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DiversityNursing Blog

Violence Prevention in Home Care Nursing

Posted by Erica Bettencourt

Fri, Jan 15, 2021 @ 03:15 PM

knockingThe need for in-home care has grown since COVID-19 because many fear contracting the virus in hospitals and clinics, especially among the elderly population.

With no security like hospitals usually have, home visiting Nurses put themselves at risk whenever they enter a patient's home alone. 

Ha Do Byon, Assistant Professor of Nursing at the University of Virginia School of Nursing mentions in a  STAT news article, "Even before the pandemic struck, I heard Nurses’ stories of home visits — some during my time as a visiting Nurse, and others as part of a study I am conducting to understand violence faced by home visiting Nurses. They told me about patients who blared pornography, or being groped while administering care. About patients who waved handguns and hurled racial insults. About being bitten, punched, kicked, or slapped. About dealing with screaming fits, intoxicated family members, and dogs that bit them or threatened to."

According to a 2015 study by BMC Public Health, the threat of workplace violence was one of home health workers’ top concerns, ranking above transportation issues or environmental hazards.

Developing a safety program for your home care workforce is crucial in reducing health care worker stress and turnover.

The rate of patient-on-Nurse violence among home visiting Nurses is unknown.

An article in Home Care Magazine states, only one-fifth of violent incidents “are ever reported in part due to embarrassment, organizational culture, tolerance or excusing the behavior of ‘ill’ clients." Nurses have cited fear of retribution from supervisors, the complexity of the legal system and disapproval from administrators as barriers to reporting workplace violence.

Nurses and providers can take measures to prevent violent situations.

The National Institute for Occupational Safety and Health Centers for Disease Control and Prevention released a list of recommendations for employers and workers to ensure safety.

Some recommendations for Employers:

• Ask employees to report each incident, even if they think it won’t happen again or it might not be serious.

• Train employees to recognize the signs and body language associated with violent assault and how to manage or prevent violent behavior, such as verbal de-escalation techniques, management of angry patients, recognizing and protecting themselves from gangs and gang behavior.

• In the case of an unacceptable home environment, advise the patient on working with social service agencies, the local police department, or family members and neighbors to make the home less hazardous so care can continue.

• Provide cell phones to all staff on duty. Home healthcare workers consider cell phones to be lifelines.

• Consider other equipment, such as employer-supplied vehicles, emergency alarms, two-way radios, and personal bright flashlights to enhance safety.

• Establish a no-weapons policy in patient homes. If such a policy is not required, request at a minimum that, before service is provided, all weapons be disabled, removed from the area where care is provided, and stored in a secure location.

• If possible, visits in high-crime areas should be scheduled during daylight hours.

Some recommendations for visiting Nurses:

•Acknowledge the person’s feelings.

• Avoid behaviors that may be interpreted as aggressive (for example, moving rapidly or getting too close, touching unnecessarily, or speaking loudly).

• If possible, keep an open pathway for exiting.

• Trust your own judgment; avoid situations that don’t feel right.

• If you cannot gain control of the situation, take these steps: Shorten the visit. Remove yourself from the situation. If you feel threatened, leave immediately.

• Use your cell phone to call your employer or 911 for help (depending on the severity of the situation).

• Report any incident of violence to your employer.

• If you are being verbally abused, ask the abuser to stop the conversation.— If the abuser does not stop the conversation, leave the premises and notify your employer.

• Consider working in pairs in high-crime areas.

• Always let your employer know where you are and when to expect you to report back.

• During the visit, use basic safety precautions:— Be alert.— Evaluate each situation for possible violence.— Watch for signals of impending violent assault, such as verbally expressed anger and frustration, threatening gestures, signs of drugs or alcohol abuse, or the presence of weapons.

• Maintain behavior that helps to diffuse anger:— Present a calm, caring attitude.— Do not match threats.— Do not give orders.

We view Nurses and healthcare workers as heroes and we should appreciate the essential work that home visiting Nurses provide by making sure they can safely do their job and feel comfortable enough to notify management when they aren't safe.

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Topics: home care, visiting nurse, nurse safety, Violence Prevention in Home Care Nursing, at home care, home care nursing, violence in the workplace

Doctors Recommended She Pull The Plug On Her Husband. She Refused, And Then He Woke Up

Posted by Erica Bettencourt

Wed, Apr 08, 2015 @ 12:09 PM 

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Matt and Danielle Davis had been married only seven months when a devastating motorcycle accident left Matt on life support and in a coma.

Given only a 10% chance of waking up, Davis told WTOC that doctors advised her to pull the plug on her husband. She recalled hearing them say, "That's what they'd want their family to do."

Danielle refused to give up on him. "We didn't really have a chance to start our life together, I wasn't going to give up."

Matt spent three months in the coma, and moved from the hospital to their home where Danielle cared for him 24/7.

Then one day, against all odds, Matt said, "I'm trying."

He eventually came out of his coma, but he didn't remember anything that had happened in the last three years. He retained no memory of his father's death, or even meeting and marrying his wife.

But in the time that has passed since the accident, Matt has made amazing progress. Physical therapy has helped him learn to walk again.

They play scrabble and enjoy going to yoga classes together, and he's recently started driving a stick shift car for fun because he loves cars.

"One conversation with Matt will change your life," Danielle shared. "He has a servant's heart and a love for people. He never complains or feels anger about his circumstance. He just wants to make a difference and give hope."

The couple is currently trying to raise funds for Matt to continue his therapy.

