An article this month by Clinical Nurse Leader and author Meghan Conroy on mobile health apps makes me marvel at how far home healthcare has come in recent years. My first job in home care was in 1976. Wearing our navy blue pantsuit or skirt with white blouse and perhaps a navy blazer or cardigan, we gathered at the office most mornings to receive our assignments. Certainly we didn't have computers or electronic databases of any kind. Patient information (address, phone number, diagnoses) was located on 4 by 6 inch cards in case the chart was out of the office with another clinician. Our schedules were penciled in on long sheets of white paper, which the supervisor clutched in her hands most of the time-ensuring every scheduled and unscheduled visit was assigned to someone.
We tried to make as many phones calls as possible before we left the office. In the precellular phone days, it could be very difficult to find a working pay phone in the community. In any event, we made sure we had a pocket full of dimes when heading out into the field. At that time many patients still had limited-call telephone plans, so I tried to avoid asking patients if I could use their phones unless absolutely necessary. We left our planned route with the department secretary and if she needed to reach one of us, it was by guessing at which patient's home we might be. Every home care clinician carried a car full of maps-no global positioning systems of course. We used the "of/off" method of describing the location of patient homes. For example, "the home is located east of Maple/north off Elm Street." The first visit could be a challenge though. Patients might tell you to look for the blue house with pink azaleas. I was once told to look for "the house hidden behind tall Cyprus trees with a lot of cats on the porch."
And then there was the paperwork! We had a slip of paper for just about everything: recertification, visit notes, home health aide supervisory visits, referrals to other specialty clinicians, and equipment requisitions. My evenings were spent at the kitchen table, completing the required paperwork. This particular agency experimented with having us phone in our visit notes, which were then transcribed by a typing pool. Too often Foley catheter came out spelled at Folley Cauterers, and that ended that "high tech" experiment. Back to writing our notes out longhand. We got so that we recognized each other's handwriting and I could tell at a glance which colleagues had seen the patient last. Charts were thick-a result of the many visits we made at that time and the relative ease of requesting a recertification. If you were asked to make an unscheduled visit and didn't have the chart with you, the supervisor would read the pertinent information over the phone as we scribbled notes. There was no electronic access to patient information. And how we would have loved telehealth to serve patients in remote areas!
Patient education consisted of pulling medication sheets from a file in the office. There were far fewer drugs back then, allowing nurses to know just about every drug prescribed for patients. I even remember teaching family members how to make their own saline for wound and Foley catheter care!
So it is exciting to read about the many electronic applications that can help patients and caregivers manage chronic disease and navigate the complex healthcare system of today.
In other features this month Deborah Fritz brings us an article on respiratory assessment-the first in a series of physical assessment articles. Dr. Yvonne Johnson discusses a common yet mysterious and poorly understood condition known as elder self-neglect. Author Tracy McNair has written an excellent article on intervening with caregivers of patients with Alzheimer disease, and author Sharon Wood describes a pilot study to introduce a home visit checklist to improve patient safety and reduce rehospitalizations.
Finally, we are introducing a new column this month-Legal Matters by attorney Barbara Bosler. If you have questions that you want Barbara to address, e-mail me at mailto:[email protected] and she will be sure to cover it in a future column.
Best regards,