how do you deal with unsafe/unsanitary conditions?

[cayenne06, MSN, CNM]

I just started a new private duty case with a sweet little boy and his family. The problem is, the apartment is just. . . . beyond the pale. I am new to private duty nursing, so maybe I am just out of touch with how a lot of people live, but this place was so awful. Stuff piled everywhere, dirty dishes covering the kitchen counters... everything was sticky and gross. Not to mention the safety hazards- there is a full fish tank (50 gallons!) on a very rickety stand, a 3/4 empty fish tank with stagnant water on a table in the corner, huge windows within easy reach of the kids with no screens (one with a huge crack in it!!!), widescreen TVs just waiting to fall over, etc. This family is well entrenched in the "system" and has regular CPS involvement, and anyway I don't even know if the house qualifies as bad enough to report. There is no overt abuse or neglect, and the family is, for the most part, compliant with medical needs.

I know some of their nurses have done cleaning for them, but I am not doing that. Dad is unemployed and home all day- there is no reason for me to be doing his dishes etc. I talk about safety with dad every visit, but they are low income and a lot of the problems are pretty much out of their control. They acknowledge the dangers of things like unsecured flat screen TVs and the fish tanks. They also acknowledge the health hazards of keeping their medically fragile child (or any child!) in an unsanitary situation. They haven't changed anything, though.

I am a very new nurse and a little unsure how to deal with this. Do I just focus on keeping my little area safe and clean? My patient is mobile and all over the place (he is only two!), so it's not like I could just keep his room clean or something. I don't want to start a cycle where they expect me to clean their house for them, but I feel like I am holding my breath the whole time I am there!

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[cayenne06, MSN, CNM]

Oops, sorry for the jibberish at the end. . . that's what I get for having my 5 year old "help" me type!

[caliotter3]

You are responsible for his little area and anything you may use in his care. Other than that you do the education and documentation. You should discuss any concerns you may have with the supervisor. If the situation is too much for you then consider changing cases. You can not force change. You can report obvious neglect, problems, abuse, etc. to the authorities, but this should be done in collaboration with your supervisors.

[applewhitern, BSN, RN]

This is why I quit doing home health. I really got tired of the filthy houses I had to visit. The last one I went to had 3 guys living there, and they were already drinking beer when I got there at 10:00 in the morning. I started feeling a little scared about being alone with 3 men who were well on their way to being drunk. I felt like I had to hold my breath in some of the homes. When I picked up a home ventilator and roaches ran out of it, I knew it was time to leave.

[JDougRN, BSN, RN]

I remember when I was in Nursing school 20 yrs ago- We had to go around with a Public Health Nurse for a day. One of the houses had several dogs, and you literally had to step around the piles of feces. They also had a fish tank- from the looks of it, the fish had died weeks previously, and was just floating there, disintegrating. Really disgusting, how some people live. When I asked my Preceptor about it being abuse or a CPS issue, she said that we could only call if we saw the child on the floor. Ya gotta love it. Right then and there, I decided I wouldn't do home care! Hospitals can be a pain in the tushie, but at least they get cleaned every once in a while! I did actually do a home care job for an older adult quad, but his house was clean. Hats off to you and everyone like you, who brave the yuckies to try to care for these people.

[merlee]

Is your supe aware of how bad the situation is? Has anyone contacted the board of health?

Best wishes!!!

[imintrouble, BSN, RN]

If there is no overt abuse and neglect, and the parents comply with medical needs, I think you have to let the rest go.

It's a matter of choices. Obviously the parents know what they should be doing, you and the other nurses have done teaching. They choose not to.

You can't make people behave in ways that are in their best interests.

I'll admit, it saddens me to see children raised in filth. THEY have no choices, and they're being taught filth is ok.

All you can do is make things a little better on your watch.

As far as cleaning. I get it. I wouldn't want to be the maid either. But maybe, one of those kids will observe something that'll stick with them. They'll see a different way.

Recognize your limitations. Then make peace with them.