This script is an analysis of a critical incident which occurred during a home visit in one of the suburbs of Cape Coast Metropolis. A brief description of the incident will be given including the interventions that were given and recommendations for future occurrence. I will apply the Gibbs (1988) reflective model to identify strengths and weaknesses observed in the analysis and how they may be enhanced. In conclusion, the lessons gathered from the incident will be stated. Pseudonyms will be used here to maintain confidentiality. NMC (2000) Critical incidents are defined as extreme behavior either outstandingly effective or ineffective with respect to attaining the general aims of the activity. The procedure has considerable efficiency because of the use of only the extremes of behavior. It is well known that the extreme incidents can be more accurately identified than behavior which is more nearly average in character. Flanagan (1954). If we were to add the critical incident to Creswell’s (1998) list of qualitative traditions, we would describe its distinctive features as the following; a) Focus is on critical events, experience of a specific situation or event. b) Discipline origin is from individual trial and organizational psychology. c) Data collection is primarily through interviews either in person or on telephone.
During a home visit exercise to one of the communities within the catchment area of the public health unit, we went to a house to see the clients who visit our facility for child welfare clinic. On this visit, we seized the opportunity to address the health needs of the house hold members as it was observed to have problems with environmental hygiene. This was when one member of the house told us about a pregnant woman who abuses alcohol. I was alarmed to hear that, so this got me curious to learn more. Substance abuse, also known as drug abuse is a patterned use of a substance (drug) in which the user consumes the substance in amounts or the methods which are themselves harmful. Some of the drugs often associated with this term includes; alcohol, barbiturates, substituted amphetamines, cocaine and opiods. Mosby’s Medical Nursing and Allied Health dictionary (2002). Public health practitioners have attempted to look at substance use from a broader perspective than the individual, emphasizing the role of society, culture and availability.
A study done in 2010 asked drug-harm experts to rank various illegal and legal drugs. Alcohol was found to be the most dangerous by far. Behave net.com. Madam AA is a 24 year old woman who co habits with a blind man, her boyfriend. The man takes care of her especially all her financial needs but she has one particular problem which according her is the cause of her recent drinking habit. According to madam AA, she wished her boyfriend had performed the necessary marriage rite so that she can also be addressed as a “Mrs.” Earlier on, Madam AA admitted that, she used to drink alcohol occasionally but the trend has now increased to drinking alcohol every day, an act her boyfriend and siblings abhors very much. Upon further questioning, she admitted that she has defaulted from Antenatal Care (ANC) services because the Tablet Fersolate she takes changes the color of her stools to green which is unpleasant to her. The public health nurse educated Madam AA on some of the benefits that one can get from attending ANC services.
A colleague also promised her to substitute the Tablet Fersolate with Tablet Vitafol which she agreed to. Madam AA’s sister added that her drinking habit is so bad that she normally trips over the abdomen. I spoke to Madam AA about the danger she is exposing her unborn child and that of her own life to. I encouraged her to try and stay away from friends who normally go out with her to drink alcohol. I also encouraged her sister to be a “watch woman” for her in order to prevent any accident in the future. Traditional pediatric care is often based on the assumption that parents have the basic knowledge and resources to provide a nurturing, safe environment and to provide for the emotional, physical, developmental, and health care needs of their infants and young children. Unfortunately, many families have insufficient knowledge of parenting skills and an inadequate support system of friends, extended family, or professionals to help with these vital tasks. Home-visitation programs offer an effective mechanism to ensure ongoing parental education, social support, and linkage with public and private community services(…)
The following day, we visited Miss AA at home. On this day, unlike the previous one when we met Miss AA drunk and unkempt, she really appeared neat. She had seen to her personal hygiene needs, did not have the alcoholic breath smell and was assisting a neighbor in preparation of food for a naming ceremony later in the afternoon. We advised her to turn down any alcoholic beverage she may be served with, which she agreed to. The Vitafol pills were then handed over to her as promised and she was congratulated for staying away from alcohol.
My feelings about Madam AA’s drinking habit reminded me of what we have been taken through on the subject of substance abuse especially alcohol being the most dangerous of these substances. I was however astonished to see a young woman who was so careless with her life. In fact, immediately I saw Madam AA, for the first time, I was prejudiced. I thought for a moment that she may be suffering from one form of psychosis or the other. This was when I realized that, keeping this woman at home was not the best of options for her. I just judged her in my heart without thinking professionally. She actually needed care in the psychiatric hospital. She needs to see a psychologist for sessions. Being on admission for monitoring would have been the best of alternative for her but all I could do was judge her.
