Community Health Nursing Care Plan

Community Health Nursing Care Plan

Ray C., Lindsay D., Julie E., Rayo E., & Sarah F.

Assessment Data

Goals & Outcome

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Statement #1

Statement #2

Resources

• Ackley, B., & Ladwig, G. (2010). Nursing Diagnosis Handbook: An Evidence-based

Guide to Planning Care. Maryland Heights, MO: Mosby. Print. pg 333, 336, 505, 750

• Anderson, E., & McFarlane, J. (2011). Promoting Health Partnership with

community Elders. In Community as partner: Theory and practice in nursing (6th ed.). Philadelphia: Lippincott Williams & Wilkins.

• Centers for Disease Control and Prevention. The State of Aging and Health in

America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. Retrieved December 4, 2014, from http://www.cdc.gov/features/agingandhealth/state_of_aging_and_health_in_america_2013.pdf

• Collins, E. (2014, February 1). Preventing loneliness and social isolation in older

people. Retrieved December 4, 2014, from http://www.iriss.org.uk/resources/preventing-loneliness-and-social-isolation-older-people

• Dillon, C., Gu, Q., Hoffman, H., & Ko, C.W. (2010). Vision, Hearing, Balance, and

Sensory Impairment in Americans. Aged 70 Years and Over: United States, 1999–2006. Centers for Disease Control and Prevention. Retrieved December 04, 2014, from http://www.cdc.gov/nchs/data/databriefs/db31.pdf

• "80206 Zip Code Detailed Profile." 80206 Zip Code (Denver, Colorado) Profile. N.p.,

n.d. Web. 05 Dec. 2014.

• Mental and Behavioral Health and Older Americans. (n.d.). Retrieved December 5,

2014, from http://www.apa.org/about/gr/issues/aging/mental-health.aspx

• Munson, M. (1999). Characteristics of Elderly Home Health Care Users. Advanced

Data from Vital and Health Statistics, 309, 1-12. Retrieved December 4, 2014, from www.cdc,gov/nchs/data/ad/ad309.pdf

• Resident Profile. (n.d.). Retrieved December 5, 2014, from http://

www.ahcancal.org/ncal/resources/Pages/ResidentProfile.aspx

• Absence of Significant Others

10% to 20% of those who have lost a spouse will develop significant depression/isolation within the first year after loss (Healthline.com, 2014).

• Comorbidities

The National Academy of Sciences states illnesses and conditions such as chronic lung disease, arthritis, impaired mobility, and depression were associated with social isolation (Connecting Families to Senior Care, 2014).

• Estimates of depression in older adults in the community range from less than 1% to 5%, but the estimates rise to 13% for those receiving home health care and 11.5% for elderly hospital patients (Anderson & Mcfarlane, 2011).

• Decline in Sensory Acuity:

Aged 70 yrs and older

75.3% have a balance impairment

27.2% have loss of feeling in their feet

26.3% have hearing impairment

15.4% have a visual impairment (Dillon, Gu, Hoffman, & Ko ( 2010).

• Social Isolation:

In a 2012 study in the Proceedings of the National Academy of Sciences, both social isolation and loneliness are associated with a higher risk of mortality in adults aged 52 and older (Connecting Families to Senior Care, 2014).

• Lack of Knowledge of Community Surroundings:

More than 50 percent of residents have some form of cognitive impairment (American Psychological Association, 2014).

• Fear of going into the community

Each year, one of three adults aged 65 years or older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and increase the risk of early death. Research shows that modifying a community’s physical environment to ensure access to places to exercise and removing barriers to walking may increase the physical activity of older adults and decrease fear (CDC, 2014)

35% of residents will participate in at least one extra-curricular activity out in the community weekly, provided by facility resources within 90 days.

80% of residents will report a decrease in fears of falling while participating in a community outing by the end of the first year of residency.

Nursing Diagnosis

Subjective data:

Impaired social interaction R/T to absence of significant others, co-morbidities, decline in sensory acuity, limited physical mobility, lack of independence, social isolation, and lack of knowledge of community surroundings (stores, restaurants, religious structures) AEB 10%-20% of residents reporting loneliness after a spouse has passed, 56% of residents report needing assistance with ADL’s, 50% of the patients report confusion about their location in the community, 75% of residents experiencing balance issues, and 33% of residents with a feeling of inability to leave the community due to fear of falling compared to the 38-57% of community members 64 years of age and older in the 80206 area code that are disabled and able to leave their home freely (80206 zip code, 2013). It is also reported that 64-88% of the community members 64 and older in the 80206 area code are disabled and living at home are able to provide self-care for their ADL’s (80206 zip code, 2013)

Our Community #1 Priority:

Cognitive Impairment and Social Isolation

• Limited Physical Mobility:

Of all elderly current patients, 56% were reported as receiving help with at least one ADL (Munson, 1999).

