Janice A.: Young Mother and Son Temporarily Living in a Shelter

Betty P. Dennis, RN, DrPH
Dean, Division of Nursing
Dillard University
New Orleans, Louisiana

Information Obtained during the First Visit/Encounter:

Janice A., age 26, and her 20-month-old son lived in the local shelter for homeless women and children for about three weeks. Janice was 30 weeks pregnant and single. She visited the health clinic located in the shelter. The clinic was operated by the local college of nursing and staffed by faculty, students, and community volunteers. Janice told the nurse that she had not scheduled any prenatal visits since she "felt all right".

During the examination, Janice’s blood pressure was 148/96, proteinuria was +1 on dipstick, ankle edema was 1+, weight was 171 pounds, and height was 5’6”. As she and the nurse talked about these data and her need for prenatal care, Janice said, "Before this pregnancy, I weighed about 145 pounds. I seem to have gained a lot more weight during the last few weeks. I remember that both my sisters had high blood pressure when they were pregnant."

Usually, Janice and her son ate breakfast at the shelter. They were required to leave the shelter by 7:30 AM and could not return until 5:30 PM. During their time on the street, they ate whatever they could find. "I am alone and can’t do any better right now”, said Janice, “but I want to find a home for me and my son. Thank goodness he is healthy. I need to talk to the social worker about an apartment." The nurse and Janice discussed ways to improve her situation and obtain housing. The nurse called the county health department obstetric clinic and social services and the community social service agency; the nurse sent the usual written referrals with Janice. The nurse gave Janice directions to the facilities and bus passes.

Application of the Omaha System:

Domain: Environmental

Problem: Income (high priority)

Problem Classification Scheme

Modifiers: Family and Actual
Signs/Symptoms of Actual:

• low/no income
• uninsured medical expenses
• difficulty buying necessities
   

Intervention Scheme

Category: Teaching, Guidance, and Counseling
Targets and Client-specific information:

• finances (needed source of funding for regular prenatal care)

Category: Case Management
Targets and Client-specific Information:

• continuity of care (called referral sites to describe homeless status and need for communication)
• medical/dental care (referred to obstetrics clinic for free services)
• social work/counseling care (referred to local social services for income assistance)

Category: Surveillance
Targets and Client-specific Information:

• finances (follow up for referrals)
   

Problem Rating Scale for Outcomes

Knowledge: 2-minimal knowledge (did not know about resources for food or transportation)
Behavior: 2-rarely appropriate behavior (did not use other available prenatal services but did come to shelter clinic)
Status: 2-severe signs/symptoms (in homeless shelter for three weeks and no plans to leave)

Problem: Residence (high priority)

Problem Classification Scheme

Modifiers: Family and Actual
Signs/Symptoms of Actual:

• homeless
   

Intervention Scheme

Category: Teaching, Guidance, and Counseling
Targets and Client-specific Information:

• home (steps to locate permanent and adequate housing for self and children)
• safety (traffic, weather, other people while on streets and in shelter)

Category: Case Management
Targets and Client-specific Information:

• social work/counseling care (referred to both county and community social services for income and housing assistance)

Category: Surveillance
Targets and Client-specific Information:

• home (status of referral/moving out of shelter)
   

Problem Rating Scale for Outcomes

Knowledge: 2-minimal knowledge (recognized that living in a shelter was not a permanent solution. " I want to find a home for me and my son.")
Behavior: 2-rarely appropriate behavior (identified social services as a resource, but did not initiate contact)
Status: 1-extreme signs/symptoms (in third trimester of pregnancy with no immediate prospects of permanent housing for self, son, and newborn)

Domain: Physiological

Problem: Pregnancy (high priority)

Problem Classification Scheme

Modifiers: Individual and Actual
Signs/Symptoms of Actual:

• difficulty with prenatal exercise/rest/diet behaviors
• prenatal complications/preterm labor
• inadequate social support
   

Intervention Scheme

Category: Teaching, Guidance, and Counseling
Targets and Client-specific Information:

• dietary management (food intake during day while on streets)
• rest/sleep (patterns during day while on streets and in shelter)

Category: Surveillance
Targets and Client-specific Information:

• signs/symptoms-physical (weight, blood pressure, protein in urine, diet, fetal health)
   

Problem Rating Scale for Outcomes

Knowledge: 2-minimal knowledge (did not recognize need to seek prenatal care; was "feeling all right" with this pregnancy)
Behavior: 2-rarely appropriate behavior (spent days on the street with 20 month old son)
Status: 2-severe signs/symptoms (family history of hypertension during pregnancy, proteinuria, probable rapid weight gain, and elevated blood pressure)