The community health nurse has a primary role to assess the relationship of variables in the community with how they relate to patients and health. Cultural, religious, ethnic, and personal upbringings are variables that are considered to gain a basic understanding of the community framework. The purpose of this paper is to discuss three nursing diagnoses related to AL and his family living in a suburban community in Staten Island, New York. Interventions and outcomes will be expected for each diagnosis and will be integrated into the care plan and educational program specially designed for the chosen family.

Family Assessment

AL is a 65 year old man with an Italian ethnic background. He is a smoker who has been recently diagnosed with Type II Diabetes Mellitus, mild obesity, and a history of coronary artery disease with one stent last year. His physician stated he is borderline diabetic that could be managed through diet and lifestyle modifications, and could not advance if he is compliant with suggested regimens. He lives in a two-family residence with his wife, and his father who lives in the side apartment downstairs. He has two adult children who live within close range and visit several times a week.

Jean Watson’s Theory of Human Caring

When caring for a special population group within a community, the nurse must integrate clinical thought to assimilate specifically designed interventions for patients. Nurses must be conscious of their responses and actions that may inadvertently affect the patient’s response. Jean Watson’s Theory of Human Caring uses a contemporary, holistic framework designed by using multiple disciplines to care for individuals and those within a community. Experienced nursing professionals are familiar with Watson’s theory viewing all persons into the dimension of mind, body, and soul. Nurses assess the surrounding environment for disharmony, which may lead to illness and disease that could be prevented through change that leads to holistic healing (Falk Rafael, 2000).

Family Nursing Diagnoses

The community health nurse is responsible for making accurate nursing diagnoses with interventions and treatment options specially designed for patients and the community. There are three nursing diagnoses that are related to AL and his immediate family: Knowledge deficit, imbalanced nutrition, and activity intolerance. NANDA (North American Nursing Diagnosis Association) is a professional nursing organization that uses standardized nursing language to create specific diagnoses related to patients used to design an accurate and effective plan of care. These diagnoses are not to be confused with medical diagnoses, but are used to support physicians by using strategic interventions with measureable goals that will result with positive patient outcomes (NANDA International, 2013).

Knowledge deficit related to lack of understanding to care for a newly diagnosed diabetic condition as evidenced by non-therapeutic blood glucose levels and asking questions regarding self-management with diet and lifestyle modifications. This is the first diagnosis of AL related to health seeking behaviors that raises increased awareness that this family needs extensive education on several factors to promote health and manage existing disease. Education must be given to assist the patient and his family for healthier nutrition, increased daily exercise, effective blood glucose management techniques, and monitoring glucose levels regularly. One Healthy People 2020 leading health indicator that is related to this diagnosis is under the topic of clinical preventative services. According to Healthy People 2020 this indicator is categorized within the “Adult diabetic population with an a1c value greater than 9 percent” with a goal to improve number of persons by 10 percent ("2020 LHI Topics," 2013). Interventions are directed toward educating patient and family on nutrition: simple versus complex carbohydrates, sugars and sugar substitute, and list of suggested foods that are diabetic friendly. The community health nurse must first assess the individual needs of the patient, readiness to learn, and identify barriers to effective learning. Education is given on proper use of the blood glucose monitoring machine, frequency of testing, normal blood glucose parameters, signs and symptoms of high and low blood sugar, emergency measures, and keeping an accurate log book.

Imbalanced nutrition: More than bodily requirements related to excess caloric intake with low activity expenditure as evidenced by sedentary lifestyle, unhealthy eating habits, and excess body weight more than 20 pounds. This is the second nursing diagnosis given to AL and his family and relates to all family members. Goals will be reasonable and measureable and the patient will develop a daily exercise regimen, verbalize support groups that will assist with attaining goals, and create a daily food plan based on suggested nutritional information provided by resources given. One Healthy People 2020 leading health indicator related to this diagnosis is topic of nutrition, physical activity, and obesity. This indicator is categorized under the topic to “Reduce the proportion of adults who are obese”, having a target of a 10 percent overall improvement to reduce persons who are obese ("2020 LHI Topics," 2013). Interventions include providing education to the patient on health conditions directly related to obesity, monitoring caloric and fat intake, organize a daily meal plan, increased water intake, provide suggestions to develop an individualized personal exercise and wellness regimen, and offer additional resources such as brochures for local weight loss support groups and nutritional information.

Activity intolerance is the third nursing diagnosis created for AL that is related to sedentary lifestyle as evidenced by fatigue when walking at fast pace, up staircase, or after prolonged periods of time. Goals will include having increased tolerance to activity that will improve by five minutes weekly and by patient stating he is not fatigued after walking up stairs, prolonged periods of time, vital signs within baseline parameters, and able to walk at a fast pace for a sustained period of time over three minutes before complaining of fatigue. According to Healthy People 2020, this is also under the topic of nutrition, physical activity, and obesity but is categorized under the topic of “Adults who meet current Federal physical activity guidelines for aerobic physical activity and muscle-strengthening activity” ("2020 LHI Topics," 2013). Nursing interventions will include a detailed assessment of mobility, nutritional status, risk for injury, monitor vital signs during activity, fatigue, nutritional needs, and provide emotional support to make the patient feel more confident for success with goals.