Hme visit

Running head: HOME VISIT WITH SALLIE MAE FISHER
Home Visit with Sallie Mae Fisher
Kathleen Bolfrey, Debra Feliciano
Sherwyn Henry & Carmette James
Grand Canyon University – NRS-410V
December 11, 2016
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HOME VISIT WITH SALLIE MAE FISHER
Home Visit with Sallie Mae Fisher
Four Problems Identified and Substantiating Evidences
Sallie Mae’s safety at home was the first priority problem identified. It can be seen that
she almost tripped on a loose rug at the floor. This condition makes her more prone to accident
which would lengthen her recovery time. The second priority problem was medication
management. Sallie Mae needs an extra drug therapy for synergistic, prevention, or palliative
care. Also, the dosages of drugs need to be titrated to attain therapeutic levels to accomplish the
anticipated therapy goals. Medications are the most important aspect of a patient’s life and are
involved in more than 80 percent of all the interventions and treatments (Gilbert, Et.al, 2002).
The third priority problem was significant non-adherence to the discharge plan and risks
associated to non-adherence. She verbalized her refusal for oxygen and lack of interest in diet.
Risk factors for non-adherence include age, polypharmacy, and solitude (Fenerty et al., 2012).
The last problem identified was Sallie Mae’s depression. Mrs. Sallie, voiced that her thoughts
have been cloudy and still mourns her husband, Woody. She feels alone and her daughter was
busy with her own home situation.
Medical and/or Nursing Interventions and Rationale for Interventions
Health education on the compliance to her discharge instructions and non-adherence is a
priority nursing intervention. Education enhances her involvement in care hence strengthening
compliance. According to Andrietta, Moreira, and Barros (2011), patient education is the best
remedy for non-adherence to discharge plan. Training her on identifying and use of appropriate
reminder systems. Fenerty et al. (2012) determined that use of reminder systems are very
effective in enhancing compliance with discharge plans and medication.
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Incorporating significant others in her care such as family members to monitor her
progress. According to Hunter, Nelson and Birmingham (2013), compliance with the discharge
plan can be enhanced by incorporation of various health workers and other significant members
such as family under the stewardship of the case manager. A final intervention involves an initial
home visit in the first week of discharge to enhance her compliance to discharge instructions.
According to Andrietta, Moreira, and Barros (2011), the primary cause of non-adherence
to the treatment plan is low levels of health literacy. Health education equips the patient
information regarding her care fostering her compliance to discharge and medications. The use
of reminder system reminds the patient on the medication frequency and diet leading to
improved compliance. Training her on use of reminder system will rejuvenate Sallie’s cognitive
function and foster compliance.
Involving significant others in care ensures the patient receives holistic support; improve
self-esteem and encouragement to adhere to the discharge plan. In this context, the incorporation
of other health professionals and family will encourage the patient to adhere to treatment.
According to a study by Mulhem et al. (2013), most of the non-adherence cases occur during the
first three days after discharge. Conducting home visit for the first seven days to guide her on
compliance will enhance her compliance.
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References
Andrietta, M. P., Lopes Moreira, R. S., & Bottura Leite de Barros, A. L. (2011). Hospital
discharge plans for patients with congestive heart failure. Revista Latino-americana de
enfermagem, 19(6), 1445-1452.
Fenerty, S. D., West, C., Davis, S. A., Kaplan, S. G., & Feldman, S. R. (2012). The effect of
reminder systems on patients’ adherence to treatment. Patient Prefer Adherence, 6, 127135.
Gilbert, A. L., Roughead, E. E., Beilby, J., Mott, K., & Barratt, J. D. (2002). Collaborative
medication management services: improving patient care. Medical Journal of
Australia, 177(4), 189-192.
Hunter, T., & Birmingham, J. (2013). Preventing readmissions through comprehensive discharge
planning. Professional case management, 18(2), 56-63.
Mulhem, E., Lick, D., Varughese, J., Barton, E., Ripley, T., & Haveman, J. (2013). Adherence to
Medications after Hospital Discharge in the Elderly. International Journal of Family
Medicine, 2013, 1-6. http://dx.doi.org/10.1155/2013/901845
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