Environmental Advice Needed

[ame222]

For all you HH Nurses out there, I need some advice. Part of our job is to assess and instruct. Aside of the general assessment and the main problem which is skin ulcers and wound care, it isn't possible to ignore the surroundings either. When assessing the environment and it is known that there are "bugs" infesting the area (such as fleas from animals and cock-roaches), also animal excrement on the floor, old food sitting out, and general filth... just WHAT is our responsibility, and what would your approach be to get the client to understand how this can/does affect their health. Infection control is such an issue as is the general environment. This is a rural area, much poverty and lack of education and simplicity. It's so hard to go to these places time and again, instructing them on the same, yet feeling like I'm not making any difference. How can I re-approach this? I'm a professional and take my job seriously, but this is really discouraging sometimes. How can I reach this client? Thanks to all of you for your advice and suggestions.

[caliotter3]

Since you have already addressed the issue and there have been no changes, I would hazard a guess to say that you won't be able to get through. What you describe is grounds for discharge from service. I would explain this to the client (if your agency is prepared to follow through with discharge) and let them know that besides the health problems, it is posing a problem in getting workers willing to go to this home. You can try to be diplomatic about it, but reality is reality. If it is that bad, and they won't make the necessary changes, then discharge from service is warranted. Otherwise, if you are willing to put up with the environment, then keep on keeping on and as you know, document, document, document.

[HmarieD]

Have you considered making a referral, either to your local Agency on Aging if the pt is over 65, which can help the pt obtain homemaker services (and sometimes offer financial assistance with these services), or a direct referral to a homemaker service agency?

You could also try a referral to your agencies MSW if you have one.

I doubt that I have to tell you this, but you should only carry in with you the essential equipment you need to complete the visit; leave your bag in the car, and if you have a laptop, roaches LOVE warm electronics, so I would do any computer charting outside of the home. Also be sure to use the appropriate barriers.

And document, document, document.

Ultimately, pts are free to make their own choices about how they live, but if none of these interventions work or are accepted by the pt, I think a DC would be in order.

[caliotter3]

The tip about roaches and their affinity for warm electronic environments is good info. I doubt I ever would have thought about this unless I saw one of the creatures coming from the computer. :wink2:

[neonatal3]

Hello all!

I can relate to your comments about frustrations with problems in the home health environment of some patients. My current private duty home health patient is a quadraplegic and the heating system in his duplex apartment does not work. The only current heat source in his apartment is to turn on the oven and open the oven door. This patient states that his landlord will not repair the heat system because he is behind on his rent payment. (I have observed that this patient has made unwise choices to spend money from his social security disability checks on entertainment type items.)

In response to this environment problem, I have tried to remain nonjudgemental and I have encouraged my patient to call his case manager to help him with resource information. This patient says he has talked with the case manager and he is calling phone numbers to apply for a move to a government subsidized, high rise type apartment. It seems that encountering patient environmental challenges sometimes is part of the "home health nursing world"! Good luck to all of us!