A CLIENT/ FAMILY CENTERD CARE STUDY

ON

SUBSTANCE ABUSE (MARIJUANA)

BY

DARKWAH JOYCE

(1319180059)

A FINAL YEAR STUDENT OF COMMUNITY HEALTH NURSES’ TRAINING

COLLEGE, AKIM ODA

JUNE, 2021
 A CLIENT/FAMILY CENTERED CARE STUDY

ON

SUBSTANCE ABUSE (MARIJUANA)

BY

DARKWAH JOYCE

(1319180059)

A FINAL YEAR STUDENT OF COMMUNITY HEALTH NURSE’S TRAINING

COLLEGE, AKIM ODA

SUBMITTED TO THE NURSING AND MIDWIFREY COUNCIL OF GHANA IN

PARTIAL FILFILMENT OF THE REQUIREMENT FOR THE AWARD OF A

DIPLOMA IN REGISTERED COMMUNITYN HEALTH NURSING

JUNE, 2021
 PREFACE

The nursing process is described as a method for assessing, diagnosing, planning,

Implementing, and evaluating the effectiveness of nursing care based on the assessed health

status and health concerns of the client. As a process, it is an orderly sequence of steps used

in gaining nursing care in a specific manner.

A client/family centered care study is based on rendering quality health care to client and

his/her family using nursing process. It is an expanded view on how to care for a client and

family in their own home. The care is based on thorough understanding that the client is a

unique with her own problems which needs to be solved to avoid complications. In order to

achieve this, attention is to be given to the physical, spiritual, social, and psychological needs

of the client in relation to the family and the community in which client lives.

Client/family centered care study is a tool that enables the student nurse to put into practice

the knowledge and skills he/she acquired in the course of his/her training to serve the society.

Care study is client and family centered project work undertaken by final year student nurses

upon complication of their academics course. It is part of the three year course organized by

the Nursing and Midwifery Council of Ghana before diploma certificate is awarded.

ACKWONLEGDEMENT

i
 I wish to give special thanks to client and family for their time and co-operation in

providing me with the necessary information and accepting me into their family which

enabled me to write this care study. My sincere gratitude goes to the writers from whom

references were made to enable me complete this study.

I owe my supervisor, Mr. Adamu Seidu Shiddo, a lot of thanks for his time, constant

corrections and careful supervision. I also wish to express my heartfelt gratitude to the

following personalities for their immeasurable support, inspiration and words of

encouragements from the beginning of

Schooling till now; Mr. Jones Abeka- Baah (the principal of the Community Health Nurses

Training School of Akim Oda, the academic board and the entire staff for their support.

I would also like to acknowledge my father, Mr. William Darkwah and his family, my

beloved mother, Mrs. Grace Kyei and my lovely sister Abigail Darkwah for their financial

support and encouragements throughout my training as well as my siblings especially who

contributed directly or indirectly to my successful training. Finally, my last gratitude goes to

Okyere Stephen for his encouragements.

TABLE OF CONTENT

CONTENT PAGE

ii
PREFACE i

ACKNOWLEDGEMENT

ii

TABLE OF CONTENT iii

LIST OF TABLES v

CHAPTER ONE

INTRODUCTION 1

ASSESSMENT OF CLIENT/FAMILY 4

CLIENT’S PARTICULARS 4

CARETAKER’S PARTICULARS 5

CLIENT’S/ FAMILY MEDICAL, SOCIAL, AND ECONOMICAL HISTORY 6

CLIENT’S PAST MEDICAL/ SURGICAL HISTORY 7

CLIENT’S PRESENT MDICAL/ SURGICAL HISTORY 8

CLIENT’S DEVELOPMENTAL HISTORY

CLIENT’S OBSTETRICAL HISTORY 10

PROBLEMS IDENTIFIED 11

SWOT ANALYSIS 12

MAIN OBJECTIVE 13

SPECIFIC OBJECTIVE 14

iii
CHAPTER TWO

LITERATURE REVIEW 15

CHAPTER THREE

HOME VISITING 28

HOME SITUATION 32

HANDING OVER AND CONTINUITY OF CARE 52

SUMMARY 53

CONCLUSION 54

RECOMMENDATION 55

REFERENCE 56

SIGNATORIES 57

iv
 LIST OF TABLES

TABLES LIST PAGES

Table 1 NURSING CARE PLAN FOR FIRST HOME VISIT 33

Table 2 NURSING CARE PLAN FOR SECOND HOME VISIT 36

Table 3 NURSING CARE PLAN FOR THIRD HOME VISIT 39

Table 4 NURSING CARE PLAN FOR FOURTH HOME VISIT 42

Table 5 NURSING CARE PLAN FOR FIFTH HOME VISIT 44

Table 6 NURSING CARE PLAN FOR SIXTH HOME VISIT 46

Table 7 NURSING CARE PLAN FOR SEVENTH HOME VISIT 50

Table 8 NURSING CARE PLAN FOR EIGHTH HOME VISIT

v
 CHAPTER ONE
INTRODUCTION

Drug abuse refers to maladaptive pattern of the use of substance that is not

considered dependent.

Some of the drug most often association with this term include alcohol, cocaine,

barbiturate, amphetamines and opioids. The use of these drug may lead to criminal

penalty in addition to possible physical, social, and psychological harm.

Substance abuse is a common phenomenon in the world and has invaded human

society as the most important social damage. Substance abuse is a non- adaptive

model of drug use, which results in a diverse problems and consequences, and

includes a set of cognitive, behavioural and psychological symptoms. According to

Simons et al., (2005), drug abuse is an inappropriate and excessive use of drugs that

may cause harm to the individual users and the society in general. In Ghana, some of

the common abusive drugs are marijuana, alcohol, cocaine, tobacco, morphine,

caffeine, phenobarbital, diazepam, tramadol and opioids (paracetamol).

The links between psychoactive substances and violence involve broad social and

economic forces, the setting in which people obtain and consume the substance, and

the biological processes that underlie all human behavior. In the case of alcohol,

evidence from laboratory and empirical studies support the possibility of a causal role

in violent behaviour.

Mr. A. M. F is 30years old whom I met at the market on the 28 th of February, 2021,

where I wanted someone to carry my food staffs into a car for me. He came around

help me carry my things. On our away to the taxi station, I asked him of his phone

number but he is not using phone, I asked him of where he stays and direction to his

house, and he gladly did. The next day I was at his doorstep of the client at Akim Oda

1
old town. On arrival, there was a woman in front of the house. The woman was my

client’s mother. I asked the whereabout of the client and she went in to call him. He

came out from the room greeted and me a seat. His mother quickly gave us a chair to

seat on.

I asked if he will be comfortable with the environment of our conversation and he

replied that is about his
ok. I asked health and he told me that he has been

experiencing severe headaches in the past days but was doing well.

During interaction, I probed further and from the client he said he has been smoking

marijuana for almost 3years and wanted to do away with that habit. I went on to find

out the reason why he wanted to quit smoking and he said that he has not been feeling

well for some time now.

