The scene is getting increasingly familiar. A knock on the door and the patient opens up to a strange person with a couple of bags hanging off his or her shoulders. "Hello. I'm your home care nurse."
The population is aging. From total knee replacements to infected wounds, and from pneumonia to post-operative status, home care is on the increase. Insurances have created lines of limitations in the amount of days people can stay in the hospital. Wounds and IVs must be tended to. People go home with these and whoever follows up must know what they're doing to monitor and prevent complications in the home. In essence, home care has become like a mini-hospital on wheels. The objective is teaching, comforting, preventing further complications. Hopefully, this prevents people from going back into the hospital.
The nurse usually comes in on the day of discharge or the next day to see the patient, who is exhausted at the time and must endure the home visit, which can take up to two hours. The patient undergoes a head-to-toe assessment. Some are on multitudes of medications. The nurse needs to ensure that the patient understands proper medication, dosage, side effects, and changes to report to their physician. Follow-up visits to the doctors are documented. Patients may be assisted with appointment calendars and medication pre-pours. Do they understand their diagnosis and treatment? Are they compliant with their blood sugar checks as the doctor ordered or does their non-compliance lead to further health degradation?
Care plans are completed in cooperation with the patient. These include how many visits are anticipated in the 60-day certification period and may include such things as making sure blood glucose and vital signs are within physician-given parameters. Patients must be educated on medications and wound care, changes to report to the medical staff, signs of infection, and other diagnosis-specific functions. If the patient needs care beyond the certification period, orders are obtained from their physician to extend. All of this must maintain compliance with knowledge of Medicare and Medicaid guidelines. For private insurance cases, authorization for visits must be obtained. Physical therapy, occupational therapy, or social work may follow. The aim is to guide the patient and his or her family to independence.
What do patients and families look for when the nurse comes to their home? At their door is another stranger in the medical field with whom they must establish trust. With staffing down in all areas, patients may see several nurses during the course of their recovery. Continuity is interrupted.
It is important for the patient and family to realize the truth that the health providers are there to serve them. If they find that the nurse is rude, in a rush and seemingly with no "bedside manner,” they need to speak up about it. Family members are reluctant to speak up for fear of retaliation toward their loved one. Someone close to the patient may help mediate between the patient and the nurse.
Time is another factor. The nurse is a professional, and should demonstrate responsibility when it comes to arranging the visit time. If the patient is waiting for the nurse and she doesn't show up, or shows up hours later without letting them know, it is rude and unprofessional. Nurses should treat you the way they would want to be treated. The patient has a responsibility to understand that the nurse has others to see, usually in a wide geographical area. She tries to schedule her patients to work progressively in the area.
Openness and honesty are important. No questions should be off limits. If you don't know the purpose of a medication, you need to ask. If there's still a question, the nurse needs to investigate it with the physician. He should be following up with a call to the doctor to clarify the medication. A good nurse will try to find the answer and call you when he finds it, or direct you to someone who has it.
An informed patient is a happy patient. Less anxiety and more of a trust bond helps the healing process. Open communication is a must for both sides. Hopefully the time of recovery in your home will become a thing of the past that you can look back on with accomplishment and satisfaction, knowing that you participated in the plan of care to help yourself get better.