Thank you to the College of Registered Nurses of British Columbia for permission to adapt their case study.
Marcie is currently employed in a home health office, delivering home-care nursing services to clients in the community.
A new client, Ray, has been referred to the home-care program for complex wound care. Ray lives in a two-bedroom apartment on the second floor of a rundown building, in a neighbourhood that has a lot of street crime. He has two roommates who he met while in an addiction treatment program. Ray has been in recovery from a substance use disorder for the past six months.
Marcie is confident she has the skills to carry out the wound care Ray needs. However, she wonders if his home is a safe place to provide care.
Concerned by recent staff reports of aggression towards the home health staff, Marcie has recently completed employer-provided education in violence prevention related to personal safety. She applies this knowledge when reviewing Ray’s information, taking note of factors that could present a risk to the client, herself and others. These risk factors may affect how and where this client’s care will be delivered.
Marcie is aware that the current client situation presents a number of risks factors. She also knows she has a duty to provide quality care to Ray, while keeping herself and others safe.
Interview the client by phone, using her organization's risk assessment tool.
The plan of care addresses risk and includes mitigating strategies, while meeting both the client’s care needs and ensuring staff safety. Both the client and care team should be involved in planning for the care. Consider:
Nurses have a professional and legal obligation to provide their clients with safe, competent and ethical care; however, they are not obligated to put themselves in danger. Marcie needs to balance her duty to provide care with her personal safety and the safety others.
After careful thought and preparation, Marcie decides that she feels safe providing care in Ray’s home when his roommates aren’t home. She speaks to Ray and they agree the best time for this care is early afternoon.