CASE STUDIES

CASE # 1 About: History of Public Health and Public and Community Health Nursing

Michael works as a home health nurse in his suburban community. He visits 7-10 clients each day. On today’s visitations, Michael will provide care for four clients who are recovering from hip replacement surgery and three clients who are recovering from heart surgery, and he will provide intravenous (IV) antibiotics for a man with an infected wound.

Among this list of clients, Michael visits Mrs. T., an 87-year-old white woman who lives alone and is recovering from triple bypass surgery that she underwent a month ago. Michael’s goals are to check on her recovery progress, reload her medications in her weekly medication container, and administer an influenza vaccine.

Upon entering Mrs. T.’s small house, Michael finds the house in disarray: clothes are scattered about, dirty dishes with crusted food line the kitchen counters, and no lights are on. Michael finds Mrs. T. lying in bed watching television. Mrs. T. complains to Michael of feeling too tired to do anything; she eats only what is already prepared (e.g., frozen dinners or snack foods like potato chips) because cooking requires too much effort. She spends most of her days lying in bed and has not bathed in a week.

Michael helps Mrs. T. out of bed and assists her with a bath. After the bath, Michael fixes Mrs. T. a quick lunch and refills her medication box while she eats. Michael encourages Mrs. T. to start getting some exercise by doing the household chores so that her heart can get stronger. “The stronger your heart is, the more energy you will have,” Michael tells Mrs. T. Michael also enlists several services for Mrs. T.: A home health aide will come to the house three times a week to help Mrs. T. bathe, and Meals-on-Wheels will bring her breakfast and lunch. Finally, Nurse Michael administers the influenza vaccine.

During Nurse Michael’s visit the following week, Mrs. T. is showing improvement. She tells Michael, “I just love that little girl who comes to help me; she is just so sweet. And the Meals-on-Wheels program is a blessing, I now have more energy to keep this place clean the way I like it.”

Questions

1. What challenges did Nurse Michael face in his first visit with Mrs. T. that public health nurses (PHNs) in the late 1800s also faced?

2. From your knowledge about the history of public health, compare an example of care displayed by nursing leaders of the past versus the current activities of Nurse Michael. For example, how was Nurse Michael’s nursing care similar to what Mary Breckinridge provided in the Frontier Nursing Service (FNS)?

3. How do the types of illnesses of Nurse Michael’s clients differ from the types of illnesses that were experienced by clients of PHNs in the early 1900s?

CASE STUDY # 2 ABOUT CULTURAL DIVERSITY IN THE COMMUNITY

Nurse Betty is teaching a health-promotion class to a group of Hispanic migrant workers. Nurse Betty is white, and this is her first time interacting with people of Hispanic culture. Nurse Betty speaks a little Spanish, but not enough to teach the whole class in Spanish. Most of the migrant workers speak only Spanish. Nurse Betty understands that she needs to provide culturally competent care to make her health-promotion class most effective but is not sure where to start.

Questions

1. What is the first step that Nurse Betty should take to prepare for her health-promotion class?

2. What are the language barriers, specific risk factors, and traditional healing practices that Nurse Betty must be aware of if she is to successfully interact with the group of Hispanic workers?

3. How can Nurse Betty involve the community to improve the effectiveness of her health-promotion class?

CASE # 3: ABOUT ENVIROMMENTAL HEALTH

John J. is a school nurse at Jackson Elementary School, which was built in 1960. Nurse John has noticed that many students from Ms. Zee’s second grade class have come to the clinic complaining about coughing, sneezing, runny nose, and watery eyes. Nurse John has also observed that Steven Tea, the only asthmatic student in Ms. Zee’s class, has had more asthma attacks this year than he did last year. Because the rest of the school is not experiencing the same respiratory problems, Nurse John is concerned that something in Ms. Zee’s classroom is causing students to feel ill.

Nurse John decides to visit Ms. Zee’s classroom. Upon entering the classroom, one of the few located in the school’s basement, John is struck by the powerful musty smell that inhabits the room. While talking to Ms. Zee, John learns that the classroom has “smelled bad for years,” and that students from previous years have complained about respiratory problems. Nurse John notes that Ms. Zee has stuffed a blanket at the base of the classroom’s small rectangular window near the ceiling because the window does not close completely.

John suspects that Ms. Zee’s classroom walls are contaminated with mold. Upon further research, Nurse John learns that if water gets between the exterior and the interior of a building’s wall, mold can grow in the moist environment. This situation can occur as the result of construction defects in the building (e.g., leaky windows). Nurse John also learns that people who are exposed to extensive mold growth may experience allergic reactions, such as hay fever-like allergy symptoms, and that people who already have a chronic respiratory disease, such as asthma, may experience difficulty breathing when exposed to mold. Nurse John is concerned about the possible mold contamination effect on his asthmatic student, Steven.

