A day in the life of a home-health nurse Line

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Although hundreds of kilometers apart, RNs Jill Matheson and Bonnie Paulusse begin each morning the same way: they both head for the fax machine to find out how their days will unfold.

A printed roster of patients arrives early, detailing the names, addresses and conditions of those patients in need of a nurse. Mapping out their days, Bonnie and Jill hope to visit as many patients as possible.

As home-health nurses, they have almost 50 years of (combined) nursing experience. Compassionate, caring, fiercely independent, devoted and highly skilled, these nurses thrive on the challenge of helping patients without the luxury of support just down the hall or supplies in the next room. Working on the road, they deliver a service with different challenges from those in hospitals.

It is difficult to convey the depth of experience and analysis required of these nurses on a daily basis. And it is even more difficult to convey the “behind the scenes” administrative work required once the patients have all been seen. But we hope this glimpse into the work of two nurses will provide a clear illustration of just why they are so important.

JILL MATHESON, HOME CARE NURSE, Saint Elizabeth Health Care, Toronto

PATIENT PROFILE: Toronto’s Homeless / Mental Health Population

“John” (a voluntary resident at a 24 hour supervised care facility) is watching TV and smoking a cigarette. He left home four days ago without telling anyone where he was going. Jill begins her week with a visit – and a couple of questions about where he’s been.

“How was your weekend John?” she asks. “We were worried about you.”

“I don’t want to talk to you,” he mumbles and turns to face the TV. “You don’t help me anyway.”

His accusation that she is not doing her job is not taken to heart. “I realize the client’s limitations as well as my own,” she explains. A lot of these clients are accustomed to superficial and negative interaction with people and they are skeptical and reticent when it comes to opening up.

With assurances from John that he will talk to her about his mystery weekend when he’s in a better mood, Jill heads south to Toronto’s Regent Park district. She’s off to see “Scott,” an older man convinced he is a “multi-multi-trillionaire.”

Scott emerges disheveled from the bathroom and Jill breaks the ice with a bit of humour. “Scott, you remember we talked about having a guest today?” she says with a laugh. “You should probably comb your hair.” Today’s visit gets him out of bed – if only briefly – and provides him with a reminder that there are all kinds of reasons to make the most of his day.

Her questions are met with listless and distant responses mumbled into a pillow as Scott settles back under the covers. Despite his mood, Jill is confident he is taking his medication and she promises to be back in a couple of days.

“It’s a guessing game,” she says. “You never know how clients will feel.”

After almost 10 years in home-care nursing, two of those dealing with Toronto’s homeless and mentally ill population (who either live on or off the street), Jill has learned how to use her judgment in each situation. “Each personality is different from the next,” she explains. “It takes a long time to build a rapport with this type of patient. But, after a while, in their own unique way, they begin to trust you.”

Jill’s patients, perhaps more than others, need that trust and continuity. Many have been diagnosed with schizophrenia and do not trust people very easily. “David” is a prime example of that. He is Jill’s third patient of the day and he has just moved into a new home. Jill is visiting to make sure he is comfortable in his new setting – and with his new housemates. Unfortunately, David is nowhere to be found this morning.

“I’ll be back later,” she promises his housemates. “If you see him, please tell him I came by.”

“If they’re not interested in being found,” she says while getting back into her car, “then we won’t find them.”

Next stop – “George,” an older man with diabetes and some problems with depression. Just one year ago, he was living in a basement apartment where he spent most of his days in bed – unable to fight not only his ongoing battle with depression but also his battle with a landlord who was taking advantage of George’s illness and finances. Jill, aided by a social worker and police, helped to turn George’s life around when she helped him find a new place to live. Her smile is like that of a proud parent when she talks to him about his life today. And the glow in his cheeks is evidence enough that Jill has been a very important person in his life.

Four hours after her brief conversation with John, Jill has visited four patients on today’s roster. She’ll head back to Regent Park in search of David this afternoon, work in a few more visits, and head home for the day, in anticipation of tomorrow’s fax and the people she will see.

BONNIE PAULUSSE, HOME CARE NURSE, Victorian Order of Nurses, Bruce County

PATIENT PROFILE: Varies

Having visited with her first patient earlier this morning, Bonnie is on her way to see a woman dealing with the repercussions of a stroke. She dropped her pill box yesterday and needs Bonnie’s help determining which pills are to be taken – and at what time. Her husband has also reported that his wife’s mouth was bleeding yesterday.

While filling the pillbox, Bonnie discovers that her patient is abnormally unresponsive and lethargic today. “It’s like you develop this radar,” she explains. “And it automatically goes on when you enter a patient’s home.”

A thorough examination reveals that her patient’s blood pressure, hemoglobin and heart rate are very low. A trip to the doctor may be in order. The visit stretches to 50 minutes as a result of these unexpected developments.

Running a bit behind schedule, she heads west to a small residential area to see her next patient – a woman undergoing treatment for stomach cancer. Despite her illness, this patient is self-sufficient. Today she needs an injection and a cleansing of the lines used for the treatment of her cancer (called “picc lines”). Many people with these “lines” learn how to clean and care for them on their own. It becomes a part of their daily routine and many say they like the independence that comes with taking care of themselves.

They teach us as much as we teach them, Bonnie says of her patients. “It’s so easy to take the small things for granted. Many patients are inspiring and serve as a reminder of just how important it is to appreciate our health.”

Bonnie’s third patient of the day lives in a retirement community. Diagnosed with cancer – and in the final stages of the disease – he has chosen to spend his remaining time at home with his wife. Today, Bonnie will conduct an overall assessment of his pain control, his ability to walk and move around the house, his medication and a variety of factors contributing to his quality of life. Midway through the assessment he tells Bonnie he’s tired and he doesn’t like being a burden to his family. After 62 years of marriage, his wife dedicates all of her time to ensuring his comfort and care. That is her number one priority. She straightens his hair as she assures him he is not a burden.

Bonnie listens.

“These people let you into their lives at a very important time,” she says. “They trust you and make you a part of this important transition.”

As the afternoon comes to a close, Bonnie heads out to see her final patient of the day. This 50-year-old man has taken several months off work due to a debilitating growth on his spine. Although his battle with the physical effects of his illness is all consuming, he seems more distraught by his battle with depression and questions if he’s done anything worthwhile. Bonnie reminds him of the many awards on his office wall and the achievements that they signify. She focuses the conversation on the promises of tomorrow in an effort to inspire hope.

After 21 years as a home-health nurse, Bonnie has visited with hundreds of patients and has helped them all through some of the most trying moments of their lives. But despite all of the faces she has seen, Bonnie remains focused on just one patient at a time. She considers herself a guest in her patient’s home, and is grateful for the opportunity to make a difference in their lives.