National Nurses United

Unusual Nurses 3_No Ginn 2 box 4/1/10 3:11 PM Page 24 vented altogether by regular movement and monitoring by a floor nurse. But once a patient gets home, such supervision is more difficult, and compliance with treatment can be difficult to ensure. "Once they come home from the hospital, they figure who are we to come into their homes and tell them what to do," she said. "What we do is a lot of teaching to make it as palatable for them as possible." While Eccles says the company she works for pressures her to see as many patients as possible, she—like many other visiting nurses— works independently and if a patient needs an hour of her time, she can give it. Visiting nurses first became popular in the late 1800s in both the United States and the United Kingdom—including Scotland, where Eccles was born—and achieved dramatic gains in public health in city slums of both countries. They have remained an integral part of health care in the U.K., Cuba and other countries with national health systems focused on preventive care. In the United States, visiting nurses tend to be less common but can play an important role, especially in rural areas. While Eccles works in town, many visiting nurses in Maine travel long miles in snow, ice and other conditions to visit homebound patients who may be an hour or two away from their nearest medical center. "We want to teach them to care for themselves better," Eccles said, "so they don't have to go to the hospital or emergency department." The Fixer Teresa Miller, RN Photo by Nancy Dionne T he rusted-out trailer in the driveway was the only hint that the modest, single-story home in Modesto might have health problems inside. Other than that, it had the same look as all the other houses on the block, said Teresa Miller, a Stanislaus County, California, public health nurse. The trailer was filled with the carcasses of old appliances. A stove and a stove hood sat on the side of the house. Once inside, it only got worse. The house looked like a home renovation gone wrong. Drywall was missing and electrical wires were exposed between wall studs. Further into the house, closer to the bedroom of the 19-year-old young man Miller had come about, there were fist- and elbow-sized holes punched into the doors. But it was the 19-year-old's bedroom that was ground zero for what Miller had come for. Miller had received a report from the local laboratory indicating that the young man's lead levels were 50 percent higher than healthy. That's a big problem. Lead poisoning can affect every system in the body, causing everything from fatigue and vomiting in children to memory loss, mood disorders, pain and miscarriage in adults. It's also known to cause developmental delays in children. This particular youth was bipolar and had attention-deficit disorder. The lead poisoning wasn't helping. That's where Miller, who stayed home to raise her own children for 20 years before becoming an RN, comes in. She's charged with following up every case of lead poisoning in Stanislaus County until the patient's health is back to normal. What she found in the room was a surprise even to her. The floor was littered with more appliance pieces and exposed wiring. It 24 N AT I O N A L N U R S E turned out that her client's hobby was working on electronics, often by soldering them with lead. When the environmental health officer who went with Miller to the house tested the bedroom for lead, it scored off the charts. And since its occupant was walking around the rest of the house after soldering, the lead was in the carpet, too. He was eating with lead-covered hands and wearing lead-covered clothes all day. So Miller came up with a plan to reduce the young man's lead levels: He must have a place set up outside to solder and he must do it there only; he must wear coveralls while soldering that he takes off before coming back in the house; and he should wash his hands before he eats or returns to the house. And, because his mother is recovering from heart surgery and her other son is autistic, Miller referred her to another agency that provides mental health day programs that can help the woman deal with her two children's special needs. "Now the challenge is going to be to follow up on monthly lead testing until his results are normal," Miller said. W W W. N A T I O N A L N U R S E S U N I T E D . O R G MARCH 2010

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