MacDonald/Jakubec: Stanhope and Lancaster’s Community Health Nursing

in Canada, 4th Edition

Chapter 03: Community Health Nursing in Canada: Settings, Functions, and Roles

Answers to Case Studies from Textbook

CHN IN PRACTICE: A CASE STUDY

Discharge Planning for Postcerebrovascular Accident Care
During her visit to the regularly scheduled blood pressure clinic in a local apartment complex,
Brigit, a 45-year-old woman, complained of feeling dizzy and forgetful. She could not remember
which of her six medications she had taken during the past few days. Her blood pressure
readings on reclining, sitting, and standing revealed gross elevation. The CHN and Brigit
discussed the danger of Brigit’s present status and her need to seek medical attention. Brigit
called her physician from her apartment and agreed to be transported to the emergency
department in the local hospital.
While in the emergency department, Brigit manifested the progressive signs and symptoms
of a CVA (i.e., a stroke). During hospitalization, she had lost her capacity for expressive
language and demonstrated hemiparesis and a loss of bladder control. Her cognitive function
became intermittently confused, and she was slow to recognize her physician and neighbours
who came to visit. The hospital discharge planning nurse contacted the community case manager
to screen and assess for the continuum of care needs as early as possible because Brigit lived
alone and family members resided out of town, resulting in intermittent family support at home.
Brigit had residual functional and cognitive deficits that would demand longer-term care.

Think About It
If you were Brigit’s community case manager, which of the following steps would you take to
construct a case management plan for her?
 Discuss with the family members their schedule of availability to offer care in the
patient’s home.
 Call the patient and introduce yourself as a prelude to working with her.
 Obtain information on the scope of services covered by your patient’s benefit plan.
 Arrange a community placement facility site visit for the patient and family.

ANSWERS
The correct sequence for the questions above is 3, 2, 1, 4. The first piece of information (3) is
essential to understanding the level, amount, and nature of services that the patient is eligible to
receive. The patient must be informed, her needs assessed, and her options discussed (2). Family
care options must be understood to formulate resource possibilities for the patient (1).
Arrangement for a facility site visit may or may not be essential but may be preferred (4).

CHN IN PRACTICE: A CASE STUDY

Case Management and Decision Making in Northern Manitoba
Initiating, monitoring, and evaluating resources are essential components of nursing case
management. You are the new CHN based in the small northern Manitoba town of The Pas.

Copyright © 2022 Elsevier Inc. All rights reserved

Answers to Case Studies from Textbook 3-2

While new to the role, you are one of only two CHNs in the town and surrounding smaller
villages. Leadership and decision making are requirement in your role from day one on the job.

Think About It
As the nurse in a lead case management role with The Pas’s Primary Health Care Centre, you
must identify the resources available inside and outside of your community that would facilitate
your community health nursing care. How would you undertake this task for the following
patients?
 A patient needing cardiac rehabilitation following discharge from the closest larger
urban health centre over 600 km south of the Pas.
 An older adult patient who is has been cared for by family in the community with
some home support worker assistance but who will require long-term care in the
closest facility which is a 90-minute drive away in Flin Flon.
 A young male patient from The Pas who is referred to an orthopedic clinic in the
nearest urban centre for rehabilitation due to a work-related accident with a local
forestry company that has impaired his ability to walk or stand for long periods of
time

ANSWERS
(1) Provide follow-up with the patient to review the rehabilitation plan. Support the patient in
seeking out peer support in the community.
(2) Supporting the family to create a plan to visit that is feasible. Assist the community in
developing some long-term care plans and advocate for long-term care development for the
community.
(3) Supporting occupational health and safety/workers compensation benefits for this patient to
access rehabilitation and a return-to-work process.

CHN IN PRACTICE: A CASE STUDY

Complex Urban Home Care
Stephanie is an HHN working with Darlene, a 56-year-old patient who lives independently but
who requires assessment, postoperative wound care, support, and teaching following cardiac
bypass surgery. Darlene lives in an urban high-rise apartment in downtown Vancouver with an
excellent adapted train system, but her mobility challenges due to chronic muscular dystrophy
coupled with fatigue and restrictions related to postoperative protocols necessitate home nursing
care. Stephanie collaborates with Darlene to understand her needs beyond just the postoperative
protocols from the surgical team. She assists Darlene in interpreting and understanding the
protocols, but also in adapting the restrictions and progressive activities to her own abilities.
Darlene has a weekly home support worker who provides basic home-making services (including
some assistance with meal preparation) as well as bathing assistance. Otherwise, Darlene
manages independently at home with some adapted equipment such as a walker, and other aids
in her kitchen and bathroom. Stephanie is proposing that Darlene consider an additional day or
two per week of home support. However, Darlene refuses claiming that the cost will strain her
already limited budget. She adds, “I can manage for the short term. Maybe I will call my sister
who lives in the suburbs and ask her to come stay with me for a week or two”.

Copyright © 2022 Elsevier Inc. All rights reserved

Answers to Case Studies from Textbook 3-3

Think About It
Stephanie assesses that Darlene’s recovery may already be prolonged due to her mobility
challenges. Stephanie clarifies Darlene’s home support needs and discusses options and ideas
including social services aid to crisis/temporary home support.

