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1st classmate
Based on the information provided in the rehab case manager report and the medical record, here are three strengths of the Gardner family that the nurse could incorporate into the plan of care. The Gardner family has a good support system with Lois’s husband Phil and daughter Sharon regularly visiting her in the rehabilitation facility. Additionally, they receive support from members of their synagogue community. This indicates a strong network of emotional support and potential assistance with caregiving tasks, which can significantly benefit Lois’s transition back home. Despite Lois’s intermittent confusion, she is cooperative with taking medications and participating in physical therapy sessions. This compliance demonstrates a willingness to engage in her care, which can facilitate the implementation of the care plan and promote her overall well-being. Lois will be returning to retirement housing with her husband Phil, providing a familiar and stable environment for her recovery. This familiarity can contribute to Lois’s comfort and sense of security, which are important factors in promoting her rehabilitation and adjustment to home care.
Physician-initiated and/or collaborative interventions for effective home care for the Gardner family may include: The nurse can collaborate with a home health agency to provide skilled nursing care, physical therapy, and occupational therapy services at home. This intervention ensures that Lois receives comprehensive rehabilitation and support tailored to her needs, while also providing education and support for Phil in implementing the new orders and managing Lois’s care at home. Collaborating with a social worker or a support group for caregivers to provide emotional support, education, and resources to Phil. This intervention aims to address Phil’s reported feelings of being overwhelmed with his caregiving responsibilities and provide him with the knowledge and skills needed to effectively support Lois’s recovery at home. Collaborating with the primary care physician or a pharmacist to conduct a medication review, optimize Lois’s medication regimen, and provide education to both Lois and Phil on proper medication administration, potential side effects, and the importance of medication adherence. This intervention aims to promote medication safety and optimize Lois’s health outcomes while empowering Phil to manage Lois’s medications effectively at home. Collaborating with an occupational therapist or a home health nurse to perform a comprehensive home safety assessment, identify potential hazards, and implement necessary modifications or adaptive equipment to promote Lois’s safety and independence at home. This intervention addresses the need for a safe and supportive home environment for Lois’s recovery and rehabilitation.
These interventions are chosen based on clinical judgment to address the strengths and needs of the Gardner family, promote patient-centered care, and facilitate a smooth transition to home care following Lois’s rehabilitation. “Patient-centered care focuses on the patient and the individual’s particular health care needs. The goal of patient-centered health care is to empower patients to become active participants in their care. “(Patient-centered Care, 2009)
Patient-centered care. (2009, December 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/19901351/#:~:text=Abstract,active%20participants%20in%20their%20care.
2nd classmate
There are several factors that are strengths that should be incorporated into the plan of care. One of these is the support that Phil can get from his daughter. She visits several times a week, and only lives an hour away. Another strength are the couples from their synagogue who also visit several times per week. These people can assist Phil if he needs any help with anything, along with checking in on his wellbeing. Lois is also independent at mealtimes, as well as being continent. This is a great aid in helping Phil care for her every day and lightens his burden.
Phil will require some support to get through this. One of these would be a physical therapist. The nurse will need to ensure that physical therapy is taking place as recommended, along with ensuring that Phil understands his role in this process. Another need will be a consultation with a nutritionist, as Lois is being placed on a special diet (National Library of Medicine, 2021). Phil needs to know what foods to buy and how to prepare them. Phil will also need to purchase a home oxygen unit (Whitt, 2022). Additionally, he will need to be educated on how to operate it, and the dangers it has as well. It will take a team of several professionals to get Phil and Lois where they need to be, and the nurse will play a critical role.
References
National Library of Medicine. (2021, June). The importance of dieticians as healthcare workers. Retrieved from National LIbrary of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756058/
Whitt, K. (2022, January 13). Can you spot the home oxygen safety hazards? Retrieved from OSF Healthcare: https://www.osfhealthcare.org/blog/can-you-spot-the-home-oxygen-safety-hazards/#:~:text=Using%20an%20oxygen%20concentrato
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