Managing Health in the Community Setting – Case Study
- Case management—development and coordination of care for a selected client and family
- Care management—coordination of a plan or process to bring health services together as a common whole in a cost-effective way
You are the nurse making a home visit to provide care for an 82-year-old woman who has returned home after abdominal surgery to repair an inguinal hernia. She is needing dressing changes and IV antibiotic therapy. Upon your arrival, her daughter meets you at the door and requests a private conversation after her mother’s care is complete. While your patient is sleeping, her daughter relates her numerous concerns about her mother’s safety if she remains living at home alone. She indicates that her mother loses her keys on a weekly basis, forgets to pay her utility bills, and continues to hoard the food her daughter delivers weekly, eating very little.
As the nurse and case manager in the community setting, what are your priorities regarding the case and care management for this patient? How should the daughter’s safety concerns be addressed?
SOLUTION
As the nurse and case manager in the community setting, my priorities regarding the case and care management for this patient would include:
- Assessing the Patient’s Needs: Conduct a thorough assessment of the patient’s physical, mental, and psychosocial needs. This would involve evaluating her current health status post-abdominal surgery, assessing her ability to manage her medications and treatments, and identifying any cognitive or functional impairments that may impact her safety and well-being.
- Addressing Immediate Care Needs: Ensure that the patient’s immediate care needs, such as dressing changes and IV antibiotic therapy, are addressed promptly and effectively. This includes providing appropriate education and support to the patient and her family members involved in her care.
- Conducting a Home Safety Assessment: Assess the patient’s home environment to identify potential safety hazards and risks. This would involve evaluating the home for fall risks, ensuring that necessary assistive devices are in place, and addressing any environmental factors that may pose a threat to the patient’s safety.
- Collaboration with Multidisciplinary Team: Collaborate with other healthcare professionals, such as social workers, occupational therapists, and home health aides, to develop a comprehensive care plan tailored to the patient’s needs. This may involve coordinating home health services, arranging for additional support services, and facilitating referrals to community resources as needed.
- Communication with Family Members: Maintain open and ongoing communication with the patient’s family members, including her daughter who has expressed concerns about her safety. Listen to their concerns, provide reassurance and support, and involve them in the care planning process to ensure that their needs and preferences are considered.
- Supportive Interventions: Implement supportive interventions to address the patient’s cognitive and functional deficits, such as providing memory aids for key management, setting up automatic bill payments, and offering assistance with meal preparation and nutrition management.
- Exploration of Long-Term Care Options: Discuss with the patient and her family members the possibility of alternative living arrangements, such as assisted living or skilled nursing facilities, if it is determined that living alone at home is no longer safe or feasible.
In addressing the daughter’s safety concerns, it is essential to validate her feelings and acknowledge her role as a concerned caregiver. Open communication and collaboration with the daughter are crucial in addressing her concerns and developing a plan of care that ensures the patient’s safety and well-being while respecting her autonomy and preferences. This may involve exploring additional support services, implementing safety measures in the home, and discussing potential long-term care options if necessary.