Glenna, age 38, lost leg function during a motor vehicle accident…

Glenna, age 38, lost leg function during a motor vehicle accident at age 16. She plays basketball at the community center and teaches aerobic classes for wheelchair-bound people three times a week. She manages a medical equipment rental business since her husband died. Business is not profitable. A physician’s referral was made to the public health department for a developmental assessment.

A nurse heard angry shouting as she stepped toward the porch of the tiny house with peeling paint. The nurse stepped over a broken tread and knocked on the weather-stained door at the end of a ramp. Suddenly a large man burst through the doorway tugging on a T-shirt and muttering. The nurse glanced passed the fleeing man. Three children, ages 18 months, 4 years, and 6 years old, knelt on linoleum worn through to the wood. The TV blared a cartoon. No one heard her knock as the children stared at their mother who was crying and holding her cheek. The nurse knocked a second time on the open door and introduced herself. The woman wheeled around to face the other way.

“We are busy. Please come back later,” the woman spoke over her shoulder.

“Pick up the blocks, Chica. Make sure the back door is locked, Stephano and please make a peanut butter and jelly sandwich for your brother and sister.

Not now, Jon. She tells the youngest child, who is banging a block on her wheel.”

The nurse replies, “I can make another appointment, but it will only take a few minutes to assess Jonathan now that I am here. Your physician said you are concerned about his development. If you could answer a few questions I feel sure we can help you. I can help make the sandwiches while we talk.” The nurse’s scan of the living room located a stained spoon and knife near a broken mirror on the coffee table along with a towel, toys, and a magazine. Chica’s hair was uncombed. The boys’ hair hung to his shoulders and looked unwashed.

The mother pulled her robe together over her chest and folded her arms. “You can’t help. Jon is normal but different. You will ask a 100 questions, insult me, and then say there is nothing you can do, just like the doctor did. He made us wait 45 minutes and then says he is going to call someone else. We don’t need that kind of help. Jon is a smart boy with attention problems. I need to clean up. We don’t have time to talk right now.” She raised her voice. “Chica, pass me the cigarettes, will ya? Gracias.”

Jon continued banging his mother’s chair and vocalizing. The children stared at the nurse. Chica looked afraid. Stephano looked hopeful. His dirty pajamas ended well about the ankle.

1. Should Glenna consider herself disabled or at risk? Why? And should the nurse consider Glenna’s family at risk? Why?
2. What history questions will reveal predisposing, social or enabling risk factors?
3. What risk clusters can be identified?
4. What community health nursing techniques could empower Glenna and her family?
5. How can the nurse avoid insulting the mother?