CLIENT/FAMILY CENTERED CARE STUDY

(A NURSING CARE PLAN APPROACH)

ON A CLIENT WITH

ALCOHOLISM

BY

AHIAKU PATRICIA

A FINAL YEAR PUBLIC HEALTH NURSING STUDENT OF THE

UNIVERSITY OF HEALTH AND ALLIED SCIENCES, HO.

SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF

GHANA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR

THE AWARD OF BACHELOR OF PUBLIC HEALTH NURSING

CERTIFICATE.

AUGUST
 PREFACE

The client/family care study is a written report of the comprehensive nursing care rendered to

a client and the family within a specific period. It entails interactions between the nurse and

the client/family and community using the nursing process which is a scientific approach to

the care of the client. The nursing process is a method in which the nurse uses the knowledge

and the skills acquired to render comprehensive health care to the client according to his or

her specific needs.

This client/family care study is an academic work designed by the Nurses’ and Midwives

Council of Ghana (NMC) and as a requirement for the award of the Certificate in Bachelor of

Public Health Nursing. This offers the student learning experience and knowledge about a

specific disease condition and its management using available resources at home. It creates

the medium for the student nurse to use the nursing skills and knowledge acquired during

his/her three (3) years training to effectively render a holistic nursing care to the client/family

and the community, while using the nursing process.

The care rendered is based on the nursing process which is a systematic problem-solving

approach in which data is collected during assessment analyzed by identifying client’s

problems and needs, and the care for the achievement of good health is planned. This is then

evaluated to determine the extent to which progress was achieved.

This client/family centered care study is on a client with alcoholism and for the purpose of

confidentiality, the names of the client and family have been abbreviated. Client was met at

Akpafu Odomi in Oti Region on 9th February 2023 during a routine home visit.

Based on his condition, visit was paid to him and confirmed he had this condition for so

many years after having broken heart relationship with a lady he had taken care of from

senior secondary to university.

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Through the interaction with A.K.I, he agreed to be the client for this study because he

confirmed that he wishes he could have come out from this condition (alcoholism). He was

given a comprehensive nursing care with an ultimate objective to manage his alcoholism.

With co-operation and support, client drastically reduces intake of alcohol from thirteen to

four tremblers and is living a normal life. In all, ten home visits were conducted. In the last

visit, he will be finally handed over to the Public Health nurse for continuity of care.

This study is organized in chapters.

Chapter one describes particulars of client, client family history, family socio-economic

history, client past and present medical history, client developmental stages, client

lifestyles/hobbies, client problem identified, SWOT analysis, broad objectives and specific

objectives. The chapter two involves the literature review of the study, definition, incidence,

etiology, types of the condition, clinical manifestation, risk factors, diagnostic investigation,

pathophysiology, medical and surgical management, nursing management, complications,

client and family education, prevention of the condition.

Chapter three involves introduction, all the entire home visits with care plan, home situation,

identified problems, handing over and continuity of care, family involvement, achievements,

evaluation of care rendered, amendment of care, summary, conclusion, recommendation,

references, signatures.

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 ACKNOWLEDGEMENT

I thank God Almighty for giving me strength, knowledge, wisdom and understanding to write

this client and family centered care study. My profound gratitude goes to my client and the

entire family who accepted me, allowed me to use them for my care study and provided me

with adequate information to be able to write.

My uttermost gratitude goes to my supervisor. Mrs. Comfort Agbadja for his time,

constructive corrections, supervision, encouragement and support throughout the period of

my care study. When I started, she continued to urge me on (with the can-do spirit) to finish

with speed. I consider myself privileged to be his student. I am also grateful to the tutorial

staff of University of Health and Allied Sciences; School of Nursing and Midwifery, Ho and

the entire staff of the Volta Regional Hospital, Hohoe, especially the Public Health and

Psychiatric units for their support.

I deem it a great honor to express my appreciation to my mother and all my loved ones for

their encouragement, prayers and assistance throughout my years of education.

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 TABLE OF CONENT

PREFACE..................................................................................................................................i
ACKNOWLEDGEMENT......................................................................................................iii
TABLE OF CONENT............................................................................................................iv
LIST OF TABLES.................................................................................................................vii
CHAPTER ONE.......................................................................................................................1
ASSESSMENT OF CLIENT AND FAMILY........................................................................1
Introduction..........................................................................................................................................1

Client Identification.............................................................................................................................1

Client Particulars..................................................................................................................................2

Family Medical and Surgical History................................................................................................3

Client’s Socio-Economic History........................................................................................................3

Client’s Developmental History..........................................................................................................3

Client’s Lifestyle and Hobbies............................................................................................................4

Client’s Past Medical and Surgical History.........................................................................................4

Client’s Present Medical and Surgical History....................................................................................5

Client Problems Identified...................................................................................................................5

SWOT Analysis...................................................................................................................................6

Objectives............................................................................................................................................7

Broad and Specific Objectives.............................................................................................................7

Broad Objective...............................................................................................................................7

Specific Objectives..........................................................................................................................7

CHAPTER TWO.....................................................................................................................8
LLTERATURE REVIEW ON ALCOHOLISM...................................................................8
Introduction..........................................................................................................................................8

Definitions of Alcoholism...................................................................................................................8

Incidence..............................................................................................................................................9

Factors that contribute to Alcoholism................................................................................................11

Clinical Manifestation........................................................................................................................12

Signs and Symptoms Exhibited by Mr. A.K.I...................................................................................13

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 How Mr. A.K.I became an Alcoholic...............................................................................................13

Diagnostic Investigation....................................................................................................................13

Pathophysiology.................................................................................................................................14

Management of Alcohol Use Disorder (AUD)..................................................................................15

Nursing Management.........................................................................................................................16

Complications of Alcoholism............................................................................................................17

Alcohol Withdrawal Symptoms.........................................................................................................19

Prevention of Alcohol Abuse.............................................................................................................19

Public Health Importance of alcoholism...........................................................................................20

CHAPTER THREE...............................................................................................................22
HOME VISITS.......................................................................................................................22
Introduction........................................................................................................................................22

Home Visiting....................................................................................................................................22

Types of home visits..........................................................................................................................22

Routine Home Visiting..................................................................................................................23

Selective or Special Home Visit....................................................................................................23

Purposes of Home Visiting................................................................................................................23

Importance of Home Visit to the Nurse and Client...........................................................................24

Home Situation..................................................................................................................................26

HOME VISITS AND CARE PLANS...................................................................................25

First Home Visit on The 27th Of February, 2023...............................................................................25

Second Home Visit On 28th Of February, 2023.................................................................................28

Third Home Visit On 4th March, 2023...............................................................................................31

Fourth Home Visit On 8th Of March, 2023.......................................................................................34

Fifth Home Visit On 14th Of March, 2023.......................................................................................37

Sixth Home Visit On 18th March,2023..............................................................................................40

Seventh Home Visit On 22nd March, 2023,......................................................................................44

Eighth Home Visit On 30th March 2023...........................................................................................46

Ninth Home Visit 8th April, 2023.......................................................................................................50

Tenth Home Visit 20th April, 2023 (Handing Over & Continuity of Care).....................................53

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 Handing Over and Continuity of Care...............................................................................................54

Evaluation Of Care Rendered to Client and Family..........................................................................55

Statement of Evaluation.....................................................................................................................55

Amendment of Care...........................................................................................................................56

Termination Of Care..........................................................................................................................58

SUMMARY............................................................................................................................59
CONCLUSION.......................................................................................................................60
RECOMMENDATIONS.......................................................................................................60
REFERENCES.......................................................................................................................62

LIST OF TABLES

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Table 1: Nursing Care Plan for The First Home Visit......................................................27

Table 2: Nursing Care Plan for The Second Home Visit...................................................30

Table 3: Nursing Care Plan for The Third Home Visit.....................................................33

Table 4: Nursing Care Plan for Fourth Home Visit..........................................................36

Table 5: Nursing Care Plan for The Fifth Home Visit......................................................39

Table 6: Nursing Care Plan for The Sixth Home Visit......................................................42

Table 7: Nursing Care Plan for The Seventh Home Visit.................................................45

Table 8: Nursing Care Plan for The Eighth Home Visit...................................................48

Table 9: Nursing Care Plan for The Eighth Home Visit...................................................49

Table 10: Nursing Care Plan for The Ninth Home Visit...................................................52

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 CHAPTER ONE

ASSESSMENT OF CLIENT AND FAMILY

Introduction
This chapter describes particulars of client, client family history, family socio-economic

history, client past and present medical history, client developmental stages, client

lifestyles/hobbies, client problem identified, SWOT analysis, broad objectives, and specific

objectives.

Client and family centered care is an approach in planning, delivery and evaluation of

healthcare that is grounded in mutually beneficial partnerships among healthcare providers,

patients and families. It is a detailed report on a comprehensive care rendered to a particular

client and his or her family in their home environment. The study involves adequate

assessment of client’s condition and a unified nursing care to prevent complications. A

nursing assessment is a process where a nurse gathers, sorts and analyzes a client's health

information using evidence informed tools to learn more about a client's overall health,

symptoms and concerns.

It helps the student nurse to improve the home visiting skills and also broaden the knowledge

of the student on the condition.

Client Identification
This study describes the care rendered to Mr. A.K.I a thirty-five (35) year old man who is

suffering from alcohol addiction and is native of Akpafu odomi, a residence in the Oti

Region.

Mr. A.K.I was identified during a routine home visit on 25 th February 2023. Client presented

the following signs and symptoms; general body pains, fatigue, tremors, inability to perform

responsibility both at home and at work and smell of alcohol in breath. A systematic care

1
plan was drawn, and appropriate nursing orders implemented to ensure speedy recovery of

the clients.

This assessment was done using physical observation during home visit and, the client’s

girlfriend was interviewed for confirmation during the home visit. During the assessment it

was confirmed that Mr. A.K.I usually takes thirteen (13) taut or tremblers a day. It was

disclosed that a Psychiatry Nurse was engaged some years back to assist him but failed.

A person with this condition does not know when or how to stop drinking. They spend a lot

of time thinking about alcohol and they cannot control how much they consume even if it is

causing serious problems at home, work and financially. This client was selected for this care

study because alcohol abuse has become a public health problem affecting people negatively

especially the youth.

