Community Health Nursing - Case Study Example

Dennis is seventy years old male and married who initially worked in the Bank of America as a teller. He is at the middle-income level with an annual pretax income that ranges from $48500 to $145,500 annually and has been able to cater to their children's needs. He is an oxford university graduate in the bachelor’s degree program that took him four years for successful completion in the finance sector. It qualified him to work in the entry-level positions and retired at the Bank of America's management positions. Being organized in mind, dealing with the numerous responsibilities, and proper management of multiple operations at the same time enabled him to observe the irregularities and as well avoid them. With the mathematical and analytical ability, he predicted the trends in customer reactions and the fluctuations in the financial sector. His proper communication skills led to the Bank of America employing him since in banking professionalism, dealing directly with the end customers, and developing verbal and written communication skills to build trust with the clients. communicating the matter to the subordinate without confusion, and therefore it is necessary to communicate appropriately. (Finn et al. 2017)

When Dennis attained 35 years old, his family was stable and had a job with their children in schools. It is time he reached his financial dreams and even invested in poultry. There were no worries of paying bills and was debt-free since they had saved money for plans and goals and overcame any emergency. He understood that the most critical investment was himself and made his finances personal, keeping track of his budgets. Later on, he retired at the age of 64 years old from his pensionable job, which started as a semi-retire when he was 55 years, due to reduced working hours. Moreover, he withdrew from the operating position to become his boss after hard work and dedication to America's bank hence still achieving the income goal.

Denis' wife, who has a mental illness, has led to feelings of loss and grief. Though losing is inevitable in life, it is the natural part of the healing process stipulating one of the most challenging situations. He experienced sleep disturbance and distressing thoughts that led to a depressed mood because of the terminal illness. Since Mrs. Dennis was exposed to environmental stressors and inflammatory conditions at birth and inherited traits from relatives with mental illness, she has depression and substance use disorder, leading to unhappiness and decreased life enjoyment. Therefore, their lives being miserable and many days to day problems. Due to no sure ways of preventing the illness, she was controlled stress and increased her resilience, which boosted low self-esteem, outing the symptoms under control. Proper sleep and regular eating and exercise are also paramount to routine medical care by not neglecting regular check-ups or skipping visits that trigger symptoms. Thus, with the help of proper medical practices, the wife is presently in good condition.

The client is enthusiastic since, at the workplace, he provided satisfactory customer service, effectively resolving interpersonal conflicts and productively working with others. Being devoted to the duty making sure the organization makes profits with the necessary procedures and guidelines involved. With an energetic and motivated attitude, it makes sure the people around him at the workplace and home have helped him pursue his dreams due to the satisfaction of plans that help them stay motivated and active. He is also creative, turning new ideas into reality, characterized by perceiving the world from a different angle and working on possibilities. In the accounting sector, he devised a new way of serving customers cost-effectively. Being a risk-taker, ignoring doubts, and facing the fears in implementing the cloud software at his workplace broke the routine and escalated the bank's business operations leading to high profitability.

In tackling situations to eliminate stress, behavior, and plans in knowing better actions to establish healthy boundaries and proper time management instead of getting involved in drinking too much alcohol and too much sleeping. Since what works for you might fail to work for another person, the client should cope with the best strategies for specific issues and emotions. They recommend fundamental set values for life, education, and freedom necessary for decision-making to their younger self. To the younger versions of themselves, majors on kindness and knowing your worth as the world seems more significant than we should just be us as our worries are not bigger than we think.

With the Geriatric Depression Scale (GDS), I identified the depression symptoms Yes/No format. Since it is related to GDS-15 and DSM-5, it rapidly detected some stress among the client; hence they should take good care of themselves, talk to others, and avoid a healthy lifestyle. With the Fulmer's employment, SPICES obtains prevention of health alterations information in sleep disorders, eating, incontinence, confusion falls, and skin breakdown. Therefore, nurses can implement the preventive and therapeutic syndromes of the elderly due to the flagging conditions for further assessment. It will lead to the prevention and detection of the most common complications frequently occurring in adults' health issues. With the mini-mental examination, I will name three objects that are unrelated clearly and slowly and then the patient to name the three of them and repeating until the patient possibly learns all of them. Through the examination, testing the cognitive ability of the elderly; hence memory, language, attention, and visual-spatial skills are incorporated. With the questionnaire, the patients follow instructions and circle or choose the boxes that apply to them.

