How can I create a nursing diagnosis/ care plan on individual and community levels for the poor and or homeless population with bad eyesight?

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Ashley Kannan | Middle School Teacher | (Level 3) Distinguished Educator

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Providing quality health care to the poor and homeless is a daunting task. Using the nursing process, one can construct paths that might prove to be quite helpful in outlining the challenges and potential paths for solutions.  

In the phase of assessing the problem, the fundamental issue is what nurses can do to provide the poor and homeless population with help for bad eyesight. Some of the objective data that will have to be collected would be where homeless people reside, what kind of services are needed and what can be provided, and how to generate rapport with this particular segment of the population.  Another aspect of this phase would be for nurses to examine their own predispositions towards helping homeless people and those who are economically challenged.  The reality is that this population contains a special set of characteristics that might be different from what nurses encounter:

Many habits of homeless people, such as panhandling, infrequent bathing, and obtaining food from dumpsters, conflict with cultural norms. Often enduring conditions that would incapacitate others, homeless people may derive a sense of achievement from their survival skills they didn't experience in the mainstream world.  

If the element of self- reflection is not present, care and effectiveness will decrease.

The actual diagnosis offered is the issue of poor eyesight and addressing the needs of opthalmology in this segment of the population.  Related factors to this condition would have to be examined in a particular group, but I think that a fair set of related factors would be how prolonged neglect in eye care can impact the life process and quality of life of individuals who are homeless or lack economic resources.  For a nurse, this can be seen in different aspects, such as difficulty in seeing traffic lights or at crosswalks or even simply recognizing aspects of the daily world for patients who are economically challenged or homeless.  

In the planning phase, there will be a holistic analysis of nursing outcomes that can be actualized.  This might involve a seres of identification outcomes, such as being able to provide on site eye exams and diagnosis to patients "on their turf."  It might also be seen in a nurse being able to travel to shelters, soup kitchens, or even to where a person might be staying.  Part of this identification of outcomes will be that the nurse most likely will have to make "house visits." This increases rapport with a population that is largely mistrusting of the medical community and reduces stigma for one who is homeless or economically challenged in going to the doctor's office. The planning phase should include how there will be an outreach from the nurse to the patient: "Outreach and case-finding is important. Building rapport is easier if patients are met on their own turf-shelters, soup kitchens, and on the street. Be aware of common factors that hinder treatment and work to overcome them."   This element is critical to establish in the planning phase of the nursing process.  In terms of addressing community concerns, this would be where the nursing plan should include some outreach to particular parts of the opthalmology community in their assistance.  It might include donation of time, materials, or even of trained professionals to assist nurses.  The nurse can help to facilitate both the individual and community approaches to this problem.  This would be featured in this aspect of the process.

In developing the implementation portion of the nursing process, the nurse would have to act as a liaison between the patients and the opthalmologist. The implementation phase will be more successful if the nurse envisions themselves as the connecting bridge between the doctors who can make critical diagnoses and provide remedies and the patient who might be distrustful of medical professionals and/ or requires a bit more help in receiving such services.  I think that the implementation phase will necessitate the nurse in making sure that resources are present, outreach is consistent, and that the patient's needs are understood.  The nurse is the first line of defense and they will be the most instrumental in being able to establish the rapport and trust to ensure that eye care is both delivered as well as sustained.

Finally, through evaluation, the nurse reflects on what worked and what more is needed.  I think that in being able to provide adequate eye care to poor or homeless individuals, this will take the form of asking the question if more could be done.  Were as many people as possible reached, could there be more reached, and how to expand the program to being more sustainable over an extended duration is a part of this.  At the same time, I believe that another issue that should be addressed is whether prescribed diagnoses are maintained. With economic challenges and homelessness, the temporal notion of being is one where diagnoses might not be fully embraced because other needs take precedence.  Part of the nurse's challenge in the evaluation phase of the planning process is to ensure that solutions are not temporary, but rather long term, requiring the nurse's rapport with the patient to continue.

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