COMMENTARY
Improvising in Home Healthcare TAMMY MCCLELLAN, RN
have been a registered nurse in the home healthcare setting since the early 1990s, and one thing that I have learned is how to improvise in difficult situations. Home healthcare is a different environment than inpatient settings such as hospitals, nursing homes, and rehab facilities. Items are not at the nurse’s fingertips like they are in inpatient units. You quickly learn to carry everything in your car, because you may need it when making a home visit. As the years passed by, I learned to have a work vehicle and a leisure vehicle. It can become very burdensome to drive youngsters to school toting durable medical equipment, dressing supplies, One particular patient taught me that you have Foley catheter kits, intravenous poles, to remember to teach not only what you want and anything else one might need to perform a home visit. the patient to do, but also what not to do. I can think of many humorous experiences I have had in my nursing career when either my patients or I had to improvise. stick into a homemade plug for the G-tube! You I have seen everything from patients washing can imagine my shock and concern about infeclatex gloves and hanging them on the line for tion and general cleanliness. I quickly got her reuse to carrying multiple outlets in my car to the appropriate equipment that was needed and plug in an electrocardiogram machine. From monitored for signs and symptoms of infection many unusual experiences, I have learned to and also reeducated her and her family regardbe very specific when giving instructions to paing cleanliness of the skin around the G-tube as tients about their health needs. One particular well as care of the G-tube. I made sure she knew patient taught me that you have to remember to call the office if she ever lost supplies again. to teach not only what you want the patient to I think we have all, in our home and profesdo, but also what not to do. This patient had a sional lives, improvised at some point. In home gastrostomy tube (G-tube), and I saw her weekly healthcare, it is expected on a daily basis and for maintenance and integumentary checks. She goes with the job. However, in this case, I wish lived in a house that did not have running water the patient had called me rather than take matinside and only a spigot on the outside. It was ters into her own hands! always dark and drafty in the house. On warm Home healthcare is a job performed in the sunny days we sometimes completed our visit patients’ homes and on their terms. You learn to outside on the porch. I saw her each week, and love it or hate it. Fortunately for me, I love it. The she and her family were very familiar with me, creativeness and personal relationships are what and I with them. One day, I went to see her and made me seek a career in this field and say that I in doing a skin assessment around her G-tube am blessed to be in this profession for more than site, and I noticed something strange poking 20 years. out of the end of her G-tube. She normally kept Tammy McClellan, RN, is the Director of System and Clinical it plugged off because she did bolus feedings, Support, Quality Home Health, Byrdstown, Tennessee. which are intermittent rather than continuous. The author declares no conflicts of interest. On further examination I realized she had a stick Address for correspondence: Tammy McClellan, RN, Quality poking in the end of the G-tube. When I asked Home Health, 8405 Hwy. 111, Byrdstown, TN 38549 (tmcclellan@ qualityhomehealth.com). what had happened, she said she lost the plug DOI: 10.1097/NHH.0000000000000190 so she made herself one. She had whittled a
I
February 2015
Home Healthcare Now
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
119
Improvising in Home Healthcare TAMMY MCCLELLAN, RN
have been a registered nurse in the home healthcare setting since the early 1990s, and one thing that I have learned is how to improvise in difficult situations. Home healthcare is a different environment than inpatient settings such as hospitals, nursing homes, and rehab facilities. Items are not at the nurse’s fingertips like they are in inpatient units. You quickly learn to carry everything in your car, because you may need it when making a home visit. As the years passed by, I learned to have a work vehicle and a leisure vehicle. It can become very burdensome to drive youngsters to school toting durable medical equipment, dressing supplies, One particular patient taught me that you have Foley catheter kits, intravenous poles, to remember to teach not only what you want and anything else one might need to perform a home visit. the patient to do, but also what not to do. I can think of many humorous experiences I have had in my nursing career when either my patients or I had to improvise. stick into a homemade plug for the G-tube! You I have seen everything from patients washing can imagine my shock and concern about infeclatex gloves and hanging them on the line for tion and general cleanliness. I quickly got her reuse to carrying multiple outlets in my car to the appropriate equipment that was needed and plug in an electrocardiogram machine. From monitored for signs and symptoms of infection many unusual experiences, I have learned to and also reeducated her and her family regardbe very specific when giving instructions to paing cleanliness of the skin around the G-tube as tients about their health needs. One particular well as care of the G-tube. I made sure she knew patient taught me that you have to remember to call the office if she ever lost supplies again. to teach not only what you want the patient to I think we have all, in our home and profesdo, but also what not to do. This patient had a sional lives, improvised at some point. In home gastrostomy tube (G-tube), and I saw her weekly healthcare, it is expected on a daily basis and for maintenance and integumentary checks. She goes with the job. However, in this case, I wish lived in a house that did not have running water the patient had called me rather than take matinside and only a spigot on the outside. It was ters into her own hands! always dark and drafty in the house. On warm Home healthcare is a job performed in the sunny days we sometimes completed our visit patients’ homes and on their terms. You learn to outside on the porch. I saw her each week, and love it or hate it. Fortunately for me, I love it. The she and her family were very familiar with me, creativeness and personal relationships are what and I with them. One day, I went to see her and made me seek a career in this field and say that I in doing a skin assessment around her G-tube am blessed to be in this profession for more than site, and I noticed something strange poking 20 years. out of the end of her G-tube. She normally kept Tammy McClellan, RN, is the Director of System and Clinical it plugged off because she did bolus feedings, Support, Quality Home Health, Byrdstown, Tennessee. which are intermittent rather than continuous. The author declares no conflicts of interest. On further examination I realized she had a stick Address for correspondence: Tammy McClellan, RN, Quality poking in the end of the G-tube. When I asked Home Health, 8405 Hwy. 111, Byrdstown, TN 38549 (tmcclellan@ qualityhomehealth.com). what had happened, she said she lost the plug DOI: 10.1097/NHH.0000000000000190 so she made herself one. She had whittled a
I
February 2015
Home Healthcare Now
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
119
