Community Health

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Introduction

In this assignment the author will explore Duchenne Muscular Dystrophy and the role of the community nurse. The author will explore the assessment, challenges and role of the community nurse in order to gain a better understanding of Community Health Nursing. The following is the case study to which the assignment will be based:

Liam Byrne is an 8-year-old boy who lives with his parents Elaine and Michael and his two siblings Fiona aged 4 years and Deirdre aged 6 years. They live in a two-story semi-detached house in a small town. Liam has Duchenne muscular dystrophy (a life-limiting genetic condition) and is now unable to walk. Michael is in full time employment, while Elaine works full time within the home.

Assessment

Richman and Schub (2010) describe Duchenne Muscular Dystrophy as the most severe group of incurable inherited muscle wasting diseases. DMD is an X-linked disorder characterized by progressive weakening of the skeletal and voluntary muscles. At present there is no cure for DMD, the main treatment focus is control of symptoms and management of complications. These complications include: • Dilated cardio-myopathy

• Respiratory Impairment
• Joint contractures
• Scoliosis
• Dysphagia

Roper, Logan and Tierney (2000) developed a model of nursing and within this model they developed a Model of Living. The main features of this highly complex phenomenon are as follows:

|MODEL OF LIVING | |Activities of Daily Living | |Lifespan | |Dependence/Independence continuum | |Factors influencing AL’s | |Individuality of Living |

Within the Model of Living Roper, Logan and Tierney (2000) developed the Activities of Living. They state that “the model of living must describe what living means.” (Roper et al 2000 p15). Upon investigation they found that many people describe eating, drinking, working, playing and sleeping were concepts of the AL’s. Roper at al (2000) found that once prompted they agreed that communicating and breathing are also AL’s but theses tasks are often carried out without much thought. In conclusion to this the AL’s of are as follows:

|ACTIVITIES OF LIVING |
|Maintaining a safe environment |
|Communicating |
|Breathing |
|Eating and Drinking |
|Elimination |
|Personal cleansing and dressing |
|Controlling Body Temperature |
|Mobilizing |
|Working and Playing |
|Expressing Sexuality |
|Sleeping |
|Dying |

Bringing in the Roper, Logan and Tierney Model of Living, it is vital in order to carry out an appropriate community assessment of Liam’s condition. Liam’s condition is forever changing due to the progression and degeneration of his Duchenne Muscular Dystrophy.

Research indicates that “Information derived from community health needs assessment forms the basis for the planning and delivery of care. (Blackie 2000). Assessment is the first initial step in any nursing process whether it is in a hospital setting or a community setting. This is where a nurse is able to interact with the patient to gather the relevant information needed to recognise change, analyze needs and plan the care. Along with the interaction the nurse also assess the patient’s physical, emotional and cognitive status. This...
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