Questions

1. Identify the agent, host, and environment in this case study, and describe how they interacted to bring about the occurrence of disease.

2. Is the mold contamination in Ms. Zee’s room a point-source pollutant or a non–point-source pollutant?

3. What can Nurse John do to learn more about indoor air quality (IAQ) and about what to do in case of mold?

4. What are some possible interventions that Nurse John could apply to address the mold contamination in Ms. Zee’s room?

CASE # 4: ABOUT INFECTIOUS DISEASE PREVENTION AND CONTROL

Hilary S. is a nurse health inspector at the county health department. Nurse Hilary visits businesses in the community that have the potential to spread infectious diseases to large and/or vulnerable populations. Today, Nurse Hilary will visit the We Love Kids daycare center and a nearby seafood restaurant.

The daycare center cares for children ages 1 month to 6 years. To enroll a child in daycare, parents must show proof that the child is up-to-date on all age-appropriate immunizations or must show proof of medical or religious exemption. Nurse Hilary finds the records in the office area and confirms that all children have received the necessary immunizations. She observes that employees use gloves when changing diapers, cleaning a baby’s spit-up, and tending to a scratched knee from a playground accident. Employees also wash their hands after each of these events, before and after giving a baby his bottle, and before entering the 1- to 6-month-old room after leaving the 2- to 3-year-old room. Nurse Hilary also notices a flyer posted in the employee break room that informs staff of the upcoming mandatory in-service that will be held to discuss the importance of checking bottles, especially those that contain breast milk, for the correct name before feeding a child.

The seafood restaurant is a chain restaurant that has become less popular over the past couple of years. Many customers have complained about the quality of the food. Recently, 20 cases of severe diarrhea were reported to the health department by people who had just eaten at the restaurant. Nurse Hilary observes the cooks in the kitchen. The refrigerator and the freezer are kept at appropriate temperatures for storing food. Food is stored in airtight, plastic containers. Nurse Hilary watches as the cook who is preparing the chicken for broiling is also in charge of prepping the plates that are going out to the customers. Upon cutting into a piece of chicken about to go out to the dining room, Nurse Hilary notes that the center looks pink and undercooked. Pieces of wilted lettuce are scattered on the countertops. During her 2-hour visit, the main chef washes his hands twice, although he leaves the kitchen four times for a smoking break.

Questions

1. How is the daycare center providing infectious disease control?

2. Describe the outbreak of diarrhea.

A. Endemic

B. Epidemic

C. Pandemic

3. Which of the five keys to safer food does the restaurant not follow?

CASE # 5: ABOUT FAMILY HEALTH RISK

The M. family consists of Mr. M. (Harry), Mrs. M. (Shirley), 18-year-old Annie, 15-year-old Michelle, 13-year-old Sean, and 7-year-old Bobby. Harry is the pastor of Faith Baptist Church, where he has served for the past 15 years. Shirley is a housemother and is the primary caretaker for the children.

For the past year, Shirley has felt tired and “rundown.” At her annual physical, Shirley describes her symptoms to her physician. After several tests, Shirley is diagnosed with stomach cancer. Shirley starts to cry and says, “How will I tell my family?”

Shirley’s primary physician refers the family to Trisha F., a mental health nurse specialist. Nurse Trisha calls the household and speaks to Shirley. Nurse Trisha tells Shirley that she was referred by the physician, and she can help Shirley cope with the diagnosis. Shirley confides in Trisha that it has been 2 weeks since she received the diagnosis, but she has yet to tell her husband and children. Shirley asks Trisha if she can help her tell her family and explain what it all means. Nurse Trisha makes an appointment to go to the M. household and facilitate the family meeting.

Questions

1. Use the five interacting variables (physiological, psychological, sociocultural, developmental, and spiritual) of the Neuman Systems Model to assess the family’s ability to adapt to this life event. Think of one question Nurse Trisha can ask the family regarding each variable.

2. Is this life event a normative event or a nonnormative event?

3. Which phase of the home visit has Nurse Trisha reached (initiation phase, previsit phase, in-home phase, termination phase, or postvisit phase)?

CASE # 6: ABOUT CHILD AND ADOLESCENT HEALTH

Glenda R. is a parish nurse for Holy Cross Catholic Church. The church’s youth group teacher has overheard several of the 13- and 14-year-old teenagers talking about dating and sexual behaviors. The youth group teacher invites the parish nurse to speak to the group about sex and abstinence. Nurse Glenda sends letters to the parents describing when she will speak to the group about these topics and what will be discussed. Parents who would like their child to attend this class are asked to fill out the permission form.