In the US, suicide is a significant cause of death. The elderly and adolescents are the greatest victims since nearly one-fifth of suicide is committed by the elderly above 64 years. Men over 70 have a high rate of complete suicidal attempts. Since men are less likely to cry for help, they resolve to commit suicide due to significant depression and mostly use hangings or gunshots and less physically resilient. GDS also has criticisms as its length leads to a difficulty in being used by the patients with depression since they have concentration troubles stipulating that administration time in the outpatient might be limited. Moreover, MMSE screens dementia in patients and, therefore, crucial for diagnosis and therapy.

Erik Erikson showed a critical conflict in late adulthood after 65 years of age, ego integrity vs. despair, which involves a reflection of life where there is either satisfaction or a deep sense of regret. This stage was triggered by his job retirement, which solves successfully due to the understanding of the contentment he has on the things he has done. Therefore, due to the few regrets and the general satisfaction feeling that is commendable, there is a sense of integrity. Thus, the client can be rated as 7/10 on the scale since he has a lesser sense of a wasted life and no bitterness feelings. (Poston et al. 2019) The clients have raised his children, and there is a good relationship between them, and proud of the years he used o work at the American Bank.

Moreover, his youngest son still asks for money since he bounces from job to job, and he remains in thoughts on what to do to set his son on the right path. He also feels he should have pursued a master's in finance and retired at a managerial post. Therefore as many people do, Dennis looks behind and sees things he is proud of and those he regrets. Moreover, how he resolves the crisis determines if he will remain in the despair feelings or escalate to integrity. At times, he realizes the things he feels would have done in another way if given a chance to do so but admits he has given the world something that will outlast him.

Since the client has some depression signs, the nursing care plans dig deeper to scrutinize the impairment degree, assess clients coping abilities, and assist in dealing with the current situation for the psychological needs promoting health wellness. The client’s mood regulation being low, it affects the normal fluctuations of his experience. Psychotherapeutic treatments constitute an effective treatment of the disorder. Therefore, I would diagnose ineffective coping, fatigue, and disturbed thought process. The patient has a feeling of tiredness and lack of energy due to lack of motivation, lack of exercise, and a low diet. His daily living has interfered with altered perception and cognition, which affects his everyday living. Hence their need for promoting reality orientation. (Smith, 2017)

The nursing care plan is:

Scenario: Finding a 70-year-old patient trying to commit suicide and in history has lost close friends and relatives, and he reports inability to sleep at night and states that his wife has a mental illness. He accepts not to try to commit suicide again.

Nursing diagnosis: reported life stress, alteration in social participation, and ineffective individual coping.

Subjective data: on assessment, the patient cannot sleep at night and states that his friends are gone, and he’s unable to deal with stress.

Objective data: Admitting a 70-year-old male due to suicidal attempts and according to the patient's history, he lost close friends and relatives and has agreed to a verbal safety contract.

Nursing outcomes: During hospitalization, he will remain safe, and by discharge, there will be increased self-control reported. At the time of emotional assistance, the patient will verbalize two people. There will better sleep abilities.

Nursing interventions: passing the patient’s suicidal thoughts. The patient will have an opportunity for his hospitalization. The patient will be encouraged by the nurse to verbalize feelings.

Reference

Finn, Stephen E; Tonsager, Mary E (December 2017). "Information-gathering and therapeutic models of assessment: complementary paradigms" (PDF). Psychological Assessment. 9 (4): 374–385

Poston, John M; Hanson, William E (June 2019). "Meta-analysis of psychological assessment as a therapeutic intervention" (PDF). Psychological Assessment. 22 (2): 203–212. doi:10.1037/a0018679.

Smith, Justin D (Spring 2017). "Therapeutic Assessment with children and families: current evidence and future directions" (PDF). Emotional & Behavioral Disorders in Youth. 10 (2): 39–43.