Client Particulars
NAME OF CLIENT Mr A.K.I
DATE OF BIRTH 07/06/1987
AGE 35 YEARS
SEX MALE
PLACE OF BIRTH ATABU AKPAFU ODOMI
MARITAL STATUS CO-HABITING
OCCUPATION FARMING
RELIGION CHRISTIAN
DENOMINATION EVANGELICAL PRESBYTARIAN CHURCH
EDUCATIONAL BACKGROUND SECONDARY EDUCATION
HOMETOWN AKPAFU
LANGUAGE SIEWU, TWI AND ENGLISH
CURENT STATE OF ABODE AKPAFU ODOMI
NEXT OF KIN B.Y
HEIGHT 511CM
WEIGHT 55KG
COMPLEXION DARK IN COMPLEXION
NUMBER OF SIBLLINGS THREE (2 MALES, 1 FEMALE)

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 MOTHER’S NAME MS C.A
FATHER’S NAME MR A.Y
ETHNICITY GUAN
ADDRESS MS C .A HOUSE AKPAFU ODOMI

Family Medical and Surgical History

Mr. A.K.I alleged that apart from the mother having hypertension there is no known medical

disease, However, the rest of the family members occasionally suffer from minor ailments

such as malaria and headache which they treat with over-the-counter medicines. He alleged

that his family members have been on admission before on the account of minor ailments but

none of the family members have undergone any surgical procedure before.

Client’s Socio-Economic History

Mr. A.K.I’s family has good relationship with the people in the community, during any

community program they actively participated Though Mr. A.K.I do not leave with the father

and the mother who are all cocoa farmers and petty seller always support their son to

optimum.

When Mr. A.K.I and his family fall sick, they used NHIS to assess medical Services.

Mr. A.K.I. is in co-habiting with Ms. B.Y. at the age of Thirty. Mr. A.K.I. lives with his

girlfriend. He depends on cocoa farming activity for a living. The girl friend always gives

helping hands by given money to support his feeding. Despite his condition he tried to

provide the family food the girlfriend always in support by providing food to feed the

family. The family of Mr. A.K.I has no taboos. The family of my client are Christians, and

they are part of the church choir.

Client’s Developmental History

According to him, he was born on 7th of June 1987 at Atabu Akafu in the Oti Region through

a normal spontaneous vaginal delivery at home. He is the third born among the three to Mr.

A.Y and Ms. C.A. He said he was born without any abnormality, at about the age of 6

3
months, he sat, crawled at eight months, and could pronounce some words. According to the

parent, he was breastfed for about 2 years but not exclusively for the first six months.

He is fully immunized against the childhood diseases, with the Bacillus Calmette Guerin

(BCG) scar shown. He experienced secondary sexual characteristics such as growth of

axillary hairs and pubic hairs at age 17. Mr. A.K.I started schooling at the age of 3 years at

Junior High School and proceeded to Senior High School for his secondary school education.

He is currently a farmer.

Client’s Lifestyle and Hobbies

Mr. A.K.I wakes up early in the morning and sleeps late in the evening sometimes because of

his job. Mr. A.K.I wakes up early around 5:30am, he brushes his teeth and takes his bath. He

then takes his breakfast after drinking alcohol in order to sustain him till evening before he

eats again, he also takes in alcohol within the day as well. Though he often got drunk he

continued working on his cocoa farm. Mr. A.K I is very sociable with everyone, and his

favorite food is banku with groundnut soup. He likes watching films, sniffing, and going out

to drink with his friends. He also, like reading books that can improve his ambition in all he

confirmed that his best book is “The power of positive thinking”. Though he drinks alcohol,

he always goes to church to praise His God through singing since he is a member of church

choir. My client developed slurred speech along the way, so it has affected his singing

patterns, but he never ends it there. He also stated that, his mother keeps supporting him

always though they are not in the same house.

Client’s Past Medical and Surgical History

Mr. A.K.I said he has never suffered from any serious illness that requires hospitalization, but

anytime he experienced minor illness, headache, malaria, bodily pains he goes to hospital for

treatment and resorted to the chemical and herbal products for treatment A.K.I has a scar on

4
his left leg as a result of alcohol intoxication. My client also confirmed that, he is not allergic

to any medication as at now.

Client’s Present Medical and Surgical History

Mr. A.K. I. said it all started when his girlfriend broke the relationship with him, he was

caring for her in school hoping to marry her after the university education. So anytime he

remembered her he needed to drink alcohol to forget her. Therefore, it has become habitual to

him which has led him to become an alcoholic.

Mr. A.K.I. said he is now taking about thirteen taut each day for the past six years. He

attempted to stop but could not. Eventually, he is a complete alcoholic.

He alleged that he observed some signs and symptoms pertaining to his health such as being

hot tempered and easily angered, violent, puffy face, incoherent speech, tremors, and red lips.

Client Problems Identified.

1. Client and family had less knowledge on the effects, signs and symptoms of alcohol

on the body.

2. Client has wounds on the forehead.

3. Client had incoherent speech.

4. Client has low self-esteem.

5. Client had difficulty in associating with people.

6. Client suffered from tremor of both extremities.

7. Client had poor. personal hygiene

8. Client’s girlfriend complained of not sleeping at night.

5
 SWOT Analysis

SWOT is an abbreviation that stands for strengths, weakness, opportunities, and threats that a

client or family may have in addressing their health problems. The strength includes the

resources the client or family have, to achieve an optimum health. The weakness happens

when the resources needed in achieving the optimum health from client and family is not

there. Opportunities are the various organizations and agencies available in the community

where help can be sought in ensuring an optimal health. Threats occur when equipment and

certain materials are not available in the home to give care.

SWOT Analysis

STRENGTH WEAKNESS OPPORTUNITIES THREATS

Mr. A.K.I has nurse Mr. A.K.I still Mr. A.K.I had Mr. A.K.I experienced
to educate him associate with support from her tremors which can lead
his drunken new girl friend to fall
friend
Mr. A.K.I has ready Mr. A.K.I lives in Mr. A.K.I lives closer to
to be assisted noise free drinking spot
environment
Mr. A.K.I girlfriend
always prepared food
for him
Mr. A,K.I has NHIS
Mr. A.K.I was
cooperative

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Objectives
The objectives are what the nurse expects to achieve after rendering nursing care to the client.

The objectives are grouped into two (2).

1. Broad objective
2. Sub objectives

Broad and Specific Objectives

Broad Objective
By the end of the study, (25th February, 2023 – 20th April, 2023), client and family will obtain

adequate knowledge on alcoholism and client’s condition will improve through health

promotion, management, rehabilitation and preventive activities.

Specific Objectives
By the end of the study, I should be able to;

1. Assess the home and the environmental situation.

2. Educate client and family on the causes, signs, and symptoms of withdrawal

syndrome of alcoholism.

3. Educate client on the effects and prevention of alcohol abuse.

4. Educate client and family on the importance of regular medical check-up.

5. Educate client and family on the importance of exercising the body.

6. Educate client and family to impr0ove rest and sleep.

7. Assist client to learn how to communicate to family member.

8. Educate client and family on good nutrition.

9. Educate client and family on good personal hygiene.

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 CHAPTER TWO

LLTERATURE REVIEW

Introduction
A family centered care study is a comprehensive approach to nursing care given to a client

and the family with relevance to the client as an important family member whose health state

impacts the other family members and vice versa. In a written report of a family-centered

care study, the literature review constitutes chapter two and covers the definitions, incidence,

etiology, clinical manifestation, risk factors, diagnostic investigation, pathophysiology,

medical management, nursing management, complications, preventions, and significance of

alcoholism for public health.

Definitions of Alcoholism
Alcoholism, now known as ‘‘Alcohol Dependence” or Alcohol Use Disorder (AUD) is a

condition in which a person has a desire or physical need to consume alcohol, even though it

has a negative implication on their life (Miloyan,2007).

Alcoholism is also defined as a chronic and progressive disease characterized by compulsive

and uncontrolled alcohol consumption, despite its negative consequences on the individual's

physical, mental, and social well-being. According to the National Institute on Alcohol Abuse

and Alcoholism (NIAAA), an estimated 14.5 million adults in the United States alone have

AUD.

Alcoholism is a complex and multifactorial disorder that is characterized by compulsive and

uncontrolled alcohol consumption. According to the NIAAA, AUD is a chronic relapsing

brain disorder that affects both physical and mental health. The Diagnostic and Statistical

Manual of Mental Disorders (DSM-5) criteria for AUD includes 11 symptoms that range

from mild to severe. The symptoms include increased tolerance, withdrawal symptoms,

8
unsuccessful attempts to quit or cut down alcohol consumption, and continued alcohol use

despite negative consequences.

World Health Organization (2015) discouraged the use of ‘alcoholism’ in medicine,

preferring the category of ‘alcohol dependence syndrome’. People suffering from alcoholism

are often called alcoholics, although the word is not used in all areas of work.

Incidence
According to a 2018 report from the WHO, in 2016 the harmful use of alcohol resulted in

about 3 million deaths, or 5.3% of all deaths around the world, with most of these occurring

among men (WHO, 2018). Globally, an estimated 237 million men and 46 million women

have alcohol-use disorders, with the highest prevalence in Europe and Americas (WHO,

2018).

The WHO (2014) reported that alcohol contributed to more than 200 diseases and injury-

related health conditions, most notably, DSM-IV alcohol dependence, liver cirrhosis, cancers,

and injuries. The 2019 National Survey on Drug Use and Health (NSDUH) revealed that

85.6% of people ages 18 or older reported that they drank alcohol at some point in their

lifetime; 69.5% reported that they drank in the past year; 54.9% (59.1% of men in this age

group and 51.0% of women in this age group) reported that they drank in the past month.

Additionally, 25.8% people ages 18 or older reported that they engaged in binge drinking in

the past month, and 6.3% reported that they engaged in heavy alcohol use in the past month

(NIAAA, 2019).

In the United States, an estimated 95,000 people (approximately 68,000 men and 27,000

women) die from alcohol-related causes annually, making alcohol the third leading

preventable cause of death (NSDUH, 2019). In Ghana, the use of alcohol is prevalent among

the youth between the ages of 15-35 years, with Volta Region recording the highest

prevalence among men (43%) and (35%) among females. The alcohol beverages sector in

9
Ghana is booming as 30 million litres of alcohol are consumed yearly (Kunateh, A., M.,

2006).

A survey conducted by the Ghana Organization on Fetal Alcohol Syndrome (NGO), 2013

estimated that the per capita consumption of alcohol is 1.5 litres to about 7 million gallons of

alcohol consumed annually (Kunateh, A., M., 2006).

