Visiting nurses provided certain care in uncertain conditions
Visiting Nurses tend to expect the unexpected. Not all houses on Cape Cod are million-dollar homes. Not all family or roommate situations are stable. Nurses who do in-home care have to be confident caregivers wherever or however their patients live.
Leslie McGuire, RN, has dedicated 21 years to treating patients where they are, no matter where that is. COVID-19 makes that a unique challenge.
“It’s been a tough year because we had no idea what we were walking into,” McGuire said. “They were scared for us to be in their home and they were scared to go to the hospital.”
The VNA has maintained consistent home care throughout the pandemic. With the exception of a four-day isolation for possible COVID-19 exposure, McGuire continuously saw patients.
She said that she and others faced resistance to home visits at first, even from long-time patients. After a telephone visit with a congestive heart failure patient, McGuire knew he needed an in-person assessment.
“I was standing at his kitchen island and he said, ‘Are you safe to come near me? I’m afraid of you,’” McGuire said. “He was afraid to have me in his house. I showed him I had my mask, that I washed my hands -- showed him I gelled up.”
In the early days of the pandemic, the fear ran in both directions. Early protocols were changing rapidly. Retired VNA nurses were stitching cloth masks for their former colleagues and leaving them in mailboxes.
“I was just as afraid as the patients were,” McGuire said. “In the beginning, there were no answers and we were still asking questions.”
She could never know for sure that a patient or their housemates were safe. Did they have a family gathering or visits from friends? Had someone in the house travelled? There was always a leap of faith in entering each new residence.
As many nurses did, McGuire would get undressed outside her house after work and leave shoes outside to prevent the possible contamination of her home, an attempt to protect her husband, who had previously suffered a significant illness.
Beyond the emotional hurdles, the work itself was more challenging, she said. Assessment for things like stroke or neurological problems had to be done from across the room. Part of the VNA’s role, however, is to adapt to different circumstances to get the job done.
Patient privacy is also a unique consideration when it pertains to their COVID-positive patients at home.
“You’ve got to put on the full gear, but you’re trying to protect their privacy, so their neighbors don’t see,” she said. McGuire has had husband-and-wife positive patients and patients who are “ashamed” they contracted the virus.
“They were embarrassed. I tell them they didn’t do anything wrong,” she said.
Now that more Cape Cod residents are vaccinated, and overall COVID-19 rates are dropping, patients are becoming more relaxed about having VNA services at home. She even encounters the occasional patient who wants to drop protection altogether.
“I’ve had patients saying ‘This is my house. I don’t have to wear a mask,’” she said, with a chuckle. “I tell them that we don’t make the rules, we just follow them. At this point, even with the vaccine, we still have to talk patients down.”