Good afternoon everyone. I just need some perspective on what I witnessed today to see if I can expect to see this kind of thing everywhere. I'm not sure if I can handle it. This is going to be kind of long but I really just need to describe my first clinical experience to someone.
I am in my final 2 weeks of my CNA course. I have applied for an RN program for this fall, but I am required to be on the CNA registry to begin. Anywho, today was my first day of my CNA clinical at a LTC facility. I was assigned to an 82 y/o female resident that suffered a CVA three months ago while at an ATF and was moved to LTC. She is a total care patient. She is unable to move very much at all but she does not suffer from dementia whatsoever. When I arrived this morning, I went into her room to wake her for early morning care and to wash my hands. When I turned the sink on, some black crap sputtered out that turned yellow. I went into the employee break room to wash my hands and used foam sanitizer. When I got back into her room, I noticed her emesis basin was on her night stand, and it was really crusty and disgusting. Her toothbrush was inside it and it was totally yellow and had some brown stuff crusted on the bristles. In fact her entire room was pretty nasty. I got out her wash basin and went to fetch her CNA to ask where I could fill it because the water in her room was yellow. The CNA yelled at me to just use the water in the room "de trays are comin out!". Eventually I found clean water to wash her face and hands and perform peri-care. It took me awhile because we had not gone over diaper changing in my CNA labs and I kind of had to wing it. I have one child but obviously changing a full grown adult is a lot different - and while I was performing peri-care she had a major BM. I cleaned that up and did my peri-care all over again to be safe. Naturally this was my first time doing this on a real person and it was taking me a while, and the CNA or my clinical instructor were MIA. So the CNA comes in and yells at me again for being so slow, and starts aggressively pushing this fragile old woman around to put her ted hose and bra and the rest of her clothes. I mean, she was just throwing her around on the bed. I could barely watch. I asked the CNA when I would have a chance to perform oral care because the resident still had her bottom row of teeth with god-knows-what caked between every tooth. She said "we don't do dat! she have dentures!" (she only had top dentures) and just threw the dentures in her lap even though she is completely paralyzed on her left side and her right hand tremored badly.
During this time, all the resident could talk about was that she wanted her red vest that was in her closet. The CNA yelled at her to just wear the clothes she put on her and let it go. I kept moving toward the closet to retreive the vest but the CNA kept turning around saying "Don't get that vest!" like it was such a huge deal. I waited until she left and went into the closet to get a very easy to put on red fleece vest that had the Cornell University logo on it. Her granddaughter was coming to visit today and she attended Cornell. The CNA was ****** when she came back in the room and the resident had the vest on. Why? I have NO IDEA... but the resident was as happy as a pig in ****.
I had reviewed my resident's chart the day before and noticed she had lost 20 lbs since she was transfered to this LTC in November. She is literally skin and bones. So I knew that I really wanted to encourage her eating when I got a chance to feed her breakfast. When the trays came I saw on the card that she had ordered an english muffin, cheese grits and oatmeal. I opened the tray and it was french toast and bacon. I went to find the CNA to tell her she received the wrong meal and the CNA said "that card don't mean nothin!" but the entire time I was trying to encourage the resident to eat she kept talking about the english muffin she wanted and she hated french toast. I felt terrible. I asked her why she's lost so much weight and she said it's because she doesn't like the food there.
After breakfast my resident needed to be moved to her wheelchair because her family was coming to visit a little later. Since she only weighed 107 I asked my instructor if I could use my gait belt instead of a lift (since we were not allowed to operate them just yet, and I wanted some kind of belt practice). With her blessing I went to get my gait belt but when I came back the CNA was in the room putting the resident's shoes on. I said I could handle the transfer to the wheelchair and started to pull out my belt. She said "No, that take too long!" and just heaved her up and into the wheelchair like a sack of potatoes. Mind you this LTC has a no-lifting policy. The resident had asked me if I could wheel her to the nurses' station so she could read the menus, so I asked the CNA where the foot rests to her wheelchair were. She snapped at me that the resident just needed to stay in her room. I repeated my request, "Mrs X would like to read the menus" and she started yelling at me that she just needed to stay out of the way. It was like she didn't like the resident for some reason - plenty of other residents were out of their rooms and just hanging out in the hallways and common areas. Luckily at this time her family showed up a bit early, so I just let them be.