According to WHO (2018), 3.3 million deaths occur every year resulting from harmful use of

alcohol, representing 5.9 % of all deaths that occur in the world. The harmful use of alcohol

is a causal factor in more than 200 diseases and injury conditions. Overall, 5.1 % of the

global burden of disease and injury is attributable to alcohol, as measured in disability-

adjusted life years (DALYs). Alcohol consumption causes death and disability relatively

early in life. In the age group 20 – 39 years, approximately 25% of the total deaths are

alcohol-attributable (WHO, 2018).

An estimated of 95,000 people (approximately 68,000 men and 27,000 women) die from

alcohol related causes annually making alcohol the third leading preventable cause of death

in the United States. (National survey on drug use and Health, 2019).

Data from Ghana Demographic and Health Survey in (2017) indicated that, the use of alcohol

is prevalent among the youth between the ages of 15-35 years in Ghana with Volta Region

recording the highest prevalence among men (43%) and (35%) among females.

The alcohol beverages sector in Ghana is booming as 30 million litres of alcohol are

consumed yearly. This shows that the country is seriously producing more alcoholics than the

quality human resources needed to affect the cherished middle-income status. A survey

conducted by Ghana Organization on Fetal Alcohol Syndrome (NGO), 2013 estimated that

the per capital consumption of alcohol is 1.5litres to about 7 million gallons of alcohol

consumed annually. Doubtlessly, this amount translates to serious economic losses to the

individual as well as the nation at large. The study by (NSDUH) observed that because of the

10
revenue government gets from the alcohol distillery companies, passing laws for banning the

production of alcohol is not possible. (Kunateh, A., M., 2006).

Factors that contribute to Alcoholism

There are many varying factors depending on the people involved and the locations being

considered (Adusi-Poku et al., 2012). These factors can influence the consumption of alcohol.

Some of these factors include social, cultural, and economic factors, personal beliefs and

attitudes towards alcohol, and psychological and genetic factors. Below are some points that

elaborate on these factors:

1. Social and cultural factors: Social and cultural factors can significantly influence

alcohol consumption. Social factors such as peer pressure, social norms, and social

activities that involve alcohol can all influence one's drinking behavior. Cultural

factors such as religious beliefs and cultural traditions can also play a role in

determining one's drinking behavior.

2. Economic factors: Economic factors can influence alcohol consumption in various

ways. For example, the price of alcohol can affect the demand for it. Lower prices can

lead to increased consumption, while higher prices can lead to decreased

consumption. Additionally, individuals who have higher levels of disposable income

may have more access to alcohol and may be more likely to consume it.

3. Personal beliefs and attitudes: An individual's personal beliefs and attitudes towards

alcohol can also play a role in determining their drinking behavior. For example,

someone who believes that drinking alcohol is a positive thing may be more likely to

consume it. Conversely, someone who has negative attitudes towards alcohol may be

less likely to drink.

4. Psychological factors: Psychological factors such as stress, anxiety, and depression

can also influence alcohol consumption. Individuals who experience high levels of

11
 stress or anxiety may turn to alcohol to cope. Additionally, individuals with certain

psychological disorders, such as alcohol use disorder, may have a higher risk of

developing problematic drinking habits.

5. Genetic factors: Research suggests that genetics can also play a role in alcohol

consumption. Certain genetic variations can make individuals more susceptible to

developing alcohol use disorder or other alcohol-related problems. Additionally,

genetic factors can influence an individual's tolerance for alcohol, which can affect

how much they drink.

Clinical Manifestation
According to the World Health Organization, (2014) the following are some symptoms

exhibited by alcoholics:

 Disorientation to place and person

 Aggression

 Agitation

 Nausea and vomiting

 Drowsiness

 Slurred speech

 Ataxia (a gentle movement when intoxicated)

 Euphoria

 Hallucination

 Reddening of the lips

 Poor balance

 Memory loss or lapses after a night of drinking.

 Diminished hygiene

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  Sudden change in eating habits.

 Tremors at the limbs, facial muscles

Signs and Symptoms Exhibited by Mr. A.K.I

My client complained of severe headache, aggressiveness, general body pains, tremors,

fatigue, and excessive sweating. He also said in the cause of the abuse he has depression and

have memory losses.

How Mr. A.K.I became an Alcoholic.

Mr. A.K.I became an alcoholic because of His girlfriend breaking up with him. According to

him, he anytime he remembers her, he needed to drink to forget about her and gradually it

became habitual which he is unable to stop.

Diagnostic Investigation
Family and friends of the individual who abuse alcohol notice the problems first and seek for

medical intervention; some of the signs and symptom noticed are loss of customers, family

problem including interpersonal relationship. The American Psychiatric Association (APA)

(2013) has developed the criteria for clinical diagnoses of alcohol abuse which include the

following:

 Individuals having persistent or current social or interpersonal problems like argument

with spouse, physical fight and others.

 Alcohol abuse results in failure to fulfill major roles and responsibilities at homes,

schools, churches and the community. (Repeated absence to duty, poor work

performance, suspensions, and neglect of children and household duties).

 Laboratory tests often assist in the diagnoses of alcohol abuse. Patient with alcohol

abuse will have elevated liver enzymes. The level of the enzymes aspartate

aminotransferase (AST) will exceed that of alanine aminotransferase (ALT) but both
13
 will be below 300IU/ML. When the ratio of AST to ALT is greater than 2, the most

likely diagnoses is alcohol dependence. Also elevated blood levels of the liver

enzyme gamma glutamyl transferase (GGT) indicate heavy alcohol use and liver

injury.

 Also, blood and urine can be screened for alcohol.

Pathophysiology
 Alcohol affects virtually every organ system in the body and in high doses, can cause

coma and death. It affects several neurotransmitter systems in the brain, including

opiate, Gamma-Aminobutyric acid, glutamate, serotonin, and dopamine. Increased

opiate levels help explain the euphoric effect of alcohol, while its effects on Gamma-

Aminobutyric acid cause anxiolytic and sedative effects (Thompson, 2020).

 Alcohol can also have a significant impact on the liver, leading to a range of liver

diseases, including fatty liver, alcoholic hepatitis, and cirrhosis (National Institute on

Alcohol Abuse and Alcoholism, 2021). The liver is responsible for breaking down

alcohol into acetaldehyde and then further metabolizing it into carbon dioxide and

water. Chronic alcohol consumption can lead to an accumulation of acetaldehyde in

the liver, causing oxidative stress and inflammation, which can ultimately lead to liver

damage and disease (National Institute on Alcohol Abuse and Alcoholism, 2021).

 The gastrointestinal system is also affected by chronic alcohol consumption, with

increased permeability of the gut leading to endotoxemia, inflammation, and changes

in gut microbiota (Bode & Bode, 2005). Endotoxemia occurs when bacteria from the

gut leak into the bloodstream, leading to systemic inflammation and immune

dysfunction. This can contribute to the development of various medical conditions,

including liver disease, cardiovascular disease, and cognitive impairment.

14
  Alcohol consumption can also have negative effects on the cardiovascular system,

including an increase in blood pressure, heart rate, and arrhythmias (National Institute

on Alcohol Abuse and Alcoholism, 2021). Chronic alcohol consumption can lead to

an increased risk of cardiovascular disease, including hypertension, stroke, and

myocardial infarction (National Institute on Alcohol Abuse and Alcoholism, 2021).

Management of Alcohol Use Disorder (AUD)

The management of alcoholism involves a multidisciplinary approach that aims to address the

physical, psychological, and social aspects of the disorder. The goals of treatment include

achieving abstinence, improving physical health, addressing co-occurring mental health

disorders, and reducing the risk of relapse. The following are some of the medical and

nursing management strategies that can be used in the management of alcoholism:

 Detoxification: Detoxification is the first step in the treatment of alcoholism, and it

involves the removal of alcohol from the body. This process should be carried out

under medical supervision to prevent complications such as seizures, hallucinations,

and delirium tremens. Medications such as benzodiazepines and antipsychotics may

be used to manage withdrawal symptoms.

 Medications: Several medications have been approved by the Food and Drug

Administration (FDA) for the treatment of alcoholism, including disulfiram,

naltrexone, and acamprosate. Disulfiram works by causing unpleasant symptoms such

as nausea and vomiting when alcohol is consumed, while naltrexone and acamprosate

help reduce cravings for alcohol and prevent relapse.

 Psychotherapy: Psychotherapy is an essential component of the treatment of

alcoholism, and it can be provided in individual or group settings. Cognitive-

behavioral therapy (CBT) is an effective approach that focuses on identifying and

changing negative thought patterns and behaviors associated with alcohol use.

15
 Motivational interviewing (MI) is another approach that involves helping patients

identify and resolve their ambivalence towards treatment and abstinence.

 Nutritional support: Alcoholism can lead to malnutrition, and nutritional support is

an essential component of the treatment of alcoholism. Patients may require vitamin

and mineral supplements, and a healthy diet should be encouraged.

 Nursing care: Nurses play a vital role in the management of alcoholism, and they can

provide support and education to patients and their families. Nurses can also monitor

patients for complications such as dehydration, electrolyte imbalances, and liver

disease.

Nursing Management
Nurses should consider patient safety and injury prevention. The patient should be

appropriately monitored, and emergency airway equipment kept at the bedside, especially for

those who require injectable benzodiazepines.

 Restraints: The critically ill patient experiencing moderate to severe Alcohol

Withdrawal Symptoms may require both chemical and physical restraints to avoid

immediate threat behavior to self and other. Use of the bed rails is advisable.

 Managing behavioral disturbances: if the patient is confused and disoriented or

hallucinating, a supportive and reassuring approach is to be used and patient should

not be confronted.

 Managing environment: The patient’s room should be kept quiet everyone should

move around quietly. Interactions should be minimal, and questions limited.

 Nutritional needs: the patient may be malnourished, causing folate, thiamine, or

vitamin B12 deficiency. If the patient is unable to eat, tube feedings or total parenteral

nutrition (TPN) should be initiated early. If a feeding Ryle’s is used it is taped at the

nose and cheek area, with the tubing running toward the head and behind the bed.

16
  Involving family: A complete care plan should involve family members in a

therapeutic alliance to provide optimal symptom relief and formulate acceptable

behavior objectives for the patient. (MOH, STANDARD TREATMENT

GUIDELINES, 2016).

