Some years ago, I worked as an oncology nurse while working on my PhD. As part of my thesis research, I went on home visits with my supervisors, some of the most experienced home healthcare nurses at two agencies in the city of Athens, Greece. On one of my first days I met my supervisor at 7 a.m. at the home care office. We had three visits planned that day, so we read the patients' files and filled the bag with all we would be needing. It took us half an hour to reach the first home. It was to be a first home visit to Mr. and Mrs. X and we had a comprehensive assessment to do and a lot of paperwork to complete. Mr. X, a man in his 80s opened the door. His eyes were full of tears and despair. It was his wife's first day home after long hospitalization for a stroke. Mrs. X had a nasogastric tube and a urinary catheter and could not communicate. He cried when talked about his loneliness and inability to care for his wife. He saw her like an extraordinary, fragile being. He feared to touch her because he thought that he would put her in danger. "What are these tubes and how will I manage them?" he wondered. The supervisor ensured him that we were there to help. It took a long time to calm him down, to assess his and the bedbound wife's needs. Even with my multiyear hospital experience, I had never thought about what patients and their families face at home following discharge. I was speechless, I put myself in his shoes, feeling his despair and helplessness and understood about the gap in continuity of care. But also, I saw how skillfully my supervisor helped this caregiver manage his emotions and understand his and our role in the care of his wife.
At around 11 o'clock, we were traveling to the next visit where the supervisor changed the dressings of a fungating wound of a woman with cancer. The whole procedure was familiar to me. What was unfamiliar was doing the dressing on the patient's own bed; adapting care to suit her needs with her school-aged children's eyes asking for help, help for more time for their mother's life!
The road to the next visit found us discussing professional boundaries and the unconditional humanistic approach that patients and their families need. It was 12:30 when we reached the third house. It was to be a quick visit to inform the family that a blood transfusion had been arranged for the following day. The supervisor observed that a funeral announcement was pasted on the door! Yes, it referred to our Mr. Y. His wife, crying, asked forgiveness because she forgot to inform us of his death. The supervisor took time to say a prayer for the patient according to Christian Orthodox custom and to support his wife. "I knew him many years, we had good and bad moments; he was a fighter; I will go to the funeral to say goodbye" she told me through tears.
We returned to the office, due to lack of time and strong emotions. The supervisor documented the assessments and interventions in the patients' files and organized the following morning's visits. The end of shift at 3 o'clock found me thinking about differences between home and hospital nursing; how the hospital environment protects healthcare providers and how unexpected a day in home care could be. Every day, every home visit, every patient is unique, as were my emotions after every visit!