Ethics Of Safe Injection Sites

Ethics of Safe Injection Sites

For this discussion, you will explore a current social health issue from an ethical, nursing perspective. Using your knowledge of the ANA’s Code of Ethics for Nurses with Interpretive Statements (ANACOE), examine the implementation of safe injection sites (or overdose prevention sites/services). Describe the provisions of the ANACOE that may be used to support and/or discourage the implementation of safe injection sites. How might the social policy of legalizing safe injection sites in the United States impact health care and the ethical role of the nurse?

Remember that all posts must include professional references; review the assignment instructions to determine how many for each.

You also need to include an intro and conclusion in your discussion board.

RUBRIC: DISCUSSION BOARD (30 pts)

Last updated: 1/31/2020 © 2020 School of Nursing – Ohio University Page 1 of 1

NOTE: No direct quotes are allowed in the discussion board posts.

*Peer-reviewed references include professional journals (i.e. Nursing Education Perspectives, Journal of Professional Nursing, etc. – see library tab on how to access these from database searches), professional organizations (NLN, CDC, AACN, ADA, etc.) applicable to population and practice area, along with clinical practice guidelines (ECRI Institute – https://guidelines.ecri.org). All references must be no older than five years (unless making a specific point using a seminal piece of information) References not acceptable (not inclusive) are UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, & secondary clinical databases. **Since it is difficult to edit the APA reference in the Blackboard discussion area, you can copy and paste APA references from your Word document to the Blackboard discussion area and points will not be deducted because of format changes in spacing.

Criteria

Levels of Achievement Meets Expectations Needs Improvement Unsatisfactory

Characteristics of initial post

10 to 10 Points • Provided response with rationale. • The post is substantive and reflects careful

consideration of the literature. • Examples from the student’s practice/experience are

provided to illustrate the discussion concepts. • Addressed all required elements of the discussion

prompt. • Well organized and easy to read.

3 to 9 Points • Provided response missing either

substantive rationale, consideration of the literature, or examples from the student’s practice/experience to illustrate the discussion concepts.

• Addresses all or most of required elements. • Somewhat organized, but may be difficult to

follow.

0 to 2 Points • Provided response with minimal

rationale. • Does not demonstrate thought

and provides no supporting details or examples.

• Provides a general summary of required elements.

Support for initial post

5 to 5 Points • Cited minimum of two references: at least one (1)

from required course materials to support rationale AND one (1) from peer-reviewed* references from supplemental materials or independent study on the topic to support responses.

• The initial post is a minimum of 200 words excluding references.

2 to 4 Points • Missing one (1) required course reference

AND/OR one (1) peer-reviewed reference to validate response.

• Post has at least 200 words.

0 to 1 Points • Missing 1 or more of the correct

type (course or peer-reviewed) or number of references to support response.

• Post is less than 200 words or there’s no post.

Responses to Peers

10 to 10 Points • Responses to colleagues demonstrated insight and

critical review of the colleagues’ posts and stimulate further discussion

• Responded to a minimum of two (2) peers and included a minimum of one (1) peer-reviewed* or course materials reference per response.

• Responses are a minimum of 100 words and are posted on different days of the discussion period by the due date.

4 to 9 Points • Responses to colleagues are cursory, do not

stimulate further discussion and paragraph could have been more substantial.

• Responses missing one of the following: o insight/critical review of colleague’s

post, o OR respond to at least two peers, o OR a peer reviewed*or course materials

reference per response • Responses are a minimum or less than

100 words and posts were on the same date as initial post.

0 to 3 Points • Responses to colleagues lack

critical, in depth thought and do not add value to the discussion.

• Responses are missing two or more of the following: o insight/critical review of

colleagues’ post o AND/OR response to at least

two peers o AND/OR a peer reviewed*

reference per response. • Responses are less than 100

words, posted same day as initial post.