Through this, I decided to choose him as a special client for my client and

family centered care study because drug abuse (smoking) can lead to serious health

conditions like lung cancer and stroke. I then asked for permission to choose him as a

special client for my client and family centered care study and he agreed. I then

promised him that all information and any data that he would reveal during the course

of our interactions and meetings would be held in confidentiality.

I scheduled with client and family the next visit thanked them and asked permission to

leave. For the purpose of confidentiality, my client will be called Mr. A. M. F. and his

mother Mrs. R. A

2
 ASSESSMENT OF CLIENT AND FAMILY

Assessment is the systematic, comprehensive method and the first stage of

nursing process which deals with collecting, organizing, validating and

documentation clients data gathered from the clients, relatives, friend, clients folder

and significant other in order to determine clients health status and identify any actual

or potential health problem. It includes physical, cognitive, social, emotional,

psychological and environmental status of the client. These information help to

identify client and family needs.

CLIENT’S PARTICLARS

NAME: Mr. A. M. F

DATE OF BIRTH: 7th May, 1990

AGE: 30years

SEX: Male

MARITAL STATUS: Single

NEXT OF KIN: Mr. A.F

RELATIONSHIP: Brother

NUMBER OF SIBLINGS: Five

RELIGION: Christian

EDUCATIONAL LEVEL: S.H.S Three

OCCUPATION: Porter

LANGUAGE SPOKEN: Twi and English

NATIONALITY: Ghanaian

CLINICAL DIAGNOSE: Substance Abuse

3
 Marijuana.

CURRENT PLACE OF RESIDENCE: Oda old town

ADDRESS: Birimso road A57

HEIGHT: 140cm

WEIGHT ON FIRST VISIT: 75kg

CLIENT’S MOTHER’S PARTICULARS

Name: Mrs. R.A

Date: 18th June, 1959

Age: 61

Sex: Female

Marital status: Married

Relationship: Son

Religion: Christian

Educational Level: J. H.S

Occupation: Trading

Language Spoken: Twi and English

Current Place of Residence: Akim Oda old town

Address: Birim road A57

4
 CLIENT’S FAMILY /MEDICAL AND SOCIO-ECONOMIC HISTORY

Mr. A. M. F made it known to me that, the only chronic condition that the

family is suffering from is hypertension. He said his mother as well as his

grandmother suffered from that same condition. As the conversation continued, Mr.

A. M. F said trading and driving are the family sources of income. He also disclosed

that he gets support from the extended family. I noticed that there was cordial

relationship between members in the family.

5
 CLIENT’S PAST MEDICAL/SURGICAL HISTORY

According to the client in the course of interaction, Mr. A.M.F said that, he

has no past medical history though he sometimes experiences some minor ailments

such as headache, waist pain, and joint pain, which he normally manages with

paracetamol bought from over the counter.

6
 CLIENT’S PRESENT MEDICAL/SURGICAL HISTORY

Currently Mr. A. M.F, he has no medical condition and has not undergone any

surgical procedure before. The only condition he complained of was having pains in

his left upper arm and sometimes general body weakness.

7
 CLIENT’S DEVELOPMENTAL HISTORY

Mr. A.M.F was born on 7th May, 1990 by Mrs. R. A through a spontaneous

vaginal delivery at Akim Oda Government Hospital. According to Mrs. R. A, Mr.

A.M.F is the second born of the three children she had no history of abnormalities.

Mr. A.M.F was breastfed, had all his immunization and passed through the normal

mile stone of growth. He then experienced his secondary characteristics at the age of

18 years. Mr. A.M.F started his education at St. Andrews boys and then proceed to

Oda Senior High School which he has completed. Mr. A. M. F is unemployed and is

not married.

Intimacy verses isolation is the sixth stage of Eric Erickson’s theory of

psychosocial development. This stage takes place during young adulthood between 20

to 40 years. This is a period in early adulthood that focuses on developing close

relations with others as friends, lovers leading to marriage. Success at this stage leads

to fulfillment relationships. The strength or virtue is love. The individual who do not

seek such intimacy or those whose repeated attempt has failed retreat to isolation. Due

to this attitude of smoking marijuana in the community, he is not loved by the

community, client is unable to become more intimacy with his relationship has

therefore retreat to isolation.

8
 CLIENT’S OBSTETRIC HISTORY

My client is a male, hence no obstetric history.

9
 PROBLEM IDENTIFIED

1. Mr. A. M. F has wound on the right toe.

2. Client complained of inability to sleep.

3. Client has bad breath (halitosis).

4. Client complains of friends and neighbors avoiding him.

5. Poor environmental hygiene.

6. Client complained of loss of appetite.

7. Client has been passing watery stool.

8. Client has overgrown finger nails.

10
 SWOT ANALYSIS

STRENGTH

1. Client has good communication skills.

2. Client is able to perform his own daily activities.

3. Client has cordial relationship with family members.

WEAKNESS

1. Client has inadequate knowledge about the condition.

2. Client’s family is less supportive.

OPPORTUNITIES

1. Client can get financial support from the relatives.

2. Client derives income from being a porter.

THREATS

1. Client is sometimes stigmatized by family members.

2. Client is still among his peers which can influence him to continue smoking.

11
 BROAD/ MAIN OBJECTIVE

To assist client to reduce marijuana abuse and obtain optimal health.

SPECIFIC OBJECTIVE

By the end of the study, I will be able to;

1. familiarize myself to the client and family.

2. educate client on the side effects and complications of drugs.

3. introduce client to the psychiatric unit at the Government Hospital-Akim Oda.

4. counsel client on withdrawal symptoms.

5. encourage client to find an income generating activity (payable) work to do.

6. educate client on sexually transmitted disease

7. educate client about nutritional needs.

8. educate client and family on good personal and environmental hygiene.

9. inform client and family about the handing over to the community Health Nurse for

continuity of care.

12
 CHAPTER TWO

LITERATURE REVIEW

Substance abuse is a common phenomenon in the world and has invaded the

human society as the most important social damage. Substance abuse is a non-

adaptive model of drug use, which results in adverse problem and consequences and

includes a set of cognitive, behavioral and psychological symptoms. (Caton et al,

2008). In Ghana, some of the substance or drugs that are abused include alcohol,

marijuana, cocaine, tobacco, morphine, caffeine, and phenobarbital.

Marijuana.

Marijuana is obtained from the cut and dried upper leaves and stems of

cannabis plant with the biological names: Cannabis setiva, cannabis indica and

cannabis rudelaris. It contains a lot of chemicals but its psychoactive ingredient is

delta_9_ tetrahydrocannabinol (T.H.C) (Cartel et al, 2016). It is a central nervous

system stimulant and has hallucinogenic and sedative properties. The potency of the

THC varies depending on the part of the cannabis sedative being used; leaves or stems

(1-15%), dried resin secreted on the flowering tops (10-20%) and the oil extracted

with the use of organic solvent (15-30%) HTC (Mathias et.al, 2005).

Street Names for Marijuana.