On evaluation, a small but growing body of research has supported the effectiveness of home-visitation programs. The following benefits have been found as an outcome of some, but not all home visitor programs. Olds DL, Kitzman H. Review of research on home visiting for pregnant women and parents of young children. Future Child. 1993;3:53–92 According to Olds DL, Henderson CR Jr, Tatelbaum R, Chamberlin R.,(1993) in the journal, Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. Pediatrics. prenatal benefits of home visiting includes; Increased use of prenatal care, increased birth weight, decreased preterm labor and increased length of gestation, increased use of health and other community resources (eg, prenatal visits, well-child visits, family, planning programs for women, infants, and children [WIC], and immunizations, improved nutrition during pregnancy, fewer urinary tract infections during pregnancy, increased attendance at childbirth classes and decrease in maternal smoking and alcohol intake.
The bad aspect of Madam AA’s situation was, she was prone to falls and normally topples over her abdomen but that never deter her from drinking the next day. In addition to her accidents, she had also defaulted from her ANC attendance so there was very little to learn from the progress of her pregnancy. That is, the present state of her fetus and that of her own health was unknown. In a report by the National Survey on Drug Use and Health (NSDUH) released on September 9, 2013, it stated that women who drink alcohol while pregnant increase the risk that their infants will have physical, learning, and/or behavior problems, including Fetal Alcohol Spectrum Disorder (FASD).
These problems are caused by alcohol and can be permanent. Alcohol can disrupt fetal development at any stage during a pregnancy, even before a woman knows she is pregnant. If a woman is pregnant, there is no known amount or type of alcohol that is safe for her to drink. To prevent problems like FASD, a woman who is pregnant or likely to become pregnant should not drink alcohol. However, the good aspect of the situation was our meeting with Madam AA was very timely so we gave the necessary education on the importance of attending ANC service. We informed her that this will help assess her condition and that of the unborn child. In addition we spoke to her on the need to abstain from alcohol so it however not surprising that we met her the next day in a better condition than the previous day.,
In analysis, public health nurses have been viewed as advocates of the poor, the disadvantaged, minorities, and any population groups in need of community-based, prevention-oriented health care services. As early as 1859, with the founding of the first district nursing association, nurses were viewed not as mere attendants of the sick, but as social reformers. Public Health Reports nurses were strategically located to become responsive to their communities’ unmet needs. (Gardner, M. S.: Public health nursing. The Macmillan Company, New York, 1917.) In this incident, I realized that the public health nurses do well to visit the various homes but their intervention to problem encountered is very minimal.
For instance, in Miss AA’s case, it can clearly be seen that we should have made the appropriate referral for further management but that could not be done. We just counseled her and left her to her own fate. I therefore recommend that, the public health nurses will make contacts with other institutions for either curative or rehabilitative purposes. This will help in the proper referral and further management of cases that are identified in the communities. I also recommend that certain special cases identified in the communities should be followed up on to know the outcome of the visit. Again, logistics such as easy means of transportation for the nurses to their various catchment areas should be provided. This will help in transporting any emergencies encountered in the communities to the appropriate facilities so that lives can be saved.
In conclusion, there’s much to be gained from effective home visit such as identifying high risk persons and offering the appropriate intervention. In using the component of nursing service, assessment of Miss AA led us to the root cause of her drinking alcohol, she was educated and counseled but continuous support and arrangement for referral to the appropriate facility for further management was not done. Despite the intuitive appeal of deploying health care professionals whose target of care is the whole community, public health nursing has not been firmly institutionalized in the nation’s health care system. Indeed, in many metropolitan areas, PHN services are facing unprecedented budget cutbacks and staffing reductions.
List of references
1. Schieber GJ, Poullier JP, Greenwald LM. Health care systems in twenty four countries. Health Aff (Millwood). 1991;10:22–38 2. Kamerman SB, Kahn AJ. Home health visiting in Europe. Future Child. 1993;3:39–52 3. Buhler-Wilkerson K. Public health nursing: in sickness or in health? Am J Public Health. 1985;75:1155–1161 4. Weiss HB. Home visits: necessary but not sufficient. Future Child. 1993; 3:113–128 5. Baker JP. Women and the invention of well child care. Pediatrics. 1994; 94:527–531 6. Chapman J, Siegel E, Cross A. Home visitors and child health: analysis of selected programs. Pediatrics. 1990;85:1059–1068 7. . Olds DL, Kitzman H. Review of research on home visiting for pregnant women and parents of young children. Future Child. 1993;3:53–92 8. Olds DL, Henderson CR Jr, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home. Downloaded from pediatrics.aappublications.org at Ghana:AAP Sponsored on April 2, 2014