HAVE BAG, WILL TRAVEL A DAY IN THE LIFE OF A VISITING NURSE.

Byline: Debbie Council Staff Writer

Instead of maneuvering through hospital hallways, registered nurse Sandy Dawson packs her black bag, hops in her blue Chevy Tahoe and travels highways to reach her patients. Armed with stethoscope, blood pressure equipment, sanitizing hand cleaner and an ample supply of samples, she drove nearly 48 miles on a recent Friday to check on four patients in Upland, Ontario and Diamond Bar.

She's a certified wound, ostomy and continence specialist for the Visiting Nurse Association & Hospice of Southern California. But the petite 56-year-old Chino Hills grandmother is so much more. She's an educator, nutritionist, counselor, clothing consultant and friend.

Nationwide, Visiting Nurse Associations have provided cost-effective and compassionate home healthcare for 120 years to individuals, regardless of their condition or ability to pay for services. Congress recently voted to designate the second week of May as National Visiting Nurse Association Week.

What follows is a typical day in the life of a home health nurse.

It's 8 a.m. in Dawson's Claremont office, but she arrived an hour earlier to go through her patients' files. The tiny station she shares with Susie Vanderpool is identified by the leg and buttocks models she uses for training purposes.

Wearing a white lab coat, Dawson says she loves being a home health nurse because of the freedom and the relationship she builds with her patients.

``I hope to never go back to the hospital. You're so mentally scattered. I don't think the patient ever gets that truly one-on-one focused attention,'' she says. ``(Patients) need that one-on-one so they learn what they need to know to live with their disease process to the highest functional level that they can.''

By 9 a.m. she's at 50-year-old David Graham's Upland home to change a compression wrap on a difficult lower-leg wound. When he was 17, he nearly lost his leg in a work-related accident. Last summer, the 6-foot-3-inch man reinjured his leg in a boating incident. The additional trauma played havoc with his scarred leg, causing circulation problems, an infection and a swollen foot. She has treated his wound twice a week since September.

``When I met Sandy, I knew she knew what she was talking about. Sandy is a very wise lady when it comes to this stuff,'' he says as she checks his vital signs.

Wearing surgical gloves, she cuts off the old dressing. After spraying the area with a wound cleanser, then a barrier cream, she adds material that resembles Styrofoam for the new skin to grow on.

In no time, she's snipped and stretched four different layers of cloth, cast batting and varying degrees of stretchy material in a figure-eight pattern to create his fresh compression wrap.

Then, it's out the door and on to the next patient.

At 9:50 a.m., Dawson pulls up to the Ontario home of 82-year-old Rubye Briggs. Briggs awoke one morning to an open wound, probably due to her thin skin, swelling and circulatory problems in her leg. Dawson checks on her every day.

``It hurt terribly last night, I have to tell ya, honey,'' Briggs says after she relaxes in her recliner. ``Honey, I was having a lot of trembling this morning.''

Dawson removes Briggs's low-level compression dressing.

``That looks nice today. I see new growth on the edge I didn't see the other day. So, it's definitely starting to respond,'' Dawson says. ``The wound is not hotter than normal.''

She checks Briggs' blood pressure, which was a little elevated. After a few minutes, she takes it again with a reading of 152/58.

``I like your numbers this morning,'' Dawson tells Briggs. ``Nice normal healthy numbers. (Your temperature is) 97.1, no fever. It means you're not getting infected.''

Dawson completes the new dressing and Briggs is appreciative.

``Sandy, you're a dear. She says the nicest things to me,'' Briggs says. ``Sandy can wrap like no one else can wrap.''

The Visiting Nurse Association provides Briggs with a Telemonitor, which is connected via her phone line to the VNA office in Claremont. An alarm reminds her to take her blood pressure medications at 11 a.m. and it checks her vital signs. A nurse at the office reviews the data, which goes to Briggs' physician.

``It gives you the opportunity to help yourself, you know,'' Briggs says, her Missouri accent still evident even after she has lived 52 years in Ontario. ``The VNA nurses are really such a treasure for our area. It keeps you from being hospitalized so much.''

At 10:30 a.m. Dawson greets David Duster, 70, and his wife, Reggie, in Ontario for his discharge visit. The 6-foot Duster has recurrent colon cancer that spread to his liver. A surgical procedure called an ileostomy brought a portion of his small intestine to the surface of his abdomen, creating a stoma, or opening, from his intestine.