Topics: recovery, coma, physical therapy, home care, health, healthcare, doctors, hospital, treatment, life support

High-tech Home Care

Posted by Alycia Sullivan

Mon, Dec 02, 2013 @ 10:13 AM

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By Debra Anscombe Wood, RN

Some patients are trached and vented. Other patients are on dopamine drips or receiving total parenteral nutrition. This sounds like a critical-care unit, but hundreds of children in New York and New Jersey are receiving this type of intensive care at home from nurses and other healthcare professionals. 

“There are many more children (with complex care needs) going home,” said Ana L. Pacheco, RN, MS, director of patient services at Montefiore Medical Center Home Health Agency in New York City. “There’s more high-tech in the home. It’s incredible. Being in their home is so much better for the children and parents.”

Bringing the child home despite needing complex care reduces the risk of nosocomial infection and often is easier on the family than continued hospitalization, said Kathy Pfeiffer, RN, BSN, director of pediatric clinical operations for BAYADA Home Health Care, headquartered in Mount Laurel, N.J.

“These kids are acute,” Pfeiffer said. “The homes are set up like an ICU.” 

St. Mary’s Home & Community Programs in New York City has experienced an increase in home care volume as medical advances have allowed premature and other medically needy children to survive longer with a better quality of life. 

“We’re getting sicker kids home, and their needs are much greater,” said Lois Long, RN, nurse coordinator at St. Mary’s Home Care. “Our job is a little more challenging because of that.”

Children may receive home care because they have been diagnosed with pulmonary and cardiac diseases, congenital defects, traumatic injuries and other conditions. They range in age from newborns to young adults. Some may live in shelters or in foster care. 

Certified agencies provide intermittent care and licensed agencies offer hourly or shifts of care, including accompanying the child to school. Some organizations, such as St. Mary’s, offer both types of home services. 

Teaching and doing

Nurses teach parents how to care for the child while still in the hospital, but once discharged, home care nurses reinforce that education, fine tune techniques, perform treatments such as peritoneal dialysis, tube feedings and nebulizer and monitor the patient’s condition and the family’s progress with providing care. “We do a lot of education,” said Anne Calvo, RN, BSN, MPS, assistant vice president at the Winthrop-University Hospital Home Health Agency in Mineola, N.Y. 

Home health nurses collaborate with physicians, parents and a multidisciplinary home team, including rehabilitation therapists, social workers and home health aides. 

“We do a lot of care coordination,” said Eno Onda, RN, MEd, coordinator of care in the Children & Family program at the Visiting Nurse Service of New York. “It is patient-centered, family-centered care, and we have to keep good lines of communication.”

VNSNY focuses on short-term care with extensive education to strengthen families to manage the complex care needs of their patients, Onda said. Nurses draw on scientific knowledge, research and nursing theory as they identify needs and coordinate care. 

“What the nurse does is very challenging,” Onda said. “You have to know your values and emotions, so you can [hear] the stories people are telling you and put everything together.” 

Staying for hours at home, school

Some children require constant care. When their parents go to work or sleep, home care nurses often fill in, even accompanying the child to school to perform necessary treatments and medications, according to physician orders and company protocols. 

“They are fragile (children with complex care needs), but despite that, they are kids,” said Donna McNamara, RN, MPA, assistant vice president of community programs at St. Mary’s. “You want to support their growth and development and cognitive function.”

St. Mary’s nurses try not to intrude on family life but become part of the daily flow of activities. McNamara said it takes a team approach to keep these children at home. At BAYADA, a transitional care manager meets with the family in the hospital. Then a clinical manager makes the initial home assessment, collaborates with physicians and other members of the team, and ensures supplies are in the home and the nurse caring for the child is competent to provide treatments. BAYADA conducts simulation drills to hone responses to emergency situations, such as a trach tube coming out or a seizure lasting longer than expected, and reassesses competencies annually.

“In a hospital, you have a team and can call out if there’s a crisis,” said Lisette Alicea, RN, RRT, clinical manager at BAYADA’s Hackensack, N.J., office. “We have to make sure we have the orders [for various situations] and train our nurses to know what to do.” 

Challenges and rewards

In addition to providing highly technical care employing the latest equipment and products, home care remains highly personalized. Nurses offer support, while watching for stressors or signs of abuse and neglect. 

“It’s difficult for parents to have a sick child, whether born premature or (born) healthy and something happens,” said Alyson Bolton, RN, CPN, BAYADA transitional care manager. “The family dynamics are challenging.”

Nurses help by showing parents they are capable of taking care of the child and identifying what the child can do, added Shawn Carroll, RN, clinical manager at BAYADA in Hackensack. 

Psychosocial issues present some of the greatest challenges for nurses. 
“We work with child protective services when needed and with social work,” Calvo said. “We are totally involved in the care.”

Home-care nurses collaborate with others on the team and community resources, such as homeless shelters, counseling and housing authority officials, to resolve concerns.“You become part of the families from day one and then watch them grow and become more self-sufficient,” Carroll said. “It’s a special type of nursing.”

Jeanette Carter, RN, team coordinator at St. Mary’s Home Care, agreed it is rewarding to care for patients who came into the program as fragile infants and watch them improve as they become young adults. 

Despite poor prognoses, many children experience positive outcomes, walking or talking when experts doubted it possible. 

“The good outcomes are really rewarding,” Calvo said. “You see the children blossom.” 


Topics: ICU, acute, home care, children

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