Thuy Mai
5/14/2012

Case Study
  Community and Public Health Nursing: Present, Past, and Future
 
As a public health nurse at a free clinic, you are assessing and interviewing a 21-year-old woman who has come to the clinic because “I don’t have any energy and haven’t felt good in weeks”.   During the interview, you learn that she averages one meal per day, smokes up to two packs of cigarettes per day and rummages through trash to find items to sell to purchase food, snacks, and cigarettes. She admits to using street drugs “every once in a while, when I can find someone who will share with me”. She admits, “My life is a mess and I don’t know how to make it better”. 
a.       What data can you gather based on available client information?
Based given information, this is a homeless client who has been dealing with hunger due to the inadequate nutrition as she claimed to have an average of one meal per day. Due to inadequate nutrition, she may be feeling fatigue. It could also due to some underlying infections or diseases that has yet diagnosed. It is fairly common for homeless people to have a higher rate of morbidity and mortality rate as many struggle with mental illness and substance addiction. This client also is a chain-smoker (up to two packs a day), and this increases her risk for heart diseases and other complications later in life. She also admitted to using drugs as long as someone is willing to share with her, this put her at tremendous risk for increase for diseases such as hepatitis or AIDS. Her drug habit regards to sharing with anyone who is willing to share stating that she's a risk-taker and this also greatly increase her risk for other activities such as promiscuity or prostitution later on if her needs were not met. However, the fact that she realizes her life is a mess and it needs to get better stating that she's willing and ready to make changes. This a promising sign that she may be more willing to take the advice of the community health nurse to make amends to her life. 

b.      What questions should you ask yourself while interviewing this client?
When dealing with anyone in this scenario, nurses need to put all their feelings aside and remain unbiased as any personal attitude toward these issues can jeopardize or the impartial and highest level of care this client ought to receive. Questions to ask oneself are:
	What is my attitude or personal feelings toward this issue?
	Do I have any prejudices or biased attitude that can undermine the level of care for this client?
	Do I have any preconceived notion with regards to homeless people or people with substance abuse?
	Will I be able to put my feelings aside and provide the highest level of care in an unbiased fashion?

c.       During planning, how can you best assist the client?
This client lacks all the basic human needs as food, shelter and safety are not being met. So the utmost importance to providing or planning for care in this client needs to include all the basic needs in the Maslow's hierarchy. Once these needs have been met, the nurse can consider looking for medical needs as this person is not feeling well and needs to have a comprehensive test such as blood-work along with a physical exam. She may be facing with infections or some other illnesses which needs prompt attention. The planning phase for this client should also include housing or shelter placement temporarily to keep her off the streets and rummaging through the trash bins. She also needs a way or mean to obtaining skills for employment so she can support herself. For the time being, she can consider applying for some sort of public assistance and housing as well as food stamps. All these can be directed or referred to the community where they can assist her with all needs. This can be done at the Women's shelter.
d.      Outline potential strategies to assist her in making her life “better”.
Refer her to community programs with more expertise in assisting people in need of housing such as women's shelter and they can further assist her with obtaining public housing or public aid such as food stamp and so forth. She can also be referred her employment agency where their expertise in job placement can assist her with obtaining employment or other essential job skills for current market. The goal is to achieve independence so she can take all the necessary steps to achieve that goal. In the meantime, she maybe eligible for Medicaid or title 19 for access to the healthcare system, which she can use for mental health issues and substance abuse. There are a numerous programs out  in the community that is established to aid people in the community but they have to go to the right sources. These programs are designed as a guide to help accomplish goals and is seen as a stepping stone.