He's adjusting to the baglike appliance that collects his fecal output. Being on chemotherapy causes the bag to fill more often. Because Duster has lost 40 pounds, Dawson tells him that eating is essential, especially while recuperating. He asks about supplies for skin diving. Dawson shows the couple a catalog of ostomy products.

``As long as this rim is the same size, any of these will fit. You want the long-wear,'' she says. ``You should be just to the point where (the stoma) is done shrinking.''

She offers information on a variety of underwear to accommodate his needs and the bag, items that will work with his preferred attire, larger trousers with suspenders for comfort.

While he and Dawson go upstairs to check his stoma and change the bag, Reggie praises Dawson's support.

``She's been awesome. When Sandy came out, I was beside myself. She brought me up and showed me what to do. He was so raw underneath. She showed me how to make him better,'' Reggie Duster says. ``The next time I changed the bag, he was almost all healed up. Now it's a way of life. If it wasn't for Sandy, I don't know where we'd be.''

After a fast-food break, Dawson heads to her final patient of the day, 52-year-old Anwar Salimi, an accounting professor who lives in Diamond Bar. A life-threatening case of diverticulitis, an infected pocketlike opening in his colon, resulted in emergency surgery and a reversible colostomy. Complications set in when parts of his incision broke open below the stoma and he wasn't healing.

At 1:15 p.m., his mother, Tayeaba Salimi, answers the door. Dawson sits next to him on the sofa.

``It's draining a little but much less than before,'' he tells her.

His appetite has improved. She discusses his ethnic diet. He mentions that walking the cul de sac makes him tired. When he walks, it feels like he has on a belt and that things are shifting. She reassures him that it's just normal post-operation symptoms.

He has questions about his surgery. She takes out a 1-inch red plastic model of a stoma that looks like an upside-down Bundt cake and explains the surgery. In her comforting, conversational manner, using her hands for emphasis, she demonstrates.

``The doctor takes your intestine and folds it back like a pair of socks. That's why it's so thick,'' she tells him. ``If you wash it a little hard it could bleed. That's OK. It's OK to touch it.''

``All this information she gives me is very reassuring to the body and mind both,'' he says. ``So much from what she knows relieves my anxiety.''

After checking his vitals, she tells him he's doing fabulous.

``That's a good way to end my week on a Friday. Everybody's well,'' she says. ``Everybody's numbers were good.''

At 2:15 p.m., she's back on the road heading to the office in Claremont.

Last year, Visiting Nurse Association & Hospice of Southern California served 6,000 patients. A large percentage are frail elderly, but the caseload also includes surgery patients and those with chronic illness and disease. More than $250,000 was spent in charitable care.

Executive director Marsha Fox said home care is part of the continuum of care. Nurses have to address a range of medical situations that they didn't have decades ago. Patients stayed in the hospital until they got better.

``Well, that's not at all what happens now. It's a natural transition from hospital to home because the patients are still so sick,'' Fox said. ``They're in (the hospital) two or three days and they're still in the acute phase of their illness. (Our nurses) are really the doctor's eyes and ears.''

Director of Nursing Gayle Wilson said the VNA nurses are more highly trained than ever before.

``One of our roles is to teach the patients how to take better care of themselves so they have a better quality of life by staying home. It gives control back to that person,'' Wilson says. ``By VNA going into the home and making it safer and getting the patients involved in their health care, people are going to stay healthier longer and be able to stay in the environment they want.''

The Visiting Nurse staff is on call 24 hours a day, seven days a week.

``You can't get your doctor here at midnight. But we can get a nurse,'' Fox said.

FIND OUT MORE

Who: Visiting Nurse Association & Hospice of Southern California

Information: VNA Referral Center [phone]

CAPTION(S):

3 photos, box

Photo:

(1 -- cover -- color) House calls

Visiting nurses bring compassion along with home healthcare

(2) Visiting nurse Sandy Dawson makes sure to wash and sanitize her hands frequently when tending to patients in their homes. Her specialties include wound care.

(3) Dawson checks vital signs during a visit to 82-year-old Rubye Briggs' home in Ontario.

Adan Omernick/Special to the Daily News

Box:

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