1. Indian Herb

2. Wee

3. Hashish

4. Ganja

5. Pot

13
 Mode of Administration.

The leaves are often rolled in the form of cigarette sticks and smoked. Sometimes,

it could be chewed, inhaled in powder form, as bitters in alcoholic drinks. The

substance one consumed is absorbed into the blood stream and metabolized by the

liver. The active ingredient tetra-hydrocannabinol (THC) which is fat soluble

substance can be stored in the body for 30days. Areas of storage within the body

include the testes, brain and adipose tissues. It is excreted by the kidney and the skin.

Incidence of Marijuana Abuse.

It is difficult to give the exact prevalence rates of substance abuse since

estimates are determined from associated factors, cultural, racial, sex, age and

psychiatric problem. Marijuana is the most frequently abused illicit psychoactive drug

in our society. It is often said to be gateway drug in for teens but has also been used

socially for many years by adults. The youth and young adults are therefore more

vulnerable because of their curiosity. The ratio of male abusers in higher than female

abusers who consume marijuana.

Stages of substance abuse

1. Experimentation: very few people set out to become addicted.

2. Regular use.

3. Curiosity.

4. Psychological or chemical dependency.

5. Using of drugs to feel normal.

14
 Etiology of Marijuana abuse.

The specific cause of substance abuse is not known. The decision to abuse

substance however due to the following factors if one employs the epidemiological

approach to disease causation that is the host, agent and the environmental factors.

1. Host Factor.

These are factors that exit in the individual that are involved in the dynamics of

substance abuse. They are essentially biological and include:

a) Hereditary: family with a history of drug abuse predisposed one to become

addicted. A study of female twins reported that genetic factors account for 60-

80% of the variance in liability to cannabis dependence (Kendler and Prescott,

1998).

b) Age: the condition is common in the adolescent and early adulthood because of

their curiosity and entry problems.

c) Sex: It is more common with males the females.

2. Agent Factor

The people who experience mood changes especially depression take to abuse

substance to avoid the situations. Some personality disorders such as psychopaths

indulge themselves in substances to attain delightful state of euphoria and avoid

situation. People suffering from chronic anxiety state resort to substance to relieve

them of their worries.

3. Environmental Factors.

15
4. Occupation: Individual who are engaged in certain occupation such as some

breweries, bar men, nurses, seaman and others are predisposed.

5. Availability of substances: In places where the substances are found almost

everywhere and at any time, the individual is likely to fall a hand on it.

6. Adventure or Curiosity: To satisfy their desire, some people especially student

experiment to see how potent these substance are.

7. Problem solving motive: People who cannot stand stresses and strains resort to

substances that will temporarily give them same relief.

8. Peer group influence: adolescents are not affected especially, group that indulge

in substances for work and learning. With this, every member is obliged to accept

the norms and habits of the group.

Effects of Marijuana Abuse

Thomson et al. (2008) reported a correlation of increased periodontal disease in a

study population of 1,015 who were assessed. The researchers assessed the use of

marijuana in the study population. They concluded that smoking marijuana may be a

risk factor for the development of periodontal disease that is independent of the use of

tobacco.

The long-term effects of heavy use of marijuana have not been well-documented with

regard to long-term cognition and the effects on pregnancy and the unborn child,

although some childhood illnesses have been reported to be increased.

In most studies, “ever users” may be affected much differently than those who would

be considered “chronic, long-term users” and the interaction of tobacco products that

are mixed with cannabis may greatly vary in composition and strength. Hashibe et al.

(2005) points out that associations between marijuana use and cancer risk are often

16
based on questionnaires, subject recall, subject honesty, and that confounders such as

tobacco and excessive alcohol use must be assessed. Since these are not socially

approved behaviors, there is reluctance on accurate exposure of these behaviors by the

patient.

There is reported incidence of tachycardia and peripheral dilation associated with

acute marijuana toxicity when an anesthetic is administered and anxiety in the patient

may add to these symptoms. It is advised that the patient discontinue use for one week

before having dental work completed when anesthesia is needed. Rosenblatt et al.

(2004) makes the point that marijuana cigarettes do not contain filters as tobacco

cigarettes do and that marijuana smokers may inhale more deeply and hold the smoke

in their lungs longer. This is an explanation of why higher tar levels may be present

and could also promote lung cancer. As the use of marijuana continues to increase

with more states legalizing the use, we may see a rise in the numbers of individuals

with both oral cancer and lung cancer.

. The effects of substance abuse can be outline under;

1. The individual

2. The general

The effect on individual

1. School dropouts increases

2. Societal rejection

3. Increase in physical abuse

4. Low sperm count.

17
5. Reproductive structures such as ovaries and testes are affected leading to

infertility.

6. Sleep disorders.

Effects on the general society

1. Increase hospital admission.

2. Increase crime wave.

3. Decrease in productivity.

4. Driving offences.

5. Moral deterioration.

6. Increase in mortality rate.

Classification of Marijuana Abuse

1. Psychedelic and Hallucinogens: The include marijuana, mescaline lysergic

acid diethylamide. They produce an exaggerated feeling of wellbeing with

change in mood, thought and behavior.

2. Stimulants: They stimulants the central nervous system examples are cocaine,

amphetamine like Benzedrine and Methedrine.

3. Minor Tranquilizers: they alleviate tension, induce relaxation and sleep.

Examples are valium, Librium, and Ativan.

4. Narcotics: They alleviate pain of physical nature and produce pleasant

feelings. Examples are Opium, Morphine, and Heroine.

Signs and symptoms of Marijuana Abuse

1. Reddened eyes

2. Drooping of the eyelids

18
 3. Increased appetite

4. Breathlessness

5. Tachycardia

6. Chronic cough

7. Dry mouth

Diagnostic Measures

1. Characteristics of breath {odor} few minutes after smoking.

2. Elevated uric acid levels.

3. Liver function abnormalities.

4. From clients behavior.

5. History of smoking marijuana.

6. Leukocytes.

7. Client can be identified with black spot on the finger.

Therapeutic use of cannabis sativa

Research has identified the modified use of active substance for managing the

following:

1. Nausea and vomiting: When often antiemetic fail or those on chemotherapy

and AIDS patients (Bergeson, 2004).

2. Lowers pressure in the eyeball making it effective for the treatment of

glaucoma.

3. As hypnotics in cases of insomnia from nervous exhaustions and pain.

Management of Marijuana with behavior disorder

19
 Patients suffering from marijuana use with behavior disorder can be managed.

1. Physical approach

2. Psychological approach.

3. Admission to a psychiatric hospital unit in a quiet room is important for

observation and treatment.

4. Monitor vital signs such as temperature, blood pressure, pulse and respiration

regularly.

5. A well balanced diet with adequate fluids to maintain the nutritional status.

This must be planned with patients and relatives.

6. Ensure good personal hygiene. Patients are encouraged and supervised to bath

and clean mouth regularly.

7. Keep all harmful objects from reach of patient and ensure protection.

8. Administration of medication which may include tranquilizers and sedatives

such as diazepam for agitation.

9. Give prescribed medication to decrease with drawl restlessness, tremors,

irritability.

10. Monitor and record drug effects.

11. Observe during drug administration to prevent hoarding by the patient.

Remember to check patient to ensure that patient has swallowed the drug.

