In your hand • 4 Days with home care nurses

4 DAYS WITH HOME CARE NURSES

2

IN YOUR HANDS

IN YOUR HANDS

IN YOUR HANDS

Stéphanie, June 16th 2020, Neuvecelle Blood sample check after the chemotherapy

This quite unprecedented situation we all live around the world because of the coronavirus bring to the light the medical workers and the exceedingly tough context for hospitals. As many of us were or still are experiencing the ‘stay at home’ situation, I was wondering how it is for less known medical workers as the home care nurses doing home visit. Their missions are multiple. They ensure, on medical prescription, certain nursing and general hygiene cares, realize the therapeutic follow-up and the administration of the treatments, follow the state of health, help with the maintenance of the autonomy and can intervene in the achievement of care formalities. They work in collaboration with other stakeholders: treating and/ or hospital doctor, physiotherapist, pharmacist, as well as providers of home medical assistance services. Let me bring you in four days of immersion with three home care nurses!

3

4

IN YOUR HANDS

IN YOUR HANDS

5

Stéphanie and a patient, June 16th 2020, Neuvecelle Blood sample check after the chemotherapy

6

IN YOUR HANDS

Stéphanie and a patient, June 16th 2020, Neuvecelle Small talks

IN YOUR HANDS

DAY 1

It’s 9am and I jump into Stéphanie’s car for the second part of the morning tour.

She picks me up, all smiling behind the mask. The car looks like a small medical office with everything she can need. “Classical nurses’ car” she tells me with a smile.

She has already done eight blood samples and we are far from the end of the morning.

This young mother provides home care in the small towns of Neuvecelle and EvianLes-Bains, France for 8 years. She was previously working in the haemodialysis hospital service. And yet we are to the next patient house. Satchel on the shoulder, Stéphanie knocks on the door. The patient, a little tired, opens. He needs blood samples control after his chemotherapy. She installs her equipment and as fast as said, the blood sample is done. Some checking on the last blood test, a small talk about the news and we’re ready to go to Evian laboratory. After a warm welcome, they talk a bit about work and the situation. Stéphanie gives her samples for test running and takes a lot of replacement blood sample kits. “Long day!” she said to the laboratory technicians and we’re back on the road. I follow her in a scrolling of patients which looks without end. The tour is about sixty to eighty kilometers a day for approximatively twelve hours of work. During this round, she provides various types of care like pricks, drugs preparation or the laying of support stockings. Then we go to the house of an old couple. Before we enter, Stéphanie told me that here is the traditional coffee of the morning. And we don’t cheat with tradition, right? The woman had a CVA (CerebroVascular Accident) 11 years ago. She needs what they call “nursing cares”.

The nurse helps her with her daily grooming and take care of her treatment. The signs of age make it difficult for her husband, so the nurses are a great and appreciated support.

While Stéphanie is providing all the cares the patient needs, the husband prepares the coffee. It’s almost 11am and it’s finally time for Stéphanie to seat a few minutes. Even the cat wouldn’t miss this little moment of sharing. Some more patients later and it’s time for me to leave Stéphanie few hours while she’s finishing her morning tour. It’s just the end of the morning and I’m already dizzy by the intense rhythm of the nurse.

I meet her back at the medical office she has with Valérie. They’re ensuring a permanence everyday at the cabinet during the afternoon. Today, Stéphanie is waiting for a patient with too much iron in the blood.

This person consequently needs to give quite a proper amount of blood (400mL) every two weeks. It looks like a blood donation. This kind of care are mostly provided in the cabinet to allow an easier control of the arterial pressure all along the donation and to give more comfort to the nurse and the patient. As he said with a tone of humor, “I’d rather be here than lying down on the living room table. It’s really not comfy”.

More importantly, it allows a quick access to all the medical equipment the nurse might need if something goes wrong. The strategic place of the office also matters. It is just in front of the pharmacy and the medical office. We must remember that being a home care nurse means that you’re working alone. It obviously requires a lot of organisation but also experience and temper to be able to manage various kind of situation by yourself.

