Jump to content

Topics About 'Home Care Nursing'.

These are topics that staff believe are closely related. If you want to search all posts for a phrase or term please use the Search feature.

Found 3 results

  1. KlineRN

    You Don't Know Smut

    I turned around towards the backseat of my Volkswagen. "Now where is that stick?", I asked myself, hunting under raincoats, gym clothes, and my school bookbag. Having located my needed piece of equipment, I turned back around in the driver's seat. Taking a long, deep breath, I assessed the home in front of me. "With God as my witness", I said out loud to myself. "With God as my witness, I am NEVER doing home visits again". But since I was in school to obtain my BSN, there was no choice. There was no Community Health course in my three-year diploma nursing program. No Community Health, no BSN. I was going inside that house again. I didn't want to open the car door. I knew who was out there. At least I didn't wait too long to get my BSN after passing the NCLEX. Two years after my first graduation from nursing school, I felt on top of my game. Poor, but with my own apartment, a reliable car, and a great job in the local CVICU. What did I need to do this for? I had absolutely no interest in "home health" or home visits. I liked the ICU because I like to be in control. This very poor home in eastern North Carolina was not where I belonged. It was not pleasant inside that house. I would not understand or appreciate this part of my training until many years later. I grumbled again to myself and stepped out of my car. I didn't see anybody on the front porch yet, so my eyes did a rapid scan of the property. "Where are you, you little devil?" I thought. Quietly, I gathered my paperwork and my stick. As soon as I closed my car door, I gasped when I saw the dog standing right in front of me. Large and in charge, his head and shoulders were already lowered. My patient explained to me on my previous home visit that "Smut" was half wolf, half dog- a great watchdog. Certainly, a deterrent for unwanted visitors. One could see the wolf in him in his elongated face, his slanted yellow eyes. "You have to watch out for him, because he will sneak up behind you and bite you in the butt", my patient warned me. The first time I came to this house, I ran from my patient's porch back to my car in about six seconds, with Smut closing in. I am a large girl, but I am fast. I jumped behind the steering wheel and slammed the car door, out of breath. Then an elderly man in a trucker hat stuck his head out the front door of the house and yelled "Go On, Smut!!" But with an eastern North Carolina accent, it was loud, drawn out, and hoarse from years of smoking, more like "Go oooohhhhwnnnn Smut!" Just like the first home visit, I never saw or heard the dog. I gently closed my car door, and Smut was standing right there. Having been raised around large dogs, he still unsettled me because he was so quiet. I unleashed all my frustration about school and work as I yelled "Go on, Smut!" while raising my stick in the air. Smut ran around the front of the car and tried to sneak around the back. "Go on, Smut!" I yelled again, backing towards the front of the house. Just then, the trucker hat appeared at the door, arriving just in time to save me from a likely unvaccinated bite in the booty. "Go oooohhhhwnnnn Smut!" I can still hear that man like it was yesterday, even after a thirty-year nursing career. (When I am very old, I will still remember it.) After many years in critical care, working holidays and weekends and nights, I accepted a job as a Medicaid Case Manager. My friends in the ICU asked me if I had lost my mind, doing home visits. But my willingness to try something new, which included a lot of home visits, turned into my favorite job in nursing after all. I was a Case Manager for 13 years. I still fussed sometimes when I got out of my car. The moral of this story is to never say never. You don't know Smut.
  2. I rang the doorbell a second time-holding it just a fraction of a second longer than usual. I could hear the chiming inside and I knew the elderly couple were at home. But the dog barked loudly and I suspected that they had trouble hearing. After several more minutes, Mr. P cracked open the door, smiling widely when he recognized me as the Parish Nurse from his church. "Hello, Mr. P! How are you? How is Millie* doing? Do you mind if I come in a visit a little while?" I had come to visit after a church member called to say that Mr. and Mrs. P had stopped attending Sunday School and seemed confused the few times they came. Previously very active, the couple seemed unkempt and unable to answer basic questions. "Oh, she's right in here. Come this way. I'm so glad you are here. We are just in here watching TV." I stepped over a pile of feces and noticed the dog penned in the kitchen, barking frantically. He did not looked pleased with my intrusion and barred his teeth with a growl, so I made a point of staying clear and followed Mr. P into the family room where I was met with more dog waste odors, along with piles of newspapers scattered on the floor, and leftover paper plates, smeared with the remains of forgotten dinners, piled up on a coffee table. I sat down beside Millie and introduced myself, gently taking her hand. She looked over vacantly at me. I told her I had brought a casserole from the church and chatted a little while with them before getting up to put