Complications of Alcoholism
Alcohol abuse has adverse effect on human system; it has an effect on all the organs in the

body;

 The Central Nervous System: Alcohol related brain damages the receptor in the

brain leading to poor thinking coordination and behaviors like aggressiveness,

talkative, and hunger. Brain damage due to alcohol abuse is also due to nutritional

deficiencies, electrolyte disturbances, liver damages and alcohol withdrawal

syndrome.

 The urinary System: Alcohol diminishes the kidneys ability to filter damaging

substances from your blood. High alcohol levels will also diminish hormones that can

help proper kidney functions. Excessive amounts of alcohol will dehydrate the body

and impair the cells that are necessary for the kidneys to do their work. All these can

lead to kidney failure.

 The Sexual and Reproductive System: It causes erectile dysfunction in men

inhibiting hormone production, which affect testicular function and causes infertility,

and diminished libido. For women there are changes in the menstrual cycles and

decreased ability to become pregnant and children born by mothers who abuse alcohol

develop the fetal alcohol syndrome (FAS), and these children grow up to have mental

growth retardation and brain damage which prevents them from living a normal life.

17
 Digestive System: Too much stomach acid in the system from drinking alcohol can

cause a host of health problems such as ulcers, gastritis, or internal bleeding. Extreme

levels of stomach acid can also cause stomach cancer. Alcohol can also cause a

buildup of digestive enzyme in the pancreas, leading to a condition called pancreatitis.

This can affect how much insulin is produced which is a risk of diabetes. Also, the

liver is the primary organ that processes alcohol. Liver enzymes can metabolize

alcohol, but only in small doses. Any unabsorbed alcohol levels in the systems can

lead to cirrhosis, fibrosis, or hepatitis.

 The Skeletal System: Alcohol abusers are prone to osteoporosis and bone fractures,

their muscles become weak. Heavy drinkers are more likely to develop pneumonia;

their immune system becomes weakened due to alcohol abuse making it difficult to

fight against infections. Gout, a form of arthritis results from painful buildup of uric

acid in the joints which can lead to gout.

 Korsakoff’s Psychosis: This is characterized by confusion, loss of recent memory

and confabulation (fitting in the memory gaps with irrelevant ideas).

 The Family Related Problems: Alcohol abuse causes an individual to be

transformed which affect their behaviors and creates health problems. This can lead to

poor communication, increase anger, reduce intimacy and sexual desire leading to

marital divorce.

 Work Related Problems: Alcohol abuse have a significant effect on the individual

which makes him/her unable to think and work effectively and this can cause low

productivity in the country and make the individual burden on the family, community

and country.

18
  Educational Problems: students who are influenced by alcohol consumption perform

poorly in school, they become disobedient and violent which leads to dropout in

school.

 Alcohol Abuse can lead to a range of both short and long term mental and physical

health problems that can cause individual to lose coordination and have blurred

speech. They can be confused and disoriented; some individuals when intoxicated can

be very aggressive, talkative, and angry. (National Institute on Alcohol Abuse and

Alcoholism).

Alcohol Withdrawal Symptoms

There are a wide range of symptoms associated with the gradual discontinuance of a

substance by a person who has become addicted to it. These persons experience high blood

pressure, sweating, illusions and delusions, tremors of the limbs, facial muscles, the lips,

tongue, insomnia, anxiety, depression, confusion, disorientation, irritability, seizures,

palpitation, headache, and hallucination. Persons should be under close observation to protect

them against any possible injury and sedatives can also be prescribed.

Prevention of Alcohol Abuse

 The public should be educated on the effect of alcohol abuse through health talks, on

the media and during community durbars, counseling sections to the families,

individual and the country.

 Alcohol business owners should not sell alcohol to children, teens, pregnant women,

aged and those who are already drank or have had too much drink.

 Alcohol taxes should be increased to affect the prices of alcohol. Alcohol taxes can be

levied at the federal state or local level on beer, wine, and distilled spirits.

19
  Develop community coalition that build partnership between schools, faith-based

organization, law enforcement, health care providers and the public health agencies to

reduce excessive alcohol use or abuse through education and counseling.

 Families must create a harmonious and safe atmosphere in their homes where they

can educate their children to keep away from alcohol and other harmful drugs.

 Those who sell and distribute illegal and unauthorized alcohol must face the laws of

the country.

 There must be regulation of alcohol advertisement on the media and those that are

authorized and permitted must have strict caution and contraindication to pregnant

women, children under 18years and the aged.

 Parents must have or demonstrate a positive and good attitude in their homes, to serve

as role models for their children. It is obvious that parents rather initiate their children

into alcoholism. (Hazelden Betty Ford Foundation, 2014).

Public Health Importance of alcoholism.

A 2005 World Health Assembly resolution calls on World Health Organization to intensify

international collaboration in reducing public health problems caused by the harmful use of

alcohol.

The hazardous and harmful use of alcohol has now become one of the most important risks to

health; it is the leading risk factor in developing countries with low mortality rates and ranks

third in the developed countries, according to World Health Report 2002.

While alcohol is deeply embedded in many societies, recent years have seen changes in

drinking patterns across the globe: rate of consumption, drinking to excess among the general

population and heavy episodic drinking among young people are on the rise in many

countries.

20
Health problems associated with alcohol consumption have reached alarming levels, and

alcohol use contributes to a wide range of diseases, health conditions and high-risk behaviors,

from mental disorders and road traffic injuries to liver diseases and unsafe sexual behavior.

Through this WHA resolution, WHO’s secretariat is requested to address a number of areas

related to the issue of harmful use of alcohol consumption and related public health problems;

preparing research and policies initiatives and recommendations for effective policies and

interventions; providing support to Members States in monitoring alcohol related harm and

implementing effective strategies and promoting identification and management of alcohol

use disorders in primary health care.

1. It causes unemployment: people who drink are unable to be employed to work. This is

because they spent most of the time at the drinking spot craving for alcohol.

2. It leads to mental problem: alcoholics are at higher risks of having mental condition

such as Wernicke encephalopathy, ataxia and so on. This therefore increases the

incidence of mental condition.

3. It leads to death: people who drinks alcohol and drive vehicles and operate machines

are at higher risks of losing their lives since they can’t control themselves when

drunk.

4. It can cause disability: The effect of alcohol use by an individual are widespread and

noticeable in all spheres (physical, psychological, social, and economic) of an

individual’s life. Alcohol consumption has health and social consequences via

intoxication, alcohol dependence and other biochemical effects of alcohol. The

immediate effect can include a flushed appearance, a false sense of relaxation, lack of

co-ordination and slower reflexes, blurred vision, and slurred speech. Some may

experience mood changes (aggression, elation, and depression) and sleepiness. The

long-term effect can also result in physical, emotional, or social problems. For

21
 example, malnutrition, frequent infections, skin problems, liver and heart damage,

brain damage, sexual impotence, reduction in fertility, memory problems, family and

relationship problems, poor work performance, legal and financial difficulties.

5. It reduces productivity: a person who drinks uses working hours to at the drinking

spots. This reduces the output of productivity.

CHAPTER THREE

HOME VISITS

Introduction
This chapter includes the various home visits made to Mr. A.K.I and his family, where each

home visit comes with objectives and reports on the specific problems identified with their

interventions.

The nursing process approach was used. With this, plans were made, objectives set, all

necessary interventions were provided, and actions evaluated which was used to solve the

problems identified. These are outlined in the subsequent pages of this chapter.

Home Visiting
Home visiting / home health service is that components of a continuum of a comprehensive

health care in which health services are provided to individuals, and families in their place of

residence for the purpose of promoting maintaining or restoring health or of maximizing the

22
level of independence while minimizing the effect of disability and illness, including terminal

illness. When going for a home visit, a home visiting bag is used. It is a specially prepared

bag for carrying supplies to the field in a clean and orderly way (Mengistu & Misganaw,

2006)

Types of home visits

A home visit is defined as the process of providing the nursing care to patients at their

doorsteps. It requires technical skills, resourcefulness, judgment, relationships. There are two

main types of home visiting namely:

1. Routine home visiting

2. Selective or special home visit (Mengistu & Misganaw, 2006).

Routine Home Visiting

This is a visit made by the Public Health Nurse to homes without problems with an objective

of encouraging them to continue with their healthful living. It is an ordinary visit made to

homes in the vicinity. With this type of visit, the Public Health Nurse goes from house to

house visiting clients in his/her work area. He/she prepares well because he has no prior

knowledge of any health problem in the home. Nursing care is rendered based on the

problems identified during the visit (Mengistu & Misganaw, 2006).

Selective or Special Home Visit

This type of visit is made to homes with special identified problems such as handicapped,

motherless, malnourished children and tuberculosis clients. The nurse usually has prior

knowledge of the existing problem, and prepares and adopts strategies to solve the problem

(Mengistu & Misganaw, 2006). My client benefited from this type of home visit.

23
Purposes of Home Visiting
According to (Mengistu & Misganaw, 2006) the following are the purposes of home visiting;

1. To prevent institutionalization (primary goal)

2. To maximize client’s level of independence

3. To maximize the effects of existing disabilities through non-institutional services.

4. Afford the opportunity to gain more accurate assessment of the family structure and

behavior in the natural environment.

5. Provide opportunity to make observations of the home environment and to identify

both barriers and supports for reaching family health promotion work.

6. Meeting the family on their home ground may also contribute to family’s sense of

control and active participation in meeting their health needs.

Importance of Home Visit to the Nurse and Client

 It gives the nurse the opportunity to examine clients e.g., infants, toddlers, nursing

mothers, the aged and pregnant women and counsel according to his or her findings,

e.g., on the childcare, personal hygiene, diet and prevention of home accidents.

 It enables the nurse to trace contacts of infectious diseases and refers them to the

hospital for investigation and treatment.

 Follow-ups: The Community Health Nurse also visits patients discharged from

hospitals, especially those suffering from chronic diseases and advise them on drugs,

rest and drugs.

 It enables the nurse to offer the needed services to families with special problems and

does follow ups to special cases such as handicapped, children, and the mentally

retarded. Under these circumstances, the Community Health Nurse would advise the

24
 family members on the full uses of health welfare agencies or services available for

these children in the community. Apart from this, he or she becomes the link between

members of such families and the welfare services available to find assistance for

them.