APA format*; Spelling/ Grammar/ Punctuation

5 to 5 Points • APA format** is used for in-text citations and

reference list. • Posts contain grammatically correct sentences

without any spelling errors.

2 to 4 Points • APA format is missing either in-text or at

end of the reference list. • Posts contain some grammatically correct

sentences with few spelling errors.

0 to 1 Points • Not APA formatted OR APA

format of references has errors both in-text and at end of reference list.

• Post is grammatically incorrect.

 

https://guidelines.ecri.org/

Assignment – Documentation Of An Examination Of The Peripheral Vascular System

Title:

Documentation of problem based assessment of the peripheral vascular system.

 

Purpose of Assignment:

Learning the required components of documenting a problem based subjective and objective assessment of peripheral vascular system. Identify abnormal findings.

 

Course Competency:

Select appropriate physical examination skills for the cardiovascular and peripheral vascular systems.

 

Instructions:

 

Content: Use of three sections:

· Subjective

· Objective

· Actual or potential risk factors for the client based on the assessment findings with no description or reason for selection of them.

 

Format:

· Standard American English (correct grammar, punctuation, etc.)

 

Resources:

Chapter 5: SOAP Notes: The subjective and objective portion only

Sullivan, D. D. (2012). Guide to clinical documentation. [E-Book]. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=495456&site=eds-live&ebv=EB&ppid=pp_91 >

 

Smith, L. S. (2001, September). Documentation do’s and don’ts. Nursing, 31(9), 30. Retrieved from http://ezproxy.rasmussen.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=107055742&site=eds-live >

 

Documentation Grading Rubric- 10 possible points

Levels of Achievement
Criteria Emerging Competence Proficiency Mastery
Subjective

(4 Pts)

Missing components such as biographic data, medications, or allergies. Symptoms analysis is incomplete. May contain objective data.

 

Basic biographic data provided. Medications and allergies included. Symptoms analysis incomplete. Lacking detail. No objective data. Basic biographic data provided. Included list of medications and allergies. Symptoms analysis: PQRSTU completed. Lacking detail. No objective data. Information is solely what “client” provided. Basic biographic data provided. Included list of medications and allergies. Symptoms analysis: PQRSTU completed. Detailed. No objective data. Information is solely what “client” provided.
  Points: 1 Points: 2 Points: 3 Points: 4
Objective

(4 Pts)

Missing components of assessment for particular system. May contain subjective data. May have signs of bias or explanation of findings. May have included words such as “normal”, “appropriate”, “okay”, and “good”.

 

Includes all components of assessment for particular system. Lacks detail. Uses words such as “normal”, “appropriate”, or “good”. Contains all objective information. May have signs of bias or explanation of findings. Includes all components of assessment for particular system. Avoided use of words such as “normal”, “appropriate”, or “good”. No bias or explanation for findings evident Contains all objective information Includes all components of assessment for particular system. Detailed information provided. Avoided use of words such as “normal”, “appropriate”, or “good”. No bias or explanation for findings evident. All objective information
  Points: 1 Points: 2 Points: 3 Points: 4
Actual or Potential Risk Factors

(2 pts)

 

Lists one to two actual or potential risk factors for the client based on the assessment findings with no description or reason for selection of them. Failure to provide any potential or actual risk factors will result in zero points for this criterion. Brief description of one or two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them. Limited description of two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them. Comprehensive, detailed description of two actual or potential risk factors for the client based on the assessment findings with description or reason for selection of them.
  Points: 0.5 Points: 1 Points: 1.5 Points: 2

Case Study Assignment: Assessment Tools And Diagnostic Tests In Adults And Children

PLEAS FOLLOW THE INSTRUCTION BELOW

FIVE REFERENCE NOT MORE THAN FIVE YEARS OR LESS THAN FIVE YEARS

ZERO (0) PLAGIARISM

PLEASE FOLLOW RUBIC BELOW & 7TH  APA  FORMAT WRITTING STYLE

MY ALLOCATED  IS Assignment Option 1: Adult Assessment Tools/Diagnostic Tests (Choose one of the cases listed below)
When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.

Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.

 

For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To Prepare

  • Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
  • By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or Child Health Case (Option 2). Note: Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.
  • Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
  • Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
  • If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.
    • Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
    • Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

The Assignment

Assignment (3–4 pages, not including title and reference pages):

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:
Include the following:

  • A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.
    • What is its purpose?
    • How is it conducted?
    • What information does it gather?
  • Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.
  • During Week 2 you analyzed diversity considerations in health assessments and applied concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment.

 

This week, you will explore various assessment tools and diagnostic tests that are used to gather information about patients’ conditions. You will examine the validity and reliability of these tests and tools. You will also examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition.

Learning Objectives

Students will:

  • Evaluate validity and reliability of assessment tools and diagnostic tests
  • Analyze diversity considerations in health assessments
  • Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment
  • Apply assessment skills to collect patient health histories

For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To Prepare

  • Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
  • By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or Child Health Case (Option 2). This has been modified to make sense  for you.  THIS MAY NOT BE WHAT IT READS CURRENTLY UNDER WEEK 3 REQUIREMENTS

 

  •  Based on the Assignment option assigned to you, your Instructor will also assign you assessment tools or diagnostic tests to apply to either an adult or the child health example assigned to you.
  • Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
  • Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
  • If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.
    • Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
    • Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

The Assignment 

  • Last names A-M Assignment Option 1: Adult Assessment Tools/Diagnostic Tests (Choose one of the cases listed below)
  • Last names N-Z Assignment Option 2: Child Health Issue (choose one of the cases listed below)

Assignment (3–4 pages, not including title and reference pages):

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:

Assessment Tool/Diagnostic tool : PSA

Diagnostic Tool: Mammogram

Diagnostic Tool:  PapSmear

Include the following:

  • A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.
    • What is its purpose?
    • How is it conducted?
    • What information does it gather?
  • Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

Case Study:Family Assessment

Instructions

Case Study: Family Assessment

 Case Study:

Review The Nursing Process in Practice: Formulating a Family Care Plan, chapter 13, page 364.

 Utilize the Box 13-7 Family Assessment Guide, pages 364-368.

Make sure to use all of the VI steps of the assessment.

 

 

Chapter 364 to 368

 

Key Ideas

· 1. Family nursing takes place within the framework of the nursing process.

· 2. Family needs, style, strengths, and functioning are assessed with the Family Needs Model of family nursing. Families are assessed on several levels: individual, subsystem, family unit, and family–environment interaction.

· 3. The goal of family assessment is mutual identification of needs and care planning that includes both the nurse and the family. The success of family health care depends on setting realistic goals related to the level of family functioning.

· 4. Several diagrams help assess families. A family map diagrams the structure and organization of the family and its subsystems. A genogram identifies family facts and process, including illnesses and multigenerational patterns of relationships. An eco-map describes the energy exchanges between the family and the environment.

· 5. Analysis of family data helps the nurse determine family needs, family style, family strengths, and family functioning. Analysis of family data includes determination of the targets of care, nursing contribution, and the priorities of family needs.

· 6. NANDA International has specified several nursing diagnoses related to families, focusing on family processes and family coping. The Omaha System identifies family problems related to the use of social resources and the environment.

· 7. Different nursing intervention strategies are used for each family need: developmental and health-promotion needs, coping with illness or loss, inadequate resources and support, disturbances in internal dynamics, and coping with the environment. Nursing interactions are adjusted to the family style. Family strengths are as important as family problems.

· 8. Families are resistant to change, but a time of crisis is often the best opportunity for change. As the importance of the family member increases, the impact of a change in that member on the family increases. Helping a family change its internal dynamics is not a goal for every community/public health nurse or every family.

