Unit 3
Objectives
Identify the major categories involved in fulfilling the CNA role.
Personal care of residents assisting with activities of daily living (ADLs)
Bathing and daily cleanliness
Choosing clothing and dressing
Physical moving, such as walking or repositioning in bed
Elimination, such as taking them to the toilet, or offering a urinal or bedpan
Cueing or provide assistance with eating and drinking
Bathing
Encouraging personal hygiene in residents, and bathing critically ill patients are important duties of nursing assistants. Bathing also relaxes the muscles and tissues, improves blood circulation and makes the residents feel good.
Ensure safety: There is a possibility of various accidents during bathing, so the nursing assistants should ensure the safety of the environment. For instance, wet and slippery floors are likely to cause falls. Such accidents can be avoided by providing assistive devices to residents such as walkers. Notice for any signs of weakness, dizziness that can cause falls. Use lukewarm water and mild soap, when bathing the elderly residents.
Other than accidents, there may be scratches or skin breaks that need to be prevented when bathing residents. Skin breaks can become an entry point for disease-causing microorganisms. Drying the body parts with a towel is also important as microorganisms thrive in wet and warm areas such as armpits and buttocks.
Ensure privacy: Ensure that curtains are used when undressing and bathing the resident.
Note any skin conditions: Redness or blisters on the resident’s skin should immediately be reported to the supervisor so that the resident receives prompt treatment. Some residents with disabilities may have bedsores or pressure sores that occur when the resident is confined to the bed for a long time. Bedsores are likely to be found in elderly on areas such as the hips, elbows, spine or shoulders.
As bedsores are painful and do not heal easily, it is important to treat them properly and in time. The best approach is to ensure that the residents do not develop bedsores. For that purpose, the nursing assistants can take the following actions:
Turn the patients at regular intervals, so pressure is not prolonged on one particular bony area
Reposition patients to make them comfortable
Use protective devices such as pressure relief cushions
Provide proper diet
Oral Care
Nursing assistants need to provide oral care to intensive care residents who are unconscious or unable to eat, drink or clean their mouth without assistance. Proper oral care helps prevent infections and other oral problems. Oral care management involves using appropriate oral care equipment and providing proper oral care periodically.
The nursing assistant should perform the following actions:
Inform the patient about oral care so that the patient can assist in the care process.
Perform hand hygiene and wear gloves. Raise the patient’s head and cover the chest with a towel.
Use a pediatric toothbrush and a small amount of toothpaste to clean the patient’s teeth, gums and tongue.
When brushing, note any signs of bleeding or infection in the patient’s mouth. If any lesions or abscesses are seen, report immediately to the supervisor so that appropriate treatment can be provided.
After brushing, help the patient take small amounts of water into the mouth to remove the toothpaste.
Place the patient back onto the bed.
If the patient is using dentures, ensure that these false teeth are also brushed and cleaned properly with warm water. Dentures should be rinsed and placed in a container stating the patient’s name, to prevent loss or damage.
Care of residents' living space
Human beings are creatures who need their own space. Most of us growing up either had our own rooms or wished we did. That need does not go away as we age. Unfortunately, for residents, having their own space and privacy is difficult, and that is something aids can help with.
Nursing homes differ as to how much space residents can have. The luckier residents have their own rooms and are allowed to bring furniture from home, so that their rooms truly seem their own. If furniture can be brought from home, encourage residents and family members to bring things that will make the resident feel more comfortable and at home.
Other residents live in more crowded conditions in which they have to share one room with a roommate, but even in shared rooms residents can have their own space. A bed, bedside table, and small chest of drawers can be considered the resident’s own personal space. Residents and their families should be encouraged to bring pictures of family or pets to put on display to make the space the residents’ own.
CNA's responsibilities:
Make beds, change sheets when soiled
Maintain an environment that is safe and clean
Assist residents with laundering personal laundry when a washer and drier is available
Food service
CNA's responsibilities:
Assist in food preparation
Assist in setting up trays or resident's place at the table
Assist resident to eat
Provide fresh drinking water
Provide snacks between meals
Record Keeping
One of the most critical responsibilities of all health care professionals is producing proper documentation. Documentation, also called charting, is a clear and accurate method of keeping track of everything that happens to each patient. It is a part of the CNA job description, a way to communicate with other team members about the patient so the team can plan for and provide the best care.
CNA responsibilities:
Record residents ability to perform ADLs
Record residents behaviors or other required charting
Record Intake and Output
Assist in admission, transfer, or discharge
Accuracy- remember that the doctor, nurses, and therapists make decisions regarding medication and lifestyle based on YOUR documentation!
Communicate clearly, using appropriate communication
Report mistakes if the CNA makes one
Respect others (residents, students, visitors and staff)
Honesty
Communication and teamwork
Effective communication by nursing home staff is related to a higher quality of life and a decrease in verbal and physical aggression and depression in nursing home residents.
CNA's responsibilities:
Listen carefully to residents
Work cooperatively with other staff
Report resident concerns to a nurse
Read communication books, if utilized by facility
Read and follow resident's care plan or care sheet
Make recommendations for changes in resident's care
Respect others (residents, students, visitors and staff)
Dependability/Responsibility
Dependability is the quality of being trustworthy and reliable. It is an important quality for a member of society to possess, whether it is in the workplace, a group of friends or in a family setting. Knowing that someone will not only show up, but show up on time, helps us trust each other. When you don't show up your resident's and co-workers are the ones that suffer.