the food in the refrigerator. Mr. P held the dog while I placed the dish beside a nearly empty gallon milk jug. Besides condiments and a small bag of wrinkled carrots, there was little else. I asked Mr. P about his son and how to contact him. While Millie was initially quiet, she warmed up and began telling me about her job and how she planned to go back to work, though I knew she had retired many years prior. Mr. P smiled. He answered questions that let me know he was still aware of date, time and general information but before I said any more he volunteered, "We are having a hard time. Millie can't remember much of anything at all and I'm not much better off myself." I asked permission to call their son and he said that would be fine. "But," Mr. P added, "he's so busy with his job. He don't come around much. And he lives away off." I called the son from my car. He lived several hours away and had not been to visit in six months. Meanwhile, he talked with them on the phone every Sunday. I could tell that he really had no idea how much things had deteriorated in that interval. I told him a little of what was going on and he assured me he would come in that week-end and take care of their needs. "So what do you think I should do? Is it time to move them out of the house? You know, Daddy built that place and he has told me that he won't move out until the hearse comes by to get him." As a Parish Nurse or a nurse that is working with a family like this, what do you do? Of course each situation is different, but there are some general principles that help us help families who face this type of situation: Making a financial assessment when possible helps to determine direction. Without having too many specifics, a nurse can help . Financial resources do play a considerable role in options for elder care. Empowering the family to work together to make decisions that make sense to them. They know their family culture, values, circumstances. Providing as many feasible options as possible and let people make decisions as long as they can. Keeping in mind that while safety and cleanliness are worthwhile goals, there are many ways to achieve these goals where people can still maintain some autonomy. State assistance programs vary widely from state to state and location to location so it is important to know how to access and refer to available social service programs. If families are unable or unwilling to provide eldercare then Adult Protective Services must be notified. As nurses, we are often called into difficult family, neighborhood and professional situations simply because we are medical and in a helping profession. Helping families through these difficult times of adjustment can be a real gift to them so it's important for us to know how to prioritize and plan. In a situation such as the one I described, it is so tempting to want to pull them out of their setting and into a more "safe" environment. As nurses we can lean toward wanting to "fix" things for them, but studies show that people are happier longer staying in their familiar surroundings (nia.nih.gov). In this particular case, the son came and was horrified at what he found. He was able to pay for a professional cleaning service to come in; he gated the back yard for the dog and provided some outside shelter; and he hired a neighbor to come in three times a week to cook a meal and do some grocery shopping. These simple interventions put Mr. and Mrs. P back on a path to well-being and better coping. They still continued to decline and experienced repeated hospital and ER visits, but with the neighbor there, the son was able to monitor things from a distance and make adjustments as needed. I also stayed in touch with all of them and provided assistance from time to time. In this setting, the son had limited financial resources, but he was able to obtain legal power of attorney and function as a supervisory caregiver for his parents. They owned their home, so even though they did not have a lot of savings, their social security income was adequate to keep them aging in place. But what if the son had not been willing or able to help out? When that is the case, the care becomes much more complicated. Generally, the levels of care include the following in order from least care to most: At home, independent, able to do all ADL's. At home but requiring cues and reminders, assistance with meals, ADL's appointments. Sometimes a maid or an occasional companion. At home with regular care coming in for several hours a week. Dependent for ADL's, meals, all medication management and transportation. Facility for independent living with meals provided but little assistance in the individual apartments. Facility with assisted living. Private pay. Must be able to transfer and do some ADL's but some assistance provided with all needs. Nursing home facility. Paid for on a limited basis when for rehabilitative services. Otherwise, private pay. Maximum assistance provided. Higher level of complexity cared for. I visited Mr. and Mrs. P again several months later. Mr. P opened the door and told me the Meals on Wheels volunteer had just left. He pointed toward the kitchen where two styrofoam containers sat side-by-side. The house was still cluttered but now leaned toward "homey" instead of hazardous. What about you? Have you had some eldercare successes and some not so successful outcomes? *Name and some facts changed to protect privacy.
  3. spotangel