· 9. Evaluation should include examination of goals and the effect of intervention on a family member who is ill, other individuals, family subsystems, the entire family, and the environment. Evaluation should also include evaluation of the quality of nursing performance. The outcome of evaluation may be modification of the plan, continuation of the plan, or resolution of the problem.

The Nursing Process in Practice

Formulating a Family Care Plan

Mr. R., an 80-year-old retired pipe fitter, lives with his wife; he has had diabetes for 15 years. Although his diabetes has been moderately controlled with diet and daily insulin, some complications have occurred. He experiences arteriosclerotic cardiovascular disease and peripheral neuropathy, and he recently spent 2 months in the hospital due to circulatory problems in his left leg. The progressive deterioration of circulation resulted in an amputation below the knee. Although fitting him with a prosthesis would be possible, he has refused this and is wheelchair bound. Mr. R. currently depends on someone else to help with transfers. He is cranky, irritable, and demanding to almost everyone. He recently has stopped following his diabetes regimen because he claims, “It just doesn’t matter anymore.”

Mr. R.’s wife, Doris, is a 74-year-old woman who has been a homemaker most of her life. She has always been the “watchdog” for Mr. R.’s health. Mostly through her changes in food preparation and her lifestyle adjustments, Mr. R.’s diabetes has been managed. She schedules his physician appointments, buys his medical supplies, and administers his insulin. He is now refusing to accept her help, and she is anxious and angry about his behavior. They frequently have arguments, after which Mrs. R. retreats to her room.

Mr. and Mrs. R. have three children and four grandchildren who live in the same city. The eldest daughter, Patricia, calls or stops by about once a week. The other children, Tom and Ellen, are busy with their families and see their parents mostly on holidays; they have very little communication with Patricia or their parents. When the children do come to visit, Doris tries to put on a happy expression and pretend that everything is going well to avoid worrying them. She is also embarrassed about Mr. R.’s behavior and does not want anyone from outside the family to see what is happening.

On her initial home visit to this family, the community health nurse notes that Mr. R. appears somewhat drowsy and unkempt. Mrs. R. looks anxious and tired, her skin color is slightly ashen, and she has circles under her eyes. When the nurse asks them what they hope to get out of the nursing visits, Mrs. R. says, “Actually, you don’t need to keep visiting. In a few weeks we’ll be back to normal and doing fine.”

Based on a thorough assessment of the family, the community health nurse may begin to develop a mutually acceptable plan of care with the family.

Assessment

In the initial interview, the community health nurse completes a genogram and an eco-map with the family (see  Figures 13-3  and  13-4 ). After the second family interview, the nurse also completes a family map that describes the members’ interactions with each other (see  Figure 13-2 ). A family guide to help structure a family assessment is presented in  Box 13-7 .

Completing the genogram helps break the ice to get the family to talk about their situation. The genogram provides a safe and thought-provoking way for Mrs. R. to supply appropriate information about the situation. During this process, the nurse obtains information about other family members, their general levels of functioning, and the possibility of acting as resources. She identifies family members’ patterns of closeness and distance.

Box 13-7 Family Assessment Guide

I Identifying Data

· Name: ___________________________________________________________________________________________________

· Address: __________________________________________________________________________________________________

· Phone number(s):_____________________________________________________________________________________________

· Household members (relationship, gender, age, occupation, education):____________________________________________________

· Financial data (sources of income, financial assistance, medical care; expenditures):___________________________________________

· Ethnicity: __________________________________________________________________________________________________

· Religion: __________________________________________________________________________________________________

· Identified client(s):______________________________________________________________________________________________

· Source of referral and reason: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

II Genogram

· Include household members, extended family, and significant others

· Age or date of birth, occupation, geographical location, illnesses, health problems, major events

· Triangles and characteristics of relationships

III Individual Health Needs (for each household family member)

· Identified health problems or concerns: ________________________________________________________________________________

· Medical diagnoses: _____________________________________________________________________________________________

· Recent surgery or hospitalizations: _________________________________________________________________________________

· Medications and immunizations: _________________________________________________________________________________