HOME VISITS AND CARE PLANS

First Home Visit on The 27th Of February, 2023

Objectives,

1. Familiarize with client and his family.

2. Assess the home and the environment situation.

The first special home visit was made to Mr. A.K.I and his family on the 27 th of February,

2023 around 9:30am. The visit was made to familiarize with client and his family, to assess

the health status and environment of the client and to identify the resources available in the

home to render care to client and his family. Also, to identify health problems, assess the

client’s health needs, prioritize the needs of the client, and help provide solution to the

problems identified using the resources available to ensure safe environment to client and

25
family. On arrival at client’s place, Mr. A.K.I was sitting outside. He offered me a seat and

we exchanged greetings. During our interaction, a quick assessment of the environment was

made, and it has been swept that morning. The mission of the visit was explained to him and

his partner who was home with him. We said a word of prayer and he was asked how he was

doing. Mr. A.K.I’s vital signs was checked and recorded as Temperature; 36.5°C, Pulse; 88

beats per minutes, Respiration; 24 breaths per minutes and Blood Pressure; 140/100mmHg.

After that, the essence of the visit was further explained to Mr. A.K.I to encourage him to

cooperate with me so he will be able to stop drinking and live a healthy lifestyle. He was

happy and showed much interest in the relationship and the objectives for the care study. He

even confirmed that it is his goal to stop drinking as he realized it is not helping him. As we

continued to interact, he was asked about his personal cleanliness. He said he bathes every

day in the morning, after work and sometimes in the evening. Also, his partner washes his

clothes when dirty and sometimes sweeps his room. About his oral care, he said he brushes

his teeth but sometimes he does not. Mr. A.K.I was educated on maintenance of good oral

hygiene, the reasons, and its importance.

Furthermore, Mr. A.K. I’s consent was sought, and a head-to-toe examination was carried out

on him. However, after assessment, it was observed that he had poor personal hygiene,

overgrown nails, bushy hair, and his room was very messy.

Also, throughout our interaction, it was realized that client had little knowledge about

alcoholism. He was assured of competent nursing care and provision of adequate information

on alcoholism, to help restore optimum health. However, because of his schedule for the day,

we had to end and reschedule for another visit. Finally, client realizing he had poor

knowledge on alcoholism, he agreed for that to be our main objective (education on

alcoholism) during the next visit on 28 th of February, 2023. Mr. A.K.I was congratulated for

co-operation.

26
Home Situation
Mr. A.K.I lives in Akpafu Odomi in the district in the Volta Region. He lives with his current

girlfriend in a single room self-contained house. The house is situated by the roadside. Mr.

A.K.I is a Christian and is also a member of his church choir.

Their house is built with cement blocks and roofed with aluminum sheets. There is a toilet

facility in the house as well as a bathroom which is mostly kept neat. The house is swept

every morning and rubbish is gathered and disposed. The house has a kitchen for cooking.

They depend on community borehole as their source of water for consumption and electricity

from the electricity company of Ghana.

Problems Identified
1. Client have poor personal hygiene.

27
DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING EVALUATION
/TIME DIAGNOSIS OUTCOME CRITERIA INTERVENTIONS
27/02/23 Infection Client’s personal hygiene 1) Reassure client of competent 1) Client was reassured that he is in 27/02/2023
related to poor will be maintained within nursing care. competent hands at
at
personal 12 hours as evidenced by. 2) Educate client and family on 2) Client and family were educated on 9:30pm
9:30am hygiene. good personal hygiene. maintaining good personal hygiene. e.g., Goal fully met
1)Client brushing his teeth, 3)Provide toothbrush, toothpaste, Client was informed about the im as;
cutting his nails, trimming nail cutter and assist client to 3) Toothbrush, toothpaste, and nail cutter Client
his hair, washing his brush his teeth and trim his nails were provided, and client was assisted to maintained good
clothes, and sweeping his 3) Encourage client to brush his brush his teeth and trim his nails. personal
room. teeth at least twice daily, cut his 3) Client was encouraged to brush his hygiene and
nails, trim his hair, wash his teeth twice daily, cut his nails, trim his verbalized that
2)Client and family clothes and sweep his room hair, wash his clothes, and sweep his room he knows the
knowing and verbalizing regularly. always need for good
the need for good personal 4) Ask client questions on . personal
hygiene. education done. 4) Questions were asked, and he answered hygiene.
5)Congratulate family and them correctly.
document activity done. 5) Client and family were congratulated,
and all activities done were documented.

Table 1: Nursing Care Plan for The First Home Visit

28
Second Home Visit On 7th Of March, 2023.
Objectives

1. Educate client and family on the causes, signs and symptoms of withdrawal syndrome

of alcoholism.

The second home visit was made to Mr. A.K.I and his family on 7 th day of March , 2023. At

10:30am. Upon reaching the house, a seat was offered to make me comfortable. The family

was greeted, and we exchanged pleasantries. A quick assessment of the environment was

made and a head-to-toe assessment of Mr. A.K.I was carried out to see if a good personal

hygiene was maintained. However, education was done on maintaining good personal

hygiene the previous visit was put into practice as client verbalized and was observed looking

neat. After congratulating him and the family on a good work done, we moved straight to the

day’s discussion as we scheduled on the first visit. Mr. A.K. I’s vital signs were checked and

recorded as Temperature, 36.7°C, Pulse, 86 beats per minutes, Respiration, 20 breaths per

minutes and Blood pressure 135/90mmHg.

Furthermore, client and family were educated on alcoholism, definition, causes, predisposing

factors, signs and symptoms, effects, treatment, management, and its prevention. After much

interaction, Mr. A.K.I appeared very anxious since he did not know or had not even heard of

some of the things associated with alcoholism. Probing further in other to explore their

knowledge on the condition and identify the factors that influence him to abuse alcohol, it

was found out that his friends are a great influence on his alcoholism. Also, we discussed on

how best we can work on breaking that channel of influence. Client and family were

reassured and again encouraged that they are receiving competent nursing care and with

adherence to the education provided and treatment regimen, the condition will be managed

appropriately. Feedbacks were asked and accurate responses were given. Client and family

were thanked and next visit was scheduled on 15th of March, 2023.

29
Problem identified.

1. Client and family have inadequate knowledge on alcoholism.

30
 Table 2: Nursing Care Plan for The Second Home Visit.

DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING EVALUATION

/TIME DIAGNOSIS OUTCOME INTERVENTIONS
CRITERIA
07/03//23 Knowledge deficit Client and family will 1) Reassure client and 1) Client and family were reassured of 07/03//23
related to receive adequate family of gaining adequate adequate knowledge on alcoholism and
at at
inadequate knowledge on condition knowledge on alcoholism competent care.
10:30am information on within an hour, as and competent nursing 11:30am
2) Client and family were educated on
alcoholism evidenced by; care.
the causes, symptoms and withdrawal Goal fully met as
1.Client and family 2) Educate client and methods on alcoholism. evidenced by client and
demonstrating family on condition family verbalized that
3) Client and family’s knowledge level
understanding on they had adequate
3) Assess client and was assessed by asking them questions
alcoholism. knowledge on
family’s knowledge on on the causes, symptoms and
alcoholism and by
2. Client being able to alcoholism. withdrawal methods on alcoholism.
answering all questions
identify factors that 4) Questions on the causes, symptoms
4) Allow client and family asked correctly.
trigger excessive and withdrawal methods on alcoholism
to ask questions.
drinking of alcohol. were asked and appropriate answers
5) Document activity done. were given.
5)All activity done was documented

31
Third Home Visit On 14th March, 2023.

Objectives

1. Educate client and family on the importance of regular medical check-up.

Third special home visit to Mr. A.K.I and his family was made on 14 th March 2023 at 3:00pm

On arrival to the house, Mr. A.K.I and his partner, Ms. G.A were met sitting under a tree

beside the house. We exchanged greetings and they offered me a seat. Mr. A.K.I and Ms.

G.A expressed their gladness for my visits which is to ensure they live healthy lifestyle. Mr.

A.K.I’s partner further went on to say that, after the previous week’s education on

alcoholism, she started seeing some gradual changes in her partner. Their vital signs were

checked, and findings were explained to them. Mr. A.K.I’s vital signs was recorded as,

Temperature, 37.0°C, Pulse, 80 beats per minutes, Respiration, 22 breaths per minutes and

Blood Pressure, 140/100mmHg. The normal values/range recognized as healthy vital values

were explained to them. However, based on the values recorded for Mr. A.K.I’s blood

pressure, he was made aware that he needs to ensure a healthy lifestyle since it is above the

normal values. He was encouraged to comply with the education given. Mr. A.K.I was

encouraged to have enough sleep, exercise, and eat well (avoid taking too much salty and

fatty foods, consume enough fruits and vegetables).

The topic for the day was importance of review visit at the hospital. Client and family were

asked on the reasons for reporting to the hospital as soon as possible when ill and

subsequently for review or checkups. They both expressed that it is not necessary for them to

go to the hospital when ill until it is severe, since they can buy drugs from the pharmacy.

And, even if they go to the hospital for treatment and they are discharged, they do not see the

essence of going for a review. Client and family were educated on the importance of seeking

early treatment, complying with health professional’s advice, and honoring review dates.

They all agreed and promised to support. They were both thanked for their time, and

32
encouraged to support each other to stay healthy. They were assured of competent nursing

care.

Problem identified.

1. Client complained of general bodily pains with severe headache.

33
 Table 3: Nursing Care Plan for The Third Home Visit

DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING EVALUATION

/TIME DIAGNOSIS OUTCOME CRITERIA INTERVENTIONS
14/03/23 Altered body Client’s body comfort will 1) Reassure client that with time 1) Client was reassured that 16/03/2023
at comfort related be restored within 48 hours and his cooperation, his pain with time his pain would at
3:30pm to general as evidenced by; would subside. subside. 3:30pm
bodily pains 1) Client verbalizing a 2) Assess client’s level of pain 2) Client level of pain was Goal fully met as
with severe reduction in pain level by observing his facial assessed by using the pain evidenced by client
headache 2) Absence of headache and expression and using the pain numerical scale (0-10). He verbalizing a
signs of pain. numerical scale (0-10) recorded 6 on the scale. reduction in pain
3) Encourage client to have 3) Client was encouraged to and absence of
adequate rest and sleep have adequate rest and sleep. headache.
4) Educate client to eat nutritious 4) Client was educated to eat
food and take in adequate nutritious food and take in
amount of water daily. adequate amount of water
5) Administer 1000mg of daily
paracetamol to relieve pain. 5) Paracetamol 1000mg was
administered to client.