12. Try to maintain a quiet, safe environment during withdrawal from drug

because excessive noise may agitate patient.

Psychological approach

1. Reassure patient and maintain good nurse-patient relationship.

20
 2. Supportive psychotherapy

An individual psychotherapy session of interaction is organized between the therapist

and patient to explain the effects and the needs for patients to avoid the drugs.

1. Family psychotherapy: The family is made aware of the roles they can play

for full recovery of the patient.

2. Group psychotherapy: Patient abusing particular substance come together

and aim at helping one another identify their problems and how to solve them.

3. Occupational and recreational therapies involve re-enforcing an old skill.

4. Rehabilitation: This aims at resting the patient to the fullest include

continuing education on discharge avoid smoking and to continue his

medication. The need for review is emphasized.

Prevention of Marijuana Abuse.

1. Primary Prevention

Reinforce law restricting the cultivation, sales and use of dangerous substance

such as cannabis.

1. Identifying health education on the hazards of marijuana abuse. This can be

done through the mass media example include television, radio, school,

churches and other social functions. Social clubs can be formed to help

educate the, public on this antisocial menace.

2. Social and psychological problems such as unemployment, poverty and

marital problems should be identified and solved promptly. This prevents

people from fallen on drugs like marijuana and alcohol for temporal relief.

21
2. Secondary prevention

1. Early identification of drug abuse and education on dangers.

2. Prompt management of marijuana users must be carried out before

dependence is established.

3. Victims must be supervised to frequently use their medication.

3. Tertiary prevention

1. Treated victims of “wee” should be taken away from previous environment

sometimes for behavior modification.

2. Patient’s relatives should be educated to critically observe their wards after

discharge from the hospital.

3. Drug abusers should be help to change their occupation if their previous

predisposes them to abuse substance.

4. Relative should be encouraged to fully support patient at home physically,

psychologically, financially and spiritually when discharged.

5. Community psychiatric nurse frequently follow up and supervise the

wellbeing of patient home after discharged.

Complication of Marijuana Abuse

1. Infertility: Low sperm count and less spermatozoa mobility in males and

failure to ovulate as well as shortened fertility period in females.

2. Marijuana addiction can lead to other hard drug addiction such as cocaine.

3. Prolong use especially if smoked lead to lung cancer.

4. Continuous use leads to mania and dementia.

22
 5. Pulmonary effect like vital capacity (amount of air that can be expelled after

full inspiration).

CHAPTER THREE

HOME VISIT

Home visit is very important in achieving the goal set by a community health

nurse. Home visit is also a kind of visit undertaken by health workers to individuals

and families in the sittings for the purpose of educating, counseling and providing

minimum package of health service as may be required by the family or individual.

TYPES OF HOME VISIT

There are two types of home visit namely,

1. Special home visit

2. Routine home visit

SPECIAL HOME VISIT

Special home visit made to a home with specially identified problems. The

nurse usually has prior knowledge of the existing problem and how to prepare are

adopts strategies to solve the problems.

ROUTINE HOME VISIT

Routine home visit is an area that is visited in terms of house to house. Here,

every house in the area stands a chance of being visited by the health worker. The

kind of home visit rendered to Mr. A. M. F is a special home visit.

23
 IMPORTANCE OF HOME VISIT

1. It enable the nurse to identify health problems and refer to the appropriate place.

2. It helps the health worker in finding or identifying at risk individual such as

malnourished children, drug addicts.

3. It helps trace defaulters.

4. It help the nurse meets the client in his/her real situation and offer him/ her the

opportunities to teach the client using the resources available.

5. Home visit offer the opportunities to give health education to

Clients or review teaching done at a health facility to ensure compliance.

DISADVANTAGES OF HOME VISIST

1. Exposure to health hazards.

2. Home visit can result in injuries from snake bit, dog bit and fall.

3. Some client feels reluctant to discuss their individual problem in the home in the

presence of other family member.

4. Difficult in locating house in poorly planned areas.

5. Home visiting is time consuming and sometime the weather may not be favorable.

24
 FIRST HOME VISIT ON 6TH MARCH, 2021

Objectives;

By the end of the visit, I will be able to;

1. familiarize with my client and his family.

2. assess the home situation and their health status.

On Saturday, 6th March, 2021. I embarked on my first home visit to Mr. A. M.

F’s house at old town, a suburb of Akim Oda. Upon arrival at the house, I came across

his mother, who was washing and I asked her of his son. Quickly she went in and

called him. The house was well kept and things was arranged in order. I was later

offered a seat to make myself comfortable. I introduced the day’s objective that was

to familiarize myself with them and assess the home situation.

During our conversation I asked Mr. A. M. F if there is any problem to be

shared in order for it to be addressed. He revealed to me a small cut at his right toe he

had 5 days ago at the market. I asked how it came about and he told me he was

actually crossing a pavement at the market and his right foot accidentally hit the edge

of a pavement block. I assessed the wound site for signs of healing and infection,

edema and the nature of the wound. There was no bleeding but a little edematous. I

asked client what he normally uses in dressing the wound and according to Mr. A. M.

F, he applied a plaster 3 days ago.

I took the opportunity to educate the client on how to dress the wound every

day, and I did the dressing aseptically for the client. I gave him a piece of gauze to be

25
used and I advised him to dress the wound every day, to keep it clean from bacteria.

Also he should eat a balance meal to aid healing. He was very happy and thanked me

for my time and effort, as I also did.

All other questions were addressed. I thanked him for the time he had for me. I

then scheduled the next visit on the 13th March, 2021, and asked permission to leave.

Problem Identified

1. Mr. A. M. F has wound on the right toe.

26
 HOME SITUATION

Mr. A. M. F stays with his mother at Old Town a suburb at Akim-Oda in the Birim

central municipality in a compound. The house is located opposite the Apostolic

Church. It is a compound house comprising of 5 rooms (chamber and hall), with 2

windows each and a porch. The rooms are large and well –spaced. The house is

walled with an iron gate in front of the house. The house is built with cement block

and roofed with aluminum sheet. It has been painted with blue and ash color. Mr. A.

M. F is a tenant in the house. There are 9 peoples living in the house, there is no

kitchen for the tenants, except the landlord. So some of them used to prepare food at

their porch. There is electricity supply in the house with a single –phase meter. There

is a pipe in the house but it doesn’t flow always, so they sometimes rely on a well at a

nearby house. There is water closet with 5 toilet seats and 3 bathrooms. Their waste

made is been separated into liquid and solid. They pour the liquid waste in a gutter in

front of the house, which is connected to the main gutter in the community. While the

solid waste is kept outside in a dust bin is emptied by the zoom lion Ghana once every

week.

