Community Nursing at HASC Residential Home for Adults
CommunityNursing at HASC Residential Home for Adults
CommunityNursing at HASC Residential Home for Adults
HebrewAcademy for Special Children (HASC) is a non-profit and non-sectarianinstitution that provides educational and medical services toindividuals from infants to adults who display irregular patterns ofdevelopment. HASC was founded in 1963 to cater for children andadults with special needs (HASCCenter,2017). The organization offers high quality educational, clinical andtherapeutic interventions to children and adults in a bid to improvetheir lives. The families of these individuals play a significantrole in their overall health and wellbeing. HASC conducts itsactivities in a creative, compassionate and motivational manner toeffect the change they want in these individuals. It is based inBrooklyn, New York, but it operates 5 different locations in thestate. The center provides its services to more than 1,100 childrenand over 100 adults with disabilities (HASCCenter,2017).
Ivolunteered for 35 hours at the HASC Center in Brooklyn, New York.The home had 10 adults with various disabilities such as Downsyndrome, cerebral palsy, mental retardation, seizures andschizophrenia and conditions such as breast cancer, hypertension, anddiabetes among others. These adults were above 50 years and could notdo everything by themselves. Thus they needed a close observation forhelp. Through my time at the center, I engaged in a range ofactivities such as taking them for walks, helping them to do lightexercises and feeding them if the need arose. I gained numerousinsights concerning community health and the role of nursing fromthis enriching experience.
and Analysis of Findings
HASCis located in Brooklyn, Kings County. The county has a population of2,621,793 (Robinson,Mueller & Bourquin, 2013).The age distribution below 18 years is 23.3% and 12.1% above 65years. The rest fall between 18 and 65 years. All races arerepresented in the County with Non-Hispanic African Americans andNon-Hispanic Whites taking the largest proportions at 31% and 35.8%respectively (Robinson,Mueller & Bourquin, 2013).
TheHASC home had 10 adults, all Caucasian females between 55 and 65years old. The adults in the residential home displayed a range ofcharacteristics based on their individual conditions anddisabilities. Ideally, adults with varying developmental andintellectual disabilities present unique challenges to theirhandlers. Therefore, the nurses or members of staff attending to themought to have the skills and sensitivity to handle these patientswith care and understand their needs. Research indicates that adultsin residential care centers are living longer and are healthier giventhe advancements in medicine, personalized care, and therapies thatthey receive (Gardner& Coyer, 2014).This community of adults had a range of strong areas, areas ofweakness, and different health conditions and needs.
Strengths,Weaknesses, health needs and conditions in the community
Thefirst strength of this community was their unity. They lived togetherlike kids who have been raised together. Despite the variations intheir backgrounds, conditions, and disabilities, they seemed to getalong well with understanding and appreciation for one another. Thiscan be associated with the idea that living together in such a set upovershadows the disabilities that they face and encourages bonding.In the same way, some individuals whose disabilities were not severecould help in helping others around. The atmosphere at the residencewas always lively as everyone was part of the group despite theirrespective physical or medical conditions. This could be attributedto the stunts that were pulled by each one of them due to theirdisabilities. Listening to them speak was fun because they couldspeak in the most intricate manner that exhibited the level ofinnocence that is observed in children. This always made my time withthem. This togetherness was the greatest point of strength for thisgroup of adults, and it played a significant role in enhancing ahealth and harmonious relationship among them.
Nevertheless,this community expressed a range of weaknesses that affected theirability to participate in similar activities in the same manner. Forinstance, their living area was always disorganized because of theway they could handle items. People with Down syndrome and mentalretardation would grab and toss anything that came their way. Thiscaused objects of all sorts to be scattered all over the place. Henceit had to be cleaned at regular intervals. Again, it was difficult tohave meaningful conversations with all of them. Although this may notseem like a weakness as such, it affected their ability to respond tosimple instructions such as ‘stand up,` ‘stop` etc. this impliedthat as a caregiver, one had to do all things without expecting theirinput whatsoever.
Moreover,handling people with such disabilities is more like handlingchildren. Therefore, they could exhibit all characteristics ofchildren ranging from crying, not eating, messing the things aroundand themselves, and sleeplessness among others. This was discouragingat times, but appreciating their conditions helped one to cope withthe situation.
