Why working in nursing at "Visit - Spital Zollikerberg Zuhause®" is unique

In more detail for us laypeople: What exactly is the difference between "Visit" and other healthcare providers such as Spitex?

Gwen Gehrecke and Debora Wahrenberger: Basically, Spitex continues an assignment started in hospital or rehab at home. It is important to note that this does not involve acute medical conditions. It's different with "Visit". Our job is to provide comprehensive support to someone in an acute medical condition. We look after patients from the moment they arrive at the hospital via the emergency department. An initial diagnosis is made and treatment and therapy is started based on this. Patients are treated in their own four walls, and telemedicine allows us to ensure close monitoring.

You have many years of experience in hospital care. What motivated you to get involved in the "Visit" project, which was new at the time?

Gwen Gehrecke: "Visit" is based on the global "Hospital at Home" definition, thinks outside the box and makes a valuable contribution to the health literacy of the population. We can support people in their familiar environment and empower them to help themselves. I think that's great. I really appreciate the personalised support.

Debora Wahrenberger: I love providing people with holistic care - and that's something completely different in their own homes than in hospital. Through "Visit", I come into contact with the patient's family, relatives and living environment. From a nursing perspective, I like the fact that "Visit" gives me the opportunity to carry out entire processes with the patients. At the hospital, I have overall responsibility for the patients, but the work is divided between different specialists.

And how does your day-to-day work at "Visit" differ from your work at the hospital?

Gwen Gehrecke: In practice, the organisational effort involved in "Visit" is greater at the beginning. You have to think about a lot of things, think about a lot of things and you're sometimes on your own. Once you're on site with the patient, you can't ask someone from the team anything so quickly. You definitely have to have confidence in your own abilities. Also because you don't see the patients again until the next morning after the last visit of the day. Of course, there is constant monitoring via the telemedicine monitor, but if I notice something, I can't just pop over to their room like I can in hospital. And the interdisciplinary collaboration with the medical service is closer and, in my opinion, more effective.

Debora Wahrenberger: "Visit" offers me a different kind of freedom because I have to approach the work in a completely different way; it's freedom with responsibility. In the medical process, I can take an individual approach with "Visit", but I have the same goal as in hospital. I also have to consider other aspects: What kind of environment do the patients have, what is the best way to get there, what is important for my colleagues to know, what can we expect on site with the patients and so on. For example, I don't have a materials room there, like in the hospital, but have to think about how I can solve a sudden problem with the materials I have with me or possibly bring in from the patient's home.

With "Visit", you are always at the patient's home or travelling to them. Can "Visit" be combined with work on the hospital ward?

Gwen Gehrecke: Many considerations come together in the theoretical work: We didn't reinvent some of the standards in "Visit", but adapted them from the hospital to the "Visit" project.

Debora Wahrenberger: The aim and vision is for "Visit" to function like an "independent ward", where we as a care team are fully utilised - even if this is at the patient's home. In the current phase, however, there is still room for manoeuvre, and then we help out by focusing on the hospital's wards. However, we don't have the main responsibility for the patients on the ward - also because we have to be available at all times during "Visit" and fulfil our task of monitoring the "Visit" patients via telemedicine monitors. "Visit" is our main task.

"Visit" has been running since November 2021, so for just over a year and a half. What fond memories do you have from this time?

Gwen Gehrecke: One great moment was definitely when I was asked to work on the project. I am very grateful for the collaboration in the project team, especially in the preparatory work - it was great and I really enjoyed it. It was a moving moment for me when I visited a patient at home for the first time and saw what we had previously thought about in theory in practice. It is always an intimate moment when we go to people's homes and there are of course many wonderful moments. But I also had realisations: The way I had imagined it, I had assumed a lot about the hospital and when I went to the patient's home for the first time, I realised that things don't happen as quickly as you're used to. For example, you first had to fluff the sofa cushion or say hello to the cat. (laughs)

Debora Wahrenberger: I particularly remember a young woman with a migration background. It was quite a difficult start, but my success was that I had the opportunity to talk to her during the late shift, pick her up and reassure her that we would find a way for everything. I was able to be a carer for a young woman who lives so far away from her family for a short time.

Let's shift the focus to you: What gives you daily motivation in the care profession?

Gwen Gehrecke: For me, it's two things: firstly, that I can achieve a lot with very little, with what I know, can do and how I am. Secondly, that our work is so essential. We experience people without make-up and without masks. When people are confronted with illness, they are in a state of emergency and we usually only come into contact with this through our profession.

Debora Wahrenberger: I think that too, as well as the holistic nature of our work. Being able to tell people what they can optimise in certain areas or to look at the deep questions of life together with them. It's the privilege of being a carer that we have to deal with issues at an early stage that others don't think about for a long time.

And what do you do when you want to take a deep breath or need a break?

Gwen Gehrecke: One strategy for me is distraction: it can be a film, a series, but also a good conversation and talking to other people. I also like going into the garden, it's my learning field because I'm never actually finished with it. It's not necessarily about creating something specific, but about letting my thoughts run free.

Debora Wahrenberger: For me, the fact that I have chosen a 60 per cent workload already provides a balance. Caring is part of my life, but not the main part. I don't go into the garden, but I do go into the kitchen - my first job was as a chef and I love cooking and baking. And more and more I'm also learning to just be.

Finally, let's take a look ahead: what do you wish for the future of "Visit"?

Gwen Gehrecke: I hope that "Visit" will gain a foothold in politics, that it will become a permanent feature of the healthcare system and, above all, that it will be billable. This is currently the biggest problem in Switzerland, whereas "Hospital at Home" has been established in many other countries for years.

Debora Wahrenberger: From an operational point of view, I would like to see a fully equipped nursing team and a certain continuity in terms of patient numbers. In the longer term, I would also like to see "Hospital at Home" established in Switzerland in whatever form.