34
Fourth Home Visit On 8th Of March, 2023.
Objectives

1. To assess the client’s nutritional status.

2. To educate client and family on good nutrition and eating habits.

The fourth special home visit was made on 8 th of March, 2023 at 10:00am with the purpose of

assessing Mr. A.K.I’s nutritional status and to educate him on good nutrition and eating

habits. Client warmly welcomed me and a seat was offered. We exchanged pleasantries. He

was asked how he was doing and he responded he is doing great. A quick observation was

made on the environment, it was realized that the environment was clean. A quick recap was

done on our previous education on the alcoholism. Mr. A.K.I was able to recollect more than

half of what was learnt. He was congratulated on his efforts. Client was able to recollect more

than half of what was learnt. He was congratulated on his efforts. The weight of the client

was checked and recorded as 50kg, Temperature as 36.3ºC, Pulse as 89 beats per minutes,

Respiration, 24 breaths per minutes and Blood Pressure 130/90mmHg. The results of the vital

signs including decrement in his weight was explained to him. Mr. A.K.I complained that he

is not able to feed well as demanded. He was reassured that he will soon have appetite for

foods.

We began our discussion by talking about the four-star diet which Mr. A.K.I said he has no

idea about it. Mr. A.K.I was educated on the four-star diets. Four-star diet is a meal plan

where the servings at each meal must contain nutrients from the four major food groups. This

way, the client or the whole family gets nutrients from the four main groups as part of an

enriched food. Examples of the four-star diets such as Staples foods which are the cereals,

starchy roots and tubers (cassava, potatoes), plantain, wheat, maize, rice, millet and sorghum

were stated. The second example was the Legumes which are beans, peas, groundnuts and

nuts of all types. Other types of the four-star diets are animal protein sources such as milk and

35
milk products, eggs, fish of all types, meat of all types and so on. Lastly, we also talked about

Fruits and vegetables such as leafy and non-leafy vegetables, mango, orange, banana,

tomatoes and so on. The family was made to understand all these and how to blend them to

get the right nutrients for themselves by demonstrating to them.

Finally, Mr. A.K.I was counseled to take diet low in salt and fat and avoid eating late at

night, take foods rich in vitamins and minerals, fruits, and vegetables. He was once again

informed that he should not forget about drinking water; the water should be at least four

liters per day. The conversations ended and the family was encouraged to ask questions for

clarifications. The family was able to give feedback and the next visit on 14 th March,2023

was scheduled with them.

Problem Identified

Client was observed to be malnourished.

36
Table 4: Nursing Care Plan for Fourth Home Visit

DATE/TIME NURSING NURSING NURSING ORDERS NURSING INTERVENTIONS EVALUATION

DIAGNOSIS OBJECTIVE

8/03/2023 Imbalanced Client’s 1. Reassure client that his 1. Client was reassured that his 08/04/2023
nutrition; (less nutritional appetite will be restored. appetite will be restored. at
at
than body status will 2. Administer prescribed 2. Prescribed amino acid and 10:00 am
10:00 am requirement) improve and amino acid and multivitamin was Goals were fully
related to body mass multivitamin. administered. met as client was
insufficient intake index will 3. Monitor weight on every 3. Weight was monitored on able to gain more
of nutrients to increase by 2 visit. every visit. than 2kg of
meet metabolic kg within 1 4. Encourage client to eat 4. Client was encouraged to eat weight within a
needs. month as foods of preferred choice foods of preferred choice (well month
evidenced by (well balanced) balanced) normalizing BMI.
measurement 5. Encourage fluids intake 5. Fluid intake was encouraged
values and counsel on excessive and counselled on excessive
improving alcohol prevention. alcohol prevention.
6. Ensure intake of nutritious 6. Client was ensured to
diet nutritious diet.

37
Fifth Home Visit On 14th Of March, 2023.
Objectives

1. To evaluate previous care rendered to client and family.

2. To discuss the effects of alcoholism to client and family.

Mr. A.K.I and his family were visited for the fifth time on 14 th March, 2023 at exactly

2:00pm. After establishing a good working relationship, a quick assessment in the

environment was done. Client was the only one at home and was congratulated on keeping

the surrounding clean. His vital signs were checked and recorded to be normal. The results

were however interpreted to him. Objectives were introduced to him, and client was very

interested. To begin with, client was asked to mention some of the things that alcoholism has

cost him (the effects) since he began consuming it. He said, he has spent lots of money in the

buying of alcohol and also because of this lifestyle he is not able to do anything productive

for himself. Also, he said because of alcohol he has lost his integrity and respect. His family

and other people see him as a burden and a good for nothing. That’s because, all effort to

make him quit drinking and be stable or productive could not yield any result.

Going further, some of the effects of alcoholism was discussed with Mr. A.K.I. Some of

which are; loss of good friends, low household income, poverty, loss of job, low productivity,

children dropping out of school because of financial difficulties and broken homes. We also

elaborated on some complications which are hypertension, erectile dysfunction, general

growth retardation, peptic ulcer, Esophagitis, cirrhosis of the liver, just to mention few. After

the education, Mr. A.K.I was made to ask questions and appropriate answers were given. He

expressed gratitude for the enlightenment and pointed out that if not for today, he did not

know alcoholism could cause so much harm than good. He only saw alcohol addiction as a

way to have fun and release stress. He was thanked and encouraged to take whatever we have

done so far very serious. The next home visit was scheduled for 18th March,2023.

38
Problems identified

1. Client is being stigmatized in the community because of his alcoholism.

39
Table 5: Nursing Care Plan for The Fifth Home Visit.

DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING EVALUATION

/TIME DIAGNOSIS OUTCOME INTERVENTIONS
CRITERIA
14/03/23 Loss of self- Client’s self-esteem will 1) Reassure that he can 1) Client was reassured that he 14/04/2023
at esteem related to be regained by the end of regain his self esteem can gain back his esteem.
at
3:00pm social the care as evidenced by; 2) Make client and family 2) Client and family were
9:00am
stigmatization 1)Client verbalizing understand why client was made to understand why client
secondary to absence of being stigmatized. was being stigmatized
Goal fully met as
alcoholism. stigmatization. 3) Encourage client to 3) Client was encouraged to
client verbalized
2) Nurse observing that participate in all community participate in all community
associating well
client can now associate activities to enhance his activities to enhance his
with his immediate
freely in the community. relationship with relationship with community
neighbors.
community members. members.
4) Encourage Client’s 4) Client’s family was
family to show love and encouraged to show love and
care to client for others to care to client for others to do
do so as well. so as well.
5) Form a self-help group 5) Efforts were made to start a
self-help group.

40
Sixth Home Visit On 18th March,2023.
Objectives

1. To assess the health status of client and family.

2. To educate client and family on the various ways of managing and preventing

alcoholism.

The sixth special home visit was made on 18th March, 2023 at 9:00am to Mr. Mr. A.K.I’s

house.

Mr. A.K.I welcomed me, and a seat was offered. We then exchanged greetings. He was

enquired about the health status of the family especially Mr. A.K.I, and He responded that

they are all fine. However, he complained that sometimes he has difficulty sleeping at night

and wakes up with a severe headache. Also, a quick assessment was made and realized the

place was neatly swept and good personal hygiene was maintained. Moving forward, the

family was asked about what progress Mr. A.K.I has made in terms of quitting or limiting his

act of drinking lots of alcohol, adopting healthy lifestyles as well as his general wellbeing and

productivity. Mr. A.K.I voiced out that he is making progress and his brother confirmed so

too. Also, from the assessment it was realized he looks better, sober and does not smell with

alcohol as much as the previous days.

Furthermore, he was enquired about how he is coping with and living beyond the criticisms

and stigmatization he goes through because of alcohol addiction. He responded, “I have been

able to put into practice what you have taught me and as people see the changes, their attitude

towards me is also changing’. The family was encouraged to support him and make criticisms

that will positively impact his life and motivate him to be better.

However, the visit was made mainly to educate client and family on the various ways by

which his condition can be managed and how to help prevent any other member of the family

from drinking alcohol in order to eradicate the condition totally from the family. His vital

signs were checked, recorded, and interpreted to him. Client’s vitals; Temperature; 36.9 ◦C,
41
Pulse; 84 beats per minutes Respiration; 22 breaths per minutes and Blood Pressure;

120/90mmHg. After checking and recording their vital signs, we began the day’s discussion

by looking at how best we can manage client’s condition apart from the usage of drugs.

When asked, Mr. A.K.I said he can best stop drinking if only he is able to avoid his friends

who he associates with.

The family was congratulated for their contributions and some few measures were pointed

out. They were made aware that; focus groups can be joined by client and also individual

behavioral principles which includes reinforcement and behavior modeling could be adopted.

This and other few measures were pointed out to him that can be useful in helping him

abstain from alcoholism so he can become sober and enjoy optimum health.

Summary on The Management Measures Discussed

The goal of alcohol treatment is to abstain gradually from the condition. Individual signs and

symptoms depend on the kind of treatment given to them, they can be educated, encouraged,

motivated and showed loved and care that alcohol is preventable. We also have medical

therapy, behavior therapy, family therapy. Medicines to treat alcohol problems are hardly to

be prescribed by health care providers.

Medicines are not the only tool for reducing drinking, successful long-term recovery centers

aim at helping the individual to stop abusing the alcohol. These approaches use goal setting,

self-monitoring of drinking, analysis of drinking situation and learning alternate coping skills.

The following are the forms of behaviour therapy management, couples & family therapy,

partners & family empowerment, mutual help groups and self-help groups.

Feedbacks were asked and appropriate answers were given. Client and family were thanked

for their corporation and next visit was scheduled to 22nd of March 2023.

Problem identified.

1. Client complained of difficulty in sleeping at night.

42
43
Table 6: Nursing Care Plan for The Sixth Home Visit.

DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING EVALUATION

/TIME DIAGNOSIS OUTCOME CRITERIA INTERVENTIONS
18/03/23 Sleep pattern Client will have optimal 1) Reassure client that sleep 1) Client was reassured that 20/03/2023
disturbance sleeping pattern within pattern will be restored. he will be able to sleep well. at
at
(insomnia) 48 hours as evidenced 2) Encourage client to comply 2) Client was encouraged to 9:00am
9:00am related to by; to care given and stop drinking. comply to care given and Goal fully met as
headaches and 1) Client sleeping 3) Encourage client to take stop drinking client verbalized
secondary to uninterrupted for at least warm Milo beverage at night to 4) Client was advised not to of sleeping well
alcoholism. 2 induce sleep. overeat at night. for at least six
hours in a day and 6 4) Advice client not to overeat 5) Client was advised to take hours at night.
hours in the night. at night. a warm bath before sleeping.
2) Client verbalizes of 5) Advice client to take a warm 6) Client was encouraged to
sleeping well during the bath before sleeping. go to bed immediately he
night 6) Encourage client to go to feels sleepy
bed immediately he feels 7) Client and family were
sleepy. educated to ensure good
7) Educate client and family to ventilation in the room and
ensure good ventilation in the provide a comfortable bed to
room and provide a induce sleep.
comfortable bed to induce

44
sleep.

