Page 474 - alligood 8th edition_Neat

CHAPTER 23 Margaret A. Newman 455

CASE STUDY two sisters and their sole daughter. They were
very self-sufficient, grew large gardens, had their
Alice is an 81-year-old widow who has lived alone own livestock, and rarely went into town. All
in a low-income apartment complex in a small these family members are now deceased except
rural, Appalachian town since her husband’s death the granddaughter, who insisted that Alice leave
8 years ago. She has one surviving family member, the cabin and move into town after the death
a granddaughter, who lives 30 miles away. Alice of her husband. It is apparent that Alice’s past
has never learned to drive and depends on her patterns have been those of independence and
granddaughter for all transportation to physician limiting social contact to mainly family members.
appointments and for shopping and getting medi- The nurse shares her perceptions with Alice,
cations. Her income is $824 monthly, and she who confirms and verifies the pattern identifica-
requires several expensive prescriptions for arthri- tion. Alice states, “I just don’t know how long I am
tis, hypertension, and cardiac problems. She has going to manage by myself anymore.” The nurse
osteoarthritis in her knees and requires a quad helps her explore sources of help, besides the
cane for support and safety when getting around granddaughter, that will help Alice remain in her
her apartment. A visiting nurse stops by weekly apartment as independently as possible. Alice
to check her blood pressure and to give her an relates that there is one man, a few doors away
injection for her arthritis. The visiting nurse notes who has stopped several times to ask if she needed
that Alice’s blood pressure is elevated, and Alice anything from the grocery store, but she hasn’t
states that she has been unable to get her medica- asked him because she hates to bother him and
tion because her granddaughter’s car is broken. doesn’t want “to be beholden.” After further dis-
Alice mentions that she is low on food in the cussion, she decides that she will ask him to pick
apartment because she can’t get out to shop. up staples and medications for her and will pay
Alice admits that she hardly knows or speaks him back by baking him some bread, saying,
to her neighbors despite having lived there for “I just love to bake anyway and haven’t had anyone
8 years, and she still feels like a stranger and much to bake for.”
doesn’t want to “push myself in.” She says that she In subsequent weekly visits, Alice and the
hates to bother people and “won’t hardly unless nurse explore the possibility of getting medica-
I just have to.” She says she sometimes gets lonely tions at a reduced price through the local nurse-
for “her people,” who are all deceased. managed clinic. Alice states that she might try
The visiting nurse, in working with Alice, rec- getting to know some of her neighbors. The nurse
ognizes the current situation as a choice point, helps Alice make arrangements to be picked up
with potential for increased interaction with oth- by the Senior Van for physician appointments. As
ers and increased consciousness. The old ways no Alice begins to build her own support system,
longer work for Alice, and new ways of relating she finds that she relies on the nurse less for help
are necessary. The nurse incorporates the ele- with maintaining her independence, and they
ments of Newman’s method to assist Alice in pat- resume their previous pattern of the nurse check-
tern recognition for the purpose of discovering ing her blood pressure and giving her injections
new potentials for action. As the nurse has Alice weekly. However, Alice and the nurse have now
relate her story, through dialogue and interacting developed a relationship that has transformed
with Alice, she helps Alice recognize past patterns them both, and the nurse is often met at the door
of relating and how present circumstances have with the smell of fresh-baked bread and an invi-
changed those patterns. Alice talks about how she tation to “have a bite.” They both enjoy this new
and her husband lived for 56 years in a rural relationship.
mountain cabin with few neighbors except for