Case Study for Discussion
This case study provides you with an opportunity to immerse yourself in the role of a community health nurse and explore the resources in your community. As you work through the case, reflect on what you have learned about community health nursing in this course, and how you can apply it to this case.
Your client: Mary is a 23-year-old Caucasian female. She is in her first trimester of pregnancy and is developmentally delayed. She has a dual diagnosis of a bipolar disorder. She is currently unemployed but receives Social Security Disability checks monthly. She lives with a roommate in a project apartment complex in a run-down part of town.
Anne has visited Mary once and provided the following information as she hands the case to you. Mary had a baby removed from her care when she was 19 years old. Mary cannot explain why this baby was removed other than her house was dirty. She met the father of her current baby on the Internet and states that she has not heard from him recently.
During Anne's visit, Mary stated that she wanted to keep the baby. She asked many questions about healthy eating and having a healthy pregnancy. Mary stated that she has visited the WIC office, received WIC vouchers, and met with Mark who talked to her about what to eat. She asked for help to find a nice apartment and to make other improvements so that she can keep this baby.
When Anne started to explore options and difficulties she might encounter in raising this child, she stated that Mary became agitated and did not comprehend why her baby might be removed from her other than "They are against me!"
Christina, Mary's social worker, was able to find the past court records indicating that her first baby was removed due to neglect and living in an unsuitable environment. At that time, Mary was living with her parents in another county. The records indicated that Mary did not show up to her court appointment to appeal the decision, so the baby was permanently removed and has since been adopted.
According to Mary's chart, Tracey from Child Protection Services has stated that CPS is planning on placing Mary's baby into foster care when it is born due to her cognitive impairment and past history.
Your charge: As your first assignment, you are to identify resources in your community that could assist Mary during her pregnancy and help to optimize the health of her infant.
Assurance is one of the three core functions of public health. Find a resource in your community (other than WIC) that could assist Mary during her pregnancy. Start by searching the Internet for your local health department's website. What services (other than your visits and the social worker) do they provide for pregnant women? What about your local welfare office? Are there prenatal or mental health services available? Are there any service organizations, crisis pregnancy centers, or churches providing help for pregnant women?
Briefly describe the types of services that you found and then choose one agency and assess this agency in terms of the 4 As. Is it accessible, acceptable, affordable, or available for Mary or other pregnant women that you case-manage?