Inthis home, the major conditions affecting the population werediabetes, hypertension and breast cancer. Similarly, the most notabledisabilities were mental retardation, schizophrenia, Down syndromeand Cerebral Palsy. Therefore, from my assessment, the most obvioushealth needs in the community were proper nutrition and physicalexercise. Most of the adults in the residence were from low-incomebackgrounds, which indicated that their families could not adequatelycater for their health needs. This increased their vulnerability andthus the need to organize the relevant care for them. Again, most ofthem suffered from diabetes and hypertension, which arelifestyle-related conditions. Therefore, improving their diets toincorporate healthy portions would be of great benefit to theirhealth. This includes engaging them in activities that increase theirlevel of activity. These interventions would go a long way inimproving and prolonging the lives of these individuals. In thatconnection, HASC has a range of programs that can suit each based ontheir disability and health condition. The center has a well-equippedexercise room, where the individuals can undergo closely monitoredand directed sessions of muscle flexing occasionally.
Among the 10 adults I interacted with, three of them were the mostvulnerable and were at a higher risk of succumbing to their healthcondition. The first individual was a 62-year-old woman who hadbreast cancer and was diabetic. She was still taking her after-chemodrugs but together with diabetes, they had taken a toll and hadsignificantly affected her health. The second individual was a69-year-old schizophrenic woman who was diabetic. The conditionseemed to affect her in the sense that she could always be confinedto a wheelchair so nobody would note when her sugar levels droppedbecause she was silent for most of the time. Therefore, she requiredclose monitoring to ensure that the change in sugar levels wasnoticed. The third individual was a 60-year-old intellectuallydisabled woman who was suffering from high blood pressure. She wasalways disruptive and could run up and down around the hall. Thisaffected her blood pressure regularly, which could be hard to keep incontrol due to her nature.
Thegoodness of life for people with intellectual and developmentaldisabilities has improved significantly in the 21stcentury. This is attributable to improved methods of care, betterdrugs, and better interventions. The life expectancy of people withmild developmental and intellectual disabilities approaches that ofthe mainstream population of similar socioeconomic status.Nevertheless, the life expectancy of individuals with severedisabilities remains low compared to that of the mainstreampopulation (Carmeli& Imam, 2014).
Theadults in this community exhibited four major mental anddevelopmental disabilities: mental retardation, Down syndrome,Cerebral palsy and schizophrenia. Besides these disabilities, thepopulation suffered from diabetes, breast cancer, and hypertension.Out of the 10 women, one had breast cancer and diabetes, four haddiabetes and high blood pressure, and two had high blood pressureonly, while three had diabetes only. Similarly, one of them wasmentally retarded, two schizophrenic, three had cerebral palsy whileone had seizures and other three had down syndrome.
Thedisabilities exhibited by this community developed since their birth,so they grew with them all their lives. Down syndrome is identifiedat birth. Out of the four individuals with Down syndrome, 2 of themshowed signs of dementia that could closely be linked to Alzheimer`sdisease. Research show that approximately 25 percent of adults withDown syndrome display signs of Alzheimer`s disease, particularlythose above the age of 65. Schizophrenia is also associated withgenetic factors with a significant proportion of the cases reportedat birth. Very few cases develop through one’s life. Theschizophrenic individuals exhibited the typical signs of people withthe disease such as hallucination, loss of motor control anddelusions among others.
Moreover,mental retardation, also known as intellectual disability resultsfrom weakened intellectual and adaptive functioning of the brain.Most cases of intellectual disability are genetic in nature resultingfrom chromosomal abnormalities (Hermans& Evenhuis, 2014).Cerebral palsy is associated with brain damage before or duringbirth. It ranks as a leading congenital disorder in the UnitedStates. Therefore, it is outright that most of these developmentaldisabilities cannot be linked to the immediate environment of theseindividuals or their socioeconomic statuses. They all occur before orduring a child`s birth and dominate the rest of their lives (Hermans& Evenhuis, 2014).
Onthe contrary, the health conditions exhibited by these individuals(hypertension, diabetes & breast cancer) can be attributed to arange of factors besides their genetic make-ups or backgrounds. Allthese disorders are largely caused by lifestyle and people’ssocioeconomic status. Lifestyle entails an assortment of elementsincluding diet, exercise, stress levels and access to medical caramong others. Given that all members of this community havedevelopmental disabilities, it can be inferred that they have beeninactive for a significant proportion of their lives. Ryskulova(2015) notes that lackof physical activity is a risk factor in many lifestyle diseases andit may have contributed to the development of these conditions.Similarly, the majority of them come from minority groups, which canalso be used to infer their socioeconomic backgrounds. Lack offinancial affluence may have prevented their families to take themfor medical check-ups, which could have played a huge role in theprevention of these conditions or managing them before they worsened.
