There's a special trust between a patient and the Home Health nurse.
Here's a favorite story from my book, Off the Chart A Nurse's Journey of Heart and Humor. It was one of my greatest experiences in nursing. When nurses are allowed the autonomy to advocate for our patients, it truly is —
job satisfaction off the chart!
Joaquin was the very first home health care patient that I had the privilege to case manage. I was told that Joaquin was just a grumpy old Marine, and that the case would be difficult. Despite the rumors, it turned out that beneath his tough exterior, grumpy old Joaquin was one of the nicest guys ever!
It was the year 2000, and the process of home health care admissions required a tremendous amount of paperwork—tremendous! Nurses were required to perform a thorough assessment. Joaquin was a diabetic, so naturally, I asked to see his diary of recorded blood sugar readings. He showed me his records and the numbers were high. But I thought, surely the doctor knows about this! Because he also had cardiomyopathy, he took Lasix to rid his body of the extra fluid he carried in his lungs and legs. But when I listened to his lungs, the sound of fluid resonated there, and his legs looked like squishy tree trunks. Clearly, the diuretic wasn't working; but again, I thought, surely the doctor knows about this! I mentioned my findings to a colleague, and she said, "You need to call the doctor and ask to make some changes." I learned that essentially, the home health nurse was the eyes and ears of the doctor. This was entirely different from working in a hospital!
When I phoned Joaquin's physician and told him of my observations, his response shocked me. He asked me what I thought we should do. I cautiously suggested that we try a long-acting insulin, and he agreed with me! Then we went on to discuss the Lasix and how the current dose did not appear to be sufficient, so the dose was increased.
Teaching my patient about his diabetes and cardiomyopathy was imperative. Joaquin was openly receptive to any information I gave him, and as we came to know one another better, he even began to ask questions. There's a special trust established between a patient and the home health nurse. Patients get "on board" with their care after they realize that the nurse truly has their best interest in mind. The exceedingly serious Joaquin began to warm up; he smiled, shared stories, and laughed at mine too.
The blood sugars did improve, but sadly the fluid retention did not. With each visit, as I put my stethoscope on his chest, I listened as his breath sounds became worse. His respirations became more of a rattle from the fluid, instead of the sound of air flowing through his lungs. One day, with his wife close by his side, they both anxiously inquired, "How is it?" As I listened, his lungs were now filling with fluid. Because of this, his shortness of breath had become so much worse, and no oral dose of Lasix was going to manage his symptoms.
He needed more aggressive treatment, he needed to be hospitalized. But, despite several hospitalizations for intravenous diuretics, his heart was just too weak, and it was merely a matter of weeks before he left us...
To read this story in its entirety, and others like it, pick up a copy of Off the Chart A Nurse's Journey of Heart and Humor at https://amzn.to/3RHn0nm
Published by Jennifer Tipton / This post may contain affiliate links.
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