ASSESSMENT/ HEALTH ILLNESS RELATED FACTORS
What is the individual's client assessment?
- Soraya
- 32 y/o F
- Widowed
- Nulliparous
- Second trimester (25 weeks)
- Unemployment; personal financial insecurity
- Newly immigrated from Iran
- Dentist (in Iran)
- Symptoms of anxiety/ depression
- Speaks English well, but has a thick accent (not easily understood)
What ethical issues might arise?
- May feel like she has not been given enough education
- Making sure Soraya has adequate social support re child care
- Proper nutrition + vitamin intake r/t to proper fetal development
- She may be more susceptible to postpartum depression--> assess how her mental health/ state will affect her baby
What specific nursing and health promotion strategies could be used to address this scenario and why?
- working w/ Soraya to learn coping strategies to address her anxiety and improve her nutrition --> capacity building
- create a supportive environment
- physical and support networks directing to resources --> referrals, employment opportunities, support groups and counselling
- developing personal skills
- educating Soraya re: healthy fetus development to help her make better choices
What are individual capacities relevant to this scenario?
- open to care and recommendations
- extremely resilient to her situation
- dentist (in Iran)- educated, work-oriented
What might be the challenges of having others involved?
- Conflicting professional opinions
- Conflicting beliefs/ values
- Leadership conflict
- Overwhelming flow of information
- Lack of continuity of care
What is the family assessment?
- Annie (older sister) and her family (husband/kids)
- Widowed
- No other family identified
How do these determinants affect the scenario?
- Income affects nutrition + access to neccessities
- Lack of social support/ isolation
- Small living environment
- Loss of culture after moving
What community health nursing competencies/standards are relevant to this scenario?
- Health promotion
- Building individual capacity
- Access and equity
What family capacities are relevant to this scenario?
- supportive environment --> sister is cautious of her health
- also states that being around her sister's family makes her feel better/ improves mood
- her sister is her current source of financial support
- helps her w/ doctors appointments, transportation, housing, and adapting to a new country
What is the role of the nurse within the interprofessional team in this scenario?
- Assessment
- Referral to resources
- Therapeutic nurse-client relationship
- Nurse management of prenatal care
Are there any underlying health problems that should be considered in this scenario? How might these influence the situation?
- Mourning her husband's death
- Anxiety r/t pregnancy, immigrating to a new country
These may cause her to be more prone to mental health issues and/or postpartum depression
What determinants of health are relevant to this scenario? (including life stage and concepts of growth and development)
- Income- anxiety r/t to lack of income and employment
- Unemployment
- Social support
- Coping skills- unhealthy
- Education/ literacy - thick accent, slight language barrier
- Housing- small, confined living arrangement
- Culture
What are the potential challenges that a nurse might experience in addressing this issue?
- Slight language barrier
- Building a therapeutic nurse-client relationship
- Postionality--> nurse's own beliefs/ values
- There may be a lack of resources for referrals in the community
What are community capacities relevant to this scenario?
- variety of resources available (lives in a big city)
- resources in close range (clinics, groceries, pharmacies)
- diverse country, large recipients of immigrants
- cultural resources available (Middle Eastern grocery stores/ restaurants/ places of worship)
Who should be involved in the situation described in this scenario?
- Dietitian
- OBGYN
- Grief counsellor
- Therapist
- Community Health Nurse
- Employment outreach programs
- Social worker
What (if any) treatments, interventions and medications that should be considered in looking at this scenario? Why are these important?
- Social supports (mental health & grief counselling)
- Anxiety coping strategies
- Non-pharmacological interventions
- Diet planner/ agenda
- Health teaching: proper nutrition and vitamin intake
What issues related to social justice and equity are relevant to this scenario?
- May not be aware of the available resources in her community
- Education- cannot acquire a job that she was previously qualified for
- Language barrier may affect access to employment
How could potential nursing challenges in this scenario be addressed?
- be mindful of positionality to issues
- therapeutic communication/ active listening
- culturally competent care
- being aware of healthcare services and resources in the community
What are the challenges/ barriers relevant to this scenario?
- Widow, single-mother
- Adapting to a new environment
- Slight language barriers
- Financial insecurity
Where/how could the nurse demonstrate leadership in this scenario?
- He/she take leadership of maternal and prenatal care
- Involving other disciplines (inter professional collaboration)
- Scheduling appointments (taking initiative to monitor progress)