Mostof the lifestyle conditions faced by members of this community areattributable to indications from the County statistics regardinghealth and the socioeconomic wellbeing of the people. For instance,physical in activity in the county is estimated to be 26% andexcessive drinking is 17%. These two indicators are vital in causingdiseases like diabetes and hypertension, which are the leadingproblems for this community.
Whileundertaking my practice experience hours at this agency, the areasthat I felt needed some changes were the resident’s nutrition andweight status. Many of the residents did not have a balancednutritious diet and were overweight. A significant proportion ofthese were overweight which is a clear indication that they physicalactivity was a community health need among them. The gain in bodyweight can be attributed to the inactive lifestyle that they have,diet and even the medications that they take for their variedconditions. For this reason, starting an initiative to help thembecome physically active can be a huge boost to their health.
Poordiet and an unchecked body weight is disastrous, especially forpeople with diabetes and high blood pressure. This is because lac ofthe right nutrients and low levels of physical activity can onlyworsen their conditions potentially causing death. Therefore, I feltthat these areas needed attention and support to be able to enhancethe quality of these people’s lives.
Inthe same way, most families with disabled persons do not give thebest care to them. Some may view allocation of their scarce resourcesto their care as wastage. This amounts to neglect, which surfaces inthe form of health conditions that could have long been prevented.Ona similar note, most of these people do not care what they feedtheir disabled family members. They disregard the fact that they arehuman and need to be monitored like children. All these factorscombined may cause stress to the disabled individuals, which may havebroad implications on their health (Cherry& Jacob, 2016).Health problems coupled with disability present the biggest challengefor their families, thus making them admit their beloved one toresidential care centers like HASC.
Thesituation at the center is slightly manageable because the 10 adultshave scheduled check-ups weekly, which has greatly improved theirhealth. The only problem remains the diet concern and physicalactivity. Giné-Garrigaet al. (2014) note that conditions like diabetes and high bloodpressure require careful consideration of one’s diet, and level ofphysical activity. These individuals may not be able to decide or dosuch activities for themselves. HASC currently offers health diets tothem, but they are at risk of eating unhealthy food that is broughtby their visitors. For this reason, they require education andmonitoring to ensure that they avoid unhealthy foods and that theybecome active with their lives. Similarly, there is need to informtheir families on the recommended diets for them to ensure that whenthey visit, they bring with them healthy foods. In addition, thecenter needs to employ at least one more member of staff to help inensuring that this community is physically active to avoid additionalcomplications that may arise from living a sessile life.Implementation of these concerns will improve the overall nutritionand physical activity of this community, which will be a major boostto their health. It will improve the quality and meaningfulness oftheir lives, and probably raise their life expectancy.
Descriptionof Advocacy and Leadership
Thiscommunity largely depends on the staff members and nurses who attendto them. They are not so much concerned about what happens aroundthem, provided they have been fed when hungry and that they haveentertainment if the form of television, magazines and soft music.The fact that they are not so much concerned about the issue to dowith their health makes them vulnerable to neglect, which may takeforms such as unhealthy diets and lack of physical therapy, medicalcheck-ups, and drugs for their conditions. Thankfully, the managementof HASC puts the needs of its patients first. The organization hasemployed personnel to help in feeding cleaning and moving them whenneed be, although more people would be better. Again, it hasacknowledged the conditions affecting these people and adopted apolicy of healthy diet to keep their health in check. This is indeeda good way to help them live meaningful lives without the stress andneglect that they may have experienced in their earlier years.
Inthe course of my time at the adult residential home, I observed theirconditions and disabilities. This gave me a glimpse of what theyneeded to be able to attain health outcomes aligned to nutrition andphysical activity. Therefore, my health promotion plan entailedteaching members of this community how to read nutrition labels, toinclude healthier foods in their diet and keeping physically activethrough taking a walk or using the treadmill at the residence. Iutilized visual aids to teach them about the food groups and therecommended servings per day. Regarding nutrition labels, I taughtthem how to read the nutritional composition of food they eat so thatthey could choose foods low in fat, sugar, and sodium. I alsoconsulted with the administrator at the residence about getting someof the adults (those who could) membership to a local gym orcommunity center where they can go swimming. This can play a vitalrole in ensuring that these people keep physically active, which is asignificant factor in their health. I collaborated with the cook inthe preparation of healthy and nutritious foods for this community.Every member of the community was on a distinct intellectual level.As such, the teaching was individualized to accommodate the needs ofeach one of them.