27
28
 TABLE 1: NURSING CARE PLAN FOR FIRST HOME VISIT ON 6TH MARCH, 2021

DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING INTERVENTION EVALUATION

AND DIAGNOSIS OUTCOME
TIME CRITERIA

06/03/2021 Impaired skin Client wound will 1. Reassure client. 1. Client reassured that his 20\03\2021
@ integrity (wound heal within 2 2. Dressed wound wound will heal. @
12:30pm at the right toe) weeks as aseptically with normal 2. Client’s wound dressed 12: 30pm
related to accident evidenced by saline. aseptically with normal saline to Goals fully met,
at market. client having an prevent infection. as client has an
3. Counsel client to keep
intact skin. intact skin.
wound area always clean 3. Client counseled to always
and dry. keep wound area clean and dry
to promote wound healing.
4. Counsel client not to
expose wound. 4. Client counseled not to expose
wound to prevent infection.
5. Encourage client to eat a
5. Client encouraged to eat a
balance diet such fruit,
balance diet such as fruits to
minerals, protein,
boost his immune system.
vegetables, vitamin's

29
 SECOND HOME VISIT ON 13TH MARCH, 2021.

Objective;

By the end of the visit, I will be able to;

1. educate client on the side effects and complications of drugs (marijuana)

On 13th March, 2021. I made my second home visit to Mr. A. M. F and family at

6:30am. I met my client, who was ready to go to work. I observed the environment and it

was kept clean. I greeted him and he responded. I then asked of his health and that of his

parents. I observed the wound on client’s toe and it was showing signs of regenerating. I

then started with the reason for my visit that, when a person takes in drug without any

prescription from a qualified medical personnel absorbs it into the bloodstream which is

then taken to be the liver for metabolism and the resultant product are sent through blood

circulation to the hindbrain which alters speech consciousness and judgment. I asked Mr.

A. M. F to mention some of the side effects of taking in drugs and he quickly side

headache, dizziness, palpitation and blurred vision. I then added some of the

complications associated with drug abuse. I made Mr. A. M. F aware that the some

complication include on the liver, one may experience hepatitis which tends to cirrhosis

of the liver after so many years of addition. On the pancreas, one may experience acute or

chronic pancreatitis. One experience myocardial infarction as a result of problem of the

muscles of the heart lead to generalized edema.

Also, I educated Mr. A. M. F on the psychological effects on the individual’s.

They includes restlessness, insomnia, but as the condition progresses he may experience

30
visual or auditory hallucination, confusion, drowsiness, tachycardia and elevated blood

pressure.

I ended that session and asked of any complaints. He complained of inability to sleep. I

asked him why and how, and he probed further by saying, because of the heavy loads he

used to carry at the market he normally gets tired. Again, he mostly does think of how he

can get a capital to start a job.

I explained to him that, the total hours of sleep is affected by physical,

psychological, and environmental factors. The physical factors include; the amount of

exercise done in a day, the amount of food taken in a day, illnesses, things and certain

drugs taken. Psychological factors include; emotional upset, fear, anxiety which affects

one’s ability to sleep. Environmental factors can either promote or hinder one’s sleep

such as light, heat, darkness and so on. I added that he should have a warm bath before

retiring to bed, put on appropriate clothing during bed time, switch off the light and

always prioritize his activities during the day, and relief herself from stress and thinking.

I also told client that I will be introducing him to the psychiatric unit of the Government

Hospital at Akim Oda for counseling

All other questions asked were addressed. I thanked him for the time and agreed on 20 th

March, 2021 as the next visit. I asked for permission to leave.

Problem Identified

1. Client complained of inability to sleep.

31
 TABLE 2: NURSING CARE PLAN FOR SECOND HOME VISIT ON 13TH MARCH, 2021.

DATE/ NURSING OBJECTIVE/ NURSING ORDERS NURSING INTERVENTION EVALUATION

TIME DIAGNOSIS OUTCOME

CRITERIA

13/03/2021 Disturbed sleep Client will have an 1. Reassure client. 1. Client reassured of 15/03/2021
pattern related to optimal amount of resuming a normal sleep
@ 2. Educate client to @
stress as sleep within pattern.
limit and prioritize his
manifested by 48hours as
6:30am daily activities. 2. Client educated to limit 6:50am
sleepless night. evidenced by client
and prioritize daily activities
verbalizing sleeping 3. Advice client to
to help his complete basic Goals fully met, client
at least 6-8 hours in have a warm bath
tasks on time.
a day. before retiring to bed. slept 6hours in a day.
3. Client advised to have a
4. Encourage client to
warm bath before retiring to
alternate rest with
bed to help him fall asleep
activity.
more quickly.
5. Advice client to put
4. Client encouraged to
on comfortable
alternate rest with activity to
clothing (cotton), bed
help him have enough
and beddings.
energy for other activity.
5. Client advised to put on
comfortable clothing, bed
and bedding to help him
stay comfortable during the
night.

32
 THIRD HOME VISIT ON 20TH MARCH, 2021.

Objective;

By the end of the visit, I will be able to;

1. introduce client to the psychiatric unit at the Government Hospital-Akim Oda.

On the 20th of March, 2021, at 1:00pm. I embarked on my third home visit to

Mr. A. M. F and his family. Upon arrival I met client’s sister cooking in front of the

compound. I greeted and was offered a seat. I asked of their health and they replied

that they were fine. I asked client that how long does he sleeps and he told me that he

sleeps 6 hours. Just as I begun with the day’s objective, Mr. A. M. F’s mum came in

with a complaint that Mr. A. M. F has been stealing from her and he also has a bad

breath. I inquired from the client why he took the money, and what he uses his

earnings for, he opened up and replied he uses the money to buy weed.

I encouraged him to try his best to avoid his friends who lure him into

smoking and stay in the house. I also educated him on oral hygiene, to always brush

his teeth twice daily especially after meals, floss at least once daily to remove food

particles and plaque from between your teeth, drink more water to keep the mouth

moist and also try his possible best to quit smoking because it’s the main reason for

his bad breath.

I proceeded with my objective for the day which is to introduce client to a

psychiatric unit at the Government Hospital- Akim Oda. Mr. A. M. F went inside to

dress up and we left right away to the psychiatric unit.

The psychiatric unit in-charge gave us a warm welcome and I introduced my

client to him. He also introduced himself as the in-charge of the unit. He told us he

33
will take the client through some therapy during his consequent visits to the unit.

Firstly, he checked his vital signs, and he took him through the mental state

examination through an interview that is his level of consciousness, appearance,

speech, thought and perception. After the examination he also informed the client to

come by regularly. He appreciated Mr. A. M. F for his presence and his decision to

quit marijuana abuse and he was assured confidentiality. The in-charge then

counselled him on ways he can quit marijuana smoking such as staying away from his

friends who also smoke, diversional therapy ,join the supportive group in the district.

He then asked if there was any further question but client said not at all. Mr.

A. M. F also thanked the in-charge and me for the exposure. The in-charge then

scheduled the next visit with client on the 26 th March, 2021 whereas we scheduled my

visit with him on the 27th March, 2021.

