Mery Tonkin

Community nursing
This paper centers round the case scenario of Mrs. Mary Tonkin, a 79 years old woman,
who had spent five days in hospital settings recovering after an episode of dizziness, shortness of
breath and fatigue. Mary has had a brief period of atrial fibrillation (AF), which has been resolved
and Mary is ready to go back to home. Mary Tonkin lives alone in a house in the suburb of Marion
in metropolitan South Australia. Mary lost her husband ten years ago. Mary lives alone and she
becomes very tired occasionally, diaphoretic and short of breath to carry out simple daily activities
of living and household tasks like gardening or cleaning. She also tends to be forgetful about
things. The past Medical history states trans ischaemic attack on 2016, a right sided
cerebrovascular accident, a diverticulosis, atrial fibrillation, cholecystectomy, hypertension,
recently diagnosed type 2 diabetes, a colles fracture due to fall at the home with internal fixation,
a humerus fracture due to a fall at home (According to case study provided).
This paper will discuss about the role of the community nurses is addressing an actual
communication issue in relation to this case study and the primary health care in relation to this
client.
How the principles of primary health positively affect the client’s management?
Primary health care can be defined as both a philosophy of health care and an approach to
provide health care services to individuals, families and communities (Roberts & Blanchfield,
2020). It is a whole society approach to health, which generally includes disease prevention,
health promotion and treatment (van den Dries & et al., 2016). Primary health care generally
embraces five types of care, i.e. promotive, preventive, curative, rehabilitative,
supportive/palliative (Smolowitz et al., 2017). The PHP principles includes equity, community
participation, intersectoral coordination and appropriate technology. In this case scenario, it has
been mentioned that Mrs. Mary Tonkin had rapid atrial fibrillation that has been resolved. Here,
the role of community nurse is crucial. For instance: Community nurse emphasized on
promoting health and also maintain an extent of balance to health, measuring care and early
identification of disease. This role of community nurse distinguishes her from hospital nurse as she
provides care to patient in his or her own environment. In case of Mrs. Mary Tonkin, she is able to
provide her with appropriate care in her home only. Under PHP principles, community nurse
provides appropriate care to patient. The community care nurses can play an important role in
providing information and advice to Mrs. Tonkin, about the management of AF in the post
discharge period (Vandermolen, Sadaf, & Gehi, 2018). Mrs. Tonkin lives independently and her
declining health over the past three years created difficulties for her to carry out daily activities. In
such a case a community nurses can pay visits to her for a follow up. This should be followed by a
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physical examination and checking of the vital signs, such as blood pressure, respiratory rate,
heart rate or would assess for symptoms like chest pain or light-headedness.
Mrs. Tonkin might also receive fortnightly telephone at home from the community nurses to
monitor her progress towards setting goals and medication adherence (Tu & et al., 2018). She will
be assessed and reviewed on her management of the risk factors like hypertension and TIA. It has
already been mentioned in the case study that Mrs. Tonkin had become forgetful recently, which
indicates that she might fail to take medications on time. She would be educated regarding the
importance of medication. As a philosophy the public health care is totally depends over the value
of equity, social justice and solidarity. The Primary health care philosophy mainly identifies that
the citizens must have the requisite skills as well as knowledge so that they can improve their
health status. Hence, in context of Mrs Mary it is the main role of nurse to provide her with better
understanding about the things that she must do in order to take better care of herself, so that
she could be able to manage herself at the time of hypertension or when she feel dizziness. This
philosophy suggest that the citizens work collaborate with health care representatives in order to
mobilize the community efforts toward promoting and maintaining good health while taking up
active role toward development of strategies for meeting up with varying health need.
Another philosophy of public health care is focusing all the actions and practices toward the
main issue that client is having which means that PHC must remain to illness oriented and expert
driven where the professional are assigned with the cases who are experienced in dealing with
particular type of issue. Hence, the case of Mrs Mary must be provided to the nurse who is
experienced in handling the patients with issues like diaphoretic, short of breath, Diverticulosis
and Cholecystectomy, so that Mrs Mary would be able to get right kind of treatment and
medication which she requires to get recover soon. Nurse must follow the procedure for providing
service such as identifying the health problem and then prepare the treatment plan and provide
follow up to senior professional for specific issue to provide better care and ask for improvement in
plan.