45
Seventh Home Visit On 22nd March, 2023,
Objectives

1. To encourage family to support the client to regain optimum health.

2. To allay any other anxiety in client and family related to earlier discussions on

condition.

3. To encourage client to go for a review visit at the hospital.

The seventh special home visit was made on 22nd March 2023 at 1:00pm to Mr. A.K.I’s

house. On arrival, Mr. A.K.I and family were greeted and asked how they were they doing.

They responded, ‘they are doing well by God’s grace’. His mother had come to visit them.

They were enquired about their health, as we exchanged pleasantries. The purpose of the visit

was explained to them that day. As we began to talk, they made me aware that Mr. A.K.I

does not comply with anything said by them, me, or anyone to stop drinking. They hinted to

me that a lot of people have been brought in to help including pastors, family members,

elders but still client is not willing to stop drinking. They said, he has become so addicted that

on every blessed day he comes home drunk. From their own words they stated “everyday our

man dey booze”. The family was encouraged not to give up on him but support him to regain

optimum health. They were made aware that enhancing a positive change in Mr. A.K.I will

not be easy nor come in a day but it is possible and a gradual process.

They decided to encourage him more to stop drinking so that he would regain optimum

health as soon as possible.

Moreover, it was quite late so the family was thanked for their time and encouraged them that

gradually over time with their support Mr. A.K.I will become better.

Problems identified

1. Client is not complying to care given.

46
Table 7: Nursing Care Plan for The Seventh Home Visit

DATE / NURSING OBJECTIVES/OUTCOME NURSING ORDERS NURSING EVALUATION

TIME DIAGNOSIS CRITERIA
22/03/23 Noncompliance Patient will adhere to
at to management management of his condition
3:30pm of condition within period of care given
(alcoholism) as evidenced by;
related to 1) Client complying to care
availability of given
trigger factors 2) Family verbalizing that
client is improving.
3) Observing that client is
making efforts to stop
drinking
INTERVENTIONS
1) Reassure client and 1) Client and family were 20/04/2023
family that client will reassured that client will at
improve. improve 3:30pm
2) Identify trigger 2) Trigger factors that motivate Goal partially met
factors for his him to drink were identified as client complied
alcoholism 3) Client and family were re- to management of
3) Re-educate client educated on condition his condition and
and family on condition 4) Client was encouraged to family verbalized
4) Encourage client to adhere to management of his that client is
adhere to management condition improving.
of his condition 5) Client’s family was
5) Encourage family to encouraged to give their
continue to support maximum support, care and
client till he improves. affection to client.
6) Document procedure 6) All procedure documented
and review care given. and care given was reviewed.

47
Eighth Home Visit On 30th March 2023.
Objectives

1. To encourage client and family to maintain good personal hygiene and environmental

sanitation.

2. To promote the use of treated mosquito nets by client and family

3. To inform client and family about termination of care.

The eighth home visit to client’s house was made on the 30th of March, 2023 at exactly

10:00am in the morning. On my arrival to the house, some children were met playing outside

and they were asked how they were doing and why they did not go to school. They said they

were on mid-terms. We exchanged pleasantries. Mr. A.K.I’s girlfriend told me Mr. A.K.I has

stepped out not long ago. She offered me a seat to wait for him to return.

However, after about thirty minutes he returned. He was invited over and requested that he

joins us. He came to sit down, and he was asked how he was doing. His vital signs were

checked and interpreted the values to him as usual. He was asked if he had any worries and

why he is not adhering to me nor the family’s advice to quit drinking. He said it seems almost

difficult not to do without alcohol, but he is trying. He was encouraged to give his maximum

best and comply with care and advice rendered to him, because all we are looking out for is

him to be healthy and productive. We went on to discuss the business for that day. The client

and family were encouraged to continue to maintain good personal hygiene and

environmental sanitation. Also, they were taught that bushy surroundings, stagnant water, and

illicit disposal of rubbish serve as breeding places for mosquitoes and aside that can lead to

lot of diseases. They were asked if they sleep under treated mosquito net, and they said not

always.

Finally, they were introduced to the last objective for the visit which was to inform them of

handing over the care to the Public Health Nursing Team. They were told, his condition is of

public health importance, hence proper care must be in place to ensure total recovery from his
48
condition. Although, he may not be visited regularly, but there is the need for someone to

continue the care to aid in speedy recovery. Observation made revealed that Mr. A.K.I was a

little bit confused, but he was reassured to allay anxiety. They were also given the chance to

express their feelings. They were assured of confidentiality and competency of the new care

giver. Client was made aware that if he does not comply with care given all efforts made by

me or the family will be in vain. Feedbacks were asked and appropriate answers were given.

Client and family were thanked for their corporation and next visit was scheduled to 8 th April,

2023.

Problem identified.

1. They were anxious about the change in caregiver.

2. They do not sleep under treated mosquito net.

49
Table 8: Nursing Care Plan for The Eighth Home Visit

DATE / NURSING OBJECTIVES / NURSING ORDERS NURSING EVALUATION

TIME DIAGNOSIS OUTCOME INTERVENTIONS
CRITERIA
30/03/21 Anxiety Client’s anxiety level will be 1) Reassure client and !) Client and family were 1/04/21
related to reduced within 24hours as family of competent reassured of competent nursing
at at
effects of evidenced by; nursing care. care.
10:00am withdrawing 1) Client verbalizing 2) Assess client’s level 2) Client’s level of anxiety was 10:00am
from alcohol reduction of anxiety. of anxiety assessed
3) Educate client and 3) Client and family were
Goal fully met as
2) Client seen looking family that withdrawal educated that withdrawal
evidenced by client
cheerful symptoms can be well symptoms can be well managed
seen looking
managed and treated. and treated.
cheerful and
4) Encourage client to 4) Client was encouraged to
relaxed.
comply/adhere to comply/adhere to management
management of of condition
condition 5) All activities carried out was
5) Document all documented.
activities carried out. 6) Next home visit was
6) Schedule next visit. scheduled.

50
Table 9: Nursing Care Plan for The Eighth Home Visit

DATE / NURSING OBJECTIVES NURSING ORDERS NURSING EVALUATION

TIME DIAGNOSI / INTERVENTIONS
S OUTCOME
CRITERIA
30/03/2 Risk for Client will be 1) Reassure client and family. 1) Client and family were reassured. 07/04/23
3 malaria free from 2) Encourage client and family 2) Client and family were at
at infection malaria to sleep under an insecticide encouraged to sleep under mosquito 10:00am.
10:00a related to infection within treated mosquito net. net. Goal fully met as
m non-use of 7 days as 3) Educate client and family on 3) Client and family were educated client and family
long-lasting evidenced by preventive measures of malaria. on were provided with an
insecticide client sleeping 4) Encourage client and family preventive measures insecticide treated
treated bed under a treated to wash and dry net in a shade on malaria. mosquito net and
net. mosquito net. when dirty and to sew the net 4) Client and family were assisted in fixing it.
when torn with thread and encouraged to wash and dry their
needle. net in shade when dirty and sew
5) Provide client and family when torn.
with an insecticide treated 5)Client and family were provided
mosquito net and help them fix with an insecticide treated mosquito
it. net and were assisted in fixing it.
6) Document procedure. 6) All necessary documentation was

51
 done.

52
Ninth Home Visit 8th April, 2023.
Objectives

1. To educate client and family on what to expect during the periods that client will be

withdrawing from alcohol.

2. To remind them of handing over care.

The ninth home visit was made on the 8 th of April, 2023 around 9:30am in the morning. They

were asked about their health, and they responded to be doing well. Mr. A.K.I’s vital signs

were checked, and it was normal. Not to waste much time, the objectives of the visit were

introduced to them, and they seemed very interested. Withdrawal symptoms were explained

to them as being the things or signs that one may exhibit or show when he or she abstains

from drugs or activities to which one is addicted to and that of an alcoholic may include;

anxiety, weakness, tremors, nausea and vomiting, fever, gastrointestinal symptoms and

delirium just to mention few of which Mr. A.K.I. is likely to show when he stops drinking.

Mr. A.K.I became anxious upon hearing this, but he was reassured that he will overcome

them in no time. Client and family were encouraged that they are receiving effective care and

with adherence to health instructions (education), Mr. A.K.I. will live a normal healthy life

again.

Client and family were also reminded that with time, direct care rendered to them by me will

be terminated, however they will be handed over to another community health nurse working

in the area for continuation of care. They were told the next visit was going to be the official

last visit to them since the period for client/family centered care study was supposed to take

two months as they were informed earlier. On the next visit the community health nurse will

be around to officially hand over the family to her. The date for the tenth and final home visit

was scheduled to 20th of April, 2023. Client and family were thanked and congratulated for

their efforts, support, and cooperation.

53
Problem identified.

1. Client was anxious about the effects of withdrawing from alcohol.

54
Table 10: Nursing Care Plan for The Ninth Home Visit

DATE / NURSING OBJECTIVES/ NURSING ORDERS NURSING EVALUATION

TIME DIAGNOSIS OUTCOME INTERVENTIONS
CRITERIA
08/04/21 Anxiety related Client’s anxiety level will 1) Reassure client and !) Client and family were 09/04/21
to effects of be reduced within family of competent reassured of competent nursing
at at
withdrawing 24hours as evidenced by; nursing care. care.
9:30am from alcohol 2) Assess client’s level of 2) Client’s level of anxiety was 9:30am
1) Client verbalizing anxiety assessed
reduction of anxiety. 3) Educate client and 3) Client and family were
Goal fully met as
family that withdrawal educated that withdrawal
client looked
2) Client seen looking symptoms can be well symptoms can be well managed
cheerful and
cheerful managed and treated. and treated.
relaxed.
4) Encourage client to 4) Client was encouraged to
comply/adhere to comply/adhere to management
management of condition of condition
5) Document all activities 5) All activities carried out was
carried out. documented.
6) Schedule next visit. 6) Next home visit was
scheduled.

