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SUBURBAN DIARY

Reflections of a home health nurse, tending patients and easing fears amid COVID-19

Katie Noonan, a registered nurse, works for Hallmark Health VNA, which is part of the Lawrence-based Home Health Foundation.
Katie Noonan, a registered nurse, works for Hallmark Health VNA, which is part of the Lawrence-based Home Health Foundation.

I didn’t always aspire to be a nurse. My mother was a nurse, and although I admired her and what she did, I didn’t think I had the stomach for it.

That is, until the summer I took a job as a nurse’s aide. I was attending UMass Amherst with no major chosen when I began working at a nursing home. I started to think this is what I wanted to do, but I couldn’t get into the nursing program. So I moved home with the intention of applying to the Malden Hospital School of Nursing, which had one spot left that fall. I graduated in 1984, and worked in telemetry and in the intensive care unit at Malden Hospital until 1994.

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When Malden Hospital was getting ready to close, I was working per diem and ran into a woman who was managing the Malden Visiting Nurse Association, which merged with Hallmark VNA. I didn’t know if I’d like it, but the more I did it, the more I loved it.

There have been so many changes in home health care, but I still love seeing how people live and how I can take care of them in their environment. Home health is a lot different than caring for patients in the hospital, where you have more time and resources to help them.

Sometimes you encounter sick people whose caregivers are very elderly. You may be dealing with difficult patients who are noncompliant, and you need to figure out how much you can change the situation to be helpful while respecting their autonomy. You go into really messy houses and other difficult situations because patients’ home lives can be very dysfunctional. Also, you’ve got to love dogs.

I had a favorite patient, a quadriplegic who has since passed away. You try to set boundaries, but some patients become very special. You can’t help it. Some people need you more because they don’t have much support.

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Home care has become even more challenging since the COVID-19 pandemic began. Not only are we treating patients in all stages of this illness, but we’re easing anxiety related to it in both patients and their family members who are concerned that we could bring the virus from another home into theirs. What I say to allay fears expressed by those individuals, or others considering home care, is that we take our responsibility very seriously and follow the protocols in order to prevent that from happening.

We screen patients by phone prior to each visit, so we know if they or anyone in their household are experiencing symptoms. We also assure them that we practice good hand hygiene and that our agency’s supplies of personal protective equipment (PPE), including face masks and gloves, are well stocked.

My colleagues and I have determined that the best practice is to visit patients with COVID-19 last so we can go straight home afterward. I put a garbage bag by the patient’s door when I arrive, and when I leave, I carefully remove my protective equipment and place it inside the bag to be disposed of. When I get to my car, I properly wash any equipment that was with me using a new pair of gloves that I then put in a bag in the back seat and throw away when I get home. Maintaining good technique has always been important in home care, but now so more than ever.

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Patients aren’t the only ones who are anxious. My family has expressed concern for my safety, but I know I’m taking the proper precautions. I also recognize there’s a need for patients to receive the care they need and deserve as they cope with this virus.

There are also good moments, such as when patients recover from COVID-19. One nice experience was with a woman in her 80s who was 14 days post-diagnosis. Her temperature was flat and she was presumed recovered, and she and I both said, “Isn’t this wonderful? You survived it!”

Another memorable patient was a man I had sent to the hospital with shortness of breath. I had seen him feeling frightened. Now he’s home and I’m caring for him again. He feels a lot better, and a lot of his nasty stomach and respiratory symptoms have disappeared.

I know I’ll be seeing a lot of patients diagnosed with COVID-19 in the future who are getting off ventilators and going to rehab. They’re still so sick that I haven’t encountered them yet, but I’ll be ready when they come home and they need me.

My fellow nurses and I really appreciate all the support from the community. It has kept all of us going. It’s so nice that people are acknowledging everyone who is making an effort to keep this world going: health care workers, employees in grocery stores and takeout restaurants, truck drivers, and food and package deliverers.

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However, I am also well aware of the intense suffering of families whose loved ones have not survived COVID-19, as well as those who have suffered serious financial consequences during this uncertain time.

As a nurse, I’m solution-driven. My attitude is we’ve identified the problem, so now what can we do? I trust that the appropriate scientists are working on developing a vaccine and treatment, and I’m hopeful that we’ll all emerge from this with lessons to return to a simpler life, and enough knowledge to respect pandemics and be better prepared in the future.

Life will be different, but in some ways, I believe it will be better.

Katie Noonan has been a nurse for 36 years, spending the last 26 in home care. She is a registered nurse with Hallmark Health VNA/Home Health Foundation.