CNA's responsibilities:
Report to work on time
Keep absences to a minimum
Keep promises related to resident's care
Completing assigned tasks promptly and quietly
Performing tasks for which the CNA is competent without being reminded
Seeking assistance when asked to do a task that the CNA doesn't know how to do or has not been taught
Being a team player with a cooperative attitude
Be positive and friendly
Demonstrate desirable personal grooming habits.
There are several important grooming habits that a certified nursing assistant should pay close attention to. Keep your fingernails short and clean. Long nails can tear a patient’s skin and bacteria can hide under them. If you have long hair you should tie it back while at work. Long hair can get in the way of patient care by falling in your face. Don’t wear oversized jewelry. Large jewelry can also collect bacteria, scratch patients and some patients may pull on your jewelry and injure you.
CNA responsibilities:
Personal grooming and cleanliness
Good Health
Clean and neat work clothing
Comfortable shoes, appropriate for workplace
Name badge attached to uniform
Watch, pen, paper
Policies that are typically in an adult care homes' employee manual include:
Dress code
Attendance policy
Personal health including drugs and alcohol use
Smoking policy
Gifts from residents' families
Personal telephone calls, or cell phone use
Criminal record checks
Performance evaluations/appraisal
Grievance procedure
How confidentiality of resident information is maintained.
HIPAA(Health Insurance Portability and Accountability Act of 1996) put into law that we must keep PHI (Protected Health Information) private and it cannot be disclosed without written consent from the resident.
Confidentiality means keeping a resident's personal information private, not disclosing it (verbally, in writing or by other means) to individuals who are not directly involved in resident's care.
Do not discuss or share residents personal information:
With other residents
With visitors, family, or friends of the resident
With other staff, unless planning resident care or in conference
With staff in a public place
Away from the care home were the resident lives.
Legal and ethical aspects of resident care
Scope of practice describes the services that a qualified health professional is deemed competent to perform, and permitted to undertake – in keeping with the terms of their professional certificate.
Professional CNAs are responsible, trustworthy and truthful. They attend in-services, maintaining state certification and are open to learning and professional development in the workplace. Professionalism also includes following the correct chain of command, knowing your own scope of practice and being a team player. The CNA should be committed to protecting patients' dignity and wellbeing and display high standards of professional behavior and attitude.
CNA scope of practice:
Providing competent basic care, assisting residents in meeting their needs
Performing only those activities or duties within their education and competency, and which are authorized by law and regulation
Maintaining an environment that respects the resident's privacy
Maintaining an environment that supports resident's safety
Maintaining an environment that safeguards a resident's possessions
Supporting the residents in exercising their rights
Reporting to the nurse any changes in the resident's mental or physical condition
Accepting tasks as assigned from the nurse, when competent to perform the task
Actions not within CNA's scope of practice:
Administering medications
Accepting orders from resident's physician
Revealing information from resident's chart
Legal responsibilities related to neglect
It occurs when residents in nursing homes do not get proper care and suffer physical or mental health problems as a result. “Neglect is the failure to meet an older adult's basic needs. These needs include food, water, shelter, clothing, hygiene, and essential medical care.”
Negligence is the failure to provide the care that a reasonable, prudent, and careful person (CNA) would use in a similar situation. It occurs when residents in nursing communities do not get proper care and suffer physical or mental health problems as a result.
Neglect is the failure to provide needed care that could result in harm NOTE- it is still neglect if a lack of care could cause harm, not necessarily that it does.
Example:
Resident falls because call light was not left accessible for use
Resident has an infection because the CNA failed to wash hands
Resident is harmed when care plan interventions are not followed
The CNA ignores a soiled brief, or does not reposition a bedbound resident, which could have caused a pressure ulcer
Legal responsibilities related to abuse
Abuse is an act that intentionally or recklessly causes harm (or is likely to cause harm) to a resident.
Examples:
Striking, slapping, hitting, or kicking a resident
Taunting, or using a patronizing or condescending tone
Throwing a resident into bed
Handling a resident roughly while repositioning
Calling a resident degrading names
Threatening physical abuse
Restraining a resident without a doctor's order
Rape
Legal responsibilities related to exploitation
Exploitation means taking advantage of a position of power in order to benefit one's self. While this includes theft of belongings, it can extend to much, much more. Residents should never feel like they have to keep their CNA happy in order to receive good care. They should never have to "tip", and they should not be asked for "favors", which puts them in a difficult and uncomfortable position to have to say "no" and risk the consequences. Will they be mad? Will they hurt me? Will they not take care of me?
Examples:
Caretaker takes items such as magazines, candy, perfume, jewelry, credit cards, or money from the resident.
Caretaker asks the resident to purchase products from them like make-up, cookies, tupperware
The caretaker accepts a gift of $10 for gas money
The caretaker borrows the resident's car
As a CNA you are a mandatory reporter!
The CNA should immediately report suspicions of abuse, neglect, or exploitations (ANE) to the nurse and the abuse officer of the facility. Always follow the chain of command.
The CNA may also call the adult care abuse hotline at 1-800-842-0078
If there is a finding of abuse, neglect, or exploitation placed on the KS Nurse Aide Registry against a CNA, it will bar the CNA from employment in an adult care home and can result in criminal conviction.