· Physical assessment data: ______________________________________________________________________________________

· Emotional and cognitive functioning: _______________________________________________________________________________

· Coping: _____________________________________________________________________________________________________

· Sources of medical and dental care: ____________________________________________________________________________

· Health screening practices: ____________________________________________________________________________________

IV Interpersonal Needs

· Identified subsystems and dyads:________________________________________________________________________________

· Prenatal care needed: _________________________________________________________________________________________

· Parent–child interactions:_______________________________________________________________________________________

· Spousal relationships:_________________________________________________________________________________________

· Sibling relationships:_________________________________________________________________________________________

· Concerns about older members:___________________________________________________________________________________

· Caring for other dependent members:________________________________________________________________________________

· Significant others:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

V Family Needs

· A. Developmental

· Children and ages:____________________________________________________________________________________________

· Responsibilities for other members: _____________________________________________________________________________

· Recent additions or loss of members:_____________________________________________________________________________

· Other major normative transitions occurring now:____________________________________________________________________

· Transitions that are out of sequence or delayed:_____________________________________________________________________

· Tasks that need to be accomplished:_______________________________________________________________________________

· Daily health-promotion practices for nutrition, sleep, leisure, child care, hygiene, socialization, transmission of norms and values: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

· Family planning used:_______________________________________________________________________________________

· B. Loss or Illness

· Nonnormative events or illnesses:______________________________________________________________________________

· Reactions and perceptions of ability to cope:________________________________________________________________________

· Coping behaviors used by individuals and family unit:_________________________________________________________________

· Meaning to the family:_________________________________________________________________________________________

· Adjustments family has made:________________________________________________________________________________

· Roles and tasks being assumed by members:_________________________________________________________________________

· Any one individual bearing most of responsibility:_____________________________________________________________________

· Family idea of alternative coping behaviors available:____________________________________________________________________

· Level of anxiety now and usually:_________________________________________________________________________________

· C. Resources and Support

· General level of resources and economic exchange with community:_________________________________________________________

· External sources of instrumental support (money, home aides, transportation, medicines, etc.):____________________________________

· Internal sources of instrumental support (available from family members):___________________________________________________

· External sources of affective support (emotional and social support, help with problem solving):_____________________________________

· Internal sources of affective support (who in family is most helpful to whom?): _________________________________________________

· Family more open or closed to outside?______________________________________________________________________________

· Family willing to use external sources of support?_______________________________________________________________________

· D. Environment

· Type of dwelling:________________________________________________________________________________________________

· Number of rooms, bathrooms, stairs; refrigeration, cooking:_______________________________________________________________

· Water and sewage:______________________________________________________________________________________________

· Sleeping arrangements:_____________________________________________________________________________________________

· Types of jobs held by members:_______________________________________________________________________________________

· Exposure to hazardous conditions at job:___________________________________________________________________________

· Level of safety in the neighborhood:____________________________________________________________________________________

· Level of safety in household:________________________________________________________________________________________

· Attitudes toward involvement in community:___________________________________________________________________________

· Compliance with rules and laws of society:____________________________________________________________________

· How are values similar to and different from those of the immediate social environment?_____________________________________

· E. Internal Dynamics

· Roles of family members clearly defined?______________________________________________________________________

· Where do authority and decision making rest?_____________________________________________________________________

· Subsystems and members:__________________________________________________________________________________

· Hierarchies, coalitions, and boundaries:________________________________________________________________________

· Typical patterns of interaction:_______________________________________________________________________________

· Communication, including verbal and nonverbal:__________________________________________________________________

· Expression of affection, anger, anxiety, support, etc.:________________________________________________________________

· Problem-solving style:________________________________________________________________________________________

· Degree of cohesiveness and loyalty to family members:___________________________________________________________________________________________________________________________________________________________________________

· Conflict management:________________________________________________________________________________________

__________________________________________________________________________________________________________

VI Analysis

· Identification of family style:__________________________________________________________________________________

