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Things are different now. I can take the time to really talk to my patients-find out what's really going on in their lives, look at them as whole persons, and assess multiple aspects of their lifestyles and health conditions. Nothing can compare to working in home care!


When I worked in long-term care I could talk to other staff and residents to find out what a resident wasn't or couldn't tell me about their lifestyle or health condition, but in home care it's just you and your patient.


Some things I've learned...the hard way!


My first lesson was never to take what the patient says at face value without further investigation. Mrs. D. was the first patient I admitted by myself. Her primary diagnosis of chronic obstructive pulmonary disease (COPD) left Mrs. D. very unstable after discharge from a recent hospital stay. She also had diabetes for several years. Before going out for the admission visit I reviewed all the paperwork sent from the hospital and investigated the medications and all potential side effects and interactions.


I spent extra time to review her diagnoses, signs and symptoms, courses of treatment, and planned outcomes. I reviewed the OASIS to familiarize myself with the questions I would need to ask. I completed the admission visit and paperwork...and now...I was a real "Home Care Nurse!"


At my second visit to Mrs. D., she immediately said she felt "horrible." She told me she took her blood sugar and it was 430! 430?? This would not do! She said, "Yes, I didn't believe it either so I took it again and it was still 430." I asked her if she had called and reported this finding to her doctor. She had tried, but the office was closed. I further assessed Mrs. D. She appeared nervous and short of breath but yet very alert and oriented.


I immediately called her physician and received an order to increase her diabetic medication from once to twice per day. I then proceed with my assessment. Vital signs were stable. Respirations were a bit high but within her normal range considering her COPD. I completed my head-to-toe assessment, conducted dietary management teaching, and was ready to leave.


As I was putting on my coat, I ask Mrs. D. to take her blood sugar once again. She went through the procedure and I saw that she was putting the blood on the strip before placing it into the machine and the machine flashed an error message. She looked at me and said, "See, there is the 430!"


Ok, now I'm pale! The strip code is 430!


Sigh, I remove my coat to teach in depth how to use the glucose-monitoring machine and lo and behold...her blood sugar is 114! Lesson learned! Never assume they know how to use the equipment, even if they have had it for a year!


Well, I made it through that learning curve and I've since had a few more major lessons, but I am very happy I made the decision to enter home care. I've conquered my fear of walking into different neighborhoods and various homes because I know I am helping a population that otherwise wouldn't be able to stay in their own homes.


I have always had a desire to help the elderly maintain or regain their independence. As a home care nurse I have the opportunity to help them stay in their own homes when the alternative is nursing home placement.


What a great feeling!


What a great job!