The bonds she forges with patients make Jennifer Markovic Velasco, HNS '89, love her job as a visiting nurse.

After working for a short time at the beginning of her career as a medical/surgical nurse in a hospital setting, Velasco realized something was missing. She wanted to get to know patients, spend time talking with them and find ways to make connections with them.

But, hospital nursing seemed to allow only fleeting moments with patients.

For some patients, healing and coping with chronic disease continue after hospital discharge. "Some teaching really should be done in the home," says Velasco.

For more than 10 years, she has worked for Christiana Care Visiting Nurse Association in New Castle, Del. After spending a year in Paraguay as a high-school student, Velasco is fluent in Spanish. She's married to Peruvian-born husband, Alfredo Velasco, AG '87, and they have three young daughters--all bilingual.

Hispanics make up 60 percent of her patient load, so her language skills are a plus. Additionally, her knowledge as a woman who has breastfed her children and completed the Nursing Mothers Inc.'s volunteer breastfeeding peer-education program make her a "value-added" nurse to her employer. Velasco's specialty is taking care of new moms who need help getting through the first challenging days at home with their newborns.

Visiting nurses have been a part of the American landscape for generations. The earliest associations were formed shortly after the Civil War, modeled after a concept established in Liverpool, England, by William Rathbone and Florence Nightingale, the founder of modern nursing. These visiting nurses were sent to the poorest homes in the community. They worked to help ensure the survival of infants and children, providing mothers and babies with milk, nutrition and health care. Visiting nurses also helped fight contagious diseases by "nursing the room" as well as the patient. They taught families that a clean home environment was more conducive to healing.

One hundred and twenty years later, visiting nurses still work to monitor health and "nurse the room." These day, however, visiting nurses are used in homes of every economic status. Visiting nurses are able to spend a fair amount of time with each patient, usually over a series of visits in which they can concentrate on what needs to be done and what changes need to be made to help a patient get better.

"With home care, you learn to take a truly holistic approach," Velasco says. In a short visit, Velasco says, she is able to notice whether family members are actively involved in a patient's recovery, whether the patient is able to acquire, understand and take required medication and whether the patient is able to follow doctor's orders. Many times, Velasco notices complications or conditions that affect the patient's health–and can suggest ways to correct problems. Necessary information can be reported back to the physician.

"We are the eyes and the ears of the physician in the home," says Velasco. It is not uncommon, Velasco says, to notice things that are askew when she visits patients' homes. She has visited homes of overweight diabetics who have been told by their physicians to "get more exercise," only to discover that the neighborhood is not safe enough for walking about. And, she has visited mothers who are feeding newborns water or tea, information that patients may not volunteer to physicians during check-ups.

Velasco sees such moments as opportunities to teach. She can look into school or YMCA-like programs for the diabetic patient, so that she may lose weight and improve her health. She can tell the mother that, unless a physician has specified otherwise, there is no need to feed a newborn additional fluids because breastfeeding, or formula, supply the newborn with everything he or she needs nutritionally. Plus, feeding babies additional water or tea can possibly result in an electrolyte imbalance, she says.

Mothers who have recently returned home need a lot of help and reassurance as they adjust to breastfeeding, Velasco says. Some new mothers find that their mothers did not breastfeed, so they are not able to offer advice. Additionally, each woman's breastfeeding experience is different; it can vary with each new baby, she says. The mother and her baby have to work out their own synergy and rhythm.

Many times, Velasco says, new mothers have questions they may hesitate to ask their physicians. "For example," she says, "they may wonder what can be done for cracked or bleeding nipples or pain during the initial stages of nursing. Also, how can a mom tell if a breastfed baby is getting enough milk? What can be done about the 'leaking' that sometimes occurs when mom is away from the baby?"

Whether the mother wants to feed short-term or part-time (by supplementing with formula), Velasco is there to help. As a nurse, she knows the medical benefits of breastfeeding, which include better general health, growth and development. Breast-fed babies appear to have a lower risk for developing a number of chronic and acute illnesses, including diarrhea, lower respiratory infections, ear infections, bacterial meningitis and urinary tract infections.?

"I am not there [in the home] to judge," Velasco says, "but to try to help." Women have their own very personal reasons for choosing how to feed their babies, and Velasco supports them.

As a Spanish-speaking nurse with knowledge of Hispanic culture and traditions, Velasco is able to be of special service to patients who recently immigrated to America. She conducts mother-baby visits to check for any complications and to ensure the baby is being fed properly. She talks about safety–about never leaving a baby for one instant in a bathtub and about placing the infant to sleep on his or her back.

Velasco also cares for patients with asthma, diabetes and high-risk pregnancies. Many of her Hispanic patients use folk remedies to treat themselves and their children–remedies that are likely to be common in their country of origin. "Reports have estimated that more than 50 percent of Hispanics surveyed use folk remedies, often for illnesses for which people would not consider consulting a doctor," she says. "These remedies may also be used by people who prefer to feel in control of their own health or because access to medical care is limited."

Many times the folk remedies used by Hispanic people–and by people of many cultures–involve the use of herbs or other natural substances, many of which are actually beneficial. For example, garlic has been used for many years by Hispanic peoples for hypertension, and research shows this practice may have validity. Yet, Velasco says, the use of certain herbs to correct medically critical symptoms or diseases needs to be gently corrected.

Velasco says she suggests realistic life changes to help her patients. She talks to diabetics about what diet choices they should make--opening cabinets, looking at labels and talking about changes that can be made. Many teenage diabetics are resistant to following the diet they should because of advertising and peer pressure.

She says she hopes to provide patients with helpful information, so that they may take care of themselves and others. *