1. Early, Jane BSN

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Home care clinicians can have many unique and satisfying experiences. One such experience for me was when I held a position funded by the PEW Charitable Foundation. The purpose of the grant was to explore improving medical care for people with mental illnesses. I have never forgotten one particular success. Mrs. J. was brought to the emergency room of a large city hospital by her family. She had recently been told she needed a total hip replacement. The news was not well received and she decompensated. It was at this juncture we met. She was a woman in her 60s with chronic schizophrenia in addition to the need for the total hip replacement. Hip replacements at the time (in the 1990s) were not as easy as today and presented the need for many postoperative modifications. Most challenging to this patient was the change in everyday tasks that would require her to alter her routine.


My first priority was to stabilize her schizophrenia. Together we visited her mental health clinic and she discussed the pending surgery with her assigned worker. A visit to her home was also necessary in order to assess for changes in her environment and to update her family. I believe having an involved and concerned family is key to success. Her husband also had mental health issues. The question I had: "Where is Mrs. J. within this process?" Is she able to accept and willing to make the needed adjustments? And "Is Mr. J. a willing and able support person?" Together, we attended all the preoperative classes. Mrs. J. demonstrated an understanding of the information and developed a trusting, collaborative relationship with not only me, but with the entire orthopedic team.


With that accomplished, it was time to assess her home. I found her bathroom had been remodeled a few years earlier. I was pleased that she should only have minimal difficulty with the space and layout. However, there was one unexpected issue-a tree had intruded into the wall of the bathroom and two or three branches about 6 to 8 inches in length were growing through the corner wall! I went outside and found the guilty tree growing next to the house in a vacant lot owned by the city. The License and Inspection Department for the city was notified, the tree was removed and the damage to the home was minimal. Thankfully, the extended family members were able to follow through and the home was repaired.


I am pleased to report Mrs. J. came through the total hip replacement without difficulty. Her postoperative course went extremely well. The orthopedic staff was quite surprised at her dedication to "doing what I am supposed to" and her diligence certainly paid off. I have often wondered how this situation would have played out without the additional help I was able to offer Mrs. J. through that program.


Over the years I learned that home healthcare workers are guests in the patient's home, albeit a mansion, a trailer, a room, or a cardboard box. Therefore, boundary respect and nonjudgmental behavior is imperative. In my experience, the family is an important but sometimes forgotten member of the team. When mental illness is part of the assessment, the importance of communication and education cannot be overstated. To be able to meet a patient in their world and impact their health and life in a positive manner is a privilege. Home healthcare work enables one to not only meet this goal but to surpass it. It is indeed a labor of love.