    Nurse Face Her Fears To Help Patient

    I pulled the car to the side and put my hazard lights on. "Ok, where is this I have to go?" I asked the staffer at homecare. I jotted the address and put it in my GPS. That would be my last patient for the day. When I finally made it to the address, my heart sank. I was in the middle of the projects. Huge buildings, drunks and drugged out people sitting on the benches. An occasional family sat on a bench, soaking up the sun. I saw very few kids outside. People looked me up and down as I passed them, my homecare RN ID prominently displayed. I plastered a shaky smile and wished people good afternoon as I passed them. Some ignored me, some smiled and some looked vacantly on. I finally got into the building. I was going to Apt 124 K on the 17th floor. The warnings of never to take the stairs in the projects rang in my ears as I waited for the elevator. The elevator was small with a gate that I had to pull close. On the 17th floor the corridors were long with dim lighting. My heart in my throat I started walking trying to find the apartment. Every instinct screamed at me to turn back and leave but I forced my steps ahead. What would happen if someone yanked me into one of these apartments? No one would know. I would never see my family again I thought. I finally reached the apartment and rang the bell. No one answered. Hoping that the patient was not there, I rang the bell a couple more times. No answer. Relief coursed to me as I turned to escape back to the safety of my car and started walking. Behind me, the door opened and I heard "Wait! Don't go"! I turned around and froze. A huge young black man stood at the door with a bare chest. His shorts were barely visible under his pendulous belly. "Are you the nurse?" "Yes, Good afternoon Peter! My name is Annie." I masked my fear under a smile as I walked back towards him. "Come in" he turned back slowly and walked into the apartment. I hesitantly entered although my feet were trying to pull me in the opposite direction! The apartment was cold and bare. I looked around. He had disappeared. I walked past a kitchen and saw a door at the end of the corridor and walked to it. Something cold touched my leg and I looked down and saw a cat. I entered the room and found Peter sitting on the bed staring at me breathing hard. There was no other furniture except a TV and a few plastic milk crates. The cat followed me into the room. I hung my bag on the door. "I am sorry. I don't have any place for you to sit. You could sit on the bed." He said softly. "Thank you but I think I found a seat!"I stacked the milk crates together, put a newspaper from my bag on top and sat on it. "Thanks for opening the door", I smiled looking him in the eye. Peter talked slowly and I realized that he was intellectually challenged. My brain went into high gear as I looked at him. He was short of breath and was breathing hard after minimal exertion. I could hear a slight wheeze across the room. Since all he had on was shorts, I could see his skin that was dry and the 3 plus edema on bilateral ankles. I saw a half-eaten Chinese takeout on his bed and a 2 liter Coke bottle on the floor. As I went through a homecare assessment and a physical exam, I knew that he was in the beginnings of respiratory failure. His weight, diet, isolation and inactivity did not help matters. He barely cooked and relied on neighbors buying him groceries but that was a hit or miss. His sister lived an hour away but had her own problems. He could not walk to the store but relied on takeout food which did not help his congestive heart failure or asthma. His black cat that he called Camper (he always wanted to go to summer camp but could not afford it) was his only company even though Camper made his asthma worse. When I checked his back, I saw a stage two pressure ulcer on his buttocks and rash under his belly and breast. I gave him a nebulizer treatment and taught him about asthma, prevention and treatment. I then sat there and made a few calls to help him. One was to his MD to increase his Lasix dose and get refills on all his meds and discuss plan of care and referrals I needed for Peter. The second one was to his pharmacy to set up home delivery. The third one was to my central base to put in an order for a hospital bed and special mattress. The fourth one was to the social service dept. for an assessment referral and to hook him up with community services like meals on wheels and para transit for transportation. I spend around two hours at his apartment. I was subbing for another nurse that called out. When I left, he hugged me and thanked me and said, "I wish you were my nurse!" I hugged him back and said, "Don't worry! You are in good hands!" He had tears in his eyes as I walked out the door and out of his life. When I left the building, I looked back at it wondering how many more Peters lived in those building, all alone with no one to help them. I sat in my car and cried for Peter. I called back base and asked the director to put a compassionate nurse to take care of him as the perdiem RN who had him as a regular patient just went in, took vitals and left. The director promised to follow up. I thought about all my fears that had surfaced when I first saw him and I was ashamed of myself. Then I thought of how I felt when I left his apartment and felt happiness and satisfaction that I was able to help a fellow human being. I realized that I was put in a position to help or ignore his needs and was able to make the right choice, even though it took an extra hour. The danger I faced going into the projects was overshadowed by what I was able to accomplish. That day, I was proud to be a nurse!