Hospice Home Visit Assignment Help

Hospice Home Visit Assignment Help

Instructions/Descriptions

Hospice Home Visit Assignment Help

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Anne McMillan is 80 years old and is terminally ill with metastatic breast cancer. She has been a widow for 5 years and has three daughters and two sons. All of her children are married with kids of their own, except one son who is handicapped and lives with Anne. Anne is too weak to care for herself and is moving in with her youngest daughter. Her daughter’s house is a colonial with all bedrooms upstairs. There is a first-floor bathroom.

During her first visit, the hospice nurse talks with Anne and her daughter and explains what hospice is all about. The nurse then admits Anne into the hospice program and begins her initial assessment. Anne’s primary physical complaints are back pain and constipation. She is still eating and drinking regularly.

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The nurse immediately recognizes that Anne will need a hospital bed. Anne already has a walker, but the nurse informed Anne and her daughter that they could have a bedside commode if needed in the future as Anne becomes weaker. Anne’s biggest concern is her handicapped son, saying, “He can’t be by himself for long and I don’t know where he can go now that I can’t take care of him.” Except for the handicapped son, all of her children and many of her grandchildren are active in her care.

Assessment

On her initial visit, the hospice nurse collects the following data about Anne, her family, and her community. In this case, the community consists of Anne’s social support outside of her family, such as her neighborhood and church.

1. Pain assessment, including history, character, severity, location, effects on quality of life, precipitating factors, and relieving factors
2. Other physical symptoms, such as fatigue, nausea, vomiting, constipation, diarrhea, decreased appetite, and decreased mobility
3. Client and family fears, anxiety about dying and the dying process
4. Support network and family dynamics
5. Client’s anxiety about situation concerning handicapped son
6. Additional support network outside of family
7. Effect of diagnosis and prognosis on Anne’s social support, including her neighbors and her church community

Diagnosis

Individual

1. Pain related to disease process
2. Potential for constipation and discomfort related to decreased mobility
3. Apprehension related to concerns about safety and well-being of handicapped son

Family

1. Strong support system indicated by active family participation in Anne’s care

Community

1. Anticipatory grieving related to social isolation after leaving neighborhood and moving in with daughter

Planning

Individual

Long-Term Goals

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1. Pain will remain controlled until client expires.
2. Client will have regular bowel movements for the next 2 months.
3. Client will verbalize satisfaction about resolution of situation concerning handicapped son.

Short-Term Goals

1. Pain will be well controlled within 24 to 48 hours.
2. Client will have a bowel movement within 24 to 48 hours.
3. Client will have decreased anxiety about handicapped son within 24 to 48 hours because the social worker will have found a place for the son to live.

Family

Long-Term Goals

1. Family will remain active in Anne’s care until she is buried.
2. Family will provide a support network for each other and use hospice services for continued support through Anne’s death and burial and for months afterward.

Short-Term Goal

1. Family will actively participate in Anne’s care.

Community

Long-Term Goal

1. Client will continue to receive support from friends.

Short-Term Goal

1. Client will verbalize feelings about moving in with daughter and leaving friends behind.

Intervention

Individual

After talking with the doctor, the hospice nurse starts Anne on methadone 20 mg daily and Roxanol 5 mg as needed for breakthrough pain. The nurse explains to Anne and her daughter that she is constipated because of her decrease in mobility. The nurse obtains an order for a stool softener and instructs Anne to take it twice daily. The nurse also explains to Anne and her daughter that, as Anne declines, her appetite will decrease and she will eat less and less and may not have bowel movements very frequently. Anne should let the nurse know if she ever feels uncomfortable because she has not had a bowel movement in a few days. The nurse talks to the social worker, who finds a group home for Anne’s handicapped son.

Family

The nurse and social worker talk with the family and help them develop a system so that Anne always has someone with her and to help ensure that all of the responsibility for Anne’s care does not fall on one person. They also inform the family about resources to support them.

Community

Anne has a nurse, social worker, spiritual counselor, and nurse assistant assigned to her care. Each of these hospice workers helps Anne discuss her feelings about her situation and works with her to continue to receive support from her friends and neighbors.

Evaluation

Individual

All of Anne’s goals are met, because she has good pain control until she dies, she no longer experiences discomfort and problems with constipation, and she expresses less anxiety and worry about her handicapped son. Although she still has some concerns, she feels much better about the situation.

Family

The family’s goals are met, because they remain active in Anne’s care until she dies. In addition, they use hospice resources appropriately and as necessary, and they support one another through the entire process.

Community

The goals are met, because Anne expresses her feelings about her situation, and her closest friends remain supportive to Anne through visits and phone calls.

Levels of Prevention

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In this case, the three levels of prevention focus on helping the client and family through all phases of hospice care from admission until death. Some examples are as follows.

Primary

1. Anticipating needs and intervening early on to prevent problems such as skin breakdown and lack of pain control
2. Educating the client and family about hospice and the dying process

Secondary

1. Responding quickly to needs as they arise
2. Continued education about the hospice and dying experience

Tertiary

1. Assisting the client and family through the active phase of dying
2. Providing follow-up bereavement support to the family

• Make arrangements to accompany a PHN, a home health nurse, and/or a hospice nurse on home visits.
• Interview a PHN about the types of client referrals received, and ask what interventions are usually performed. Repeat this activity with a home health nurse and a hospice nurse. Ask the nurses what they like best about their jobs.
• Attend a team meeting in a home health agency or a hospice program to see how the roles of the various team members blend together to provide family-centered care.
• Interview a PHN and a home health nurse, and ask how the community affects the care they provide.

1. Define home health care.
2. Discuss the purpose of home health services.
3. Differentiate between the purpose of a public health nursing visit, a home health nursing visit, and a hospice nursing visit.
4. Use the nursing process in outlining the steps involved in conducting a home visit.
5. Identify the types of home health agencies.

1. Apply the nursing process to a home health client situation.
   

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