In such a case, the patient can be provided with dose administration aids such as Webster
packs and satches. Community nurses provide accessibility of care with referrals to appropriate
health professionals under PHC principles. Hypertension and type 2 diabetes are the important risk
factors that is associated with atrial fibrillation and an increased risk of cardiovascular events in
the patient with atrial fibrillation. Both the risk factors can be addressed by proper diet and
exercise regimen (van den Dries et al., 2016). The community nurses can provide advice on the
life style behaviours like diet and incidental exercises, all of which fall under the remit of the nurse
in improving the health of patient (Roberts & Blanchfield, 2020). This would prevent any further
health related complications and thereby relieving the costly burden. Mrs. Tonkin will be asked to
establish a personalized life style modification goal and develop personal action plans. Mrs. Tonkin
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can be provided with an “intervention diary” for documenting her life style goals, progress towards
the goal, medication adherence related to hypertension, Type 2 diabetes mellitus, adverse
events”. Mary has left sided leg hemiparesis due to her recent stroke but, somehow manages to
walk with the assistance of a walking stick. In that situation, community nurse plays crucial role in
providing appropriate care to Mrs. Mary Tonkin at home. For instance: Community nurse can
administer supportive care services to her which helps her in overcoming the issues that she faced
related to her health. Community nurses can assess the patient for falls, by using fall risk checklist
including assessment of the intrinsic factors such as mobility, functioning of the lower extremity,
medications, vision, medications, footwear and past medical history (Zhang & et. al., 2020).
Extrinsic factors like tripping, or other environmental hazards that can occur at Mary’s home
require to be considered (Zhang & et. al., 2020). Accordingly, community nurses can educate Mrs.
Tonkin’s son to live with Mrs. Tonkin as it would be risky to leave her alone. The community nurses
are responsible to provide supportive care services like arrangement of community based
approaches in order to overcome the health related issues from which she suffers. Community
nurses are responsible to ensure wellbeing of individual as well as community by timely screening,
assessment, education and management (Muntean, Tomita & Ungureanu, 2013).
Role of the community nurses in resolving potential communication issues
The community nurses have to work with patients with cultural, linguistic and religious
differences. They need to have good communication skill so that they can communicate effectively
with the patient in order to ensure better patient outcomes. Hence a community nurse should
ensure that the patient receives high quality care and a constant communication is maintaining
with Mary Tonkin so that she get appropriate care. By using appropriate communication channels,
effective communication can be maintaining between nurse and Mrs. Tonkin. Furthermore, it has
already been mentioned in the case study that Mary Tonkin is getting forgetful these days. These
symptoms depict that the condition of Mary Tonkin leads her towards mild to moderate dementia,
which establishes a genetic association with her mother’s medical history of dementia. A body of
literature on the communication between the health care workers and patient has suggested
speech characteristics such as “elder speak” or controlling of the vocal tone which may assist in
understanding the situation of Mary and treat her effectively (Stanyon et al., 2016). Some of the
other approaches includes use of smaller sentences and increase the communicative behavior
(Stanyon et al., 2016). Short term memory loss is a common symptom for those suffering from
dementia (10 Early Symptoms of Dementia, 2018). For instance: As Mrs Mary Tonkin suffered from
several health issues, and forget many things, it creates communication issue between her and
community nurse. This may make it difficult for community nurse to develop appropriate care plan
for Mrs. Mary Tonkin.
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For better care of a Mrs. Mary Tonkin it is very much crucial for the nurse to communicate
with her and try to identify the number of issues she is facing so that proper treatment and care
plan can be developed to provide better care services to her. As Mrs Mary Tonkin is suffering from
numerous of issues and also experiencing the forgetful these days it become quite difficult for her
to remember all the things together and take care of herself. Due to this the community nurse is
also facing issue in communication as when nurse ask her for certain practices that Mary have
done, then she not be able to respond them properly due to her issues of forgetting thing. Addition
to this she also sometimes forgets to take medicines and tell nurse that she had. These all creates
a communication barrier among both of them which make it difficult for nurse to sometimes
understand the situation and responses that are provided by Mary which in turn affect her care
plan. Other than this due to her forgetful nature it seems quite difficult for Mrs Mary to understand
the things which nurse communicate to her as she doesn’t able to decode things clearly. So, nurse
found difficulty in communicating with Mary as she doesn’t understand the information that nurse
communicate her, not able to assess the instructions provided to her and also find difficult to
respond to nurse.