7

8

IN YOUR HANDS

IN YOUR HANDS

Stéphanie, June 16th 2020, Neuvecelle Grooming support

9

10

IN YOUR HANDS

Rollingchair, June 16th 2020, Neuvecelle « Coffee on it’s way! »

IN YOUR HANDS

11

Stéphanie, June 16th 2020, Neuvecelle Even the cat wouldn’t miss this moment of sharing

12

IN YOUR HANDS

June 16th 2020, Neuvecelle The home care nurses’ cabinet in Neuvecelle

IN YOUR HANDS

13

Stéphanie and a patient, June 16th 2020, Neuvecelle The ‘blood donation’

14

IN YOUR HANDS

Cécile and a pat

IN YOUR HANDS

DAY 2

tient, June 17th 2020, Neuvecelle Sore treatment after a surgery

The next day, I’m joining Cécile for her morning tour. All radiant as Stéphanie, she welcomes me in the car and tells me the program of the morning. During the drive, she explains me her different status. She’s doing only replacements for four cabinets in the county for four years now. She was working in a clinic before. She enlightens the fact that there are many advantages of doing only replacements. First and foremost, you have flexibility. Secondly, you don’t have any administrative tasks to do. In exchange, 10% of the salary is given to the home care nurses cabinet to compensate the time spend on these tasks. She’s a young mother as well and she appreciates this organisation so she can spend more time with her son. We arrive to the first house. Here is an old Italian lady who needs a daily treatment for a painful osteoarthritis. She also needs to wear support stockings which the nurse helps her to wear and then to remove in the evening. We continue the tour of mainly nursing and sores’ cares this morning. One patient retains my attention. This old deaf lady developed an eschar because of her condition. Not being able to move could lead to this kind of skin damages which are long to treat. And I start wondering how lonely some patients might be. I ask Cécile. She confirms that some of them are. They don’t always have a caregiver to spend the day with them or don’t have children or family close to them or neither of that for different reasons. Therefore, the nurses become an important support and sometimes one of the only social contact some patient might have. She tells me that the end-of-the-year celebrations period is sometimes particularly tough for these patients. The roles of a home care nurse are indeed various. Psychological support is part of it. The social

15

16

IN YOUR HANDS

The satchel, June 17th 2020, Neuvecelle The indispensable of the nurse

IN YOUR HANDS

relationship they develop with the patients matters a lot. The nurses are a non-negligible assistance for the senior’s patients lonely and isolated. They offer a great support against solitude and sickness. That’s why those coffee traditions are important not to be missed. It’s the time for small talks about life, news, whatever, just to disconnect a bit from the medical situation and appreciate the nice little things life has to offer. Stéphanie tells me that calling the patient by their first name was appreciated, it creates more proximity and the patients forget a little bit about their condition and the fact that it’s a medical visit. I also notice that the three nurses have a great sense of humor which really lightens the mood! They all arise a lot of good spirits. They, by the way all, explain me that one of the things they appreciate the most in working as home care nurses is this relationship they can develop far from the distance inspired by white coat in hospitals. They choose this way of working for the variety of cares they can provide as well.

17

18

IN YOUR HANDS

IN YOUR HANDS

19

Cécile and a patient, June 17th 2020, Neuvecelle Grooming support

20

IN YOUR HANDS

DAY 3

The next Monday, I meet Valérie for the afternoon/evening tour (she was on holidays the previous week. That’s why Cécile was here). Did you know that the average career length for a nurse is seven years in France?

Well, Valérie is definitely not part of that. She is a nurse for twenty-nine years and for seventeen years in the home care nurses cabinet in Neuvecelle. She works for many years with a diabetologist in the Evian hospital (which has been replaced by the MGEN few years ago. It is now a health and rehabilitation center). We besides start this tour by a diabetic couple she’s following for around fifteen years now. The man has been hospitalized at home after a surgery to remove one of his toes. One of the many damages caused by diabetes. In this case, the nurses are in close collaboration with the hospital. One nurse from the hospital come every Monday. The treatments are also brought by one of them every Friday but most often still provided by the home care nurses (like installation of perfusions for instance).

The man will have to endure another surgery soon and I can feel how much Valérie bring some appeasement. Indeed, the situation is quite complex for the couple. Both are diabetic and the wife will need a surgery as well.

Unfortunately, this one, less urgent, was cancelled because of the over frequentation of the hospital due to the coronavirus. She explains me that she completely understands the situation even though her condition is quite uncomfortable. She hopes that the surgery will

Valérie and a patient, June 22nd 2020, Neuvecelle, office Insulin injection

IN YOUR HANDS

21

22

IN YOUR HANDS

Valérie, June 22nd 2020, Neuvecelle On the road

be reprogrammed soon. A ronavirus and the lack of p it’s not possible to organiz time. The man can’t stay that’s a problem to solve w the nurse’s concern.

