In this section:
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These are all real case studies of how community nurses helped vulnerable people in the community. Names have been changed.
‘John’ is a 67 year old man who has slept rough for almost 30 years. He had episodes of binge drinking and suffered from frequent falls, often requiring A&E attendance. His falls and injuries became more frequent and more severe - I was concerned in case he was suffering physical abuse from someone.
On taking a detailed history it was clear that the falls occurred both with and without the effects of alcohol. I persuaded him to attend his GP (not seen for over 10 years) which he did after asking me to accompany him there. He then willingly attended for chest x-ray, ECG and blood tests, and went alone after I explained where to go and the process to expect. The results of his tests showed severe iron deficiency anaemia and he was referred for treatment.
He has complied with treatment and has had no further falls or injuries. After accompanying him to two GP appointments he has developed a good relationship with his GP and now attends approximately every 6 weeks. He calls at my office to ask me to book his next appointment without prompting. He comes to see me each month to let me know his progress or discuss any new health issues (I have been able to prescribe simple skin moisturiser that has resolved his dry, flaky skin). An added bonus is that he has not drunk any alcohol since July 2009 now, he has put on weight and feels “better than for years”.
‘Kevin’ is a 50 year old man with severe psoriatic ankylosing spondylitis, causing reduced mobility and pain. He is a quiet, gentle and rather shy man who was living on the third floor of a small bedroom in an old, very poorly maintained guest house. He had no access to hot water, shower, laundry or cooking facilities. The walls of his room were covered in thick black mould and he tried to keep clothing and possessions in plastic boxes to prevent them becoming mouldy too. Water leaked into the room from the floor above which he caught in a bowl. He has no family or social circle of friends to support him. Pain, lack of sleep and reduced mobility often made him stay indoors for days. All other tenants had moved out of the building.
I made numerous referrals to various agencies and 6 months later, with the support from Environmental Health, he is now in a well maintained 1 bedroom flat. Both physiotherapy and occupational therapy have visited him at home and his mobility and self caring abilities have improved. Community dental service has restored his remaining teeth and provided a partial denture, which, along with his new kitchen, means that he can cook fresh food and is enjoying fruit and salads again.
He is in touch with local charities (one of which sent him his one and only 50th birthday card) where he can get support, social activities and, for example, a free haircut. After much persuasion to apply, and my assistance in completing ‘the forms’, Alan has been granted Disability Living Allowance. His confidence is now growing and he is considering joining the local disability swimming club. New spectacles mean that he can enjoy TV and he has started to write a book about aviation. Podiatry has improved the condition of his feet and his mobility is improved. His sleep pattern is also improved with better pain control. Smoking is now reduced to 2 cigarettes a day with a view to stopping completely.
On my final visit he thanked me and asked me to please “write me up as a success story”.
59 year old ‘Robert’ was in insecure accommodation (bedroom, laundry and shower facilities but no kitchen/ cooking facilities). He had a history of depression and alcohol misuse since being made redundant a few years ago - a very quiet man who was reluctant to join in conversation. By gradually gaining his trust and starting, progress was made. He had needed new spectacles for some time and was using old ones with out of date prescription lenses and a broken, uncomfortable frame.
I made enquiries and with financial help from Benefits Department ‘topped up’ with money from a charity he was able to have an eye test and get new specs. This resulted in a fairly rapid transformation (and acceptance of further referrals) – he now attends Mental Health Service regarding his depression, has complied with treatments, kept all appointments and is making good progress. He has done some voluntary work, has much improved self esteem, and is now very ‘chatty’ (even joining in to help design some ‘Health Diaries’). He has moved on to address a long standing foot problem with his GP by himself and has an appointment to see the Orthopaedic Consultant.
An added bonus is that this man has not drunk any alcohol since 1st Jan 2010 and he is currently visiting his mother who he has not seen for 12 years.
‘Richard’ is 24 years old. He is an insulin dependant diabetic who also has coeliac disease. I first met him following a referral from the police, who had arrested his flatmate, but had also recognised Richard’s vulnerability.
In the Care system from the age of 3 - 18, he regularly self-harmed, usually sniffing lighter fuel, cutting and/or mismanaging his diabetes (because “the nurses in A&E are always nice to me”). Self-harm occurred approximately 1-3 times each month. Richard had little interest in his personal appearance/hygiene and had not brushed his teeth “for months”. He was living in a damp, poorly maintained flat. His coeliac disease was causing discomfort and embarrassment because he did not adhere to a gluten free diet.
I began by inviting him to meet me at my office base as we have a neutral, non-medical (non-threatening) room available. Following a couple of these informal ‘chats’ over a cup of tea he relaxed, became much less defensive and more receptive to addressing his health issues.
12 months later, after weekly, fortnightly and then monthly contacts; and with referrals to numerous services (I accompanied him to initial contacts with several agencies) he has made great improvements. He is in social housing and “loves” his flat – “it’s the first thing I have ever had that’s my own”. He has made friends with his elderly neighbours (one of whom often gives him home made soup). He has attended Podiatry, Dentist (last seen aged 16), Dietician, Diabetic Centre, GP, and has not missed any appointments for over 9 months. He is very proud of his lovely teeth/smile and has new specs and a new hairstyle. Gluten Free products are obtained on prescription and he freely admits he notices the benefit of adhering to the diet. Diabetic control is much improved.
We have explored help re shopping/budgeting skills, voluntary work and better alternatives to self harming actions (he plans to phone the Samaritans if needed). Richard is currently considering smoking cessation (having cut down “to keep my flat nice”) and also planning to try and return to paid employment.