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Problem-Solving Skills
As a part of my Community Health rotation, NURS-4560, I visited a family residing in Antioch Tennessee. I had to use problem-solving skills in order to formulate appropriate nursing diagnoses for this family and make the proper referrals to help them achieve a better quality of life. The summary of this visit is attached below.
On September 21, 2008, I visited the home of T.M., a 49 year-old, married, Caucasian female, in order to complete my family visit clinical requirement. T.M. currently resides in Nashville, TN with her husband and their three dogs. She has a history of smoking, Type II Diabetes Mellitus, Generalized Anxiety Disorder, Severe Depression, Hypertension, Insomnia, Caregiver Role Strain, and myocardial infarction. I began my assessment after I had her sign the permission form, which will be submitted to the School of Nursing later this week.
I will begin by evaluating how I met the objectives of this assignment. The two tools that I decided to use in order to assess this client and her family were the Pittsburgh Sleep Quality Index (PSQI) and the Holmes-Rahe Stress test. I decided to use these tools for the following reasons: It is critical that T.M. manages her stress successfully because of her history of myocardial infarction; increased stress levels increase her risk for a subsequent M.I., especially because she is a smoker. Due to her history of insomnia, I decided that the PSQI was relevant. These two tools helped me evaluate whether or not T.M. needed any additional education in these areas, or if she needed to be referred to any local agencies.
T.M. has many micro-environmental risks within her home. She is a smoker, which increases her risk for another myocardial infarction and respiratory problems, she lives on a limited income, which sometimes prohibits her from acquiring the medications she needs in order to mange her health problems, and she recently lost her mother to a cancer battle of twenty years, which has subjected her to depression, anxiety, insomnia, and many other issues. The windshield survey did not make me aware of any macro-environmental risks within her area.
This particular client has the following healthcare needs: Education on smoking cessation and the importance of medication compliance, certain community referrals, and grief counseling. To address these needs, I began by explaining the purpose, action, and side effects of all of her prescribed medications, while also informing her of the reasons why compliance with these drug regimens was so important. I also answered any questions that T.M. had concerning her medications; I was surprised to see how deficient T.M. was in her knowledge that pertained to her medications. I referred T.M. to the following places throughout the community: The Dispensary of Hope, in case she ran out of money and couldn’t get her medications during any particular month, Community Helpers, in case she needed assistance with paying her bills, and to the Public Health Department, so that she could try to enroll for food stamps. T.M. currently sees a psychiatrist and stated she receives her grief counseling through him. However, I did inform T.M. that many support groups exist for family members who have lost loved ones to cancer and that there are also some that provide support for former caregivers.
I developed two plans of care for this particular client. The first pertains to T.M.’s history of myocardial infarctions. The diagnosis that applies for this particular plan is: risk for decreased cardiac output related to decreased contractility and altered conductivity of the heart as evidenced by myocardial damage that occurred with previous infarction. I informed T.M. of this diagnosis and intervened by instructing her on how she could prevent this risk from turning into a reality. For example, I once again reiterated the importance of smoking cessation and stress management. I explained that smoking subjects her to increased levels of carbon monoxide, decreased levels of oxygen, and increased heart rate, all of which can precipitate cardiac problems. My second plan of care pertains to T.M.’s anxiety diagnosis. This particular plan’s diagnosis is: fear/anxiety related to the symptoms experienced during previous MI, fear of possible future disability, and recent death of a loved one as evidenced by patient stating that she knows something bad is going to happen. I intervened by providing as much education that I could in order to reassure T.M. that she could feel less anxious if she could make simple lifestyle changes and learn effective stress management. I also informed T.M. that many different relaxation techniques can be used in order to decrease her anxiety level. For example, I shared information on progressive muscle relaxation, guided imagery, and deep breathing. My plans of care consisted mostly of primary prevention interventions, such as stress management education, discussion of relaxation techniques, and smoking cessation education.
I believe that community health nursing is vital in helping families understand the risks that exist for them in their community and what they need to do in order to prevent these risks from affecting them. By visiting T.M., I was made more aware of how deficient our community is in regards to knowledge pertaining to their health. When it comes to health maintenance, prevention is key, and by going out and doing visits like these, nurses can help families prevent health disparity, and therefore, help promote a better quality of life.
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