Ethnography

Walking into the home care agency, are lines of cubicles similar to what a library looks like. There are lines of computers, waiting to be used by office personnel and clinical staff. Clinical staff here consists of nurses, physical therapists, occupational therapists, social workers, speech therapists, home health aides, occupational therapy aides, and physical therapy aides. The office personnel consist of nursing supervisors, administrative assistants, receptionists, and home health aide schedulers. As you walk into the front entrance you are welcomed by the receptionist to the right. She is a pleasant lady, but you can definitely see the stress on her face. She eases herself by listening to her favorite Portuguese radio station at a minimal volume. She turns up the volume just loud enough for her to hear, but low enough making sure not to bother others in the office. As you walk in, the radio station sets the tone for the office. You can tell that the office staff and management are laid back. They’re only there to bother when you don’t do your job. On the right hand sight, there is a rather quite large conference area. This room consist is two large picture windows and a large table in the center of the room with approximately twenty chairs lined around. This area is often used for education purposes, team meetings, rehabilitation meetings, office interviews, and very rarely for Christmas parties. When used for a meeting, there is often a laptop set up to a projector. This laptop is used for patient case and chart reviews for clinical staff. As you walk further into the office, you are able to see more of the offices and closet spaces. The biggest closet they have is set aside for medical supplies. The supplies they stock range from normal saline and two by two’s to theraban for rehab staff. In the back of the office is the copy room. There is a large copying machine along with two fax machines and a universal printer. These machines are used by everyone in the office.
After sitting down with one of the nurses, I got a good look at her. She has her hair pulled back in bun, is wearing clean clothing, and her fingernails are cut at a perfect length. It is protocol to have hair tied back and nails to be cut to a reasonable length. This allows patients to see the cleanliness of their nurses and provides less of a chance for disease to be transmitted from one to another. She wore bright red reading glasses, the same color as her working scrubs. Considering the cold weather, she did also wear a tight white knit turtleneck underneath to ensure her warmth throughout the day. I began to think that I should have dressed warmer for the day. Her earrings were shiny and silver. She also wore around her work badge around her neck. This badge is used to enter the office and most importantly to ensure to the patients the credibility of our nursing staff. It is very important for patients to feel comfortable with the level of service these nurses and therapist provide them. Usually if the nurse comes into the office around 8:30 a.m. most of the other nurses are already there. They begin their day by calling their patients in the morning to let them know when to expect them. These nurses can travel up to 140 miles in one day. Their days can begin in Fall River and end in Norwood. Scheduling and timing is extremely important to them because it can save them an incredible amount of time.
On this particular day, the first phone call was a success. The visiting nurses first appointment would be at 9:30. The second patient didn’t answer their phone. A call was made to them twice. They are now at the bottom of the list. If they don’t call back before 12 o clock then the nurse will take another patient for the day. The third patient was called and their response was, “Well, I’m not feeling up to it today, can we reschedule for tomorrow?” The nurse agreed and then rescheduled the patient for the next day. The last 5 phone calls were a “go”. They all agreed to the time the nurse would visit. Today is Tuesday, and their team meeting is held at 12:30. It lasts about an hour long and is usually a drag. She has arranged her visits around this meeting. She then began to replenish her clinical bag with medical supplies she will need for the day. After all the talk and chit chat in the office, we were on our way. But before we could even think about leaving, the Intermec computer needs to be downloaded. These computers that the nurses carry look like the personal computers that the Fed Ex and UPS employees carry around with them. They are about 2.5 pounds in weight and are very durable. The nurse enters patient information into a secured program that wirelessly downloads into a database. This database then downloads and transmits the information to the office computers. Home care has a lot of paperwork requirements that these nurses must complete, more so than any other nursing facility. They are required to input Daily Activity reports, Oasis C documentation, admissions, resumption of cares, clinical notes discharge clinical notes, medication reconciliations and all calls made to doctors offices, supply companies and or home lab draw companies. Everything they do through out their day needs to be documented and accounted for. Finally, after the Intermec had downloaded we are on our way and I mean it this time. We hop into her light green Honda CRV- Hybrid. It seems only reasonable with this profession to invest in a Hybrid considering all the mileage she puts on it on a daily basis. As we head to the first patient house, the phone calls on her cell phone begin. First there was one from a doctor’s office regarding orders on a patient and then there was one from a patient. They somehow figured out her cell phone number. They try not to give the patients their personal numbers because they tend to call at all hours of the night. Needless to say, by the end of the seventh patient and the hundredth mile I was exhausted. As she dropped me off around 4:30, I knew that I would sleep like a baby tonight. The scary thought was that the nurse wasn’t done for the day. Although she would be home, she would still continue to document throughout the night. It’s a job that requires dedication and patience. I know for sure, that I would not be able to be as patient as some of these nurses.