· Identification of family strengths:_____________________________________________________________________________

· Identification of family functioning:____________________________________________________________________________

· What are needs identified by family? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

· What are needs identified by community/public health nurse?______________________________________________________________________________________________________________________________________________________________

The eco-map presents a picture to both the nurse and Mr. and Mrs. R. of a family that is not well connected to outside resources. Little energy is coming in or going out of the immediate family system, with the exception of intervention by the health care system, which the family wants to discontinue. When the community health nurse later completes a family map, she becomes aware of Mrs. R.’s tendency to act as a parent and Mr. R.’s tendency to act as a child. This blurring of boundaries has set up a behavior pattern in which Mr. R. gives away responsibility for his own health. At the same time, however, the rigidity of these boundaries keeps the children out of these interactions. After assessing the family, the nurse tries to guide her practice with some questions. She asks herself about the family’s needs, strengths, functioning, and style. She examines the family’s priorities and the resources they are using or are potentially able to use. She looks at her own skills and abilities and attempts to define her responsibility to the family system. These questions help her begin to analyze the family data. This analysis leads to several determinations.

Family Health Needs

The family needs help coping with this illness and connecting with resources and sources of support. Some minor disturbances in internal dynamics are influencing the way the family is dealing with the problem. The nurse assigns the family the nursing diagnosis of “Family Coping: Compromised.”

Family Style

This family is a distancing family that prefers to keep its problem-solving activities to itself. However, this isolation limits family members’ ability to support each other. The community health nurse must adjust her nursing interactions to accommodate this family’s style of operating. The nurse should respect the family’s need for distance, approach them cautiously, and observe for cues that indicate that they are becoming anxious.

Family Strengths

This family has some ability to organize activities that need to be accomplished to maintain Mr. R.’s health. Family members are concerned about each other and may be able to adjust schedules or routines. Mrs. R. is committed to Mr. R.’s health care and will try to do what is required. The family has a long history together and in the past has developed a sense of identity and common purpose.

Family Functioning

Even though the family is currently stressed, long-term functioning is fairly healthy. No one member has consistently been a problem or has failed to fulfill her or his role. The adult children are not acting in their age-appropriate roles of support to parents. This status seems to reflect the family style but can possibly be modified.

Targets of Care

The community health nurse believes several levels of this family— the individuals with health problems (both Mr. and Mrs. R.), the couple, and the family as a unit—are potential targets for care. When she reviews who the most likely person in the family is to be able to change behavior, she looks for someone who seems willing to change. She decides this person is Mrs. R. and potentially the children.

Nurse’s Contribution

The community health nurse reviews her own caseload and her available time and attempts to make an accurate assessment of her skills. She is fairly comfortable in dealing with families and decides she will intervene on three levels: individual, subsystem, and family unit. Her contribution will be to offer information, counseling, and connection with other resources. She can visit one time per week and will try to schedule these visits when some of the children can be present.

Priorities

The family has several needs. Which one is the most crucial? Any life-threatening situation must be top priority, but nothing will be accomplished without the family’s agreement that this is their concern. After discussing these ideas with the family, the nurse and the family decide to first address individual health concerns. Mr. R.’s hyperglycemia is noted, and he admits it is making him feel bad. Mrs. R.’s cardiac status is to be assessed next week at an appointment with the family physician. Although Mr. R. seems agreeable to resuming his insulin injections, he has no desire to change his diet or learn how to walk with a prosthesis. The community health nurse puts aside these problems for the time being and addresses Mrs. R. She wonders if Mrs. R. would be interested in exploring her current care for herself. Mrs. R. tentatively agrees. Using additional resources to help Mr. R. transfer in and out of his wheelchair is something that can be accomplished, but the family is still reluctant about this course of action. This problem, too, is put off to a later time.

Planning

The community health nurse and the family together develop both long-term and short-term goals.

Mr. R.: