A final grade will be applied on successful completion of tasks 1, 2 and 3 This task will represent 50% of the final grade
The case study is to be completed in your own time using available reliable sources such as the course text books provided to you at orientation, credible internet sources such as the department of health and other text and online journals available to you through the online library service offered to all students and discussed at orientation.
It is important that you reference all sources of information that you use to obtain information used in your answers. Referencing must be included and failure to adhere to this requirement will result in a not satisfactory outcome for the assessment.
Use the following Case information for each Part of your case study.
Mr. Jones and Mr. Smith have both been referred for home nursing.
Mr. Jones is married and has a supportive wife and family but requires home visits for wound care due to a lower leg ulcer. He cannot attend the wound clinic because his wife does not drive. Mrs. Jones provides nutritious meals and helps him in the shower.
Mr. Smith is single, lives alone. He has a large dog on the premises and is a bit of a recluse.
There is evidence he also does not eat properly and is reluctant to shower unassisted. He continues to smoke.
Has been referred for home nursing as he has Chronic Obstructive pulmonary Disease( COPD) and has had 2 recent admissions to hospital for exacerbation of COPD .Mr Smith has appointments to attend the hospital’s outpatient clinic to assess his lung function and provide him with physiotherapy. Mr Smith does not want to attend the outpatient clinic.
PART A: The Nursing Process.
The nursing Process begins with a thorough client assessment to provide the information needed to plan appropriate care. It also provides a baseline for evaluation of nursing care that has been provided.
Conducting a nursing assessment means getting to know the client and their family, their environment and lifestyle as well as their goals and perception of care. Assessment in this context includes an assessment of the client’s needs and a risk assessment. The information you gather enables you and the client and responsible family members to identify actual and potential problems.
Nursing care in the primary health environment is client focused and includes understanding and using available family and resources. Expected outcomes are identified; this provides a guide for implementing care and the achievement of goals. Goals need to be set in partnership with the client and appropriate family members.
Care plans are individualised and incorporate clinical pathways and best practice objectives to ensure that care is evidence based and meets quality standards.
When formulating nursing care plans the Primary Health Care Nurse (PHCN) should consult and collaborate with the client, registered nurse and /or case manager.
It is important to consider who will be involved in providing the planned care. If a partner or relative or appropriate other person is to be significantly involved, then the plan will need to include provision of adequate information to ensure safe, relevant care is delivered. Care providers roles need to be clearly defined. Planning of care for clients in a home environment also incorporates identifying relevant referrals and accessing additional services.
A care plan should also include appropriate education of the client and family.
You must prepare thoroughly before your visit. An organisational pre visit check list is completed to ensure aspects associated with the client, family and the specific environment have been identified.
Questions and Assessment Part A:
Use the above client scenario information as a guide to complete the following:-: (Refer to Marking criteria Part A)
1 Identify 3 specific care needs (Nursing Diagnoses) and 3 Goals for each client.
2. Provide individual pre-visit check lists for each scenario. Your pre-visit check lists should include identification of any risks
PART B: Nursing Intervention and Rationale.
Nursing interventions must be provided in a professional, ethical and legal manner. Interventions reflect the client’s needs and individuality. Nursing interventions should be specific and relate to the goals.
When providing nursing interventions in the primary care environment, remember that you are not in a facility where the client is subject to the organisations routine. You are a guest in their home. Respect their privacy, beliefs, lifestyle and requests. Adapt your nursing interventions to meet their needs while maintaining professional, ethical and legal standards. Informed consent forms part of those standards.
Nursing Interventions must have rationales and should be specific to each client.
Questions and Assessment Part B:
Use the above client scenario information as a guide, and your client assessment, nursing diagnosis and goals for each client to complete the following:-: (Refer to Marking criteria Part B)
1. Provide nursing interventions for each client. The nursing interventions for each client
should include teaching that is specific to each client scenario. Identify what teaching you would need to
include in each scenario.
2. Provide nursing rationales for each client.
3. The nursing Interventions should include community and other resources that match the client’s needs and
how to access these resources.
4. Compare the likelihood of success for each client. How could you increase the likely hood that your
interventions will be successful?
5. Document what you would do when you do when you arrive at each client’s house.
PART C: Evaluation
Evaluation is the final step in the nursing process. Evaluation identifies the achievement of outcomes. Evaluation can also lead to re-assessment of care. During evaluation it becomes evident whether the previous steps of the nursing process were effective and if the expected outcomes have been reached. The purpose of evaluation is to monitor the client’s responses to nursing interventions and their progress toward planned goals.
Evaluation of care should be a continuous process that occurs with every visit to the client and through the documenting and reporting process. Each evaluation that is made depends on your ability to form a judgement or an opinion about the data that has been collected. Evaluation findings will help to:
• Determine if original assessment data still applies
• Identifies further potential or actual complications
• Analyse responses to nursing interventions, this may identify the need for first aid or emergency care.
• Determine if care meets standards and is evidence based
• Identify opportunities to improve the quality of care
• Assess outcomes from other health care team members
Questions and Assessment Part C:
Use the client scenario information as a guide and refer back to your previous client assessment and nursing care plans to complete the following :- (Refer to Marking criteria Part C)
1. What criteria would you look for when evaluating whether you have met the goals you set for each
2. As the PHCN conducting the home visits, who would you report the outcomes to?
3. What specific documentation would you complete after the home visit for Mr Jones, and Mr Smith?
In response to the continuous changes in health care today, nurses are charged with staying well informed on many rapidly evolving aspects of patient care.