1. How can Stephanie conduct her assessment and planning in ways that are respectful and
supportive of Darlene’s choices in relation to her own nursing goals, plans, and realities?
2. Stephanie assesses that Darlene’s recovery may already be prolonged due to her mobility
challenges. How can Stephanie ensure that best practices and referral for support information is
thoroughly discussed to aid decision making with the patient?

ANSWERS
1. Mutual goal setting will be important. Stephanie can share a variety of options including
referrals for social work and financial support. While the decisions are Darlene’s to make, if
there are resources available that she is not aware of, it is the HHN’s responsibility to support the
patient to make decisions with the best possible information.

2. Stephanie can also provide some estimation of recovery time from best practices and the goals
of rest postoperatively. These practices can be discussed with pros and cons and decision making
options so that Darlene can choose her options with the best possible information.

CHN IN PRACTICE: A CASE STUDY

Sexual Assault Nurse Examiner Practice in the Emergency Department
Sarah, a 20-year-old female, presents at the emergency department at 5 a.m. She tells the triage
nurse that she thinks she was sexually assaulted. The SANE is notified and arrives within a
timely manner. The triage nurse has determined that Sarah does not require emergency medical
attention. The SANE escorts Sarah to a private and secure location and obtains the following
history. Sarah states she was at a dorm party earlier in the evening. She recalls having two beers
and denies any use of illegal substances. Sarah states that she remembers feeling “woozy” and
then waking up 3 hours later in her room, naked and alone. She recalls a thick white substance on
her inner right thigh and is complaining of genital “soreness.” Sarah is nauseated and appears
exceptionally anxious, as she is unable to recall a portion of the evening’s events. Sarah has a
steady boyfriend and is sexually active. She has no known allergies, is not on medication, and
has a current immunization status.

Think About It
1. What are three primary concerns that Sarah may have?
2. What can a forensic nurse (i.e., a SANE) offer Sarah?
3. What might be an advantage of having a forensic nurse care for Sarah?

ANSWERS
1. The primary concerns that Sarah may have are concerns that she has an injury, that she may be
pregnant, and that she may have acquired a sexually transmitted infection. She may also have
concerns about feeling safe, which is a common response following an assault.

Copyright © 2022 Elsevier Inc. All rights reserved

Answers to Case Studies from Textbook 3-4

2. A forensic nurse can provide victim-centred forensic health care. The SANE can provide
options that include medical assessment and treatment, the collection of forensic evidence and
documentation, crisis support, advocacy, and community resources.

3. A forensic nurse has specialized training in the handling and collection of evidence. This nurse
has advanced knowledge and skills in the use of forensic equipment and in conducting physical
examinations of victims. A forensic nurse completes impartial, precise documentations of victim
injuries that are credible in court.

CHN IN PRACTICE: A CASE STUDY

Rural Palliative Care Practice
Sally is in the terminal stages of breast cancer and lives on a farm in a small rural community.
You have been visiting Sally weekly for the past 6 weeks. Sally is a 30-year-old married mother
of a 10-year-old daughter named Brittney. You are the HHN who has been the direct care
provider for Sally in her home. The following palliative care team members are also involved
with the family: palliative care volunteers and a homemaker, physiotherapist, chaplain, family
physician, pharmacist, dietitian, and social worker.
Sally has been told that there are no new options for palliative treatment, and she is preparing
to die at home with the support of you, her palliative care team, community members, and
family. While Sally accepts the terminal condition, she is experiencing stress and sadness that
you are discussing with her for her own problem solving and reflection.

Think About It
1. Reflect on the experiences you have had with death and dying. What values and beliefs do you
hold about death and dying? How can you interact with Sally in a way that demonstrates your
self-awareness while still holding Sally’s situation as the primary focus of your care?
2. Based on this situation, what possible family health concerns can you identify? How might
you support the family in the end-of-life experience?
3. Consider the roles of each of the palliative care team members, the family, and community
members. How will you work collaboratively with this team?

ANSWERS
1. Answers will vary, based on students’ personal experiences.

2. Numerous family health concerns will surface in this home palliative care circumstance and
the loss of a young and significant family member. In this case the 10-year-old child may be
assuming heightened responsibilities and stress (a range of spiritual and emotional distress may
surface for the child and other loved ones). There may also be financial strain on the family as a
result of lost work and needs for costly home support aids and equipment and so on. There may
be conflict over end-of-life choices and Sally’s interest to die at home.

3. All members of the team have special skills and capabilities to bring to the palliative care
situation. To work collaboratively is to acknowledge all the strengths of each and to draw upon
this expertise as needed—sometime the skills of pharmacists are needed, at other times
physiotherapy support, and often it is the community and family who can best support the

Copyright © 2022 Elsevier Inc. All rights reserved

Answers to Case Studies from Textbook 3-5

palliative patient and their family. Often the HHN can simply support these natural/informal
caregivers to provide the informal support and be part of the end-of-life experience with their
loved ones. A focus on bringing the most appropriate team member to the unique situations will
enable a collaborative practice. Also, the recognition that no one can do it all, can prevent
distress and burnout amongst the collaborative team members.

Copyright © 2022 Elsevier Inc. All rights reserved