Granite VNA News

It’s National Nurses Week and Granite VNA celebrates all of our nurses who provide care, education, and comfort to patients and clients and play a supportive role in various leadership positions throughout our organization. 

Most recently, Chelsea one of our home care case managers, offered a first-hand account of one of her days. 

“Every day is different,” she said. “I start my day by calling patients before heading out. Sometimes, you start your visits right away and other times you start a little bit later.”

“You have to be flexible and plan your day accordingly,” she added. “As a home care case manager, I have additional responsibilities such as answering calls from doctor offices. At times, I also talk with our nurses who provide updates on shared patients at the beginning of the day. Sometimes we have team meetings to help ensure we all have pertinent patient updates.”

Quality versus quantity
Chelsea’s first stop on this day was to see an older woman who has chronic obstructive pulmonary disease (COPD) and pneumonia. During visits, Chelsea conducts respiratory teaching and educates the patient about new medications she has to take. When Chelsea enters, the woman is sitting at her kitchen table smoking a cigarette. Chelsea asks the patient to extinguish her cigarette before walking into the kitchen and reminds her that smoking and using oxygen increases the risk of fire. 

“A lot of patients won’t be honest with you if you don’t have a trusting relationship with them,” Chelsea explains following the visit. “Many patients want to live how they want to live – ‘I just want to live my life with quality, not quantity.”

During the visit, Chelsea checks the patient’s vital signs such as oxygen level, blood pressure, and listens to her heart and lungs. The patient also takes her own vital signs daily and submits them through our Telemonitoring program. Chelsea is able to view the patient’s daily vital signs, if needed, and can coordinate care with our Telemonitoring nurse who also contacts the patient’s primary care provider if vitals are outside of established parameters. 

As part of her assessment, Chelsea reminds the patient to regularly check their weight, limit salt intake, and drink plenty of fluids. 

Multiple health challenges
During her next visit, Chelsea spends time teaching a middle-aged man about his medications and the use of inhalers. He is living with anxiety which limits his ability to learn and maintain new information. 

“It is a very complicated case,” said Chelsea following her second visit. “A lot of mental health components mixed in with medical components such as breathing and cardiac issues. He has appetite and nutrition insufficiencies which is common for people with respiratory issues because it takes a lot of energy to breathe.”

Wound care
During the next visit, Chelsea checks her vital signs and spends some time re-educating the patient on taking care of her own wound that is now under control with no signs of infection. 

“It’s important to encourage patients so they can provide self-care,” Chelsea said. 

Admitting a Patient to Home Care
Completing an Outcome and Assessment Information Set (OASIS) typically takes more time than a regular visit and is required by the Centers for Medicare & Medicaid Services (CMS). It is a tool used by CMS to collect information from home health providers licensed by Medicare. Chelsea uses the assessment to admit a patient who has been previously diagnosed with dementia and has recently fallen. Supporting the patient and the caregiver can be particularly challenging.

“Caregivers don’t necessarily always have the resources to care for dementia patients in the home,” she said. “It can be very difficult and stressful watching your loved one decline [due to dementia] and slowly become a different person. If caregivers get agitated, the patient can feel that frustration.”

“As home care nurses, we provide care, support, and resources for patients - and their caregivers,” she added. “For patients, it can be terrifying to have someone come into your home when you don’t know the day or year. It’s definitely challenging when it comes to home care and developing those trusting relationships. Essentially, you are a stranger in their home.”

Finishing her day
After her last visit, Chelsea calls doctor offices to provide updates on their patients she visited. Among other items, she discusses comparing medication lists between the medical providers and what she recorded during each visit, home safety, and the latest vital signs. If any of those items were an emergency, she calls the doctor’s office immediately following the visit. 

Chelsea also completes documentation and provides updates to team members about shared patients, as well as any changes to the Intake and Clinical Review teams.  

“As I mentioned previously, I love seeing patients in their homes and having the opportunity to develop relationships with them. For me, home care provides a much deeper and rewarding experience as a nurse.” 

For more information about home care, please (603) 224-4093 or visit our home care page.