Case Study, Working With Vulnerable People Glenna, age 38, lost leg function dur

Case Study, Working With Vulnerable People
Glenna, age 38, lost leg function during a motor vehicle accident at age 16. She plays basketball at the community center and teaches aerobic classes for wheelchair-bound people three times a week. Since her husband died, she’s managed a medical equipment rental business, but the business is not profitable. Her physician has referred her to the public health department for a developmental assessment.
A nurse hears angry shouting as she steps toward the porch of the tiny house with peeling paint. The nurse steps over a broken tread and knocks on the weather-stained door at the end of a ramp. Suddenly a large man bursts through the doorway tugging on a T-shirt and muttering. The nurse glances past the fleeing man. Three children, ages 18 months, 4 years, and 6 years old, kneel on linoleum worn through to the wood. The TV blares a cartoon. No one hears her knock as the children stare at their mother, who is crying and holding her cheek. The nurse knocks a second time on the open door and introduces herself. The woman wheels around to face the other way.
“We are busy. Please come back later,” the woman speaks over her shoulder.
“Pick up the blocks, Chica. Make sure the back door is locked, Stephano, and please make a peanut butter and jelly sandwich for your brother and sister.”
“Not now, Jon,” She tells the youngest child, who is banging a block on her wheel.
The nurse replies, “I can make another appointment, but it will only take a few minutes to assess Jonathan now that I am here. Your physician said you are concerned about his development. If you could answer a few questions, I feel sure we can help you. I can help make the sandwiches while we talk.” The nurse’s scan of the living room located a stained spoon and knife near a broken mirror on the coffee table along with a towel, toys, and a magazine. Chica’s hair was uncombed. The boy’s hair hung to his shoulders and looked unwashed.
The mother pulled her robe together over her chest and folded her arms. “You can’t help. Jon is normal but different. You will ask a 100 questions, insult me, and then say there is nothing you can do, just like the doctor did. He made us wait 45 minutes and then says he is going to call someone else. We don’t need that kind of help. Jon is a smart boy with attention problems. I need to clean up. We don’t have time to talk right now.” Raising her voice, she says, “Chica, pass me the cigarettes, will ya? Gracias.”
Jon continues banging his mother’s chair and vocalizing. The children stare at the nurse. Chica looks afraid. Stephano looks hopeful. His dirty pajamas end well above the ankle (Learning Objective: 3).
1. Should Glenna consider herself disabled or at risk? Why? And should the nurse consider Glenna’s family at risk? Why?
2. What history questions will reveal predisposing, social, or enabling risk factors?
3. What risk clusters can be identified?
4. What community health nursing techniques could empower Glenna and her family?
5. How can the nurse avoid insulting the mother?