Guidelines for Elderly Client Selection for Home Visits
1. Select a client 65 years of age or older who is essentially well. The client must live full-time with at least one other person.
NOTE: Before you begin your visits, hand in your client-nurse contract and discuss the suitability of the client with the instructor.
2. The client MAY NOT be a close friend, an immediate family member, or a person with whom you presently live/previously have lived. It is suggested that the client not be a close neighbor or someone with whom you frequently interact.
To gain the most from this assignment, choosing a client who is not known to you-will help you to rely on your assessment skills rather than your familiarity with the person.
3. The client must be someone with whom you can communicate verbally, i.e., no language barrier between you and client, no interpreter necessary.
4. Select a client who is willing and able to contract with you for the specified number of visits during the semester.
5. Explain to the client the general professional purpose of your visits: health assessment and health promotion.
6. Inform the client that, for educational purposes, you will be conferring with your instructor about your visits. Assure the client that all information will be kept confidential.
NRBS 3000 Professional Nursing Practice in Health Promotion
Guidelines for Elderly Client Study:
1. The study is to reflect a synthesis of the data collected, theories presented in the course and other course content in order to develop a comprehensive health assessment and analysis of the client selected for your home visits.
Use the “Guide to Collecting and Using a Nursing Data Base” when writing your paper.
Content: Include all the data outlined in the “Guide.” (To enhance your data collection process please review Allender (2013), pp. 799-801, Displays 24.4; 24.5 and 24.6 prior to 1st Client Visit)
Format: Use the same format as outlined in the Guide (i.e., same headings, same sections, data presented in the proper section).
2. Length: Seven PAGES not including the title and reference pages.
Please note: The grade for the paper will be based on the first Seven pages.
3. Style: The paper must be written in APA format.
Use the Publication Manual of the American Psychological Association for the correct style and typing of references.
Please Note: Any paper submitted late without prior approval from the instructor will be subject to lateness penalties. Paper may be submitted to the instructor before the due date.
NRBS3000 Guide to Collecting and Using a Nursing Date Base
This guide will assist in assessing clients, and, as necessary, planning care for those clients. It includes content areas that will yield information about clients experiencing stressors and clients in need of health promotion. Data may be collected over a period of time and may be subjective (client’s perceptions) and/or objective (can be measured). When writing the data base, support all conclusions with OBJECTIVE examples validation. Data THROUGHOUT the assessment in EACH section, indicate areas NEEDING FURTHER ASSESSMENT (NFA) and which additional data are needed.
Collection of Data:
a. Initial Orienting Data:
Specify source of information gathered. List date(s) of interview(s). Include the client’s: initials, birth date (DOB), age, birthplace, sex, marital status, religion, ethnicity, reason for seeking health care (chief complaint), current health care contact(s), allergies (describe reactions), main person responsible for client care (may be client). Describe past health history (medical/surgical) and current health status. Include client’s own perception of health status. Give a brief description of the client’s general appearance. Provide a genogram of at least 2 generations of family history with ages and health problems of family members.
b. Developmental Data: Contrast client’s CURRENT level of physical and psycho social functioning with norms appropriate for client’s age. Identify behaviors that indicate achievement of age-appropriate developmental tasks. Consider using theories of the Elderly to guide you in identifying these tasks. Identify client’s (intrapersonal, interpersonal, and extrapersonal strengths) and support systems and/or resources that are available.
c. Psychological Status: Using one of the nursing theorists discussed in class and theories of the elderly, describe client’s: level of cognition, thought and perceptual processes, orientation to person, place, and time (orientation X 3), and patterns of communication. Note the use of any behavior-altering substances. Discuss past and present patterns/methods of problem-solving.
d. System Dynamics: Describe the client’s family/group structure and the involvement of client and family/group members with each other.) Identify client’s interaction with the community. Identify clients and other members’ position(s) and role(s) in the family/group, including who assumes leadership. Describe the nature and pattern of verbal and non-verbal communication within the family/group, including expressions of emotions, attachments.