Itwas my hope that the action plan to introduce a balanced diet andengage those adults physically could help in the attainment of theHealthy People 2020 objective of health promotion while reducing therisk for chronic illnesses by eating healthy food and maintaining ahealthy weight. To facilitate this action plan, good communicationskills were necessary and the ability to mediate conflict resolutionif it occurred. Another thing that ranked key to the success of thisinitiative was the creation of a positive and motivated atmospherethat encouraged support and team building.
Theintended outcome of these interventions is to make positive changesin their health to help manage some of their medical conditions suchas diabetes and hypertension and prevent future complications.Physical activity will not only help them with weight issues but willalso benefit them emotionally. The evaluation entailed monitoring toestablish the effectiveness of my plan. I requested that each keep adaily food and activity log. At the end of each week, I could go overthe log with each one individually to see where there are areas ofprogress and where there is room for improvement. There was also aweigh in once a month to see if there is any progress. Challengesthat I faced trying to implement this plan are that the change thatinvolves diet and exercise were challenging to the generalpopulation, yet alone to those with disabilities. This required ateam effort and a lot of dedication and involvement from the directcare staff.
Throughoutthis practice experience, I used two key public health nursingcompetencies to meet its goals. The first PHN competency entailedpopulation health planning and evaluation whereby I took part in thepanning, implementation, and evaluation of health promotion in thecommunity through teaching and advocating for physical activity. Thesecond PHN competency involved partnership, collaboration, andadvocacy. Here, I engaged with the members of staff at the residenceto advocate for the creating and implementation of strategies thatcould enhance the health of the adults in the community.
Throughthis experience, I learned that developmental disabilities are thingsthat people can cope with. It only takes understanding, and one caneasily get along with the victims. I also learned that life is whatyou make it and that one should celebrate every moment. This isbecause the members of the community were always happy and they didnot let that happiness fade due to the conditions. Moreover, Irecognized the fact that these people were in need of more activityin their lives to boost their health. Similarly, I realized that theindividuals of the community do not care about most of their needsmostly because they are aware of them and that creating awareness tothem can help them observe their health as well. This informationwill greatly influence my upcoming nursing career in that I will beable to observe the needs of my patients keenly and find ways throughwhich their conditions will be improved. Furthermore, I willconstantly be encouraging my patients to adopt healthy lifestyles toavoid most of the medical conditions caused by lifestyle.
Asan advocate of population focused care, I can effectively play asupervisory or oversight role. This role would entail theimplementation of programs and management of community-based andpopulation-based programs, home visits and clinical services forpatients. This is because in most cases, implementation of thenecessary programs and initiatives fails because the individuals whohave been tasked with the oversight role fail to play their part. Asin the case of the residence, most programs such as ensuring thepatients lead active lives and preventing unhealthy food fromreaching them could have long been implemented if the administratorwas keen on the needs of the patient. Therefore, as a supervisor, Iwould ensure that every recommendation is executed immediately forthe benefit of the patients.
Carmeli,E., & Imam, B. (2014). Health promotion and disease preventionstrategies in older adults with intellectual and developmentaldisabilities. Frontiersin public health, 2,31.
Cherry,B., & Jacob, S. R. (2016). Contemporarynursing: Issues, trends, & management.Elsevier Health Sciences.
Gardner,G., & Coyer, F. (2014). Beyond competencies: using a capabilityframework in developing practice standards for advanced practicenursing. Journalof advanced nursing, 70(12),2728-2735.
Giné-Garriga,M., Roqué-Fíguls, M., Coll-Planas, L., Sitjà-Rabert, M., &Salvà, A. (2014). Physical exercise interventions for improvingperformance-based measures of physical function incommunity-dwelling, frail older adults: a systematic review andmeta-analysis. Archivesof physical medicine and rehabilitation, 95(4),753-769.O`connell, J.,
HASCCenter.(2017). Building Futures One Person at a time. Retrieved fromhttp://www.hasccenter.com/residential_services.php
Hermans,H., & Evenhuis, H. M. (2014). Multimorbidity in older adults withintellectual disabilities. Researchin Developmental Disabilities, 35(4),776-783.
Robinson,E., Mueller, A. H., & Bourquin, F. (2013). Robinson`s atlas ofKings County, New York.
Ryskulova,A. (2015, November). Progress Review of Healthy People 2020 PhysicalActivity objectives: Are We There Yet?. In 2015APHA Annual Meeting & Expo (Oct. 31-Nov. 4, 2015).APHA.
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