• Lack of Independence:

Thirty-eight percent of residents receive assistance with three or more ADLs (The National Center for Assisted Living, 2014).

• Eighty-seven percent of assisted living residents need help with meal preparation, while 81 percent need help managing their medications (The National Center for Assisted Living, 2014).

• Many argue that loneliness being categorized as a subjective negative feeling, while social isolation is an objective state mediated by the presence or absence of strong social networks (Collins, 2014)

• Studies suggest that 5 to 16% of people aged 65 and over state they are lonely (Collins, 2014)

• Amongst the older old, those aged over 80 years, rates of self-reported loneliness climb steeply to approximately 50% (Collins, 2014)

Outcome Evaluation & Re-Planning

Nursing Interventions

Outcome #1

Outcome #2

Nursing Interventions Statement #1

• Methods-The CHN kept a weekly log of each residents participation status of going out into the community and participating in an activity. This log was then analyzed, and summarized.

• Goal was met, 35% of the residents participated in weekly outings into the community, within 90 days.

• Interventions helped achieve and promote the goal by utilizing advertisements, paying close attention to sensory difficulties, and encouraging healthy socialization.

• Method-Questionnaires were distributed analyzing if the resources given relating to falls reduced the fears of leaving the community.

• Goal was NOT met, based on questionnaire results, 65%, of the residents did not report a decrease in fears of falling by the end of the first year of residency even after the resources were given.

Nursing Intervention Statement #2

Rationale

Primary Intervention

1.CHN will properly advertise weekly outings by using posters, flyer's, and utilizing the nursing network channel

Secondary Intervention

2.CHN will assess the residents potential or actual sensory problems with hearing and vision screenings and make referrals if needed.

Tertiary Intervention

3.CHN will encourage socializing by referring residents for behavioral interventions (life skills program) to increase social skills.

Primary Intervention

1.CHN will collaborate with community resources (ministers/counselors) to provide monthly consultations and education services regarding falls.

Secondary Intervention

2.CHN will identify underlying hesitations and fears of falling related to leaving the facility for an outing in the community and distribute screening questionnaires.

Tertiary Interventions

3.CHN will focus on the residents disease process that contribute to their fears of falling while going into the community and help restore function.

Rational Statement #1

Future Plans For Both Goals

Rational Statement #2

Future Possible Goals

1. Advertisements will act as constant reminders for the residents and families to venture out into the community.

2.Sensory problems are common experiences within the older U.S. population, and there is substantial difficulty sustaining social participation activities (Ackley, 2012 pg 750).

3.Facilitator-administered behavioral training product can have significant beneficial effects on psychosocial well-being in a healthy community sample (Ackley, 2012 pg750).

1.Advocating for the residents participation in a community based program has shown improved outcomes (Ackley, 2012 p 505).

2. The Get Up and Go scale is a screening tool that is helpful to determine the residents abilities and ways to plan for improvements to ensure safety (Ackley, 2012 p 333).

3. Recognize that risk factors for falling include recent history of falls, fear of falling, confusion, depression, altered elimination patterns, cardiovascular/respiratory disease and altered mobility (Ackley, 2012 p 333).

• CHN will continue the distribution of surveys and questionnaires. Further data can then be collected regarding the goals of encouraging residents to get out in the community and further encouragement of expression of fears related to falling.

• CHN will also routinely re-evaluate how data is collected in addition to the exploration of new goals being incorporated to the isolation problem with the community elders.

• Future goals will include the CHN teaching the elderly how to prevent injury while out in the community. This will be implemented using evidenced based interventions to prevent falls. For instance, “teaching exercise for balance, gait and strength training, environmental adaptation, and identification and treatment of foot problems (Ackley &Ladwig, 2010 pg 336).”

• Another possible goal will be for the CHN to educate the elderly about traffic rules, for instance, teaching only to to use the cross walk, utilizing the crossing guard, always walk with another person, and walk where the streets are safe.