Nursing News:
Just another rewarding day in the life of a Visiting Nurse

By DEBBIE COUNCIL, Daily Bulletin Staff Writer
Instead of maneuvering hospital hallways, registered nurse Sandy Dawson packs her black bag, hops in her blue Tahoe and travels highways to reach her patients. Armed with stethoscope, blood pressure equipment, sanitizing hand cleaner and an ample supply of samples, she drove nearly 48 miles on a recent Friday to check on four patients in Upland, Ontario and Diamond Bar.
Sheıs a certified wound, ostomy and continence specialist for the Visiting Nurse Association & Hospice of Southern California. But the petite 56-year-old Chino Hills grandmother is so much more. Sheıs an educator, nutritionist, counselor, clothing consultant and friend. Nationwide, Visiting Nurse Associations have provided cost-effective and compassionate home healthcare for 120 years to individuals, regardless of their condition or ability to pay for services. Congress recently voted to designate the second week of May as National Visiting Nurse Association Week. What follows is a typical day in the life of a home health nurse.
AN EARLY START
Itıs 8 a.m. in Sandy Dawsonıs Claremont office but she arrived an hour earlier to go through her patientsı files. The tiny station she shares with Susie Vanderpool is identified by the leg and buttocks models she uses for training purposes. Wearing a white lab coat, Dawson says she loves being a home health nurse because of the freedom and the relationship she builds with her patients.
³I hope to never go back to the hospital. Youıre so mentally scattered. I donıt think the patient ever gets that truly one-on-one focused attention,² she says. ³(Patients) need that one-on-one so they learn what they need to know to live with their disease process to the highest functional level that they can.² By 9 a.m. sheıs at 50-year-old David Grahamıs Upland home to change a compression wrap on a difficult lower leg wound. When he was 17, he nearly lost his leg in a work-related accident. Last summer, the 6-foot-3-inch man reinjured his leg in a boating incident. The additional trauma played havoc with his scarred leg, causing circulation problems, an infection and a swollen foot. She has treated his wound twice a week since September. ³When I met Sandy, I knew she knew what she was talking about. Sandy is a very wise lady when it comes to this stuff,² he says as she takes his vitals.
Wearing surgical gloves, she cuts off the old dressing. To the untrained eye, the wound looks raw with a creamy center. The redness is actually new tissue growing. After spraying the area with a wound cleanser, then a barrier cream, she adds material that resembles Styrofoam for the new skin to grow on. In no time, sheıs snipped and stretched four different layers of cloth, cast batting and varying degrees of stretchy material in a figure-eight pattern to create his fresh compression wrap. Then, itıs out the door and on to the next patient.
AN EXPERT TOUCH
At 9:50 a.m., Dawson pulls up to the Ontario home of 82-year-old Rubye Briggs. Briggs awoke one morning to an open wound, probably due to her thin skin, swelling and circulatory problems in her leg. Dawson checks on her every day. ³It hurt terribly last night, I have to tell ya honey,² Briggs says after she relaxes in her recliner. ³Honey, I was having a lot of trembling this morning.² Dawson removes Briggsıs low-level compression dressing. ³That looks nice today. I see new growth on the edge I didnıt see the other day. So, itıs definitely starting to respond,² Dawson says. ³The wound is not hotter than normal.² She takes her blood pressure, which was a little elevated. After a few minutes, she takes it again with a reading of 152/58.
