
Understanding pathophysiology and pharmacology can be simple by using the following 10 steps:
1. Underline/identify key words.
2. Define the disease or condition. Do you understand these terms? If you don’t understand, begin reading around these terms. You may also need to look at or revise your old anatomy and physiology notes to really understand how ‘normal’ bodies work before you can explore your patient in the case study.
3. List the common signs and symptoms associated with the disease or condition. Again if you are unsure look them up in a text book. Can you explain why each of these signs and symptoms manifest?
4. List the signs and symptoms your patient in the case study has presented with. Ask yourself do these signs and symptoms match those listed in the text book?
5. Are there signs and symptoms that don’t match or don’t make sense? What are some possible reasons for this (we could call this an hypothesis)? Begin exploring and eliminating possible reasons based on further reading.
6. Now ask yourself: are there any reasons this case could be complicated? Is it the condition/disease, the patient’s management of the condition, are there investigations missing or does the patient have other co-morbidities?
7. How would you investigate this case study? What might a doctor order to better understand this case study, e.g. blood tests or x-rays?
8. How is this condition treated/managed?
9. What pharmacotherapy is used to manage the disease/signs/symptoms?
10. When looking at pharmacotherapy: look at mode of action, therapeutic use, pharmacokinetics, side effects, drug interactions and nursing considerations.

Often on clinical you see a more simplified example of this 10 step process called ISBAR. ISBAR (or introduction, situation, background, assessment and recommendations) is a tool or framework that can be used to assist health professionals to communicate critical information to each other. As you explore the case study ask yourself the following questions:
• What is the situation at the moment with this case study?
• What is the background to this condition(s)?
• What is your assessment of the situation or the patient?
• What action do you recommend now (to make a recommendation you need to have a hunch, a hypothesis or a nursing diagnosis).
• Use the 10 steps or ISBAR to assist unpacking the many aspects of each case study. The more you do this the quicker, easier and more detailed your analysis of the case study will be. This is good news for your assignment.
Topic 2—Renal failure and diabetes
1. List the differences between acute and chronic renal failure.
2. List the signs and symptoms of diabetes type 2.
3. Outline focal points of connections of renal functions and the complexity of diabetes type 2.
Patient case study

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