STATEN ISLAND, N.Y. -- “I’ve always wanted to be a nurse from the time I was very young, I always wanted to be involved in something in the medical field,” said Nichole Nesci, 32. “There was something inside of me that always drew me to it.”
Nesci, a Westerleigh resident, has been a member of the Visiting Nurse Service of New York (VNSNY) for nearly three years, and as the coronavirus (COVID-19) has gripped New York City inexorably, she has seen her role of providing comfort care to patients and their families change significantly.
Ranging from providing medication to residents, playing music to provide consolation and educating family members to ensure understanding, Nesci is part of a small army of nurses at VSNY treating over 100 vulnerable Staten Islanders.
Working 12-hour shifts, Nesci assists five coordinators of care on Staten Island that divvy up the borough — each treating between about a dozen to 20 patients in either assisted-living, nursing home or at-home settings.
“If they can’t get to this patient on that schedule, then I would be the one who picks that up,” Nesci said.
VNSNY, a non-profit that has existed for over 125 years, has a wide swath of services for city residents, but its visiting nursing service serves as a part of the fabric of hospital workers, nursing home staff and others who have seen their roles magnified on Staten Island during the coronavirus outbreak.
That role, according to interviews with multiple VNSNY nurses, is centered around individual patients and their families.
Naturally, patients require different needs and families have varying goals, all of which require Nesci to be adaptive on a daily basis; however, “Most of the time, their goals are no more hospitalizations — quality of life and remaining at home and having as much quality time with family and loved ones as possible,” she said.
“So that’s my goal," Nesci said.
Interventions to complete those goals include weekly visits, but also educating family members about what to prepare for — even in the most tragic of circumstances. “We’re there to explain to them what to expect — how the process progresses — the transition process to the end-of-life process to the symptoms you might see...," Nesci said.
And, at a time when visiting is restricted to nursing homes, Nesci said many families struggle with the emotional burden of being unable to see their loved ones.
While using tele-health options when possible, including to screen patients before an in-person visit, Nesci said VNSNY has adequate personal protective equipment (PPE) to see patients in these facilities “not only to be there for the patient, but to support the families.”
“We act as like the advocate,” Nesci said. “We’re the bridge between the facility staff and the family.”
Nesci’s experience with her own family fuels her ambition today. About seven years ago, her grandmother fell ill, and — along with her family — Nesci became her “caretaker." Even as she had her child, Nesci said she “would have the playpen next to me on one side and grandma on the other side of me.”
At the end of her grandmother’s life, her family “really, really wanted to bring her home and provide hospice services for her” to allow her to “enjoy her last days at home," Nesci said, but her grandmother never made it back.
“Knowing all that I know now, looking back on that time in my life, I wish we would have done things differently,” Nesci said, saying her grandmother’s final days have affected how she approaches every patient she comes into contact with.
“I take all of those feelings and those emotions and everything I experienced at that time and I use it every time I go into a patient’s home," she said. “I use that by educating a family on what I really see is happening with the patient. I try to give them tips and pointers on how to provide more comfort ... that’s what really brought me to this.”
Mike Guglielmelli, 26, a Grasmere native and lifelong Staten Islander who is a registered nurse for VNSNY. (Photo courtesy of VNSNY)
HOME CARE
For Mike Guglielmelli, 26, a Grasmere native and lifelong Staten Islander who is a registered nurse for VNSNY Home Care, his experience with his mother — who fought and beat breast cancer in 2010 — is a driving force in his quest to help others.
“I just saw how the nurses and the physicians really took care of her,” Guglielmelli said. “And after that, you know, I said, this is what I want to do.”
Treating borough residents in their homes, he said his job is focused on assessing patient’s individual needs and providing education, “whether it’s therapy services, getting them in contact with different types of physicians and teaching the patients, teaching the family, assessing their emotional needs as well, not just physical.”
The coronavirus, however, has upended patients and left some incapable of understanding the totality of their situation.
