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Personal Experience

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Home is home.

Magda Hrašková
Language: English
Country: Slovakia
Typology: health care professionals
Text:
Mr. Julius lives alone in his small house and is bedridden. Both of his legs are amputated, the right one practically from the hip and the left one over the knee. He is quite bulky and overweight. The injury also hit his urinary tract and intestines. Operating the bottom part of his abdominal cavity ensured reconstruction of the elimination function with the use of a permanent urinary catheter and colostomy. However, the healing process created a weeping fistula created at the scarred buttocks along his sphincter which is a possible gate for an infection. It failed to heal. Julius alone can change a little the position of his torso, but the lower back and buttocks are used practically all the time. She lies on them with his whole heavy weight and the skin here is with many scars and very sensitive to abrasion. Julius is able to use his arms. With a help of electric bed he can pick himself up to drink and eat. He refuses institutional care. Julius is 62 years old. He has never been married. When he was 48 he had an accident at work, he fell under an agricultural machine which completely destroyed his lower body. Accident was followed by series of stays in hospitals and various nursing facilities. Healing processes reached the maximum possible; Julius will live in his posttraumatic condition which is complicated and according to his tying to a bed he is threatened by complications. He has lived in a country, was working in agriculture and has a small house in a village he lives in. He has friends there with whom he shared his life before the accident. His brother lives at the next street. His doctor sees him at home and sends him to the hospital only when Julius gets ill or when his health state requires new examinations and healing in hospital. According to the fact that Julius and his brother made an agreement that Julius will have home care, it is needed to organize house and professional nursing care, which will be provided by mobile nursing care. A nurse comes to the house and talks with Julius and his brother about his actual health state and after nursing reminiscence they start to create a nursing plan together. They agree on 2 visits daily for 7 days in a week. During the morning visit nurses help Julius with hygiene and changing clothes, they change his urine bag and write down the amount of the urine. They tie the colostomy and clear and tie weeping sinus according to the doctor’s recommendation. They provide prophylaxis of bedsores in the lower back area where he has sensitive scars. He needs 30 degree positioning. They give him his medication and the daily injection. Food and drinks are brought by his brother in the evening and neighbor for lunch. Together with the food they give him the medication. Julius has a TV with remote control, enough napkins on the table next to the bed where he has also food, drinks and a flapper. His foods are provided to him by his family and his relatives according to his wishes, sometimes he orders a food in the local pub – mainly when he wants something special. The night nurse visit means preparation for sleeping. Every time the nurse is there Julius asks for something he will need when he will be alone so that it is available for him. He has special air mattress which prevents bedsores by changing the pressure in its individual chambers. Julius has also a phone in case he would need something immediately. His brother brings him daily news. Julius can clearly say to nurses what he needs or what he does not want. The nursing plan which involves solving of various situations enables Julius to live an independent live despite his injury in the environment which is close to him without losing a professional care. His friends and relatives visit him and he perceives visits of nurses as part of his life, in which he can decide what is going to happen. On the contrary, in the hospital he would have to adapt to the conditions of the hospital and he would have been isolated from his home environment, for example he would not have been eating his own food, he could not invite his friends for the game of schnapps on the Friday evening as usually. By his choice to stay home he kept as many habits as possible and he added to them the professional care. He also manipulates his money by himself in the way that he can rely on his brother that he will buy him everything he needs or wants. Despite his apparent dependence he keeps all the possible freedom. OBJECTIVES: Provide the necessary nursing care at home. Avoid complications from possible infection, complications of impending immobility and of being alone. Participate in the overall care with the family and neighbors- ensuring drinking and dietary regime, positioning, household order, social network and the daily activity content. Reduce the feeling of helplessness and dependency in these circumstances. Create a space for sharing needs and when possible ensure their fulfillment. MEANS AND STRATEGY: Providing companion, expressing an interest and relationship, motivational directing and comforting talks, supporting the daily life activities, assisting with physical hygiene, special nursing care at home, humor and creating a space for expressing burdensome feelings. CONCLUSIONS: Julius needs the support to discern what he is able to handle physically and with what he needs an assistence so he will not become helpless and irresponsible. He needs to deal with accepting help.


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