³I like your numbers this morning,² Dawson tells Briggs. ³Nice normal healthy numbers. (Your temperature is) 97.1, no fever. It means youıre not getting infected.² Dawson completes the new dressing and Briggs is appreciative. ³Sandy, youıre a dear. She says the nicest things to me,² Briggs says. ³Sandy can wrap like no one else can wrap.² The Visiting Nurse Association provides Briggs with a Telemonitor, which is connected via her phone line to the VNA office in Claremont. An alarm reminds her to take her blood pressure medications at 11 a.m. and it checks her vital signs. A nurse at the office reviews the data, which goes to Briggsı physician. ³It gives you the opportunity to help yourself, you know,² Briggs says, her Missouri accent still evident after living 52 years in Ontario. ³The VNA nurses are really such a treasure for our area. It keeps you from being hospitalized so much.²
At 10:30 a.m. Dawson greets David Duster, 70, and his wife Reggie in Ontario for his discharge visit. The 6-foot Duster has recurrent colon cancer that spread to his liver. A surgical procedure called an ileostomy brought a portion of his small intestine to the surface of his abdomen, creating a stoma from his intestine. Heıs adjusting to the bag-like appliance that collects his fecal output. Being on chemotherapy causes the bag to fill more often. Because Duster has lost 40 pounds, she tells him that eating is essential, especially while recuperating. He asks about supplies for skin diving. Dawson shows them a catalog of ostomy products. ³As long as this rim is the same size, any of these will fit. You want the long wear,² she says. ³You should be just to the point where (the stoma) is done shrinking.²
She offers information on a variety of underwear to accommodate his needs and the bag, items that will work with his preferred attire, larger trousers with suspenders for comfort. While he and Dawson go upstairs to check his stoma and change the bag, Reggie praises Dawsonıs support. ³Sheıs been awesome. When Sandy came out, I was beside myself. She brought me up and showed me what to do. He was so raw underneath. She showed me how to make him better,² Reggie Duster says. ³The next time I changed the bag, he was almost all healed up. Now itıs a way of life. If it wasnıt for Sandy, I donıt know where weıd be.²
A GOOD ENDING
After a fast-food break, Dawson heads to her final patient of the day, 52-year old Anwar Salimi, an accounting professor who lives in Diamond Bar. A life-threatening case of diverticulitis, an infected pocket-like opening in his colon, resulted in emergency surgery and a reversible colostomy. Complications set in when parts of his incision broke open below the stoma and he wasnıt healing.
At 1:15 p.m., his mother Tayeaba Salimi answers the door. Dawson sits next to him on the sofa. ³Itıs draining a little but much less than before,² he tells her. His appetite has improved. She discusses his ethnic diet. He mentions that walking the cul de sac makes him tired. When he walks it feels like he has on a belt and that things are shifting. She reassures him that itıs just normal post-operation symptoms. He has questions about his surgery. She takes out a 1-inch red plastic model of a stoma that looks like an upside down Bundt cake and explains the surgery. In her comforting, conversational manner, using her hands for emphasis, she demonstrates.
³The doctor takes your intestine and folds it back like a pair of socks. Thatıs why itıs so thick,² she tells him. ³If you wash it a little hard it could bleed. Thatıs OK. Itıs OK to touch it.² ³All this information she gives me is very reassuring the body and mind both,² he says. ³So much from what she knows relieves my anxiety.² After taking his vitals, she tells him heıs doing fabulous. ³Thatıs a good way to end my week on a Friday. Everybodyıs well,² she says. ³Everybodyıs numbers were good.²
At 2:15 p.m., sheıs back on the road heading to the office in Claremont. Last year Visiting Nurse Association & Hospice of Southern California served 6,000 patients. A large percentage are frail elderly, but also surgery patients and those with chronic illness and disease. More than $250,000 was spent in charitable care.
Executive director Marsha Fox said home care is part of the continuum of care. Nurses have to address a range of medical situations that they didnıt have decades ago. Patients stayed in the hospital until they got better. ³Well, thatıs not at all what happens now. Itıs a natural transition from hospital to home because the patients are still so sick,² Fox said. ³Theyıre in two or three days and theyıre still in the acute phase of their illness. (Our nurses) are really the doctorıs eyes and ears.²
Director of Nursing Gayle Wilson said the VNA nurses are more highly trained than ever before. ³One of our roles is to teach the patient how to take better care of themselves so they have a better quality of life by staying home. It gives control back to that person,² Wilson says. ³By VNA going into the home and making it safer and getting the patient involved in their health care, people are going to stay healthier longer and be able to stay in the environment they want.²
The Visiting Nurse staff is on call 24-hours a day, seven days a week. ³You canıt get your doctor here at midnight. But we can get a nurse,² Fox said. FIND OUT MORE
Who: Visiting Nurse Association & Hospice of Southern California. Information: VNA Referral Center (800) 969-4862.