On the night of the class, 18 of the 20 youth group members arrive for the class with their consent forms in hand. The room is set up with chairs in a circle and a computer with projector next to Nurse Glenda’s chair. Using pictures on the computer, Nurse Glenda illustrates the basic anatomy of the reproductive system and discusses what should be expected during puberty. Most of the class time is then spent discussing reasons for abstinence, how to know when you are ready for sex, and how to say no if you are not.

Questions

1. 1. Which teaching intervention designed to gather questions and feedback about the lesson would be most effective for this age group?

A. A confidential question box passed around for students to submit any questions they have about sex. Each student is asked to write something on a piece of paper, even if it is not a question or a comment, and to place it inside the box. Nurse Glenda reviews the papers and answers questions at the end of the class.

B. An open forum where students raise their hands and ask questions. Nurse Glenda responds appropriately.

C. A survey completed at the end of the class that students give to Nurse Glenda as they leave.

2. After the class has been given, Nurse Glenda talks to the parents and the church’s religious education teacher. Nurse Glenda believes that she can do more with this age group and would like to offer her services to them. She suggests that an evening of preventive screenings should be offered. What should Nurse Glenda screen for in this group of teenagers?

3. How can Nurse Glenda use interactive health communication (IHC) to reinforce the lesson?

CASE # 7: ABOUT POVERTY AND HOMELESSNESS

The community of Finnytown has identified the need for a shelter to serve homeless women and children. Finnytown currently has a homeless shelter for men. Women and children can obtain health care services there but are not allowed to stay overnight. The Finnytown health care task force performed a community assessment that revealed that a higher number of homeless men than women reside in Finnytown, but the percentage of homeless women is steadily increasing. Results further showed that more women with children than men are living in poverty. The task force speculated that many women who are living in poverty are being overlooked and thus are becoming women without homes.

The task force and the community of Finnytown decide to open a homeless shelter for women and children. The new shelter will primarily serve women with children who are homeless or in poverty. Georgia B. is the community health nurse who is a member of the task force team. Nurse Georgia and other health care professionals are charged with planning health care services for women with children to be provided at the new homeless shelter.

Questions

1. What common health problems should Nurse Georgia and the task force be aware of when planning health services to be provided at the new shelter?

2. What effects of poverty on the health of children should Nurse Georgia and the task force be aware of when planning appropriate services?

3. After the shelter opens, Nurse Georgia becomes one of the nurses who works in the clinic. What strategies are important for Nurse Georgia to implement when working with this population?

CASE # 8: ABOUT THE NURSE LEADER IN THE COMMUNITY

Ann T. is the state school nurse consultant. Nurse Ann provides guidance for school nurses across the state and organizes policy development for school nursing. Many of Nurse Ann’s hours are spent communicating by phone, face-to-face, or by e-mail with nurses and families who have questions regarding health services in the schools.

Terry L. contacts Nurse Ann. This is Terry’s first year as a school nurse, and she is working in a rural high school. She is worried about delegating medication administration to unlicensed personnel. “What exactly can be delegated, to whom, and how should I document it?” asks Nurse Terry.

Nurse Ann explains to Terry that some state laws specify who may delegate tasks, and the State Board of Nursing gives advice on which nursing tasks can be delegated. Nurse Ann tells Terry where on the Internet she can find these laws along with advisory opinions, and she e-mails copies to Terry. Nurse Ann shows Terry how to use the delegation decision tree and discusses some of Nurse Terry’s more challenging delegation issues. Nurse Terry must then use the materials to decide what she is comfortable delegating. Nurse Ann also gives Nurse Terry some sample training materials and documentation forms that other nurses in the state are currently using.

Questions

1. Which type of consultation model did Nurse Ann use? Explain your answer.

2. What can Nurse Ann do to reduce for other school nurses the confusion that surrounds delegation in school nursing?

3. What should Nurse Ann do to communicate effectively with the nurses and families whom she encounters?

CASE # 9: ABOUT FORENSIC NURSING IN THE COMMUNITY

Amanda J. is a forensic nurse who has been trained as a sexual assault nurse examiner (SANE). Amanda works part-time in the emergency room, where she occasionally examines victims of rape and sexual assault. Amanda also works part-time as a consultant for a local domestic-violence shelter for women and children. Every year Nurse Amanda helps to organize a Walk to Prevent Domestic Violence in her community. Proceeds raised from the walk go toward the domestic-violence shelter. Nurse Amanda provides literature about domestic violence at the walk as well as at other organizations in town.

Questions

1. Which levels of prevention does Nurse Amanda address in her practice?

A. Primary only

B. Secondary only

C. Tertiary only

D. Two of the above

E. All of the above

F. None of the above

2. What are the most common types of trace evidence of victims of violence, including those who are raped?

3. The concepts in forensic nursing theory include, but are not confined to, safety, injury, presence, perceptivity, victimization, and justice. How might Nurse Amanda address these concepts in her nursing practice?