What to do?

This conversation came up between myself and a couple of the other home care nurses in the agency i work for. NObody really has any good ideas...

The situation is that our agency has a few cases that are 2-3 year old ambulatory kids on vents. These children require 24 hour care and very close watching. They no longer regularly take naps during the day. The nurse is generally home alone with the child.

Now, here's the trouble... what is the nurse supposed to do when he/she has to use the bathroom?!?

The child I care for seems to have a 6th sense about when i'm in the bathroom. At least twice a week I'll think he is napping, get into the bathrooom, hover over the toliet, and I hear that unmistakeable vent curcuit disconnected whistle. I'll yank my pants back up and rush in to replace his vent tubing.

I spoke with a few other nurses about this and nobody really has any answers. These kids can't be out of your sight for even a second! We all try to limit our fliud intake and "just hold it". During "that time of the month" we have all seemed to come up with the same solution independantly of wearing both a tampon and a pad, cause you can't be sure to have time to change.

I'm sure this isn't an isolated problem... and I know it's a bit of an odd topic, but seriously... what to do?

That is really a diffucult question. I have only done vent cases where the child still napped. Gees Louise, I'm sorry I don't have a clue other than ask the parents.

Last resort the agency should supply a BSC for the nurses!

As much as I pee I'd be incontinent. What on earth do you do when you have to have a BM? Really tough question...Interesting. Let us know what the parent says, k?

The agency I worked for required that there be a family member in the home, even if the child was not ambulatory, although they were able to go out for chores and appointments, the nurse was not left alone with the child. After all, the child is ultimately the parent's responsibility and the nursing staff is there to assist the family, not replace them.

lacking that all I can think of is a BSC in the child's room, or a foley

Why is the child alone with the nurse? Parents do have responsibility to the child too. I would have a meeting with the director and address this situation. A bathroom break every 2 hours is not unreasonable.

Not really sure why, but most of our pediatric patients are from single parent homes. Same story each time. The father bailed after he couldn't deal with the disabled child. These are homes with single mom's. One of them is in nursing school. The others have jobs that they must continue for their child to remain insured.

While mom is in school or at work, the nurses are alone with the child.

Parents here get 16 hours a day of nurse coverage, the other 8 hours, they care for the child by themselves.

One of the mom's is trying to find one-way glass like you see in TV cop shows. Her idea is to insert that as a mirror/window in the bathroom door so we can set her child in a playpen or something on the other side of it and have the child still in line of sight.

I think that will work, but I doubt we will be able to convince the other parents to do that.