recognize cues
What physical cues from Alex’s story indicate concern?
History of fainting, dizziness, nausea, palpitations, poor sleep, and not eating or drinking before the appointment.
What additional information would you want to gather to better understand Alex’s situation?
Mental health history (anxiety, depression, trauma supports)
Group home policies on food, medication, and confidentiality
Alex’s coping strategies and current supports
mental health supports,
Based on Alex’s situation, what is the most important hypothesis the community health nurse should address first?
mental health distress and lack of safety related to unmet basic needs and trauma.
What immediate CHN action could reduce physical risk? Any nursing consdierations
Ensuring access to food and fluids, assessing for syncope risk, modifying the clinic environment to reduce stress, and advocating for appropriate pain management access.
what priority actions are needed? what will be the impact on Alex's current situation?
preventing physical harm (e.g., fainting), reducing psychological distress, and addressing environmental barriers that contribute to his anxiety.
What mental health cue suggests Alex is experiencing more than procedural fear?
withdrawn anxiety, feeling overwhelmed
Which cues are most concerning from a community health nursing perspective?
Inconsistent access to food, trauma history, and fear of disclosure.
Why should the nurse prioritize Alex’s unmet basic needs over focusing solely on his fear of injections?
unmet basic needs increase both physical and mental health risks.
What is a desired outcome for Alex that would indicate improvement in his situation?
- Alex feels safe and supported in group home
- he has access to mental health services working on adressing anxiety and trauma he has
- acccess to resources is not restricted
What impact could these priority actions have on Alex’s current situation?
Reduced anxiety and physical risk, increased sense of safety and control, and improved ability to continue engaging in treatment.
What family-related cue is relevant to Alex’s current mental health?
Parental rejection and emotional abuse related to his gender identity.
Which determinants of health are most relevant in Alex’s case?
Housing, food security, family support, social inclusion, and gender identity.
How does prioritizing Alex’s mental health and basic needs reflect the role of the community health nurse?
By focusing on prevention, advocacy, and addressing social determinants of health.
What interprofessional members could support Alex’s overall wellbeing?
Social worker, mental health provider, group home staff, clinic team, child welfare caseworker.
Which Community Health Nursing competencies or CHNC standards are most relevant to this scenario?
- Health Equity: addressing discrimination and unequal access to resources
- Professional Relationships: building trust with Alex and collaborating with staff
- Capacity Building: supporting Alex’s autonomy and self-advocacy
- Evidence-Informed Practice: using trauma-informed and gender-affirming care
- Professional Responsibility: advocating for ethical and equitable care
What community-level cues are impacting Alex’s health?
Living in a group home, lack of food before appointments, limited access to medication, and privacy concerns.
Why is focusing only on needle anxiety problematic?
It ignores trauma and systemic barriers.
What are the potential risks of not prioritizing Alex’s mental health and social context in this situation?
Ignoring mental health and social determinants can lead to missed appointments, increased distress, and withdrawal from gender-affirming care. These outcomes place Alex at greater risk and contradict the goals of community and mental health nursing.
What community or institutional barriers are affecting Alex’s care?
Systemic discrimination toward transgender youth, underfunded child welfare and group home systems, restrictive institutional policies, lack of access to basic resources such as food and medications, limited staff training, and inadequate privacy protections.
What specific nursing and health promotion strategies could be used to support Alex, and why are they important?
Trauma-informed care, advocacy for food and medication access, confidentiality planning, and youth-centred health education.
What follow-up assessments would be needed to evaluate whether nursing interventions are effective for Alex?
What findings would suggest that the nursing interventions are working?
What findings would suggest that the interventions are not effective?
- Follow-up assessment of Alex’s anxiety levels, physical symptoms (e.g., dizziness or fainting), access to food and medications before appointments, perception of safety and privacy, and continued engagement in care.
- Positive outcomes indicate that nursing interventions have successfully addressed both individual needs and community barriers
- If these findings persist, it suggests that interventions may not be adequately addressing systemic barriers or trauma-related needs