If you benefit from Hospice and Home Care, thank a nurse

Posted: Wednesday, September 26, 2007

If you are ever a client of Hospice and Home Care of Juneau, you may see the occupational or physical therapist, chaplain, social worker or volunteer, but you'll almost certainly have contact with an HHCJ registered nurse.

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It's often Hospice nurses who work most closely with patients and their families, and the nurses coordinate communication among the physicians and others who serve each patient.

At least one HHCJ nurse is on call 24 hours a day, seven days a week. When a patient or family calls with an emergency, it is usually a nurse who answers the call, whether that means giving reassurance or advice, or making a 20-mile drive at 3 a.m. in a raging snowstorm. Recently I interviewed the five Registered Nurses who work with HHCJ about what they do and why they choose to do such challenging work.

Arna Waterhouse, nursing clinical coordinator, recalls that she took the state boards for certification 40 years ago this year. "I worked in a hospital for many years, and also in public health," she said, but after working in a nursing home in California she was appalled that people died away from their families and often with hurried and impersonal care. She moved to Hospice nursing, and that is where she has been for the last 26 years. Seven of those years have been at HHCJ.

"This is my niche," she says. "I've done many other kinds of nursing, but this is the most personally satisfying. It uses all the clinical skills you have. You have to feel comfortable with every kind of tube, every kind of dressing, so you can work independently. You have to know a little about everything: symptom management, teaching patients and families, dealing with interpersonal relationships. It's also unique because you're not in a clinical setting. You're one-on-one with patients in their own homes. It's your job to assess each situation and come up with a plan, and patients are depending on you to make good decisions."

HHCJ program director Kim Redifer gained much of her experience with Visiting Nurse Services of the Northwest in Seattle. She visits patients in their homes and shares the 24/7 on-call schedule. Besides monitoring the agency's staff and budget, she pays special attention to changes in regulations and determining how HHCJ programs can evolve to meet them. She also coordinates weekly meetings of the interdisciplinary team, where nurses and other staff carefully review the status of each patient and look for the best ways to serve them. "We really rely on each other's skills," she said, "and we work well together as a team. HHCJ is one of the few resources in our community that provides skilled care at home-a choice that many people want."

Kathy Riederer began nursing in a hospital in California 21 years ago. "When I moved to Alaska I did some nursing for doctors in town, and then I put that on hold to raise my kids," she said. For a number of years she worked as an elementary school nurse, then in 2003 she began working with HHCJ.

Riederer works a lot with Home Care patients. "Sometimes after knee or hip surgery, it's difficult for people to get out of the house for physical therapy and other treatment," she said. "Or someone newly diagnosed with diabetes may need Diabetic education." Other home care situations involve teaching family members to dress a wound, monitoring medications for patients, applying intravenous medications and catheter care, or dressing wounds that require professional nursing skill.

"It's a learning process every day, and the nurses exchange ideas that come from our varied experience," Riederer said. "If patients call and say they're suffering from nausea, vomiting or pain, we discuss options that might work for them. As a team we rely on each other's varied experience, and we work closely with the patient's doctor and their nurse."

"After one of my patients died, a family member said to me, 'Your job is really difficult,'" Riederer said. "And-yes-there are challenges. But this is a very rewarding career. You get really wrapped up in your patients and their families because you help them at some of the most vulnerable times in their lives."

Leslie Chandler has been nursing for 33 years. She worked in intensive care and emergency departments for some 15 years, as a home health nurse in Oregon, and as a flight nurse with a helicopter company. "I dealt with a lot of death in that work," she said, "and the process was often very traumatic. It became obvious to me there was more to that process than what was done at the scene. I had strong feelings about what patients and families needed at those times, and I wanted to see that go better."

"We are patient advocates and intermediaries in so many respects," Chandler said. "Homebound patients often don't know what services are available-how their lives and health could be improved. With Hospice patients we may not be able to prolong life, but we can make it better. Death is a scary time, and it can be a very sad time. But if we help people through it and take away the fear by giving suggestions and helping them understand what to expect, family members are more secure providing care throughout the process."

Chandler said sometimes patients or their families are hesitant to have people they don't know come into their home. "Most everyone will tell you, though," she said: "Once we start, we're not strangers anymore."

Born and raised in Juneau, Ann Lockhart worked for 22 years as a nurse in Dr. William Palmer's office. In specialized work with cancer patients, she said, "The Hospice nurses were real life savers for us in patients' homes." After she retired in 2004, she found she missed nursing, so early this year she joined the nursing staff at Hospice. "Home health nursing is challenging and very rewarding," Lockhart said. "It involves dealing with whole family units and seeing more of the story than you see in a hospital or doctor's office. It's a privilege to be able to help in a more useful way."

For more information about Hospice and Home Care, call 463-6111. HHCJ is a program of Catholic Community Service, which serves all persons regardless of faith. Marge Hermans is an HHCJ volunteer.

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