Problem Identified

1. Client has bad breath (halitosis).

34
 TABLE 3: NURASING CARE PLAN FOR THIRD HOME VISIT ON 20TH MARCH, 2021.

DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING EVALUATION

AND DIAGNOSIS CRITERIA INTERVENTION
TIME
20/03/2021 Self-care deficit Client bad breath 1. Reassure client. 1. Client reassured that his 24/03/2021
@ @
related to (halitosis) will be condition will improve.
1:00pm 1:00pm
marijuana abuse reduced within the 2. Encourage client to brush his 2. Client was encouraged to
Goal fully met as
as manifested by period of care as teeth regularly. brush his teeth regularly. client mouth
odour is reduced.
halitosis. evidence by nurse 3. Encourage client to visit the 3. Client was encouraged to

observing client dentist. visit the dentist.

having good breadth

during conversation. 4. Educate client on the causes 4.Client was educated on the

of mouth odor. (halitosis) causes of mouth odor

(halitosis)

35
 FOURTH HOME VISIT ON 27TH MARCH, 2021.

Objective;

By the end of the visit, I will be able to;

1. counsel client on withdrawal symptoms.

On 27th March, 2021, I made my fourth visit at 3:00 pm as scheduled to the client. I

met client at home sitting in front of the house. I observed the environment was clean. I

asked of his health and that of the family and he responded that everything is going well.

I assessed the previous care and client’s mother made it known to ne that client’s bad

breath has reduced. I then made my objectives for the visit known to him which was to

educate him on the withdrawal symptoms he might experience in the course of doing

away with drug (marijuana). I asked him if he had stayed in a day or days without

smoking and he said yes, sometimes a day. I asked about the reaction that he experienced

and he said that he felt ill and weak, but when he smoked, he felt normal and fine again.

Client revealed to me that he used to smoke 8 rolls of marijuana but he has reduced it to

5rolls a day. I told client that it’s possible that he can stop smoking.

I added that substance abuse withdrawal syndrome is a group of symptoms that

usually manifest suddenly after total cessation or reduction in the usual amount of drug

intake. If a person regularly smokes marijuana too much, his body may become

dependent on the substance. These signs and symptoms one experienced vary depending

on the stage of addiction. These signs include, increase body temperature, tremors,

insomnia, hallucination, anxiety, seizures and disorientation etc. Again recovering from

substance abuse is a gradual process because sudden avoidance leads to the withdrawal

36
symptoms. I then encouraged Mr. A. M. F to limit the rate at which he consumes the

drugs (marijuana).

I asked the client if he has any questions, and he complained that he is been

avoided by some friends and people in his neighborhood which makes him feel isolated. I

encouraged him to direct his attention on his quest to quit smoking and build his self-

respect and self-esteem. I thought him some coping strategies such as positive self-talk,

relation etc. and advised him to practice it so he can apply it when he faced with the

situation again.

I then asked them to summarize our discussion and they did it perfectly. I commended

them and moved the discussion to an end. We then scheduled our next visit together

which will be on 6th April, 2021.

Problem Identified

1. Client complains of friends and neighbors avoiding him.

37
 TABLE 4: NURSING CARE PLAN FOR FOURTH HOME VISIT ON 27TH MARCH, 2021.

DATE AND NURSING OBJECTIVES/ NURSING ORDERS NURSING INTERVENTION EVALUATION

TIME DIAGNOSIS OUTCOME

CRETIRIA

27/03/2021 Social Client will express 1. Reassure client. 1. Client reassured of 1/04/2021

@ interaction an increase 2. Allow client to verbalize overcoming his problems. @

3:00pm impaired satisfaction with his worry. 2. Client allowed to verbalize 7:30am

related to socialization within 3. Teach client copping his worry. Goal fully met.

alienation the period of care strategies. 3. Taught client copping There is

from friends as evidenced by 4. Encourage client to have strategies such as reduction in

and neighbors client verbalizing a positive image. 4. Client encouraged to keep a friends and

secondary to reduction in neat appearance. neighbors

marijuana avoidance by avoiding him.

abuse. friends and

neighbors.

38
 FIFTH HOME VISIT ON 6TH APRIL, 2021.

Objective;

By the end of the visit, I will be able to;

1. encourage client to find an income generating activity (payable) work to do.

On the 6th of April, 2021, I made my fifth home visit to Mr. A. M. F’s house at

1:00pm. I knocked and upon response I was asked to come in. I met Mr. A. M. F and his

mother in the house I greeted and was offered a seat, I made a quick observation of the

environment and it was clean. I asked of their health and they replied that they were fine.

I assessed client’s knowledge on the previous visit and client revealed to me that his

friends that avoid him has reduced. During the previous visit, client was educated on

substance abuse withdrawal syndrome which is a group of symptoms that usually

manifest suddenly after total cessation or reduction in the usual amount of drug intake. If

a person regularly smokes marijuana too much, his body may become dependent on the

substance. These signs and symptoms one experienced vary depending on the stage of

addiction. These signs include, increase body temperature, tremors, insomnia,

hallucination, anxiety, seizures and disorientation etc.

Afterwards, I made the purpose of my visit known to them and that was to encourage

client to find an income generating activity payable work to do. I inquired from Mr. A.

M. F if he would like to find a more lucrative work and he responded yes. Also asked of

what kind of job he would like to do and he responded he had no particular work in mind.

So I suggested a list of work which includes a shop attendant, mobile money vendor, fuel

pump attendant, and carpentry or plumbering which will take his mind from smoking.

After a while he made an informed choice on carpentry. I asked of his consent of inviting

39
his mother to join the conversation and he agreed to it. I informed his mother the

discussion we’ve had about his choice of work and she was impressed about her son’s

decision, and she opted that she will find someone who is good and will allow him to go

and learn. I advised Mr. A. M. F to be serious at work. Upon observation, I noticed there

were uncovered dust bin with files all over it. I educated client and family on the effects

of poor environmental hygiene and I asked client to quickly dispose of the dust bin in the

zoom lion container.

After our conversation, I asked if they had any other question for which my client.

We scheduled our next visit on 16th April, 2021. I commended him for his time and bade

them goodbye.

Problem Identified

1. Poor environmental hygiene.

40
 TABLE 5: NURSING CARE PLAN FOR FIFTH HOME VISIT ON 6TH APRIL, 2021.

DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING INTERVENTION EVALUATION

AND DIAGNOSIS OUTCOME

TIME CRITERIA

6/04/2021 Risk for Client and family 1. Encourage client and family to 1. Client and family were educated 7/04/2021

@ infection will be free from keep clean environment. on how to keep their environment @

1:00pm related to infection within 24 2. Educate client and family on clean. 1:00pm

ignorance. hours as evidenced the effects of poor environmental 2. Client and family were educated Goal fully met.

by client and family hygiene. on the effect of poor environmental Client passes stool

keeping the 3. Show pictures of some hygiene. easily twice a day.

environment clean. conditions that can be caused by 3. Pictures of some conditions

poor environmental hygiene to caused by poor environmental

the client and family. hygiene was showed to the client

4. Educate client and family on and family.

the benefits of keeping clean 4. Client and family were educated

environment at all times. on the benefits of keeping clean

environment at all times.

