Question

Case Study- Read the case study scenario, answer the questions below, and explain the rationale for your answer.

Glenna, age 38, lost leg function during a motor vehicle accident at age 16. She plays basketball at the community center and teaches aerobic classes for wheelchair-bound people three times a week. She manages a medical equipment rental business since her husband died. Business is not profitable. A physician’s referral was made to the public health department for a developmental assessment.

A nurse heard angry shouting as she stepped toward the porch of the tiny house with peeling paint. The nurse stepped over a broken tread and knocked on the weather-stained door at the end of a ramp. Suddenly a large man burst through the doorway tugging on a T-shirt and muttering. The nurse glanced past the fleeing man. Three children, ages 18 months, 4 years, and 6 years old, knelt on linoleum worn through to the wood. The TV blared a cartoon. No one heard her knock as the children stared at their mother who was crying and holding her cheek. The nurse knocked a second time on the open door and introduced herself. The woman wheeled around to face the other way.

“We are busy. Please come back later,” the woman spoke over her shoulder.

“Pick up the blocks, Chica. Make sure the back door is locked, Stephano and please make a peanut butter and jelly sandwich for your brother and sister.

Not now, Jon. She tells the youngest child, who is banging a block on her wheel.”

The nurse replies, “I can make another appointment, but it will only take a few minutes to assess Jonathan now that I am here. Your physician said you are concerned about his development. If you could answer a few questions I feel sure we can help you. I can help make the sandwiches while we talk.” The nurse’s scan of the living room located a stained spoon and knife near a broken mirror on the coffee table along with a towel, toys, and a magazine. Chica’s hair was uncombed. The boys’ hair hung to his shoulders and looked unwashed.

The mother pulled her robe together over her chest and folded her arms. “You can’t help. Jon is normal but different. You will ask a 100 questions, insult me, and then say there is nothing you can do, just like the doctor did. He made us wait 45 minutes and then says he is going to call someone else. We don’t need that kind of help. Jon is a smart boy with attention problems. I need to clean up. We don’t have time to talk right now.” She raised her voice. “Chica, pass me the cigarettes, will ya? Gracias.”

Jon continued banging his mother’s chair and vocalizing. The children stared at the nurse. Chica looked afraid. Stephano looked hopeful. His dirty pajamas ended well about the ankle.

Answer 1

1. Should Glenna consider herself disabled or at risk? Why? And should the nurse consider Glenna’s family at risk? Why?

Answer: I believe Glenna is for sure disabled. If you look at definition of disability, A disability is any condition that makes it more difficult for a person to do certain activities or interact with the world around them. These conditions, or impairments, may be cognitive, developmental, intellectual, mental, physical, sensory, or a combination of multiple factors. So through this definition it's clear that Glenna is disabled cause she cant do basic chores like taking care of her kids. Basic chores like making food.

Yes, Glenna's family is at risk . If it continues this way, accidents are bound to happen which may lead to something bad. A house consisting of a disabled person with three kids definitely is at clear cut risk .The fact that the nurse witnessed Glenna being harassed by a large man shows how helpless and weak she is physically and also mentally.

2. What history questions will reveal predisposing, social, or enabling risk factors?

Her past shows how active she is for a person who is disabled. But because of her husband's death daily life with three kids would be very hard for her and the unexpected presence of the large man in their house raises alot of quetions. To find out about her wellbeing I would ask her the following questions. Have you got ideas about good ways to do your job?” “Do you have ideas for making your workplace safe?” “Do you take any medication that might make it unsafe for you to do any of the job's tasks?” “How will you let us know about medical appointments so we can change your work roster?" These questions will give the nurse some idea about the kind of life she is living.

3. What community health nursing techniques could empower Glenna and her family?

Families of people with disability, especially parents, have often experienced negativity when dealing with health professionals and health systems. They often experience ongoing grief, stress and anxiety related to practical and emotional difficulties encountered because of their child’s disability. Communication may be affected because of negative experiences, misunderstandings, and ongoing anxiety and distress. Many families struggle to cope. When communicating with families, it is important to remember that they know their child better than other people and are the experts in care and support.

When working with families, nursing roles include:

• recognition of the impact of disability on parents and families
• active and non-judgemental listening, openness and honesty, open-ended questions
• working with families as partners
• promoting family-centred support
• referral to relevant services, including counselling if necessary
• advocacy for people with disability and their families
• enabling others to understand patterns of ability and difficulty, along with implications for learning and living.

4. How can the nurse avoid insulting the mother?

The nurse should keep reminding herself about the patient's circumstances and show empathy. Patience is the key component. Hearing out the patient in distress without shouting can help alot . Here are some more points to keep in mind when talking to a person who is disabled

• Talk to persons with disabilities in the same way and with a normal tone of voice (not shouting) as you would talk to anyone else.
• Avoid being self-conscious about your use of wording such as “Do you see what I mean?” when talking to someone with vision impairment.
• Talk to people with disabilities as adults and talk to them directly rather than to an accompanying person.
• Ask the person with a disability if assistance is needed; do not assume that help is needed until you ask.
• Use “people-first language”: refer to “a person with a disability” rather than “the disabled person” or “the disabled”.
• When communicating with a person with a disability, it is important to take steps to ensure that effective communication strategies are used. This includes sitting or standing at eye level with the patient and making appropriate eye contact.