Nur4636 Case Study Chapter 28 Working With The Homeless Sall
Nur4636case Studychapter 28 Working With The Homelesssally Anne Age
Nur4636 Case Study Chapter 28 – Working with the Homeless Sally Anne, aged 19, brought two children into the emergency room. The 6-month-old boy’s complaints are a cold with mild fever, fatigue, vomiting with dry coughing spells, decreased intake of cola (2 ounces every 3 hours—her version of clear liquids), one scraped diaper per 12 hours— the diaper is not soaked so Mom recycles it after scrapping off the solids. The child’s cry is weak, red eyes, sneezing moves thick mucus, prolonged cough, high-pitched noise during intake. The child’s condition did not improve over the last 24 hours. The family of three lives in the family sedan parked behind a service station due to Mom’s fear of lack of shelter safety.
Turk, the 3-year-old, sports bruises on arms and legs, and a knot on his forehead. He appears semiconscious (responds to light pain), coughs when disturbed, refuses fluids and food, and pulls away from touch. Mother states that he has been sick for more than a week, but she is concerned that he has not been as fussy the last 24 hours. His skin tents when pinched. Sally Anne believes he lost weight but has not used a scale.
Turk does not look adults in the eye or follow a finger point. He moans but has not communicated with words. He appears to fantasize, and finger plays violently. His fingers seem to attack each other. He does not seem to listen nor does he respond NUR4636 to questions.
Both children are wearing dirty clothing. Mom is exhausted and asks for help with formula and diapers. Treatment: Both children kept overnight for assessment in a room with a bathroom and couch. Mother permitted to bath and wash children’s clothing after their baths. Cooling mist tent ordered.
Children placed next to each other for convenience and for precautions. Social worker involved for discharge planning. The boys are placed on IVs for hydration and given clear fluids for drinking. Antibiotics are placed in the IV.
What information is needed for a complete assessment?
A comprehensive assessment requires detailed history and physical examination of both children, including developmental, nutritional, and psychosocial factors. For the infant, assess hydration status, feeding patterns, immunization status, and signs of respiratory distress or infection. For Turk, evaluate the extent of physical injuries, neurological status, nutritional status, and behavioral indicators of trauma or neglect. It’s essential to obtain maternal history regarding prenatal care, past medical history, and social circumstances. Environmental assessment should include housing stability, safety, and possible exposure to abuse or neglect. Screening for possible abuse, neglect, or trauma is critical, especially given the physical findings and behavioral symptoms observed. Laboratory tests, imaging if necessary, and developmental screening tools should be employed to obtain a complete picture.
Will this family be worse off when released from the hospital? What community resources for homeless families could be activated in the small town? What prevents the family from falling through economic cracks that will prevent developmental assessments and treatments?
This family is likely to face ongoing challenges upon discharge due to their homelessness, lack of shelter, and socioeconomic hardships. Without stable housing, access to consistent healthcare, and social support, their children are at increased risk for developmental delays, untreated medical conditions, and further abuse or neglect. Community resources in small towns that could be activated include homeless shelter networks, community health clinics, home visiting programs such as family support or parenting education, food banks, and local charitable organizations. Local social services can assist with temporary shelter placement, Medicaid or other health insurances, and developmental assessment services. Barriers include transportation issues, limited healthcare facilities, social stigma, and lack of awareness of available resources. Coordinated case management and collaboration among social workers, healthcare providers, and community organizations are essential to bridge these gaps.
In conclusion, addressing the needs of homeless families with young children requires a multidisciplinary approach emphasizing assessment, intervention, and connecting families to community resources to break the cycle of homelessness and ensure developmental and health needs are met.
Paper For Above instruction
The case study of Sally Anne’s family highlights significant challenges faced by homeless families, especially those involving young children. The complexity of assessing and managing such cases underscores the importance of comprehensive evaluation and effective connection to community resources. This paper discusses the assessment needs, potential post-discharge challenges, and community interventions vital for supporting homeless families with children, emphasizing the nurse’s role in advocacy, assessment, and resource coordination.
Assessment of the Children
A complete assessment begins with detailed history-taking and physical examinations for both children. For the 6-month-old infant, the focus should be on respiratory status, hydration, nutritional intake, and immunizations. The infant’s respiratory symptoms—weak cry, thick mucus, and cough—suggest respiratory infection requiring thorough examination and possibly chest radiography. Hydration status is critical due to decreased intake and vomiting; laboratory tests like serum electrolytes, blood counts, and possibly a chest X-ray will help determine severity. Developmental screening is also necessary to note any delays that could indicate neglect or trauma.
