The document presents a case study for community health nursing focused on child abuse and maternal-child mental health, illustrating the roles of a community health nurse managing pregnant women on Medicaid. It describes the challenges faced by two clients, a pregnant teenager and a developmentally delayed young mother, both in need of support and resources to ensure the well-being of their children. The nurse is tasked with assessing and coordinating interventions through an interdisciplinary team while addressing child protection concerns.

1. Chamberlain College of Nursing NR443/435/436: Week 3
Case StudyWeek 3 Case Study: Child Abuse
This case study provides you with an opportunity to immerse
yourself in the role of a community health nurse and examine
primary, secondary, or tertiary prevention strategies related to a
population health problem. As you work through the case,
reflect on what you have learned from this course about
community health nursing, and apply it to this scenario.
Your Role
You are working as a community health nurse in your local
health department. One of your roles with the health department
is to case manage pregnant women who are on Medicaid. You
continue to work with an interdisciplinary team both within and
outside the agency.
Team Members
· Anne, a fellow nurse with the health department, is on medical
leave, so you have been assigned this case.
· Christina is a social worker with the health department.
· Tracey is a case worker from Child Protection Services.
· Mark is a dietician with the local WIC (Women, Infants, and
Children) office.
The Case
You are assigned to a new case. Marissa is 15 years old and is
pregnant with her first child. Marissa lives with her mom and
her five siblings in a two-bedroom apartment. You arrive to
your first visit, and a young boy, Marissa’s brother, who is
about 5 years old answers the door. He lets you in to find
Marissa sleeping on the couch. There is also another couch
where her 10-year-old sister is sleeping. Even though the
apartment is dark and everyone seems to be sleeping, you
decide to continue with the visit as Marissa wakes up and is
willing to participate.
As you are getting to know her, more of the family wakes up,

2. and you can now hear whom you assume is her mother yelling at
one of her siblings. You continue talking to Marissa, but her
mother is getting louder and all of a sudden you hear three
smacking or hitting noises. They are in a back bedroom, so you
do not see anything, but you hear a child crying and her mother
telling the child to “shut up” or he will get “more.” Marissa
tells you her siblings range from 3 to 12 years old.
As you leave the visit, you know that Marissa, as well as her
mother, need additional support and education regarding
parenting and proper forms of discipline. As a nurse, you know
you are a mandated reporter, so you go back to your office and
research child abuse and Child Protective Services (CPS). You
decide to talk with your team about what just happened, too.
Your team agrees that Tracey, from CPS, needs to be notified.
Next, please go into the Week 3 Discussion, and answer the
prompts.
NR 443/435/436 Week 3 Case 1/2018 MM LS
2
Chamberlain College of Nursing NR443/435/436: Week 3
Case Study
Week 3 Case Study: Maternal Child and Mental Health
This case study provides you with an opportunity to immerse
yourself in the role of a community health nurse and explore the
resources in your community. As you work through the case,
reflect on what you have learned about community health
nursing in this course and how you can apply it to this case.
Your Role
You are working as a community health nurse in your local
health department. One of your roles with the health department
is to case manage pregnant women who receive Medicaid. You
work with an interdisciplinary team both within and outside the
agency.
Team Members
· Anne is a fellow nurse with the health department. She is

3. going on medical leave and has asked you to assume this case.
· Christina is a social worker with the health department.
· Tracey is a case worker from Child Protection Services (CPS).
· Mark is a dietician with the local Women, Infants, and
Children (WIC) office.
Your Client
Mary is a developmentally delayed 23-year-old Hispanic female
in her first trimester of pregnancy. She has been diagnosed with
bipolar disorder. She is currently unemployed but receives
monthly Social Security disability checks and health coverage
through Medicaid. She lives with a roommate in a project
apartment complex in a run-down part of town.
Anne visited Mary once and provided the following information
as she hands the case to you. Mary had a baby removed from her
care when she was 19 years old. Mary cannot explain why this
baby was removed other than that her house was dirty. She met
the father of her current baby on the Internet and states that she
has not heard from him recently.
During Anne’s visit, Mary stated that she wants to keep the
baby. She asked many questions about healthy eating and
having a healthy pregnancy. Mary stated that she visited the
WIC office, received WIC vouchers, and met with Mark who
talked to her about what to eat. She asked for help to find a nice
apartment and make other lifestyle improvements so that she
can keep this baby.
When Anne started to explore options and difficulties Mary
might encounter in raising this child, Anne stated that Mary
became agitated and did not comprehend why her baby might be
removed from her care other than, “They are against me!”
Christina, Mary’s social worker, found that past court records
indicated the first baby was removed due to neglect and
unsuitable living conditions. At that time, Mary lived with her
parents in another county. The records indicated that Mary
failed to show up for her court hearing to appeal the decision,
so the baby was permanently removed and has since been
adopted.

4. According to Mary’s chart, Tracey from Child Protection
Services has stated that CPS plans to place Mary’s newborn
baby in foster care due to her cognitive impairment and past
history.
Your Charge
As your first assignment, you are to identify resources in your
community that could assist Mary during her pregnancy and
help to optimize the health of her infant.
Next, please go into the Week 3 Discussion, and answer the
prompts.
NR443/435/436 Week 3 Case Study 1/2018 LS MM 2
This is discussion post. PLEASE USE the textbook below for
reference and at least one SCHOLARLY PEER-Review.
Choose one of the two attached case studies, and reflect on the
vulnerable population that the case study portrays.
· Identify which case you chose.
· Discuss several risk factors that may impact health outcomes
for the vulnerable population in your case study.
· Identify one agency in your community that can assist this
vulnerable group and assess this agency in terms of the 4 A's
(see the lesson). Discuss each of the A's separately to assess
accessibility, acceptability, affordability, and availability for
this population.
The 4 A’s
Acceptability
· Does the client have confidence that the referral source will be
able to help?
· What were the past experiences, either positive or negative?
· Does the referral fit with the client’s values?
· Does it conflict with higher priorities? Consider Maslow’s
hierarchy of needs.
· Is there fear of the unfamiliar or of having to admit that help
is needed?
· What is the cost to the client other than money-time, loss of

5. work, and so forth?
Accessibility
Consider things in the client’s situation that may limit access to
the referral agency or hinder the client’s ability to follow
through on the referral.
Examples
Transportation, language barriers, hours of operation, and
conflicts with client’s work or school schedule.
Availability
Is there a referral source that meets the client’s need?
This goes back to community assessment and being aware of the
resources that are available in the community. Part of the role
of a CHN is to identify gaps between client needs and existing
resources (assessment) and to work to fill in any identified gaps
(assurance).
Affordability
· What fees does the referral agency charge?
· Is there a sliding fee scale?
· Will the agency accept third-party payment?
Nies, M. A., & McEwen, M. (2015). Community/Public health
nursing: Promoting the health of populations (6th ed.). St.
Louis, MO: Saunders/Elsevier.