“Some of these patients are, you know, they’re fine one day and then a few hours later they’re going into the hospital, being intubated, waking up a week or two weeks later” before coming home only days afterwards, he said.
“So it’s a lot for them to really absorb and see,” Guglielmelli said, adding that emotional support has been key for those recovering from the virus, and those thrust out of their homes and into hospitals or other medical settings.
The emotional toll on a patient — even one who recovered from the coronavirus — could cause depression, anxiety and confusion, he said, making him a facilitator to try and find the best “safe place to speak freely,” including psychiatric or therapeutic help.
And with unknowns still surrounding the virus, Guglielmelli said the task of teaching family members is one he views as paramount.
Many relatives “want to provide direct care to these patients,” so educating those in the home with a VNSNY patient about elements of the virus, including transmission, is integral in providing the best care.
“And, with them too, we have to offer a lot of emotional support because that is a lot of stress, a lot of fear ... knowing that they could possibly catch it."
Despite the strenuous circumstances, Guglielmelli said the success stories help keep him innately absorbed in his goal to help patients.
“I have a patient that on (a ventilator) for 25 days and woke up and just couldn’t walk ... this is someone who had wounds from being in bed for so long,” he said. “And now she is walking with a cane. And by next week, she won’t even need the cane."
“When they take those first steps, it’s really, really amazing.”
Alisa Giambalvo, a Tottenville resident, is an eight-year veteran of VNSNY. (Photo courtesy of VNSNY)
‘THIS IS MY HOME HERE IN STATEN ISLAND’
Alisa Giambalvo, an eight-year veteran of VNSNY, serves as a hospital liaison for the non-profit at Richmond University Medical Center (RUMC) in West Brighton.
On-call 24 hours a day and seven days a week, Giambalvo, a Tottenville native of 20 years, is responsible for the inpatient hospice for VNSNY at RUMC, and works to screen patients being moved from home or nursing home care into a hospital setting in an effort to have patients “avoid the emergency room and go directly to a bed.”
However, with visiting still restricted at the borough’s hospitals, and facilities still caring for dozens of coronavirus patients on Staten Island, Giambalvo said her role of providing comfort to patients and their families has become more challenging than before.
Donned in a full outfit of PPE, including a gown, face shield, two pairs of gloves and booties, Giambalvo said the effort to contain the spread of the virus between her patients in RUMC has been immense — changing her “snowsuit”-like attire between rooms.
And, serving as a binding force between patients and their families, sometimes otherwise unable to see their loved ones, she said she has focused on the small moments of humanity she has been able to provide.
“I’ve been able to FaceTime the families and give them the chance to say goodbye or to see the patient,” she said. “And it really brings comfort to them.”
“When they see you holding the patient’s hand and spending some time in the room and stroking their hair, they understand that for that time that I’m with the patient, we are the patient’s family, that we’re really giving them a lot of support," she said.
Working alongside workers at RUMC, she said she has seen the brunt of the coronavirus and its effect on its staff. “You’re seeing patients come in, in sometimes rough shape and then sometimes, you know, they’re not going to leave the hospital,” Giambalvo said.
“It’s taken its toll on a lot of nurses and physicians,” she said, “and I think that you really have to have a good support system, which at VNSNY we do.”
For herself, a longtime borough resident, Giambalvo said she is managing through the help of “a very, very strong faith based background” and by “doing the best that I can do every day.”
“This is my home here in Staten Island, and I would do everything for the community that I possibly can to support them,” she said.
And, while “numbers are declining" on the borough, which has seen a dip in new cases and deaths in recent weeks, “somebody knows somebody that was affected” by the virus, Giambalvo said, speaking to the prevalence of the virus not only globally, but locally as well.
Doing her part to help those neighbors affected, she said “I think that the best thing that we can do is try to alleviate suffering.”
“I really do believe that knowing that they can have a peaceful passing, you know, with respect and dignity — I think that’s really what it’s all about.”