Some techniques like validating the feelings of the patient and provision of reassurance
and redirecting them to another topic, breaking questions to multiple parts, keeping background
noises to minimum, communicating through affection, touch, comfort and assurance are
necessary to communicate with patients having dementia (Wang, Hsieh & Wang, 2013). The role
of nurse is to provide appropriate care to Mrs. Mary so that her condition can be improve.
Dementia affects thinking, reasoning and memory, but the feelings of the patient remain intact.
Hence, the suggested method for caring of dementia patient is to encourage patients in
expressing their feelings. It is necessary to pay close attention to the tone, pitch and speed of the
speech (Judd, 2017). Use of non - verbal cues, like facial expressions, grimacing or eye contact are
important for community nurse while communicating with Mrs. Tonkin as these helps her in
understanding what the nurse wants to say. Crying or facial grimacing can be used for
understanding whether the patient is in pain or not. Non-verbal cues help to clarify problems which
patients often fail to articulate (Judd, 2017).
Community nurses can set alarms on devices in order to remind patient like Mrs. Tonkin
about medications and their meal time. However, it is necessary to remain mindful that constant
reminders cannot hinder her personal time or sleep. Constant time restrictions can make Mrs.
Mary Tonkin agitated. A community nurse plays crucial role in maintaining the dignity and self-
respect of a patient (Conway, O’Donnell, & Yates, (2019). It has been suggested by the
Alzheimer’s society, that flexibility, listen appropriately to the patient and showing affection in a
way which is comfortable for the patient and caregiver helps in improving the health of patient by
providing them with effective care. Time constraints placed on the nurses and deteriorating
condition of the patients to communicate can create frustrations (De Vries, 2013). Since, Mrs.
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Tonkin stays alone at home, there can be an emergency contact system that can be used by Mrs.
Tonkin during an emergency. The community nurses can improve their ability to communicate
with elderly patients by understanding the barrier to communication. Employing effective
communication strategies improves the patient’s care quality and reduces the stress of care
providers, the family members as well as the patient.
Hospital avoidance aimed at declining unplanned presentations, readmissions or
admissions acute care facilities. These services are generally rendered in ambulatory setting -
either community or home based - are targeted to individuals with high risk of unplanned
readmissions, presentations or admissions. However, some strategies associated with hospital
avoidance may also be executed in acute care setting. These aims to decline acute phase of
health care of patient and reduce their length of stay in hospital. In relation to Mrs. Mary Tonkin,
she was fearful of hospitals as well as adamant that she wished to stay in her own home. She
forgets things at times and had some left sided hemiparesis due to her decent stroke. Due to her
declining health, she needs appropriate care. In the situation, the role of community nurse is to
provide basic care to her like checking blood pressure, temperature and breathing on regular basis
in order to monitor and review her health condition appropriately and providing proper treatment
to her. For instance: In providing treatment to Mrs. Mary Tonkin at home as she was fearful to
hospital and didn’t want to go there, it is the role of community nurse to deliver her care out with
acute hospitals, i.e., in home, in community hospitals, within General Practice facilities or in a care
home. This role of community nurse distinguishes it from the role performed by nurse in any other
setting. Community health nurse able to serve Mrs. Mary Tonkin in her own home to improve her
health and promote wellness. Community nurse aims to decline the risk of Mrs. Mary Tonkin and
eliminate the need of hospital treatment.
Conclusion
In conclusion, it can be said that community nurses can play an important role in caring for
elderly patients like Mrs. Mary Tonkin by using promotive, preventive, curative, rehabilitative,
supportive/palliative approaches of primary care. The primary health care provided by the
community nurses would include timely follow up and visit, assessment of health and fall risks.
One of the role performed by community nurses includes patent’s education about medication
adherence, diet and life style modifications. Community nurses can carry out effective
communication with elderly patients by following appropriate verbal as well as non-verbal
techniques. Active listening, using appropriate and short sentences, appropriate tone, using
appropriate voice and speech can be helpful in effective communication with an elderly patient.
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