Although most women envision being a hospital patient at least once-for childbirth-very few of us anticipate needing home healthcare. But when it is "our turn" to be a patient, not a nurse, it's gratifying to know that home healthcare may be as wonderful as we say it is.
I knew I would need a visiting nurse when I chose to have a bilateral mastectomy with reconstruction following my diagnosis of breast cancer. As a nurse liaison for a Visiting Nurse Association (VNA), I often coordinate referrals for similar patients going home with Jackson Pratt (JP) drains. I chose to have the deep inferior epigastric perforator reconstruction, which also meant having a 22-inch abdominal incision.
I was told that my hospital stay would be 5 days, but I worked hard to meet my short-term goals and after 4 days I was more than ready to go home. I was grateful the hospital staff did not assume being a nurse meant I knew what to expect or all about my discharge plan. I quickly learned that manipulating JP drains and caring for incisions was challenging as a patient, and I tried to proceed with a sense of humor.
Just as I had told many patients, a call from the VNA shortly after I was settled at home confirmed a nurse would visit the day after the hospital discharge, and the nurse called the following morning to tell me what time she would arrive. For patients waiting at home, I learned firsthand that those phone calls are important! Although I was referred to the VNA I work for, it is a large agency and I did not personally know the nurses that came to my home. Everyone had the right information and seemed to handle the visits and paperwork with ease. As a patient, I was always looking for reassurance that my recovery was progressing according to plan and my nurse was helpful in highlighting the progress I was making with mobility and wound healing, although it often seemed frustratingly slow to me.
Having the expertise of an enterostomal therapy nurse to assess my slowly healing areola wound (a frequent occurrence with nipple sparing surgery) reinforced the importance of measurements and the perspective of weekly wound assessments. As a patient it seemed that things change so little from day to day, but I know my nurses saw progress from week to week and made sure that I did too.
Once I was more mobile and my wound care issues were resolving, it was time for me too to be discharged from home healthcare. Although I had been anxious to leave the hospital, I would have liked my time in home care to continue longer! The personal relationship that develops over time with healing is really the climax of recovery. I now understand why patients often want their services to continue for just one more visit, or 1 more week-there's nothing like a home care nurse to make you feel like you have really recovered.
Lessons Learned
Although your patient may be a nurse, the nurse isn't used to being a patient; the same step-by-step teaching is appreciated when learning self-care.
Telephone calls to confirm home visit schedules are really appreciated by patients and families and provide reassurance the nurse is coming.
Wound care progress and healing feels much slower to patients than to clinicians.
Patients and families really do notice if you wash your hands and use good bag technique.
Patients are relieved to recover, but regret having to be discharged.