In 1970 the community health teacher and 16 seniors conducted a survey of the perceived health needs of mature individuals housed in two nearby senior citizen housing facilities for older citizens. Two- hundred tenants maintained residency in the housing projects. A random sample of 85 residents were given questionnaires. The questions were read to the residents and the replies were written on especially prepared 5x8 inch index cards. The answer cards were tabulated and the findings were analyzed. Over 70 percent had one or more health problems. Failing vision, hearing loss, loneliness, heart disease, hyper- tension, arthritis, obesity, inadequate diet, diabetes, nervousness and worry were among the frequently occurring problems identified.
The students made a recommendation to have a staff nurse from the local health department be assigned to assist this particular at-risk group.
The findings and recommendation were taken to our health officer. He commended the work, recognized the existence of needs, but had no available staff to carry out the nursing activity suggested. We do not fault the physician-his nursing staff is a small one considering all the work in which they are engaged.
Our next step was an approach to the housing personnel at which time our services were offered with that of faculty and senior students; but, we were rejected. One person expressed herself by saying, "You would be making hypochondriacs of these people."
Efforts then were expended in setting up discussion groups and classes in various settings throughout the area. Topics consisted of foot-care, diabetes, home safety, heart disease, basic nutrition, constipation and laxatives, quack medicine, community resources, proper body mechanics and exercise, and ways to lessen loneliness. Series of lessons on home nursing and first aid were taught as well as sessions on, "What would I do if I needed a doctor?"; "If I were stung by a bee"; "If I forgot to take my medicine" and so on. (We continue to conduct these type discussions and classes each quarter.)
We endured, still feeling strongly that nurses have a responsibility to all persons and especially to the aging in helping them maintain their health, present disease, and to have satisfying relationships in their lives. We realized, too, that there were potentials involved as well as problems! Often the idea of nursing clinic service to the aging was brought up in talking with Community Action workers. One community organizer was not only in full agreement with our philosophy but she agreed to find a location for a clinic as long as we would continue to be interested, enthusiastic, and willing to serve the people.
A notice of the initial free nursing clinic was published in the Community Action weekly paper. We designed a poster and leaflets and the Community Action group ran them off. The format was something like Figure 1.
We developed a brief form with a nursing history and assessment with a plan of action on two sides of a 5 χ 8 inch card. After a year we expanded into a three-page form and are currently revising it.
Our first clinics were held upstairs in a small community action office room. We were soon given access to the community building in the housing project to accommodate persons who experienced stair- climbing problems and to provide larger quarters enabling us to have more adequate space in which to work.
We feel we are still pioneering although we have had a second clinic in operation for over a year in another section of the city. The second clinic is presently housed in a senior citizen high-rise housing establishment.
Our average client attendance has been 15 persons per session. Usually one instructor and two or three community health nursing seniors conduct each clinic. Many persons have been referred for follow-through to their family physicians. We've been able to get physicians to see some clients who had no physician. Several individuals were admitted to nursing homes after referral to their physicians and we visit them, "as friendly visitors," during their institutionalization. Glasses were obtained for needy clients; at times, garments were obtained, reading materials were given to people, and sewing supplies shared with clients. Minor injuries were occasionally cared for, eyeglasses cleaned, and toenails trimmed. Realizing the value of touch, back rubs have been given when indicated as helpful therapy.
Referrals have been made to the health department for tuberculin tests, chest x-rays, and immunizations. The health department staff is most cooperative, collaborative, and congenial in working with the nursing clinic nurses and clients. This year we have been giving some tuberculin tests.
Faculty and students have increased in number. We retained the various group sessions and classes in the dinic setting at different times than the clinic sessions however. Multiple classes and discussion groups are initiated each quarter in many different locations. Our teaching-learning methods vary: some lecture with discussion periods, more question and answer sessions, demonstrations, films, slides and role playing.
Our goals have been:
* To help the elderly identify health needs
* To increase individual knowledge of health
* To increase knowledge of health resources
* To relieve individuals of "pain"
- pain from low self-esteem to feeling "I'm O.K." "I'm Somebody"
- pain from isolation to friendship, to a feeling of belonging, feeling wanted
- pain from worry to expecting to enjoy each day, to choose happier thoughts, to accept what can't be changed.
On the client's initial visit to the clinic we obtain a health history, do a physical assessment, use nursing judgment, look for nursing implications, intervene when appropriate, involve people in their own care and encourage them to make decisions about their own health.
Our concern is the total person in his total environment and this includes health, housing, food, fears, rats, roaches, and garbage.
A persistent nursing role is that of therapeutic friend with this age group. We must listen, comfort, counsel, touch, teach, suggest, and even do for when the client can not do for himself or herself.
People frequently tell us things they feel are not important enough to impart to their family or their physician. They expect nurses to tell them if the need is great enough for more expert attention from other disciplines.
Our nursing students feel physicians are experts in diagnosing and treating disease. But we feel nurses know health and can recognize major deviations and refer the person to the physician. We are aware of our limitations but we are also aware of our nursing competencies. We continually seek to improve our skills and up-date our knowledge. We know nursing requires lifelong learning. We have used the Sherman and Field's text and this school year are using Barbara Bates' book on physical assessment. We think we have earned a reputation of good nursing and of caring in our clinics. We have learned that indeed there is healing capacity in touch.
We have learned that speaking clearly, looking at people, clarifying, not rushing and demonstrating things, and illustrating really do improve communica- tion. Writing out instructions, directions, or informa- tion can give security and reinforcement.
We believe the physicians who know of our service have facilitated acceptance of us within the local medical society. The physician on our school faculty has helped us with assessment and has supported us in all our endeavors.
New ideas for this year include use of the written contract with clients of what to do, when to do, how to do, how well did I do, and for some persons possibly the keeping of personal weekly diaries.
Our nursing clinics were designed mainly to determine the feasibility of using nurses to assess aging persons health status. We have proved nursing clinics serve a definite clientele by assisting particular indivi- duals in meeting their health needs.
- Bates B: A Guide to Physical Examination. Philadelphia, J.B. Lippincott and Co, 1974.
- Sherman JL, Fields SK: Guide to Patient Evaluation. Flushing, NY, Medical Examination Publishing Co, 1974.