Identify family/group goals and achievements. Indicate how the client/family/group members meet their sexual needs. Describe client’s and family/group’s understanding of their health care status and their knowledge of health-promoting behaviors. What changes in client/family system patterns of functioning have occurred due to past or present stressors? How have client and family/group members adhered to health care regimens in the past and currently?
e. Environmental Data: Evaluate client’s home situation with respect to: access to home via stairs and/or elevator, number of rooms, ventilation, lighting, noise, temperature, availability of heating, air-conditioning and hot and cold water, presence of loose/falling plaster, asbestos, or other hazardous substances, presence of pets, telephone, and safety hazards (e.g., exposed wires, cords and/or scatter rugs.) Assess risk factors that may affect client’s health (drugs, alcohol, smoking, pollution) Evaluate neighborhood with respect to: accessibility of resources, such as stores, health facilities (hospitals, clinics, etc.), houses of worship, transportation, parks, environmental hazards to health (eg. fumes from traffic, factories, state of roads and sidewalks, cleanness of streets, loafers on street cornors).
f. Cultural Patterns: Identify client’s ethnic, religious and cultural associations. Describe how the beliefs/practices attributed to these (ethnic, religious and cultural) groups affect health-related behaviors, i.e., how do they affect language and modes of communications, beliefs regarding illness causation, use of home remedies, current sense of well-being and present and future orientation to seeking health care. Describe how ethnic, religious, and cultural regulators of behavior are expressed in dress, food, attitudes toward privacy and privacy time, moral judgment(s) and attitudes towards authority and authority figures.
g. Socio-Economic Status: Indicate client’s economic status, client/ family/group’s perception of adequacy or inadequacy of income and assets, source(s) of income, level of education, work history, current occupation and place of employment. If retired, state prior occupation. Include social roles and client’s perception of social status. Is client’s residence rented or owned? Describe adequacy or inadequacy of health insurance coverage and source of insurance, accessibility to health care and cost of transportation to health facilities. Is client eligible to obtain supplements such as food stamps, Meals- on-Wheels? Which supplement(s) is/are client receiving?
Collection of Data (Cont.):
h. Physical-Functional Data: Interview and observe client and perform a physical examination. Include an assessment of client’s sensory functions (vision, hearing, taste, smell and touch.) Assess general appearance of client (skin, hair, etc.), heart and lung sounds, circulation/perfusion and presence/absence of peripheral edema, vital signs. Assess and describe the patterns and characteristics of client’s: sleep, elimination, toileting and bathing, cooking, shopping, feeding, dressing, recreation and use of assistive devices.
Outline client’s typical dietary intake for 2 days. Do the same for client’s CURRENT intake and describe differences, if any. Identify client’s nutritional needs and whether typical and current diets supply client’s nutritional requirements. Evaluate client’s weight in relation to height and body build and in relation to health problems.
Outline typical and current WEEKDAY and WEEKEND activity patterns. Identify the client’s activity needs and whether typical and current levels of activity meet client’s activity requirements. Identify changes in activity tolerance and if they are related to health problems.
Include the client’s: current health care regimen and understanding of and
responses to the regimen (e.g., medications taken, knowledge of therapeutic and
non-therapeutic actions, responses to medications.)
Analysis of Data: Data collected must be analyzed before it can be applied. Analysis includes interpretation of the data collected and identification of interrelationships among the data so that a plan of care may be developed for the client. Using the selected nursing theorist(s), include the following in your analysis and interpretation:
1. Identify current ACTUAL and POTENTIAL health condition(s) IN PRIORITY ORDER. Medical diagnosis should not be included.
Include data regarding onset health problem(s) (when occurred, manner in which occurred, duration, precipitating factors) and course since onset (incidence or frequency, duration, patterns of remission & exacerbation, alleviating or aggravating factors), and relevant family history.
2. Discuss how ACTUAL and/or POTENTIAL health condition(s) disrupt client’s health.
-Consider physical, physiological, sociocultural, spiritual and developmental
factors when discussing the effects of the stressors on the client.
Analysis of Data (cont.)
3. Discuss how the selected nursing theoretical framework guides your approach to planning nursing care for this client. Demonstrate how the selected nursing theoretical framework(s) and theories of the elderly are applied to the client.
4. Formulate 1-2 nursing diagnoses for the PRIORITY health condition(s) (may be actual or potential) that disrupts your client’s health.