For the first twenty-five years of my career, I worked in a hospital or clinic setting. My patients came to me. I climbed the same stairs, hung my coat on the same rack, walked the same halls, and did things my way.
And now, for nine years this week, I have been driving all over the county, seeing patients where they live. It's truly been an eye-opener.
In the hospital, we don't give a thought to where the patient comes from, or where he is going to when he is released. We only seem to think in terms of the pseudo-environment we have created. We think nothing about the cleanliness of our surroundings, or the ready availability of help and supplies.
Seeing a patient in his own environment, as a guest in his home, is much better, to me. It's real. It's the way things are. And whatever I want to teach him to do has to work in his space and in his time frames. And, since many patients do not live alone, the plan of care has to take others into account.
My “interpreter” if I need one, is on my cell phone. I call the number, tell them what language I need, then put the phone on speaker and place it on the table in front of me where we can all hear the interpreter. I know better than to use a young family member to interpret: they seem to have their own agenda and only tell their parents what they want them to know....
I tend to dress casually but professionally. Slacks, shirt and nursing jacket usually. Comfortable shoes are a must, and, if there are dead cockroaches on the floor, no open-toed shoes or sandals.....Don't ask, it really happened....
I guess what happens is, as a nurse, I give up control of the patient. In the hospital, they have their labs drawn at 5 in the morning. Breakfast is between 7:30 and 8. Medications are at 9. And so on, through the day.
In the home, I am a guest. The patient doesn't have to do what I say. All I can do is try to educate them on the benefits of doing what I suggest. Just this past week, I was doing diabetic teaching with a male patient in his fifties. He is not happy about what he has to give up, or eat in much smaller portions.
The teaching materials I use don't say that patients can't eat certain things. The lists say “eat less of these” or “eat more of these.” That seems to be a little more palatable, I think. And the portions aren't written in ounces: they are “golf ball” size, or as big as a “deck of cards” or a “fist”.....works better.
Knowing that, as soon as I leave, the patient is going to do whatever he pleases, I know that I have to make a case for doing what I think is best for him. If he does it, great, if not, well, it's his health that's going to suffer.
Dealing with patients in their own homes is so much more rewarding. Patients are more relaxed and comfortable in their familiar surroundings. They eat the foods that they usually do, instead of hospital food. Their families can come visit whenever they like, not when the hospital says it's okay.
Looking at the benefits to the patient makes the surroundings more tolerable. I have had to sit on the floor to do wound care, as it was the only option. I have sweltered in the heat in the late afternoon on a hot summer day, starting an IV and giving medications to a young child. Only when his father came home from work was the air conditioning turned on....
I have cared for a newborn in the dead of winter, too. The mother and two sisters were huddled together in a bedroom, with the baby, trying to keep warm. The heater in their apartment was broken and it wasn't going to be fixed any time soon. I talked about it when I got back to the office and our Director gave me the little heater she was using in her office. I took it back to the family.
I have been in homes that were “mansions,” too. Homes where there were all the things I needed to comfortably do my work. Homes where the air conditioning, or heater, worked just fine. Clean homes, friendly homes. Welcoming homes.
Homes with practically no furniture in them. And homes with practically no room to walk because there was so much “stuff” everywhere. Homes where there was music playing. Homes that were deathly quiet. Homes with dogs, or cats, or canaries. Homes full of people and life.
Homes that needed cleaning. Homes that were immaculate. Homes that should be condemned and knocked down. Homes without running water, or flooring....
All of them, big or small, clean or dirty, hot or cold, have one thing in common: there is someone there who needs nursing care. Someone who is ill, and suffering, and doesn't know what to do. Someone else who is trying to care for that person, and is unsure of herself, and scared about what is going to happen.
Yes, there have been places that I was afraid to go, or didn't want to go back to. And people who were rude and angry and unwilling to learn what needed to be taught. I respect that. I offer to keep coming and teach them, or stop coming and let them be. They choose, and I respect their wishes. And yes, breathe a sigh of relief after I leave......what I do doesn't work for everyone, and that's okay, too.
It's been nine years this week. Nine years of finding homes in the dark. Wondering what I was going to see when I got inside the home. Being “escorted” to the patient's apartment by his fellow gang members. Calling for an ambulance when the patient needed it. Taking home oranges, or peaches, or apples or whatever the family wanted to give me in thanks for my care.
Learning, growing, sharing, reaching out, and being rewarded, every day, by the people and places I have been. In their homes.....
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