41
 SIXTH HOME VISIT ON 16TH APRIL, 2021.

Objective;

By the end of the visit, I will be able to;

1. educate client on sexually transmitted disease

I embarked on my sixth home visit on the 16 th April, 2021 to Mr. A. M. F’s

house. Upon arrival at the house, I met client and his mother in the house, I greeted

them and asked how they was fairing and they responded that they were fine. Upon

observation of the environment the house was well kept and things were arranged in

order. I was offered a seat. The previous care was to encourage him get an income

generating work to do, which the client in still interested in the work he chose. His

mother said she has find a place for him and have started buying his tools.

I asked client if he has any idea on sexually transmitted disease, and he said its an

infection which is contacted from an infected person when having unprotected sexual

intercourse.

I congratulated him and added to what he said, I made them aware that unwanted sex

puts an individual at risk of sexually transmitted infections (STIs) including HIV. I

further mentioned some of the causes of STIs, which includes; having unprotected

sexual intercourse with an infected person, sharing sharps like blade needle, sharing

of panties and unwires with infected ones can also put one at risk. The most important

measure one need to adopt is sexual abstinence.

In the course of our conversation Mr. A. M. F complained that he has been

having loss of appetite. I informed him that loss of appetite is part of the withdrawal

symptoms of weed smoking, so as time goes on he will feel better and eat well again.

I advised him to eat more fruits and vegetables, eats his favorite food and eat in bit. I

42
asked of any other question and he responded no, so we drew the curtain to the end of

our discussion. I then thanked them for their time and scheduled my next visit

together with them on 24th April, 2021.

Problem identified

1. Client complained of loss of appetite.

43
 TABLE 6: NURSING CARE PLAN ON THE SIXTH HOME VISIT ON 16TH APRIL, 2021.

DATE AND NURSING OBJECTIVES/ NURSING NURSING EVALUATION

TIME DIAGNOSIS OUTCOME ODRERS INTERVENTION
CRETIRIA
16/04/2021 Imbalanced Client will regain 1. Reassure client. 1. Client reassured to 17/04/2021
@ nutrition less than normal appetite within gain her appetite back. @
2:00pm body requirement 24 hours as evidenced 2. Educate client to eat 2:00pm
related to loss of by client eating 1/2 of foods that are highly 2. Client educated to eat Goal fully met as
appetite. meal served. nutritious. foods that are highly client eat ½ meal
nutritious. served.
3. Food should be
served attractively. 3. Food served
attractively.
4. Client should
involve in meal 4. Client encouraged to
planning. be involved in meal
planning.
5. Serve food in bits
and at regular 5. Client educated to be
intervals. served in bits and eat at
regular intervals.

44
 SEVENTH HOME VISIT ON 24TH APRIL, 2021

Objective;

By the end of the visit, I will be able;

1. educate client about nutritional needs.

I made my seventh home visit to the client on the 24 th April, 2021, around

10:00am. On arrival, I met Mrs. R. S and his son. I greeted them and asked of their

wellbeing they responded positively and offered me a seat. Upon asking client about

the previous visit he made it known to me that he can now eat ½ of meal served. Upon

observation I saw that Mr. A. M. F is not faring well. I asked Mrs. R. S what is wrong

with his son and she responded that he has been vomiting and passing out watery

stools since yesterday but it seems somehow okay this morning. Apart from that, they

were all fine.

I introduced the day’s objective to discuss with them about nutritional needs.

Firstly, I inquired about the type of food he normally prepares and he said banku with

okro stew and sometimes with beans stew but mostly in the morning, she prepares

porridge, and on weekends, groundnut soup with banku. I congratulated her for the

food choice, because at least she has tried providing the family with nutrients needed.

However, she need to add certain nutrients found in food that we eat, which are

protein, fats, vitamins, calcium, iodine, iron, zinc and others and these are very

necessary for human growth and development.

I used the meals she prepares, e.g. banku and okro stew to explain according to

the amount, time, and the age group can be found. They can get some food nutrients

such as carbohydrate, fats, and some vitamins and even iodine since iodized salt was

45
added. I advised her to add egg or fish to the rice anytime she wants to prepare the

rice and oil in order to benefit from protein.

I finally advised her to improve their diet and also consider the amount of these

nutrients in their food because it will help them repair body tissues, enhance growth

and development, and prevent other food nutrient deficiencies. Also, the most

important thing is to ensure good personal hygiene in the preparation of the meals,

and adequate intake of fruits and water.

I educated them to always wash their hands with soap and water before eating

and food should not be left over for long before eating. Food should be thorough

cooked and covered. His son’s symptoms can be as a result of food poisoning caused

by eating or drinking contaminated food or water. Finally, I advised Mrs. R. S to send

her son to the nearest health center for further investigation.

All other asked questions were addressed. I thanked them for their time and

contribution towards the discussion. We agreed on 4 th May, 2021 as the next visit. I

asked for their permission to leave.

PROBLEM IDENTIFIED.

1. Client has been vomiting and passing out watery stools.

46
 TABLE 7: NURSING CARE PLAN FOR SEVENTH HOME VISIT ON 24TH APRIL, 2021
DATE NURSING OBJECTIVES/ NURSING ORDERS NURSING INTERVENTIONS EVAUATION
AND OUTCOME
DIAGNOSIS
CRITERIA
TIME
24/04/2021 Risk for Client fluid 1. Reassure client and 1. Client and family reassured 25/04/2021
deficient fluid volume will be family. that fluid volume will be
@ @
volume maintain within 2. Educate client on the maintained within 24hours.
10:00am (vomiting and 24hours as causes, signs and 2. Client and family educated to 10:20am
passage of evidence by client symptoms of diarrhea. maintain clean environment to
watery stool) verbalizing the Goals fully me,
3. Educate client and prevent contamination. there are
related to absence of family to give enough 3. Client and family educated to
egestion of vomiting and absence of
fluid to son eg ORS take enough fluid to replace vomiting and
contaminated passage of watery
teach client how to lost fluid. passage of
food. stools.
prepare ORS with 4. Client and family educated on watery stools.
water the intake of well dense diet to
4. Educate client and obtain the necessary nutrients.
family on the intake of 5. Client and family educated on
well dense diet. proper hand washing before
5. Educate client and handling food to prevent
family on hand contamination.
washing with soap and
water before and after
eating.

47
 EIGHTH HOME VISIT ON 4TH MAY 2021

Objective;

By the end of my visit, I will be able to;

1. educate client and family on good personal and environmental hygiene.

I made my eighth home visit on 7 th May, 2021 at exactly 10:00 am. On arrival, I met

client in front of the house, I greeted him and he responded. He ushered me into the

house and offered me a seat. I asked about the welfare of client since he was not

feeling well during the previous visit. He made it known to me that there is absence of

vomiting. I introduced my objective to them as to ensure good personal and

environmental hygiene. I asked Mr. A. M. F what personal and environmental

hygiene is and my client answered that, it is the way of keeping our body and

environment clean and also sweeping our compound daily and by bathing and

brushing our teeth regularly. I compliment him and added that personal hygiene is

concerned with the individual measures taken to preserve one’s own cleanliness,

physical fitness and mental health. Ways to keep personal and environmental hygiene

include; emptying of the bowel, washing of dirty clothes, exercising, proper disposal

of waste, and washing of utensils to ensure a clean environment. I explain to them that

failure to observe and practice good personal and environmental hygiene will lead to

contracting infection such as cholera, malaria, typhoid fever and sometimes body

odour. I also told them that proper maintenance of good personal and environmental

hygiene helps promote, protect and prolong a healthy living. After the education

I observed that my client was having long finger nails. I asked why he hasn’t been

trimming the nails, and he said he has been busy and sometimes, he forgets. I asked

for a nail cutter, to trimmed his finger nail and continued to educate them on why the

48
 finger nails need to be kept short always to prevent contracting infections such as

worm infestation and other diarrheal diseases and also may cause injury to the skin

through scratching.

