Emma B.: Woman With Mental Illness
Phyllis M. Connolly RN, PMHCNS-BC, PhD
Information Obtained during the First Visit/Encounter:
A psychiatric home care nurse visited Emma B., age 62, in the licensed board and care facility where she lived for the past two years. Her medical diagnosis was schizophrenia. She was facing a possible eviction because of personal hygiene problems. The administrator told the nurse that he was concerned about Emma's hygiene and questioned if her psychiatric medications were controlling her symptoms.
When the nurse stopped at Emma's room, she invited the nurse in to visit. Emma's clothes were wrinkled and soiled with food, her hair was matted, and her finger nails were long and dirty. Broken handbags were everywhere. Emma continued to look through her handbags as if she was searching for something. She moved about the room, picked things up, then looked distracted and moved to the next handbag. Emma frequently stopped and argued with herself. Her mood shifted rapidly during the visit. She asked the nurse, "Are you my new conservator? You look like one. They are all after my money, and try to keep me from my family. As soon as my boyfriend gets a new job, we will get out of this place. They want to throw me out anyway."
The nurse asked Emma if she knew the purpose of the visit. Emma suspected that other residents complained about her; she had not taken a shower because the bathroom was always occupied. "I know showering is one of the rules and they said they could even throw me out, but it's not my fault." The nurse confirmed that Emma's personal hygiene was a problem and offered to help. Emma said she tried to take a shower but had difficulty gathering her soap, towel, and clothes. Sometimes she had trouble concentrating because she "heard voices" while she was in the shower. "I'm not sure when I showered or changed clothes last." Emma also reported that a new resident banged on the bathroom door and demanded that she leave. The nurse asked if a mental health worker (paraprofessional) could help her assemble her supplies and prevent the other resident from disrupting her shower. She agreed to try.
The nurse asked to see Emma's medications. She identified them correctly, but said she forgot to take them sometimes. She was willing for the mental health worker to help her. She indicated that the doctor and nurse practitioner had changed her medications because they were not effective. "They keep telling me not to drink so much coffee and coke—something about the medications." The nurse briefly explained the effect of caffeine, and asked if she had tried decaffeinated drinks. Emma responded that she had not.
The nurse left Emma and talked to the administrator. They arranged assistance with medications, showering, changing clothes, and laundry, and scheduled an appointment to evaluate Emma and her medications. The administrator said that decaffeinated coffee and coke were available. When the nurse returned to Emma's room, she thanked the nurse for helping.
Application of the Omaha System:
Problem: Mental health (high priority)
Domain: Health-related Behaviors
Problem: Personal care (high priority)
Problem: Medication regimen (high priority)