Unit 24
The CNA's role in first aid
The CNA is often the first on the scene when an emergency strikes and it is important to know what to do before it happens so you can act fast. As a member of the healthcare team you are expected to be more knowledgeable and prepared than the average person off the street. When performing first aid there are some specific guidelines that apply to the CNA in a long term care facility.
General guidelines
Ensure safety- in any emergency always rescue the resident from any immediate threat first
Remain calm
You can't think straight if you allow fear to consume you- you can be emotional later
Your resident will likely mirror your reaction- meaning that if you panic they will too
You are suddenly in the driver's seat and must take charge
Call for help- stay with the resident if possible
If the injury is unknown or there is any possibility the resident has fallen, avoid moving the resident until you are directed to do so by the nurse
Only perform first aid measures that you are trained in while waiting for the nurse
Be prepared to give an objective report to the nurse regarding what you witnessed and what injuries you suspect
Always take the time to follow standard precautions before coming in contact with blood or bodily fluids
DNR
In case the emergency is severe enough to stop the resident's heartbeat, you should know whether or not you can perform CPR on a resident, or if you aren't BLS certified, you can be prepared to assist in CPR. Most residents in an LTC have a DNR, or a Do Not Resuscitate order, meaning that if their heartbeat stops, they do NOT want CPR done. The reasons for why a resident may not want CPR are vast and highly personal, but know that there are more residents with a DNR than without so it may actually be easier to memorize who does want CPR.
Bleeding
Put on gloves
Apply pressure using a sterile bandage, gauze or the cleanest cloth you can readily find
If the bleeding is to a limb and there is no concern it may be fractured try to elevate while holding pressure
If there is excessive bleeding and the resident is standing, have the resident sit or lay down
Once the bleeding is controlled, if help has not yet arrived, replace the bandage with a sterile dressing, dampened so it doesn't stick
During the emergency
Follow the nurse's directions
You may be asked to gather supplies such as blankets, bandages, pillows
You may be asked to call 911
Be prepared to offer 911 dispatch with an address and description of the emergency
You may be asked to be the note taker so the nurse can refer to it later for documentation (the nurse will usually call out information to be documented)
Note the time on every event being described
when EMS arrives
when the nurse gave any medications or applied oxygen
when anything out of the ordinary occurs or changes in the resident's status
Note the name of who does what
The name of the medication provided
How many liters of oxygen was given and by what route (nasal cannula or mask)
Note any use of a defibrillator or other medical procedure performed
Note any results from interventions
If there is little left to do and multiple helpers around it is best to stay out of the way and ensure that other residents are cared for
After the event
After an emergency it can be a very emotional time for you, the resident, and your co-workers. You should take a moment to clear your head and calm down. Comfort each other, and if you need to, talk to your supervisor about how you are feeling about the situation. There should be a meeting between the staff involved to discuss what happened, how it happened, what went well, and what could have been done differently. If the resident still remains in your care you may need to provide more frequent checks on them and report anything unusual right away. Other interventions after an emergency may include:
Checking VS at regular intervals
Changes may be made to the care plan
According to your facilities policies and procedures, everyone involved will need to write an incident or occurrence report describing what they witnessed
Don't forget HIPPA. No matter how emotional the situation may have been you cannot share it with your family, friends, or other residents. If you need to talk to someone about it, choose your supervisor. Counseling may also be an option and is often offered and encouraged by your employer after particularly traumatic events.
If a resident falls, do not assist them to stand, rather comfort the resident, call for help and stay with the resident. Note the time and ask the resident what happened. The nurse will need to assess or give approval before they are to be assisted up, this is to check for injuries such as a fractured hip or subdural hematoma, or spinal injury which can cause more injury if a resident is moved. You will probably be asked to assist the nurse in getting v/s and assisting the resident up and then to fill out a report.