Lately in the afternoon, Va of coronavirus lockdown work for their office. Far know them for years and them were of course mo lockdown and it was, tim

Another problem caused by the coplaces in the hospital is the fact that ze both of the surgeries at the same alone because of his sickness and while her wife is hospitalized. I feel

Valérie explains me that this period hasn’t been a decreased period of from that! Most of their patients are trustful in their care. Some of ore anxious than other during the me to time, necessary to be educa-

IN YOUR HANDS

tional about the situation. Unlikely, not so far in Saint-Jeand’Aulps (where Cécile is working as well), the number of patients decrease during this period. Hard for the nurse to explain exactly why. She also tells me that one of her friends working as a home care nurse in Paris has to face particularly dire situation. Some patients refused home care for fear of being sick and try to take care themselves of their sores.

The Parisian nurse had to do a drastic work to repair the harm that was caused. Few hours later of cares and summer warmth in the car and it’s time to do the permanence in the office before Stéphanie arrives. Today only two patients for post-operative cares come. The rhythm of work in the Neuvecelle’s cabinet is: two days of work, one day of rest and three consecutive days during the weekend. For example, one nurse will work on Tuesday and Wednesday, rest on Thursday and work again on Friday, Saturday and Sunday. While one nurse is resting, the second one is working. Each time there is a change, the nurses meet during the permanence for the instructions passage about the patients.

Stéphanie’s here. It’s time to start. During the meeting, they review all the patients and their treatments, in which stage are the sores, how is going the post-operative recovery, the patients’ behavior, how they felt, etc. They also talk about their personal situation. For instance, they mention one old woman who will soon be placed in a nursing home. Her stubbornness jeopardizes her safety. She, for instance, often falls on the ground and it becomes too hard for her husband to help her. He often has to ask help from the nurses or the neighbours. At times, it’s not possible to avoid the placement in a nursing house. The nurses also have this adviser function. Along the debrief, they also organize their tour, see if there are new patients, etc. (a tour is organized by type of cares and of course as much as possible by the geographical positions of the patients). Then, they also check some administrative papers, see if everything is in order (very often done on the resting days as well). Hard not to be impressed by the number of patients they see a day! I was wondering if they sometimes must refuse patient. They said that it’s more often the day which become longer than a patient who is refused. It’s hard to say no when you know that nobody else will do it. But as they kindly said: “We do it because we want to.” On these fine words, it’s time to go back on the tour until 21:30pm.

23

24

IN YOUR HANDS

IN YOUR HANDS

Valérie and a patient, June 22nd 2020, Neuvecelle, Neuvecelle Sore treatment after a surgery

25

26

IN YOUR HANDS

IN YOUR HANDS

27

Stéphanie and Valérie, June 22nd 2020, Neuvecelle Meeting during the permanence

28

IN YOUR HANDS

At last, I meet Stéphanie again for the evening tour on Tuesday. My curiosity raised by my discussion with Valérie about the coronavirus, I wanted to know more. She explains me that for them the situation was ‘well’ experienced. They fortunately have some medical equipment stock in advance to compensate the time it takes to restock and have been able to work properly with all the equipment they need (besides, at the very beginning of the coronavirus in France, when the panic exploded, they sometimes had to hide the medical equipment in their car to dissuade anybody to stole it. But nothing compared to the situation in some big cities). The protocol to visit the coronavirus positive patient is quite the same than at the hospital “you have to wear the complete protection outfit. The one which makes you look like a cosmonaut” she said to explain me. It means a hairnet, a mask (certified FFP2, to protect the patient and themselves), protection glasses, a glown and gloves. Everything is one use and then thrown in a specific bin. All the car and equipment must also be ‘decontaminated’ after each visit. They are planning these patients at the end of the day by efficiency but mostly to avoid the risk of contamination to other patients.

She mentions something extremely important which for me spotlights very well the responsibility they have. If both are sick at the same time (coronavirus or anything else) or have unexpected personal constraints which unable them to work, who will take care of the patient? Cécile unfortunately plans to move, and It seems that substitutes are quite a scarce commodity in the county and probably in the rest of the country.

DAY 4

Stéphanie and a patient, June 23rd 2020, Neuvecelle, o Skin treatment

office

IN YOUR HANDS

As the other medical workers, their work conditions have to be improved on some part: old fashioned software to manage the administrative tasks like the payment, unproportioned remuneration on some cares… but all I can remember for now is the positivism they bring despite all of that.

29

IN YOUR HANDS 4 days with home care nurses A story by Amandine Ollier, June 2020