55
Tenth Home Visit 20th April, 2023 (Handing Over & Continuity of Care).
Objectives

1. To officially terminate my care for Mr. A.K.I. and his family.

2. To handover to the Public Health Nurse in charge of that area for continuity of care.

Termination of care is seen to be the last phase of interaction between the nurse, patient and

his family. It becomes a very difficult phase as a period of separation which in turn results in

anxiety. Before the tenth visit, the Community Health Nurse who works at the Volta Regional

Hospital, Hohoe was met with Mr. Mr. A.K.I’s particulars and informed her about the

intention to hand over to her for continuity of care. She agreed to assist Mr. A.K.I in his care

and go with me on the next visit to the client’s house. On the day of the final visit, the

Community Health Nurse accompanied me to Mr. Mr. A.K.I’s house as arranged.

Interaction with Mr. A.K.I and his family successfully came to an end on 20th April, 2023

when the last home visit was made. The objective was to bid them farewell and to hand over

Mr. A.K.I and his family to the Community Health Nurse (CHN) through the Public Health

Nurse in – Charge of the area. The family were very happy to see us. They warmly welcomed

us and offered us a seat. The Community Health Nurse who was going to be their new care

giver was introduced to them.

They were assured of competency and confidentiality of the Community Health Nurse, they

promised to co-operate with her as they did with me. He was encouraged to comply and

adhere to all care that will be rendered to him. The Community Health Nurse also took the

opportunity to educate them on lifestyle modification, personal and environmental hygiene

and the need to adhere to treatment compliance.

She also assured them of quality health care delivery and urges them to collaborate with her

for successful end. She exchanged mobile contacts with the family. A profound gratitude was

expressed to Mr. A.K.I and his family for their cooperation and for allowing himself to be

used towards the success of this care study.

56
Mr. A.K.I and family were then handed over to the community health nurse. Care was

officially terminated on the 20th April, 2023 when he was finally handed over to a community

health nurse to continue the care in the community. The entire family was thanked for

allowing me to use Mr. A.K.I as a client for the client/family centered care study. They also

appreciated the efforts and time spent with them. We asked permission and bid them

goodbye.

Problem identified

No problem was identified during the last home visit.

57
Handing Over and Continuity of Care
My interaction with Mr. A.K.I and his family began on the 25 th of February, 2023, and ended

on 20th July 2023 when the last home visit was made, and care terminated. During the visit,

client and family were informed that the interaction with them will last for some period.

Health education was done on pertinent issues which include education on alcoholism, its

causes, effects, risk factors, management and treatment, and preventive measures, good

nutrition, personal and environmental hygiene, use of insecticide treated mosquito net,

compliance and emotional support to client.

Ten official home visits were made to the client and family. During the last home visit, the

care was officially terminated, and client was handed over to the Public Health Nurse for

continuity of care. Profound gratitude was expressed to Mr. A.K.I and his family for their co-

operation and the help offered towards a successful interaction with them. They were

encouraged to put into practice all that we have discussed during our interaction.

Evaluation Of Care Rendered to Client and Family

According to Weller (2009), evaluation is a critical appraisal or assessment; a judgment of

the value, worth, character or effectiveness of that which is being assessed. In the health care

field this includes the assessment of the patient’s position on the health /illness continuum,

and of the effectiveness of patient care activities in bringing about a change in the patient’s

position. This consists of the following:

1. Statement of evaluation.

2. Amendment of nursing care plan for partially met or unmet outcome criteria.

3. Termination of care.

58
Statement of Evaluation
The study was on a 35year old client with alcoholism. During this period, client was nursed

using the nursing process approach. As a result, a lot of health problems were identified and

goals set were achieved appropriately.

Moreover, during an interaction with Mr. A.K.I and his family during the special home visits,

various health problems that were identified were successfully addressed and almost all the

goals were fully met. The reason being that, convincing the client to visit the hospital was

very challenging and difficult. Thus, it took time for him to comply and be reviewed by a

Physician Assistant for medical treatment. This delayed and slowed down the recovery

process. However, support from the nurses at the Psychiatric Unit of the Volta Regional

Hospital, Hohoe helped in convincing the client to accept treatment for his alcoholism. The

support gained from the health facility helped in achieving the partially met objective of

client complying to management of his alcoholism. However, at the time of the termination

and handing over of care, the goal to assist client to stop drinking was not fully met but client

showed great enthusiasm to change. His health was improved upon and was looking far better

at the last home visit than the first day he was met.

Another important care rendered was client and family’s anxiety were allayed within 24

hours with evidence of them looking cheerful and relaxed and complying with the care

rendered.

In addition, the sanitary condition of client’s environment was improved and maintained

appropriately. Finally, client and family were made to practice good personal hygiene and

adopt healthy lifestyles.

59
Amendment of Care
After rendering an inclusive nursing care to Mr. A.K.I and his family, all goals, objectives,

and outcome criteria were met evidently within the scheduled time frame. However, an

amendment of care was done to accomplish the goal of ensuring patient receives other

medical and psychological intervention from the hospital. First, the Mental Health unit of the

Volta Regional Hospital, Hohoe was visited to talk with the Mental Health Nurse to make a

visit with me to client’s house for him to be assessed and put on further management. On the

14th of April, 2023, the Mental Health Nurse and I visited the client’s home. We could not

meet the client but we met the family. She spoke with them and encouraged them to support

the client in coming to the hospital for treatments. On another occasion, when the client and

the family were visited, it was fortunate to meet them all. The Mental Health Nurse was

called and she spoke with Mr. A.K.I to come for review at the hospital. He agreed for us to

go the following day which was 15th of April, 2023. Fortunately, that faithful day we went

and client was reviewed by the Physician Assistant. Also, he was further referred to see the

psychologist at the psychiatric unit of the Ho Teaching Hospital for insight and motivational

therapy. The following medications were also indicated; IM Modecate 25mg stat, Tab

Olanzepine 10mg daily times 30days, Tab Benzhexol 5mg daily times 30days and Tab

Vitamin B-Denk daily times 30days.

60
Termination Of Care
This is the process of ending the care rendered to Mr. A.K.I and his family during my visits.

Interactions with Mr. A.K.I and family began on the 25th of February, 2023, and ended on 20th

April, 2023 when the last special home visit was made. Several visits were made to the

family but with ten special visits. On the last special visit, the family was happy and cheerful,

and it was observed that client’s condition had improved so much that he and his family were

informed about my termination of care without fear of any deficiencies. A profound gratitude

was expressed to client and his family for the opportunity offered, that enable me to bring the

care study to a successful end.

61
 SUMMARY

This client and family centered care study was on Mr. A.K.I who is 35 years of age and his

family.

He was identified at Akpafu Odomi during a routine home visit on the 25 th of February, 2023.

Upon interaction, a consent was gotten from both client and family to use Mr. A.K.I as a

special client for the family centered care study. The first special home visit was on the 27th

of February, 2023.

The main objective of this study was to assist client and family to gain optimal health with no

complication. Mr. A.K.I and family were visited as scheduled and were educated on the

client’s condition and their environment. The best nursing care was given to them with their

support and cooperation; most of the objectives set for the client and family centered care

study were achieved.

The care ended on the 20th of April, 2023. Finally, Mr. A.K.I and family were handed over to

the Community Health Nurse through the Public Health Nurse in – charge of the catchment

area.

62
 CONCLUSION

The study has offered me an opportunity to provide total nursing care to a family by putting

into practice the knowledge and skills acquired during my training. It has helped me to be

conversant with use of the nursing process and how to care for an individual and families

using the nursing care plan. The client and family gained more insight into their health

problems and how to practice good and healthy lifestyle to prevent unwanted disease. The

client and family had the opportunity during the period of care to identify the factors at home

and in the environment that are detrimental to their health and ways of preventing or dealing

with them. Thus, client and family through various health promotion activities were

empowered to become responsible for their own health. Also, I had the opportunity to

collaborate with other professionals in Volta Regional Hospital, Hohoe to render care to Mr.

A.K.I and his family. However, the condition of Mr. A.K.I (alcoholism) offered me the

opportunity to read lot of literature and broaden my scope of knowledge and skills in the

management of alcoholism. Objectives were achieved and the study was successful owing to

the co-operation and support of Mr. A.K.I and his family. I hope to utilize the new

experiences acquired to nurse clients and families of the community and the country as a

whole.

63
 RECOMMENDATIONS

Alcohol abuse today has become rampant and unacceptable, both parents and children are

showing high level of alcohol consumption based on the literature findings. Alcoholism being

one of the conditions of public health concern needs continuous education and measures to

reduce intake.

I recommend that the Government of Ghana (GOG), Ministry of Health (MOH) in

partnership with the Ghana Health Service (GHS), NGO’s, churches and other stakeholders

should mount a serious public education campaign to create the needed awareness on health,

effects and dangers of alcohol abuse and bring attitudinal change among the people and to

provide medical care, counseling for early detection and prompt treatment of diseases related

to alcohol abuse.

The mass media needs to be advertising on the effects of alcohol abuse rather than showing

the drinks to market them for consumption using the youth for the advertising their product.

Individuals, restaurants and hotels who sells the alcohol should be made to face the law if

they do not have the license to sell. Also, drivers who are caught to have abused alcohol or

drunk should be made to face the law and be fined.

Finally, since the rate at which alcohol is being sold and consumed in the Volta Region of

Ghana, policy makers and law enforcers should take a critical look at it in enforcing stricter

laws which I believe will go a long way to put an end to this threatening and heart-breaking

problem.

64
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American Psychological Association (APA). Understanding Alcohol Use Disorders and
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Amoateng, A. (2019). Alcoholism in Ghana: Causes, effects, and solutions. GhanaWeb.
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Ghana-Causes-effects-and-solutions-723110
Centers for Disease Control and Prevention. (2021). Alcohol and public health. Retrieved
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Diagnostic and Statistical Manual for Mental disorders: DSM-5(2013). Alcohol Abuse. (5th
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Ghana Statistical Service, Ghana Health Service, & ICF. (2019). Ghana demographic and
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Kunateh, A., M. (2006). Alcohol industry and alcohol policy in Ghana. Addiction, 101(8),
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Meyers, J., Sartor, C. Werner, K. Koenen K., Grant, B., & Hasin, D.(2018). Childhood
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