Tuesday, March 5, 2013

TING AND I, Home Nursing Care, 2

Why Dontcha?

“Why don’t you…?” This is followed by an explanation of how you could do more, better. It’s helpful, in offering an idea you may not have considered, and not helpful, in seeming to add yet another burden. My response is often along the lines of “Yes, but….”


Nurse Michele Shehata says her grandmother has a saying, “Everybody wants to fish, but no one wants to get his feet wet.” When I’m given a suggestion that requires added work, I try to delegate that work to the one making the suggestion, such as the suggestion that we make “fruit and vegetable smoothies“ in a blender for Tina. Delegating the suggestion to the innovator may discourage input, but it makes me feel less stressed. Often, the suggestion is not carried out, because there were good reasons why it had not been done already.

Why not make smoothies for Tina?

The benefits are small. She cannot taste the smoothie, given through a gastric tube. She is already getting a balanced nutritional diet, without evident deficiencies, although a variety of foods might provide something not known to be missing.

The problems are numerous: We keep track of everything she gets, to help interpret her responses, such as rashes, flushing, etc. We would need a standard formula for the smoothie, one that we tried out in small increments at first. The ingredients would need to be purchased, then washed and cut up and prepared in the same proportions each time. They need to be processed in the blender, with the excess saved or discarded. The blender needs to be cleaned thoroughly. Who is to be responsible for each of these steps? We have a crew of ten nurses. Which ones will do what, when? This will need to be “charted,” scheduled. Right now her daily calorie intake is 1,200, and her weight seems stabilized (we almost never get her to a scale). An extra 100 calories per day would mean she might gain an extra pound each month or two, unless something else is reduced or dropped. What would we eliminate?

“Smoothies” died a natural, organic death.

How Many Nurses?

There are 168 hours a week to be covered in round-the-clock nursing. We generally have had eight to ten nurses at one time, whose weekly hours usually ranged from about 8 to about 39, averaging roughly 16 hours per nurse. As a rule, our nurses got along very well with one another, often chatting awhile about personal matters during the change-of-shift periods, which we did not discourage. Different nurses had different strengths and weaknesses, but by the end of a week, what needed to be done got done.

How Old?

The nurses who worked out best for us were typically forty to sixty years of age. All had been married. Almost all had children. Almost all used this as a part-time job, as we did not offer health insurance, which they typically had through other means. Compassion and intelligence were most valuable traits, and these women became the primary source of Tina’s social life, as we had few friends and family who could visit us regularly. To lessen the risk of contagion, we mildly discouraged visitors.

Male Nurse?

Only rarely has a male applied for the position. Tina would not feel comfortable with one, nor would I. We have not ended up with one.


The doctors who have treated Tina have remarked on the exceptional care she has obviously been getting. Her continued survival is little short of a miracle. We are proud of her and proud of ourselves.

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