Additional Useful Information:
In the United States, a Certified Nursing Aide (CNA), Patient Care Assistant (PCA), State Tested Nurse Aid (STNA) or Nursing Assistant-Registered (NA/R) is a person who assists individuals with healthcare needs (often called "patients", "clients", "service users") with activities of daily living (ADLs) and provide bedside care—including basic nursing procedures—all under the supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN) (Meyer). Activities of daily living (ADLs) are "the things we normally do in daily living including any daily activity we perform for self-care (such as feeding ourselves, bathing, dressing, grooming), work, homemaking, and leisure." [1] A number of national surveys collect data on the ADL status of the U.S. population. [2] Health professionals routinely refer to the ability or inability to perform ADLs as a measurement of the functional status of a person.[3] This measurement is useful for assessing the elderly, the mentally ill, those with chronic diseases, and others, in order to evaluate what type of health care services an individual may need. There are several evaluation tools, such as the Katz ADL scale and the Lawton IADL scale. Most models of health care service use ADL evaluations in their practice, including the medical (or institutional) models, such as the Roper-Logan-Tierney model of nursing, and resident-centered models, such as the Program of All-Inclusive Care for the Elderly (PACE).
Patient Rights
It is the job of the entire health care team to make sure that a patient's rights are always adhered to. These include, but are not limited to the right to privacy and dignity while care is being given, the right to be informed of their care plan, the right to be included when making their care plan, the right to accept or refuse treatment, and the right to confidentiality of their patient information.
Certified Nursing Assistant Skills Learned
Universal Precautions:
Proper hand washing is an important part of nurse assisting. It is the first step in preventing the spread of germs. Hand washing must be performed both before and after contact with a patient. Hands that do not appear soiled can still spread disease. It is important to wash hands even when using gloves as they do not provide an absolute barrier to the transmission of disease.
Gloves should be worn as needed, such as when exposure to bodily fluids is likely, when any care is given, or when the patient is infected with a pathogen that is spread by direct contact (such as MRSA).
Ambulation:
Ambulation assistance is a set of techniques for helping patients to walk. One example is the use of a gait belt or transfer belt for patients who cannot stand on their own. The gait belt is put around the patient's waist and enables the assistant to lift the patient safely without straining his or her back. It can be used to help patients get in and out of bed, get up from a chair, or enter a walker. Walkers help the elderly get exercise. Many elderly patients cannot walk on their own due to osteoporosis or other conditions. Exercise promotes movement, helps with circulation, helps the patient heal faster, be in better health, and ultimately have a longer, happier life.
Applying antiembolic stockings:
An antiembolic stocking is a device that is used on patients under observation for (or at risk for) circulation problems. It is a high sock which applies pressure on the legs to prevent blood clots. It may also have a hole on the top or bottom of the foot for comfort, and easy access to the feet, so that the nurse assistant doesn't need to remove the sock every two hours to check circulation.
Bedpan Use and Output Measurement:
A bedpan is a device that is placed under patients who are unable to get up and use a bedside toilet or go to the restroom. It is used to catch all of the urine and feces. The patient must be properly wiped and cleansed after elimination to prevent infection. The color, odor, consistency, and amount of urine is often measured and recorded. If a bowel movement has taken place, that is noted along with any significant characteristics of the stool.
Oral care:
Denture and mouth care is very important in providing proper hygiene for patients. Teeth must be cleaned in the morning and after each meal. This will help prevent tooth decay or gum conditions that could lead to tooth loss. When providing oral care, it is important to check the patient's teeth, lips, mouth, and tongue for bleeding and discoloration, sores, odor, cracking, or coating, and to report unexpected observations to the nurse immediately.
Dressing:
For the dependent patient, dressing is not an easy task. In fact it is very difficult and needs to be done properly. The best way to ensure that it is done right is to dress the weak side first so that the patient can help with their strong side, and to undress the strong side first so they can help undress the weak side as much as possible.
Feeding:
Patients must not be overassisted in feeding or they may stop helping themselves. Assistance should be confined to those parts of the task they cannot accomplish for themselves. For example, a patient who cannot load a spoon but is capable of conveying it to their mouth should be assisted only in loading the spoon. They should convey it to their mouth themself, even if it would be faster for the assistant to do this for them.
Hair care:
Providing hair care will help patients feel good about themselves. Long-term care facilities may have a salon where residents can have their hair done once a week just as they would at home. Hair must be maintained every day as well. Hair should be brushed from roots to ends, and care should be taken to avoid irritating the patient's scalp.
Bedmaking:
Bedmaking as practiced by a nurse assistant is a skilled task that must be performed precisely. The bed must be wrinkle-free to prevent bedsores, which not only cause discomfort to the patient but can cause serious health problems, and the open end of the pillow case must be facing away from the door to prevent an infection control issue. There are specific bedmaking techniques for use when a bed is occupied by a patient.
Nail care:
Nail care is important to ensure that bacteria do not enter the nail bed and cause serious infections in elderly patients. It is helpful to soak nails for at least five minutes to help loosen dirt and germs that are lodged in nail beds.
Bed bath:
Due to lack of staff, patients may only get a full bath once or twice a week; on other days, patients get bedbaths. This involves cleaning the underarms, torso, and perineal areas.
Serving water:
Fresh ice water should be offered frequently (at least once every 8 hours) to promote hydration. It is important to encourage drinking, because it is not unusual for elderly patients to be unaware of thirst and thus be easily subject to dehydration.
Positioning:
Positioning refers to a set of techniques for changing the posture of a bedridden person in order to avoid health problems such as bedsores. Many states require that bedridden persons be checked and repositioned at intervals of two hours or less.
Range-of-Motion Exercises:
If not exercised, joints gradually lose their ability to move. Nurse assistants must be able to assist patients in performing a series of range-of-motion exercises that flex the joints of their arms, wrists, legs, fingers, hips, and feet. This aids circulation, prevents arthritis and stiffness, and speeds recovery from such conditions as strokes, seizures, and falls.
Vital signs:
Vital signs (such as the patient's temperature, respiration, blood pressure, pulse, and level of pain) are often taken and recorded at least once a day depending on the physician's order. Increasing temperature can indicate infection or other disorder, while decreasing temperature can indicate shock or decreased cardiac output; increasing blood pressure may require medical treatment and special diets while decreasing blood pressure may indicate shock or hemorrhage; and irregular, weak, fast, or slow pulse can indicate heart problems. If a patient's vital signs have changed significantly within a short period of time, a double check for accuracy may be warranted. Any unusual findings should be brought to the attention of a supervising nurse or doctor.
“There is a light in this world a healing spirit more powerful than any darkness we may encounter. We sometimes lose sight of this force when there is too much suffering, too much pain. Then suddenly the spirit will emerge through the lives of ordinary people who hear a call and answer in extraordinary ways.”
-Mother Teresa