For Turk, the assessment must include a detailed injury history, neurological examination, and behavioral assessment. Bruises on extremities and a forehead knot raise concern about physical abuse, requiring careful documentation. Signs of dehydration—skin tenting and refusal to eat—must be addressed alongside neurological status evaluations. Behavioral signs, such as violent finger movements and apparent hallucinations or fantasizing, indicate possible trauma or neglect. Standardized trauma screening instruments should be employed, and observations should be made regarding developmental milestones. Laboratory assessment may include blood tests to evaluate for infection, anemia, or trauma-related anomalies.
Environmental assessment involves evaluating living conditions—recognizing that the family lives in a vehicle, indicating extreme housing insecurity. The social history should probe for signs of abuse, neglect, or exposure to unsafe environments. Mental health screening for both mother and children, considering her exhaustion and the children’s health status, is critical.
Post-Discharge Prognosis and Community Resources
Families facing homelessness are at considerable risk of adverse health and developmental outcomes. Upon release, this family may be worse off unless extensive support structures are activated. Continuous access to healthcare, stable housing, and social services is crucial to prevent deterioration in health status, developmental delays, and recurrence of neglect or abuse.
In small towns, community-based resources are often limited but still vital. Local homeless shelters, if available, can provide immediate shelter. Healthcare services, such as community clinics or mobile health units, can offer ongoing medical care. Family support programs, such as home visitation services (e.g., Nurse-Family Partnership), can address child health, parenting skills, and developmental monitoring. Food banks and clothing programs alleviate basic needs, reducing stressors associated with poverty. Collaboration among social workers, law enforcement, and healthcare providers ensures timely intervention and ongoing support.
Barriers to Preventing Family Neglect or Developmental Cracks
Several barriers exist in small rural settings, including limited healthcare infrastructure, transportation difficulties, and social stigma. Lack of awareness of available services often impedes access. Additionally, the transient nature of homelessness complicates ongoing follow-up and intervention. Financial constraints, cultural factors, and limited workforce trained in child trauma recognition further hinder early intervention. Addressing these barriers requires strategic partnerships, telehealth utilization, mobile outreach, and community education initiatives.
The Role of Rural Nursing Theory Principles
Rural nursing theory emphasizes the importance of understanding community dynamics, resourcefulness, and cultural competence. In the context of this case, nurses play a pivotal role in advocating for vulnerable families, assessing needs in resource-scarce environments, and facilitating connections with local support systems. Principles such as relationship-building and community participation support sustainable health improvements. Nurses may also lead efforts in health education, trauma screening, and designing culturally appropriate interventions to promote resilience among at-risk children.
Conclusion
Supporting homeless families with young children requires a comprehensive, multidisciplinary approach grounded in thorough assessment and robust community linkages. Rural nursing principles highlight the necessity of community engagement, resourcefulness, and cultural understanding. Ensuring timely intervention and continuous support can mitigate the adverse effects of homelessness on children’s health and development, fostering a pathway toward stability and improved well-being.
References
1. American Academy of Pediatrics. (2019). Health Care for Children Experiencing Homelessness. Pediatrics, 143(2), e20183651.
2. Burt, M., & Pearson, M. (2005). Homelessness and Health. In P. R. Flaherty (Ed.), Rural Health Practice (pp. 155-170). Springer.
3. Cohen, R. (2018). Social and Emotional Well-Being of Homeless Children. Journal of Child and Family Studies, 27(7), 2134–2145.
4. National Center for Homeless Education. (2020). Supporting Homeless Children and Youths: Resources and Strategies.
5. Rorke, M., & Goldstein, S. (2018). Pediatric Homelessness: A Public Health Priority. American Journal of Public Health, 108(7), 900-901.
6. World Health Organization. (2013). Health in Small Rural Communities. WHO Publications.
7. Johnson, K., & Bullard, R. (2019). Addressing Childhood Trauma in Rural Settings. Counseling Outcomes and Research, 10(3), 212-228.
8. United States Interagency Council on Homelessness. (2021). Strategies for Ending Family Homelessness.
9. Krug, E. G., et al. (2002). World Report on Violence and Health. WHO.
10. Hill, C., & Turbin, M. (2020). Rural and Urban Healthcare Disparities. Rural & Remote Health, 20(1), 5878.