Chapter 16

Community Nursing View

Evelyn is an 88-year-old widow who continued to live in her own home after her husband, Edgar, died just a year ago. Evelyn was independent and drove to the grocery store, church, and beauty shop. Evelyn and Edgar had always enjoyed the company of friends for dinners and cards. Evelyn was proud of the fact that she had stayed home to raise her children and had been a good homemaker.

For the past several months, her neighbor Hilda thought something was wrong. Evelyn forgot Hilda’s birthday. Evelyn was taking her walk in baggy, rumpled old clothes. Hilda worried about what else might be going on. Hilda persuaded Evelyn to see her doctor. Hilda explained her concerns and her observations to the doctor.

After the doctor completed a physical examination and had some blood drawn, he suggested that Evelyn consider moving to a nursing home. He was very concerned about her 20 pound weight loss since her physical last year. Evelyn started to cry and stated that she wanted to stay in her own home. Th doctor reluctantly agreed but only for a trial period and only with certain conditions. The doctor’s conditions were that Evelyn would have a home health care nurse visit her, take daily vitamins, and work on gaining weight. He told Evelyn that Hilda would be making unannounced visits to see if she was taking better care of herself. He gave her three months to work on these conditions.

Nursing Considerations

Assessment

  • What observations prompted Hilda to be concerned?
  • What objective data did the doctor have?

Diagnosis

  • Which nursing diagnoses apply to Evelyn’s problems?
  • What contributed to the development of Evelyn’s problems?

Outcomes/Identification

  • What changes do you want to see in three months for Evelyn?
  • How much weight can she realistically gain in three months?

Planning/Interventions

  • Name at least three methods that Evelyn could use to improve her nutrition?
  • How could Meals on Wheels help?
  • How will the home health care help?
  • How could friends and neighbors help?

Evaluation

  • What changes would you expect in three months with the above program?
  • What would the doctor measure?
  • What observations would the home health care nurse or aide make?
  • What observations would Hilda make?

From Hichcock, J.E., Schubert, P.E., and Thomas, S.A. (1991). Community Health Nursing. Albany, NY: Delmar Learning.