Betty’s first home health service is nursing. She is seen in her home by the nurse , who covers both pain education
and home safety during the home health assessment.
Pain Education Checklist
Acute pain vs. Chronic Pain
Acute Pain
Acute pain occurs as a direct result of tissue damage or potential tissue damage and is a symptom. It serves as a warning of disease or a threat to the body.
Chronic Pain
Pain that outlasts the normal healing time, the impairment is greater than would be expected from the physical findings or injury and/or it occurs in the absence of identifiable tissue damage. It is typically pain that has lasted more than 3 months.
Pain Management Tools
Pain management tools allow you to help manage your pain. They may include using hot packs, cold packs, balancing activity and rest, modifying how you do things to decrease your pain – such as changing the height of items, changing the weight of items, changing your posture at rest or with activity.
Self-Monitoring
Self-monitoring involves keeping track of your pain with rest and activity as well as monitoring your general health, sleep, nutrition, water intake. In addition selfmonitoring includes keeping track of your emotional and spiritual health along with your physical health. Rating your pain with a tool like the Iowa Pain Thermometer (IPT-R) can
be a guide for recording pain levels.
Stress Management and Coping Skills
Stress management and coping skills can include Practicing relaxation exercises or meditation exercises, utilizing your support network, engaging in your spiritual practices, engaging in enjoyable activities despite experience of pain (reading, watching a movie, something fun), talking to a friend or professional about stress and concerns
related to your pain and the impact it is having on your life.
Pacing and Prioritizing
Pacing and prioritizing involve alternating you level of activity and rest so that you don’t overdo or underdo. It is working on the balance of activity and rest that allow you to accomplish more. It can include alternating high energy consuming activities and low energy consuming activities; or alternating physical postures, prioritizing your activities so you do not become overwhelmed.
Problem Solving
Problem Solving skills allow you to identify a problem, develop possible solutions to the problem, try a solution, set a goal and then evaluate the success of the solution. It is an important skill in self-management for pain. Developing problem solving skills leads to better resiliency in managing your pain.
Pain Education Review
After the pain education session, the nurse has some question for Betty to help summarize Betty’s impressions about home safety.
Home Safety
Home safety will be evaluated by nursing and physical therapy. For this scenario, nursing focused on overall safety, flooring and recognizing hazards. Physical therapy will focus on walkways and stair-climbing, bathrooms and lighting.
A review of each room for home fall prevention is as follows:
Living Room
- Chairs and sofas are sturdy and secure
- Chairs and sofas are not too low or soft to get in and out of easily
- Chairs and sofas have arms to aid in sitting or rising
- Leave enough space to walk through the room easily
- Furniture is steady and does not tilt if used for support
Kitchen
- Keep the items you use most often in easy reach – at waist or shoulder height
- If you use a step stool, make sure it has a handle to hold
- A single lever faucet is easier to use
- Keep hot pads near the stove
- Unplug small appliances when not in use
- Keep cupboards and drawers closed
Floors
- Create a pathway of 36 inches
- Pull up floor rugs or add a non-slip backing to keep the rugs from slipping
- Pick up objects off the floor
- Coil or tape cords and wires next to the wall so you do not trip on them
Bathrooms
- Put a non-slip rubber mat or stick strips on the floor of the tub or shower
- Have grab bars put in next to the tub, shower and toilet
- Single lever faucets are easier to use
- Bath or shower doors have safety glass or plastic
Stairs & Steps
- Check stairs or steps outside and inside the house
- Pick up things on the stairs; keep the stairs picked up
- Fix loose or uneven steps
- Check that lighting is enough over stairs and landings
- Check the carpet on stairs or add non-slip rubber treads to stairs
- Check handrails are secure or if not handrails install handrails for safety
Bedrooms
- Make sure lighting is enough and in easy reach from the bed
- Make sure lighting from bedroom to bathroom is enough
- Nightlights can help light up the pathways
- Keep plenty of room to walk around the bed
- Keep a sturdy chair with arms for dressing
Prevention
- Do exercises for balance and leg strength
- Home safety will be evaluated by nursing and physical therapy. For this scenario, nursing focused on overall safety, flooring and recognizing hazards. Physical therapy focused on walkways and stairclimbing, bathrooms and lighting.
- Regular eye checkups
- Wear shoes inside and outside the house
- Keep the lighting bright inside your home
- Paint a contrasting color on the edge of steps to see the stairs better
- Keep emergency numbers near each phone
- Think about wearing an alarm to bring help in case you fall
Home Health Nursing: Home Safety
The nurse and Betty walk around Betty's home to go over safety in some areas. The walk through included looking at lighting, flooring, and walkways in the home before going over different aspects.
Highlights About the Safety of Betty's Home
Flooring in Betty's Home
Other Hazards in Betty's Home
Home Health Social Services: Interview
Betty’s next home health service is from social services.
Betty's Family
Daily Activities
Support Systems
Pain Levels
Insurance Coverage
Social Services: Key Elements Review
Key elements of each social service interview topic Betty and the Social Services Provider discussed is as follows.
Family Involvement
- Family knowledge about pain
- Family knowledge of medical needs
- Family involvement in medical care
Pain in Daily Activities
- Impact of pain on daily activities
- Functional limitations due to pain.
- Emotional response to pain.
- Pacing of activities, stress management and coping skills, monitoring moments when you notice more pain, moments when I notice less pain.
Support Systems
- Support systems outside the family
- Support system knowledge of problem
- Support system involvement in providing assistance
Financial Concerns
- Price of medications
- Insurance coverage
- Financial worries/needs
