When I started caring for my grandmother at 4 years old I did the exact cares I'm doing in LTC minus the the peri cares that I'm doing now. I'd lay out her clothes for the next day, arrange her medications, set up her DuoNeb, clip her nails and such forth. The chores were light when I was young but progressed as I aged up until the day of her death. As I've stated in previous articles I was able to play nurse as a child just as other little girls were able to play house. I don't even like calling what I did/do chores because I have always enjoyed doing what I do.
Tonight my husband and I were chatting and he asked me how I establish good relationships with everyone of my patients and how I seperate being able to bond with someone and give them professional cares. So I've decided to do another list of tips and tricks that I've always used. I do want to remind people to check with their facilities policy's to make sure they're following set guidelines.
(1) The first thing I always do is look at the care chart. Its normally a sheet of paper that gives you some information such as Continent/Incontinent and if they walk. Most times they give a brief history of the patient all within our "need to know basis" (Especially if you're working with patients that have a history of behaviors and what redirections work/don't work). I think it's extremely important to have a knowledge of the patients you are directly caring for and it can help you understand how to act around them.
(2) I always address the patient as Mr./Ms. "Insert last name" when I first meet them. You never know how they like to be addressed and Mr/Ms is the most platonic unoffensive term you can possibly use. Most times the patient will correct you and say, "Oh no please call me Bob/Betty".
(3) I have worked all three shifts in 5 years. I have worked 8 hour shifts, 12 hour shifts and 16 hour shifts. In each of my positions I've found that time management is key. It's important to not only get your work done but if you get it done in a quick, efficent, timely manner you will have time to go in to your patients rooms and chat for a few minutes. During NOCs I've had patients that can't sleep and since my chores were all done I would go into their room with my co worker and we'd watch TV together. The patients loved it and I wont lie some of those old AMC movies are pretty funny.
(4) When family visits I always go out of my way to introduce them to my self or say hello the moment they walk on to the unit. I make sure they don't need extra chairs and I always make sure the patient is in the mood for visitors first. The families of your patients will be your greatest ally. They will talk to you about things their family members enjoyed doing before they came to the facility and supply you with the tools you will need to be a successful caregiver and build a relationship with the patient. When the family sees that the patient is happy, everyone is happy. (It looks especially good when the family calls the facility to praise you by name instead of complaining about this or that).
(5) When a patient seems "out of it" or almost "comatose" watch what you say just as you would if they were completely alert! Hearing is the LAST thing to go on anyone right before death and they can hear everything you say. Can you imagine the horror you'd feel if you found out the last conversation your family member heard before (s)he died was about Lisa belittling her tool of a boyfriend who was caught talking to Brittany? We as caregivers are here to ease the process along not make them beg for it.
(6) Keep your cell phones in your car. Dont even put them in your purse or locker they're too much of a temptation. I have been guilty of carrying it (hypocrite alert) but one day my DON told me to leave it in my purse for a week and I'd be surprised how less stressed out I was. I did as I was instructed and the stress of hiding my phone or looking for the next text message has been gone for 4 years. Not only that but if you have a patient fall and your phone is on you, guess who's liable and can face serious trouble. If you are a phone carrier you're looking in the mirror. Remember protect the patient first but also remember to protect your self first.
(7) I can't stress this point enough through all of the posts I've written. Do not under any circumstance call your patient/resident any nick name like "Sweetie, honey, grandma, grandpa etc etc" I dont know how many of you have been hospitalized where someone had to do your personal cares but I can completely understand the degrading feeling of having a person do Peri-Cares on me and call me "Sweetheart" the entire time. It, by law, is considered abusive and degrading and dare I say slightly mortifying.
(8) When I first started CNA work doing cares on deceased patients that I grew to care about devestated me. I remember doing the final wash down crying because I was remembering what I was losing. One day I had a Charge nurse helping me and she pulled me to the side before we went in and told me the one sentance that would change my life on caring for the deceased. She said, "Don't focus on the fact that you've lost them, focus on the fact that you are giving them the dignified care they deserve one last time, be honored that it's you that has this responsibility." From that day I volunteered for any PM care I could to help me learn the best way to do cares and to give them the dignified care they deserved.
(9) Every weekend most of our male residents are up by 6 am. Because of this I go and straight shave them every saturday and sunday from 0600 until 0630. They are normally shaven with an electric shaver so it's not as close as it can be. I don't do it because I feel better when they thank me extensively for it (maybe a little but I'm human) but I mostly do it because it's the little things that matter to your residents/patients. When someone you care for sees that you're taking the time out of your schedule to do something a little extra for them they really appreciate it.
(10) Your "Difficult" or "Cranky" patients are probably the best patients you will ever have. Take the time to find out why they're "cranky" or "ticked off". I've found that most of the patients I run into that have problems adjusting to LTSK (Long Term Skilled Care) are the patients that are transitioning from Independance to a declining position. You also have to realize the Brain injuries such as Strokes, seizures and other traumatic injuries will greatly affect your patients personality. Mother Teresa herself would probably tell you to P*** off and to go F yourself if she had a traumatic brain injury. Does that mean they're terrible patients? Absolutely not. Thats why it is incredibly important to learn about the people YOU care for and how to care for them. If you're unsure, your co workers are you greatest allies when dealing with a "difficult" patient. Patience is a virtue in the case of behaviors.