Pediatric Home Care

  1. I have been doing Pediatric Home Care for 17yrs. I work 8,10, or 12hr shifts. I havent seen any posts from nurses in HH who do what I do, but am interested in their experiences. I have worked in Minnesota, Kansas, Illinois and Florida and what a difference there is in funding for these kids! We used to say, "If you have a disabled child, DON'T move to Florida." "If you have a disabled child, live in Minnesota."
    Lately, I have experienced problems with the members on the healthcare team. (with recent grads who come to home care and think this is a "mini" hospital.)
    I have been searching on-line for articles on providing normalicy for these kids. If anyone has any suggestions, please send them on.
    I look forward to any replies
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  2. 8 Comments

  3. by   ArwenEvenstar
    Hi! The private duty nursing forum may be a better spot for your post. I have also been doing private duty (shift work in private homes) for 3 years now. I've had 2 cases - a ventilator dependent child, and a 23 year old severely disabled female. Private duty does have unique issues at times, huh?

    I was not sure what you meant in your post about new nurses thinking it is a "mini" hospital??? Do you mean that they act like it is the hospital in regards to technique instead of remembering it is a home and being more "relaxed" with their care? For instance, some procedures that would be "sterile" at the hospital are acceptable to do using only "clean" technique in the home. In the home, we often re-use supplies that would be single-use at the hospital. Also, you sometimes have to "go with the flow" of the family's routines, even if it is not by the book. Is this the type of thing that you were getting at?
  4. by   lvnandmomx3
    Quote from pldlpn
    I have been doing Pediatric Home Care for 17yrs. I work 8,10, or 12hr shifts. I havent seen any posts from nurses in HH who do what I do, but am interested in their experiences. I have worked in Minnesota, Kansas, Illinois and Florida and what a difference there is in funding for these kids! We used to say, "If you have a disabled child, DON'T move to Florida." "If you have a disabled child, live in Minnesota."
    Lately, I have experienced problems with the members on the healthcare team. (with recent grads who come to home care and think this is a "mini" hospital.)
    I have been searching on-line for articles on providing normalicy for these kids. If anyone has any suggestions, please send them on.
    I look forward to any replies
    I work with diabled adults not peds. But do have some info try this website, we had a training a few weeks back and she was a speaker and I absolutly loved her. www.disabilityisnatural.com . I have a few more resources that I will get to you on Monday when I get to work.
  5. by   lvnandmomx3
    http://www.universallifestiles.com/

    Here is another link that may help you out. I hope you find what you are looking for.
  6. by   pldlpn
    That is exactly what I mean. Some nurses find it hard to go with the flow of a home routine. As a result, the parents become confused. The parents are used to the routine of the hospital and find it hard to relax with their child. This especially happens with premies coming home. How to explain to these nurses there is "grey" area when you work in someones home. You don't need a Dr. order for everything.
  7. by   lvnandmomx3
    I have been searching on-line for articles on providing normalicy for these kids. If anyone has any suggestions, please send them on.
    I look forward to any replies
    I apoligize I misread this thread thought you were looking for info for providing the kids with disabilities a normalized surrounding. The links provided were for that purpose.
  8. by   ArwenEvenstar
    Quote from pldlpn
    That is exactly what I mean. Some nurses find it hard to go with the flow of a home routine. As a result, the parents become confused. The parents are used to the routine of the hospital and find it hard to relax with their child. This especially happens with premies coming home. How to explain to these nurses there is "grey" area when you work in someones home. You don't need a Dr. order for everything.
    Hi again! Yes, for sure there are "grey" areas when you work in a home. Preemies....wow! I don't do babies. But I imagine the nurses would play an important role in helping the parents relax and adjust to life at home with their little one.

    In your original post, you mentioned looking for articles about this aspect of private duty. In my 3 years now of private duty, I have not been able to find specific articles or info about some of the unique issues of private duty. It seems lacking...

    My one case was a long-term disabled child. At one point I was looking for articles/info on how families cope and respond to long-term disability as the years go by and their child's condition only progresses. I was facing some challenging psycho-social family dynamics, and wanting a nursing perspective on it.

    Actually, I have not experienced personally nurses acting like the home is a "mini-hospital". But an issue I have faced now with two nurses, is nurses who totally lack a professional boundary. (They socially integrate into the family, become too close, and lose all nursing objectivity. It causes/creates multiple issues and problems.) I wish I could find an article to give to nurses new to private duty on the importance of maintaining a professional boundary.

    Hmmm...maybe we should consider writing some articles! : )
  9. by   caliotter3
    Be careful with what you do without a doctor's order. Just because it is done in the home does not mean that the skilled nurse does not need an order. The opposite is true. Family members frequently will go against doctor's orders and attempt to get the nurse to go along with them, endangering the nurse's practice if they fall for this. If you have any doubts about a medication or procedure, call your office and speak to a supervisor. Obtain an order if necessary. When the family tries to get you to do otherwise, tell them that they will have to give the med their way or perform the procedure their way and document, document, document. Read the 485 and follow the doctor's orders and protect your license.
  10. by   ArwenEvenstar
    be careful with what you do without a doctor's order. just because it is done in the home does not mean that the skilled nurse does not need an order. the opposite is true. family members frequently will go against doctor's orders and attempt to get the nurse to go along with them, endangering the nurse's practice if they fall for this. if you have any doubts about a medication or procedure, call your office and speak to a supervisor. obtain an order if necessary. when the family tries to get you to do otherwise, tell them that they will have to give the med their way or perform the procedure their way and document, document, document. read the 485 and follow the doctor's orders and protect your license.

    although i can't speak for the original poster (op), i don't think the op or myself were inferring that it is okay to do medical tasks without a md order. i am an extremely conscientious nurse that guards her license carefully. i would never dream of giving a med or performing a medical procedure without a md order.

    however, there truly is a more relaxed atmosphere in the home. in a long-term, stable patient at home (as opposed to an acutely ill hospitalized patient), there does not have to be such a strict adherence to regiment. sometimes procedures or med times may be altered/adjusted to help the patient and/or family have more normalcy. care in the home is different than in the hospital. there are shades of gray, whereas the hospital is more black and white.

    when i was brand new to private duty 3 years ago, i had to call my supervisor from time to time to clarify if something was "okay" to do a certain way in the home. for instance, some procedures that are strict "sterile technique" at the hospital are fine to perform using "clean technique" in the home.

    the op referred to nurses who act like the home is exactly like the hospital. if you get a nurse who suddenly comes in acting like the home is a hospital - ie: strictly adhering to regiment, refusing to alter a procedure time, doing every procedure using strict sterile technique - this does not help the child or family relax and adjust to life in the home. i think the op works with new infant cases. the family is tense enough being at home with their infant for the first time, without a nurse acting like it is still the pediatric intensive care unit.

    however, i totally agree that nurses do need to be careful. very careful. families can do whatever they want. for instance, if they want to go to the store and get an otc med to give to the child, that is their right. however, the nurse can not give the med until she gets clearance from the md. a nurse must keep a professional boundary and stay objective. sometimes you will have to take a stand with the family. i've had to nicely but firmly tell family that i could not do something because i lacked a md order.





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