Now would be a good time to mention the overall demenor of this resident. She was obviously a very educated woman, as the entire time I spent with her we discussed our families, education, traveling, literature, good food, politics, her upcoming 63rd wedding anniversary, pretty much everything. At one point before her family came she asked me if I liked poetry, and then recited Walt Whitman's "O Captain, My Captain" from memory. I actually had to turn away so she wouldn't see me tear up because my heart was breaking that such a beautiful soul was stuck inside such a broken body. She seemed so incredibly grateful that I was clumsily providing such basic care. Anyway...
While the family was visiting, I went to join some fellow classmates to assist with their residents. One girl said her resident had a nasty pressure ulcer on her thigh but it was not being taken care of, and she had to clean liquid poo out of the ulcer. One had told me that her resident had such a dry mouth that scales were falling out during her oral care. I told her about what my CNA said about oral care and she looked shocked. I went to my clinical instructor and told her that my CNA said she doesn't perform oral care, and she told me to do it as soon as I could. After the family left I went in to do oral care but then remembered that her toothbrush was disgusting. I threw it out and went to look for a new toothbrush but could not find one. I asked the LPN's at the nurses' station and they sent me on a wild goose chase looking for toothbrushes in every supply closet, but eventually I turned up empty-handed. The charge nurse just sighed, "I'll tell them to order more." I had to try to gunk out the resident's mouth with swabs. I was horrified the crap that came out of her teeth and I didn't even get most of it because I didn't have a toothbrush. At some point during this time the CNA yelled at me for cleaning her mouth and dentures ("she about to eat lunch! we don't clean dentures just put them in the water") but at this point I was so disgusted by how neglected my resident had been I just ignored her. After I performed oral care my resident told me she would like a new diaper. I went to get linens and my CNA of course stopped me to ask what I was doing. I told her I was about to change her diaper and provide care for her and the CNA grew furious and said "She's not that wet!". Of course at this point I had grown so fond of my resident through our conversations that I just didn't care what the CNA had to say whatsoever. And plus, she's my only patient, so who cares if I pay this much attention to her?!
At this point I had to move my resident from her wheelchair to her bed. She looked at me and said "Ok, so you get my legs and can get my head?" like the CNA's just fling her back onto the bed. I was horrified and explained to her I would be using my belt. So I get her back onto the bed and change her diaper, at which point she shows excitement to receive two AM changings, poor thing. She asks me for water so I go to get some. The CNA starts of course yelling at me about getting her water "The lunch trays are coming!" and I ask when, she says in an hour and a half. What? So what? The resident wants some water now. So I ignored her and went to get my resident water and whatever else she requested of me today. Ice? Lotion? Lip balm? Sure. I was having a good time caring for her, talking with her, making her smile, and she needed some extra attention. All the while the CNA is telling me to stop getting her stuff because "she'll run you all day!" and getting very angry that I was just ignoring her ranting. I was documenting all her fluids even though she was not on I&O (I don't know why, she is practically a skeleton, they seem kind of content to let her just circle the drain, which is none of my novice business but at least we could make her happy and comfortable). Her chart indicated she was just to be made comfortable, she was not on any kind of therapies or procedures scheduled or anything. Her only med was ambien.
A few other little things happened but this post is already too long and I think you all get my gist. During clinical I reported my concerns to my clinical instructor and I think she may have spoken to someone at the LTC about it. I'm worried that tomorrow when I go in (I'll be assigned to a different resident/CNA) that I will catch hell from the staff, but I couldn't let this precious angel of a woman be treated so poorly. It got to the point where I prayed she would pass soon so she wouldn't have to bear being stuck inside such a shithole LTC for much longer. Can anyone give me some feedback on this? Is this common for LTCs? Did I do anything wrong? Am I just too green?
