Ladder Of Influence

Ladder Of Influence

this is no more than a 2 page case study  on the topic below APA format no plagiarism

Mia is the oldest of six children from a two-parent family. She was diagnosed with osteosarcoma of the left leg and was experiencing intractable pain. She received her diagnosis at 15 years of age under the care of a pediatric oncologist at a local hospital. Mia underwent months of radiation and intensive chemotherapy. Mia’s community nursing team was struggling to meet her needs and referred her for palliative care services through a local home care agency.

Her parents had a complex history of substance abuse and domestic violence, and Mia had a difficult relationship with both, although recently she has become close to her mother who has attended most of her chemotherapy treatments.

During one episode of severe uncontrolled pain which required that Mia be transferred by ambulance to the emergency department, she noticed all of the nurses except for one being attentive and kind. Mia overheard the nurse saying:

“I don’t know why her parents bring her here… We can’t meet her needs and we are short-staffed…”

The conversation Mia overheard was incomplete, which left her to draw her own conclusions. The whispering nurse was actually the charge nurse who was in the midst of planning staffing for a pending snowstorm. Her complete statement is as follows:

“I don’t know why her parents bring her here. The home care nurses should be addressing pain management issues with her oncologist in a more timely manner so that Mia can remain in her home for treatment. If we had available resources to address Mia’s pain, we could plan to make her stays in the emergency room more comfortable. I wish that we could meet her needs better and in a timelier manner. I feel frustrated that once again we can’t meet her needs more effectively. We are short-staffed, and that shortchanges Mia.”

Upon Mia’s mother’s return to the bedside, Mia begs her to take her home, even though the pain medication has had little effect in relieving her pain. Throughout the ride home, Mia becomes increasingly sullen and tells her mother she doesn’t ever want to go back to the emergency room for care.

Using the Ladder of Inference Worksheet (Nelson text, page 300), fill in the information on Mia’s Ladder of Inference.

This week is dedicated to completing and submitting your term paper and also the case study on The Ladder of Influence (chapter 9 Nelson).  There are two steps for this case study.  Recreating the actual ladder with a short discussion.  Be sure to include a statement somewhere that reflects this and cites the book.  Something like…

According to Nelson (2011) the Ladder of Influence…..

OR some people have been creative and included the discussion within the actual ladder.  Now if you can’t make a ladder use bullet points, label each step and then define the relationship have a BRIEF discussion. Nelson, page 301 has the best summary and focus for the brief discussion.  For example:

  • Observable date- what is observed? How can this add to drawing our own conclusions?

Or be free to be creative!  I’ve had student write their info on an actual picture of a ladder.  Be sure to label each ladder step as well if you do this! And then they referenced the picture.


HINT!!! Be sure to look at ALL OF THE RELATIONSHIPS Mia has to contend with.  There is an extra relationship that the book example does not include. The assignment should be no longer than about 2 pages maximum and is worth 5 points.


Everyone should have the Nelson reference within the ladder and on the reference page

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