All questions asked were addressed. I congratulated them for their time and

contributions. I promised them to visit next weeks on 14 th May, 2021 as we agreed to

be the next visit. I asked for their permission to leave.

Problem Identified

1. Client has overgrown finger nails.

DATE NURSE OBJECTIVE/ NURSING ORDERS NURSING INTERV

DIAGNOSIS OUTCOME
/TIME
CRITERIA

04/05/2021 Self-care deficit Client will perform 1. Encourage client to 1. Client encouraged t

@ related to proper hygienic practice proper oral hygiene to prevent ora

10:00am inadequate practices as expected hygiene. such as halitosis.

knowledge on the within 48 hours as

2. Advice client to trim 2. Client advised to tri
importance of evidenced by client
nails to keep them short short to prevent dirt fr
personal hygiene. verbalizing a feeling
and clean. long nails.
of comfort and body
3. Educate client to practice 3. Client educated to p
satisfaction with

49
 cleanliness and hand and body hygiene. and hand hygiene to p

answering about 80%

4. Advice client to wash 4. Client advised to w
of questions asked
under wears properly and regularly to ensure cle
correctly.
regularly. prevent infections.
TABLE 8: NURSING CARE PLAN FOR EIGHTH HOME VISIT ON 4TH MAY

2021

50
 NINTH HOME VISIT ON THE 14TH MAY, 2021.

Objective;

By the end of visit, I will be able to;

1. inform client and family about the handing over to the community Health Nurse for

continuity of care.

My ninth home visit to Mr. A. M. F and the family was on 14 th May, 2021. On

arrival, at the house, I observed the environment was clean. I was offered a seat after we

exchanged greetings. I asked about their health and they answered they were fine. I

assessed the previous visit. We began our discussion by introducing the day’s objective. I

inform client and family of handing over to a community psychiatrist nurse. I asked

client and mother to evaluate the care they have received so far and client responded that

the care really have an imparted on him so far. He affirmed that he has now gained

confidence and has been able to remain decisive about the kind of friends he moves with.

He added that he has been able to reduce the number of rolls he takes daily from 8 rolls

drastically to 2 rolls now for which he thinks has been possible with the nursing care. I

have provided within this period of time. I commended him for the response and

encouraged him to keep on with the newly adapted lifestyle.

I encouraged and assured them that the community psychiatric nurse is competent and

experienced to continue the care and that he will be in safe hands and should not worry

but feel free to share health related issues with her.

We brought our discussion to the end and promised to come back for the handing over

on 21st May, 2021.

Problem Identified

1. No problem identified

51
 HANDING OVER AND CONTINUITY OF CARE

I made my final visit to Mr. A. M. F and family on 21 st May, 2021 with a

community psychiatric nurse who has over sight responsibility of the area. When we

arrived, they gave us a warm welcome and offered us a seat. We asked of the health

condition of client and the family and they were all fine.

I introduced the community psychiatric nurse to them and vice versa. I

explained to the family that just as they co-operated with me for a successful nursing

care, they should do the same to the new care giver. The family said since I did my

best to give care to them, they knew the community health nurse will do same. After

accepting the care giver, he expressed his gratitude to the family for accepting him.

He also assured them of competent nursing care.

I expressed my sincere gratitude to Mr. A. M. F and the family for accepting

and helping me to bring my care to a successful end. The family also expressed their

gratitude and they promised to cooperate with the new care giver as well. I

encouraged them to continue to practice all that we discussed and learnt. Community

psychiatric nurse took the contact number and booked a date with them for his visit. I

bade them bye and fare well and asked permission and left.

52
 SUMMARY

This care study is a detailed account of the nursing care family actions given to

Mr. A. M. F, a 30year old man and his family who reside at Oda Old Town

suburb of Akim Oda.

I started the supervision of this situation (marijuana abuse) on 28 th of February,

2021 at the market and my main objective was to assist client to reduce

marijuana abuse and obtain optimal health. He was wretchedly dress and also

looking timid when I met him. Based on problems identified, nursing

diagnosis were formulated, plans were developed, objectives were set and

nursing interventions were instituted to meet the set goals. The interventions

were applicable on routine basis till a period of significant improvement in

client’s condition.

These specific objectives includes educating client and family on the

effects of marijuana abuse, educate client and family on the withdrawal

symptoms of marijuana abuse, introducing client to a rehabilitation center at

the Government hospital- Akim Oda, client and family were finally handed

over to with all relevant data and information to the community psychiatric

nurse for continuity of care. At the end of the care, client’s condition improved

massively as client reduced the abuse of marijuana from 8 (eight) rolls per day

to 2 (three) rolls per day.

53
 CONCLUSION

The goal set for this client and family centered care study was for the client and

family members to have adequate knowledge including the causes, effects, the

complications as well as well as the preventive measures that would be put in place to

help curb drug abuse in the family and community at large. Currently, the client Mr.

A. M. F has reduced the number of drugs he abuses and promised not to go back to

his old behavior.

Therefore, this study has become a successful one with the co-operation of the

family. I was also able to put into practice the theoretical knowledge I have acquire

over the three years period. This experience will enable me to be apply it in most of

the client I will be dealing with after completing school.

54
 RECOMMENDATION

It is recommended to the Birim Central Municipal Health directorate to

intensify health education on the health risks involved in abusing drugs. Community

Health Nurses should also help intensify home visits to help identify individuals with

drug abuse in the community and provide education on the causes, effects, preventive

measures and the needed care to attain optimal health.

I also recommend to the authorities of community Health Nurse’s Training

school, Akim Oda to introduce the client and family centered care study early enough

to equip students and enable them gain more experience on it.

55
 REFERENCES

Bergeson, S.E. (2004). Understanding the Global Problem of Drug Addiction is a

Challenge for IDARS Scientists. Current Neuropharmacology

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 SIGNATORIES

NAME OF CANDIDATE: DARKWAH JOYCE

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DATE: ………………………………………………………………………

NAME OF SUPERVISOR: ADAMU SEIDU SHIDDO

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DATE: ……………………………………………………………………….

NAME OF DISTRICT PUBLIC NURSE: MS GRACE DANQUAH

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SIGNATURE: ………………………………………………………………...

DATE: ………………………………………………………………………...

NAME OF PRICIPAL: MR. JONES ABEKA- BAAH

SIGNATURE: …………………………………………………………………

DATE: ……………………………………………………………………

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