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Community nursing - This assignment will focus on the issue of Risk Assessment with relation to falls in the home in the elderly population.

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COMMUNITY NURSING This assignment will focus on the issue of Risk Assessment with relation to falls in the home in the elderly population. It will discuss the relationship between the community healthcare team and the individual client, the government policies related to the topic, and the influences of health policy upon the provision of community care. The role of the community nurse in public health education and promotion will also be explored. The client, in this particular instance, is Mrs Pugh. She is an 84-year-old female who lives alone since her husband's death 3 years ago. Mrs Pugh has a previous medical history of 'unexplained falls'. Her medical records also highlight the fact she is suffering from osteoporosis and arthritis. Mrs Pugh has recently been discharged home from hospital following surgical repair of a fractured tibia and fibula, the result of another 'unexplained fall' at home. Mrs Pugh has a carer who comes in daily to assist with hygiene, helping Mrs Pugh have a shower each day; she also supports Mrs Pugh with general domestic tasks. It is important to emphasise that the pair of them have developed a very good relationship. Mrs Pugh has always been a fiercely independent lady and doesn't take kindly to any, as she puts it, interference in her personal life. However, the relationship she has with her carer is very important to her. Health promotion is based on theories about what influences peoples' health and then what constitutes an effective intervention or strategy to improve health (Naidoo and Wills 1999). ...read more.


sedating or blood pressure lowering medications, visual impairment, postural hypertension and impaired cognition i.e. depression, Alzheimer's disease, memory loss. Environmental risk factors within the home include: poor lighting, steep stairs, loose carpets or rugs, badly fitting footwear or clothing and lack of safety equipment. To identify those older people at risk of falling assessing these factors may help: have they had previous fragility fractures? Have they attended an Accident and Emergency department as the result of a fall? Do they have two or more of the intrinsic factors documented above? Are they afraid of falling after a previous fall? Home visits and surveillance to assess, and where appropriate, modify environmental and personal risk factors can be effective in reducing falls. This can be carried out by nurses, health visitors, occupational therapists or trained volunteers (NHS 1996b). With regard to the individual patients' previous medical history, Mrs Pugh has a diagnosis of osteoporosis. This can increase the potential for serous fractures if she falls, this is due to the osteoporosis reducing bone mass and density. Fractures occur most commonly in the hips, spine and wrist (Alexander, Fawcett and Runciman 2000). Consequences for an individual falling or not being able to get up after a fall can include: psychological problems i.e. fear of falling again, loss of confidence, loss of mobility leading to social isolation and depression, increased disability, dependency, hypothermia, infection and pressure related injury. ...read more.


As our presentation was to be in a clients' home environment, both Stephanie and I felt we should try to recreate a believable setting. The props we used, such as the zimmer frame, were organised well in advance, with the kind help of the physiotherapy department. We also bought things in from home. It was important for us to set the scene right, after our efforts to get the props, so we decided to arrive early and rearrange the room into our 'set'. We rehearsed our dialogue well, although I think I still managed to surprise Stephanie a couple of times, and I feel the presentation clearly represented a challenging situation. I feel the group enjoyed our presentation, as I did theirs, and was pleased with the feedback and the discussion our presentation prompted. There were some very good constructive opinions, which I have taken on board. The topic was interesting to research and the actual performing of the scenario was enjoyable. Personally, I feel so much more confident liasing with my peer group and of speaking openly and honestly when offering opinions. Professionally, I have learnt, through my research into this topic and the presentation, that as a professional nurse, dealing with people, you have to be prepared to be able to deal with whatever situation you may find yourself in. communication skills are the nucleus of nurse-patient relationships, not every patient is willing to conform to what you maybe telling them, especially elderly patients who are living independently in the community. JAYNE HOBSON. 28001001339742 10 ...read more.

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