Running head: COMMUNITY CASE STUDY 1

Community Case Study

Giselle Franklin

Nursing 210 Health Promotion

September 21, 2016

COMMUNITY CASE STUDY 2

Introduction

An observational study of a Kailua, 81-year-old community client was conducted Friday,

September 16, 2016 by a Kapiolani Community School nursing student. The study took place at

the KCC nursing students home and lasted two hours. The community client is an eighty-one-

year-old Hawaiian-Japanese-American female and will be referred to as J.N.

The purpose of the study is to facilitate a cohesive understanding of the clients

functional abilities and development. Additionally, the nursing will assess the community client

needs and suggest suitable nursing interventions.

Functional Abilities

Functional ability occurs across the lifespan, for older adults, functional status ordinarily

refers to the safe, effective performance of activities of daily living (ADLs) (Giddens, 2017, p.

xx) (see Appendix B).

J.N. is able to perform all ADLs independently based upon her developmental, cultural,

environmental and social factors (Giddens, 2017) (see Appendix C).

Family Dynamics

J.N. was born in 1935 on the island of Oahu in Hawaii and grew up in the Kalhi-Palama

neighborhood of Honolulu. J.N was born to a native Japanese father who immigrated to Hawaii

from the city of Kumamoto, in Japan. J.N.s father was born in 1903. J.N.s mother was born in

1906, she grew-up in Waialua on the Northshore of Oahu. J.N.s mother was born in 1906. J.N.

is the youngest of her siblings. Two of J.N.s siblings are still living, a brother and sister. J.N.

has been married to D.N. for 56 years, they have three adult children and two grandchildren.

J.N. lives in Kailua, Oahu with her husband and an adult daughter (see Appendix A: Eco-Map).
COMMUNITY CASE STUDY 3

J.N. has a loving and supportive relationship with the members of her family. She

continues to communicate often with each of her siblings, her children and grandchildren.

Regular visits, holidays and Sunday dinners are typically shared. J.N. speaks highly of her

family, she feels valued and revered as the matriarch. J.N.s live-in daughter provides support in

her home to both she and her husband. The positive and supportive interactions J.N. and her

family have shared, have shaped who she is and how she interacts with her family as well as her

community (Giddens, 2017).

Psychosocial Developmental Stage

Using Eriksons theory of Integrity vs. Despair (Potter, Perry, Stockert, & Hall, 2017), .J.N.s

psychosocial developmental stage was identifiable as integrity. J.N. showed participation in

family-life, friends, her church and various volunteer organizations. J.N. owns and rents a home

to her church where members of the community may come to worship, eat or pick-up free

household items. J. N.s. spirituality is related to her psychosocial development, as it has

changed over the course of her lifetime. Through decades of generative experiences, an

emotional maturity that interrelates to her spiritual development allows J.N. to principally view

herself with integrity (Giddens, 2017) and without regret (Potter et al., 2017).

Moral Development

Kohlbergs theory of moral development Level III: Postconceptional Reasoning, Stage 5:

Social Contract Orientation (Potter et al., 2017) identified J.N. as one who adheres to societal

norms, but is also able to act independently based upon that which the individual believes

society should do, rather than that which society would do (Potter et al., 2017, p. xx). Many

societal conventions are biased against elderly drivers. J.N. broke with societal norms when she

decided to drive regularly to Mililani to help raise her granddaughters. In order to provide a
COMMUNITY CASE STUDY 4

higher standard of living for her family, J.N. became an accountant in an era where womens

careers were predominately defined as homemakers. J.N.s moral principles have influenced her

independence as evidenced by decisions that both fit into societal norms and exceeded them by

acting in accordance with her own moral construct.

Cultural Practices

J.N. was raised in the Shinto Buddhist Religion, when she was a child she contracted

meningitis, was hospitalized and treated with western medicine. When J.N. did not improve, her

mother consulted a Shinto Priest who prescribed black carps blood as a medicinal cure. J.N.

recovered shortly after she drank the fish blood and has always credited the Shinto God who

dwelled in the black carp for healing her. J.N.s causal belief that supernatural forces were

responsible for her healing are part of her cultural belief system (Giddens, 2017).

J.N. switched to western biomedical solutions to treat illness, such as Vicks Vapor Rub to

treat sinus congestion. This is an example of acculturation, J.N. acquired new health customs

after exposure to western medicinal practices (Giddens, 2017).

Nutritional Assessment

The nursing student conducted a nutritional assessment and a twenty-four-hour dietary re-

call was obtained from J.N. (see Appendix C). At 51 tall and weight of 102 pounds, J.N.s

BMI was 19.3, the low side of a healthy BMI, optimal body weight composition; elderly

persons should strive for BMI >21 (Giddens, 2017). The community client attributed her BMI

to difficulty maintaining an appetite and tendency to skip meals, unintentional weight loss is a

common problem among older adults. Other essential nutrients, including protein and

micronutrients, are likely to be depleted at the same time (McKevith, 2007, p. 34).
COMMUNITY CASE STUDY 5

The Kapiolani Nursing student visually and verbally assessed J.N.s oral dentition. The

findings showed that reduced chewing ability due to an ill-fitting, partial denture may have

contributed to the community clients loss of appetite and skipped meals. J.N also salts most of

her food, leading the nursing student to conclude she has a reduced ability to taste individual

flavors (Giddens, 2017). J.N. exercises by cleaning the house, garden and playing with her

grandchildren.

