Homecare Nursing: Survival Medicine’s Missing Link

Medical planning and training is a huge subject among preppers, and with good reason. In a large-scale disaster or worst case scenario, medical treatment may be impossible to access. Preppers, as a group, know more than the average person, but there is one area that very few preppers even seem to notice: Homecare Nursing.

My Experience with Homecare Nursing

I am a Licensed Practical Nurse, EMT, Wilderness EMT, phlebotomist, and CPR/ First Aid instructor. I also instruct disaster medicine with a well known firm and am currently working on my RN. In addition to all that, I work full-time and have done this over the last several years. In addition to this training, I have had the opportunity to care for two relatives on hospice.

I have noticed that many preppers want to know how to suture a wound or remove “the bullet” or some other “glamorous” task. But the more training I receive and practice in the field, the more I realize how much I do not know, in spite of all my training and experience. That concept really scares me but it’s a healthy fear. Preppers will benefit from that realization as well. 

The first steps are to learn the basics and have the proper supplies ready. Then, take the next step to learn how to suture a wound or remove a bullet.

The Most Neglected Medical Training

The most ignored area in medical training that I have seen in survival circles is homecare nursing. Per longtermcare.gov, a person age 65 has a roughly 70% chance of needing some type of long-term care services and supports before they die. However, it’s not just the elderly who may require homecare nursing. Anyone with special needs may also require more specialized care.

So while it may be a boring subject, but it’s an absolute necessity to keep your patient alive and viable.

It saddens me when I deal with a person (young or older) who has contractures, bed sores, develops pneumonia, or just fights to maintain some level of independence because no one in their life provides basic homecare nursing skills.

A Basic Overview of the Homecare Nursing Skill Set

Good basic patient care can be learned and mastered by becoming a CNA (Certified Nursing Assistant). The job of CNAs is to take temperatures and blood pressures, give bed baths, turn, and feed patients. They help monitor for bed sores, pressure areas, changing incontinent patients, and providing basic necessary care. It may not have the glamour or prestige of removing a bullet, but basic patient care is actually more necessary.

Bed Sores

Not everyone understands that a person cannot lie in bed for hours, days, or even weeks without someone really involved in their care. An immobile patient must be turned and checked every two hours. If you turn them and see a red mark on their side, butt, or back, you are probably looking at a bedsore very soon. Bedsores can kill patients!! I have seen Stage 4 pressure ulcers that go to the bone. Do not let that happen. Patients need to be clean, dry and intact – always!

Daily Exercise

Bed-bound patients need to be exercised daily to help prevent contractures, a shortening or distortion of muscle or connective tissue. Contractures ultimately have the patient going into a fetal position. In nursing school we have worked with patients that required four adults to just change them and get them out of bed.

Very, very sad.

This exercise involves having the patient move all their joints through their full range of motion. One or more caregivers may have to help with this. Start with the head by going side to side and rotations, move to the neck, shoulders, arms, fingers, knees and toes.

Pneumonia

I also use incentive spirometers for lung exercises, which can help prevent pneumonia. If that is not available, try chest physiotherapy. Try cupping your hands and have the patients on their side. Use your cupped hands and tap on the patients back to loosen anything in the lungs. Be care to not use too much pressure but tap several times a day.

Homecare Nursing Supplies

• Gloves – No latex. I prefer Nitrile for durability (available at Costco). It is impossible to have too many. I personally have 10 –12 cases. Each case has 10 boxes of 100 gloves. (Latex allergies are fairly common; there are nitrile allergies but they are far more unusual.)
• Bed pan
• Urinal – Male and female.
• Wash basin
• Emesis basin
• Bed pads for incontinence – Reusable or disposable. The reusables are strong and can be used to help turn/ reposition your patient
• Incontinence briefs (diapers) and pull-ups
• Baby wipes – You can never have enough.
• Thicken – Makes liquids thick for people with swallowing difficulties.
• Nosey cups – Plastic cups with the nose section cut out to help with liquids for patients with limited mobility
• Incentive spirometers – Lung exercisers.
• Walkers
• Crutches
• Cane – Carbon Fiber is far lighter than other options.
• Bedside commode
• Gait belt – Assistive belt to help a patient ambulate.
• Thermometer
• Oximeter – Necessary to keep track of blood oxygen level
• Blood pressure cuff and stethoscope
• Manual wheelchair
• Hand Cleaner
• Clorox and sprayer
• Bed with hand cranks – I designed a “raised platform bed” for homecare nursing because I could not justify a hospital bed with hand cranks. The raised bed allows me to care for the patient without killing my back.

Sourcing Supplies

Other than your typical medical supplies store, you may be able to find some items second-hand.You’ll want to check them closely for quality and function. Ask to plug items in or for batteries to test them.

Final Thoughts About Home Care Nursing

This is just a starting point to help you begin to think about skills and supplies you may want to add to your repertoire. While it is far from complete it should give you an idea about needs for your patients. The American Red Cross may offer classes in your area to provide more training.

Remember, everyone in your family or group will need training and practice. Someday, the patient may be you, and these simple procedures may save a life, including your own. Also and most important, many of these tasks are not fun. Many are done for infants and young children without any thought. Please be kind and offer privacy and dignity to your patients. Treat them as you would want to be treated.

What homecare nursing items would you add to this list?

Guest post by Dave, LPN, EMT, WEMT. Originally published February 3, 2011 and updated.