Case Study, Chapter 30, Home Health and Hospice Care

Gil W. is a 55-year-old hog farmer referred to the county health nursing service’s home health agency by the only surgeon in this rural county of 5,200 people. Gil fell several days before in his hog lot, and the deep cut on his left knee is infected. He did not seek medical care for the cut until today. Gil refuses to be hospitalized for treatment. He lives in a remote area of the county with his 55-year-old wife, Jane, a wheelchair-bound polio survivor, and Sam, his 80-year-old father-in-law, who has dementia. Gil and Jane have one son, who lives in another part of the state, several hours away.

Because the home health agency’s office is located next door to the medical clinic, the home health nurse’s initial contact with Gil is in the surgeon’s office. When the surgeon explains the situation to the nurse, the nurse tells the physician that she attempted a home visit on the family several months before at the request of a neighbor, a county commissioner, but Jane, while cordial, refused to let the nurse in the home. The surgeon tells Gil that since he refuses to be hospitalized, he will need the home health nurse to see him twice a day for at least a week, to clean and pack the wound. The number of visits may be reduced depending on how well the wound is healing and Gil’s ability to perform his own wound care. He will also have to elevate his leg and stay off of it as much as possible until it heals.

The home health nurse arranges to see Gil at 8 am and 6 pm, starting the next day, to provide the wound care and begin teaching him how to care for his wound. Gil provides her with insurance information, and the surgeon gives the medical orders for the home health service, so that prior approval for home health services can be obtained from the insurance company. The nurse also learns that Gil will ask his neighbor (the county commissioner) to help tend to his hogs and other farm work while he is recuperating (Learning objectives: 4 and 5).

1. How can the nurse establish trust with the family, given that a previous attempt to provide assistance to the family was rejected?
2. What would be priority assessments for the nurse to make on the initial home visit?
3. How can the nurse teach Gil self-care for packing the wound and changing the dressing?
4. The nurse will be changing dressings on an infected wound. What does the nurse need to consider for infection control

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