Concluding Assessment

J.N. is emotionally, cognitively, spiritually and psycho-socially balanced. She is able to

perform all ADLs required to function independently (Giddens, 2017).

J.N. has dual health insurance coverage, which includes dental care. The Kapiolani

Nursing student recommends the community client see a geriatric dentist to address her oral

discomfort and poor-fitting, partial denture. A visit with a dietician familiar with the nutritional

needs of octogenarians is suggested to maintain proper nutritional levels, meal regularity and

implementation of proper meal portions.

J.N. should eat foods that are sufficient sources of potassium, B vitamins and vitamin D.

She can continue to eat calcium-rich foods like tofu, soy-beans, cheese and fiber as found in her

oatmeal. Portion size should be increased to maintain proper energy levels as well as meeting

caloric needs. The nursing student recommends J.N. supplements spices for salt to make foods

more flavorful (U.S. Department of Agriculture. ChooseMyPlate.gov).

A slight increase of fluids to meet nine cups or 72 ounces per day would add to J.N.s hydration

level. J.N. can try adding cucumbers, lemon or oranges making water tastier, thus increases

intake of fluids. The clients exercise level is considered active and appropriate for her age.
COMMUNITY CASE STUDY 6

References

Giddens, J. (2017). Concepts for nursing practice (2nd ed.). St. Louis, MO: Elsevier.

McKevith, B. (2007). Undernutrition in elderly people. Practice Nurse, 34(8), 33-6.

Potter, P., Perry, A., Stockert, P., & Hall, A. (2017). Fundamentals of nursing (9th ed.). St. Louis,

MO: Elsevier.

U.S. Department of Agriculture. (n.d.). ChooseMyPlate. Retrieved from

http//www.choosemyplate.gov/healthy-eating-tips/older-adults.html

J. Oehlers reviewed APA Format for this paper

 COMMUNITY CASE STUDY 7

Appendix A: Eco-Map

T.N. T.S.
J.N.S 91YO Y.S. 84YO
DECEASED CLIENTS CLIENTSIS
BROTHER BROTHER TER
KANEOHE KAIMUKI

J.N
D.N. 81y.o.
83y.o COMMUNITY CLIENT
J.N.S g
HUSBAND g
Diabetic
Arteriosclerosis
Glaucoma
K.N. 53y.o.
Lives with J.N. and
K.N.
Kailua D.N. JR.
A.K. U. 49 y.o.
51 y.o. Mililani
Kailua

Married:

K.N. L.N
Children:
12 y.o. 10 y.o.
Mililani Mililani
Siblings:

Grand Children:

Same House:

Deceased:

Female: Male:
COMMUNITY CASE STUDY 8

Appendix B: Functional Abilities Evaluation

Pre/Post Pneumonia

Feeding 0 Grooming 0
Bathing 0 General Mobility 0
Toileting 0 Cooking 0
Bed Mobility 0 Home Maintenance 0
Dressing 0 Shopping 0

Functional level codes:

Level 0: Independent
Level I: Requires use of equipment or devise
Level II: Requires assistance or supervision from another person
Level III: Requires assistance or supervision from another person and equipment or
device
Level IV: Is dependent and does not participate
COMMUNITY CASE STUDY 9

Appendix C: 24-Hour Diet Recall and Total Fluid Intake

Breakfast:

1 Multi-Vitamin, 1 Calcium Supplement (values unknown)

16 ounces Matcha Green Tea
Approximately 1& cups of steel-cut oatmeal (Costco Brand)
2 slices avocado

Lunch:

8 ounces water,
8 ounces Matcha Green Tea
Approximately 6 broccoli florets
1 tablespoon sharp yellow chedder cheese
teaspoon salt

Snack:

8 ounces water
8 ouncesWomens Energy Tea
cranberry, orange chocolate cookie
1 strawberry

*Dinner not eaten at time of interview.

Fluid Intake:

Water: 16 ounces
Tea: 32 ounces

Total consumed fluids: 48 ounces.

COMMUNITY CASE STUDY 10

Kapiolani Community College

NURS 210 Health Promotions
Community Case Study Paper
Grading Rubric

Student: Instructor:
Criteria Pass Needs Non-Pass
Improvement
Complete Data, Major Data
Specific Missing Data, Omitted
description, Unclear Data, Vague or Overly
Examples Incorrect Data Generalized

Score 5 Score 3 Score 1

1. Introductory data
2. Developmental
assessment
(psychosocial and
moral development)
3. Functional abilities
assessment
4. Family dynamics
(ecomap)
5. Culture (2 health care
practices/beliefs)
6. Nutritional
assessment
7. Identification of
area(s) of need
8. Recommendation of
appropriate nursing
interventions for
area(s) of need.
9. Format: Introduction,
Body, and
Conclusion, page
length
10. APA format, cover
page, citation,
grammar, spelling,
reference page, etc.
Grand Total Score