I just got transferred to our dementia care unit and we are trying to change the way the system works in that area. I am the new dementia care coordinator and I will be supervising the CNAs. The administrator and health services director would like to change the culture and get the CNAs more involved in the facilitation of activities and getting them to understand that every interaction they have can be considered an activity with the dementia residents. Not only is every interaction an activity, but we want the staff to make each encounter meaningful. For example, when they are helping the residents with their ADLs like dressing, do not simply put their clothes on for them. Include them in the activity and ask them what outfit they would like to wear, what matches what, etc. Or when brushing their teeth, some residents have trouble carrying out multiple steps. Therefore, to help the resident, the CNA should break down the process into single steps like get your tootpaste, open the cap, get your toothbrush, squeeze the toothpaste on the toothbrush, and so on. This way you are helping them go through the steps, fostering independence, and giving them a sense of achievement.
So, my situation is... I would like to put together some kind of documentation form for the CNAs that they would fill out at the end of their shift on each of their assigned residents. It has to be a checklist form of documentation so that it does not take up too much time. It would have something like a general list of interactions/activities and how it was meaningful to the resident. I can't decide whether it should have a list that states the category of activities (ADLs, fine/gross motor, social, sensory, reality orientation, etc.) or if I should list specific activities (dressing, grooming, arts & crafts, exercise, musical entertainment, etc.). Then for the section where they would explain the activitiy was meaningful, I am not sure what choices to put (fosters independence, step breakdown, emotional support, self esteem, etc.). What choices are most appropriate? Does anyone have a form already put together that can send me in the right direction?
Here are some sections I would like in the document: type of activity, value/meaningfulness (or another section name), resident response (conversed, refused, eye to eye, etc.), and resident participation (active, observer, passive).
Hi! I am a recently retired LPN and CNA instructor. Your goals are admirable and I have a few suggestions. My last two years at school, I had two classes of 11/12th graders all graduate with their NYS CNA certification. May I suggest you borrow or order a copy of your state's newest CNA training textbook. I think it important you first understand the scope of not only their practice within your facility, but also the scope of their training. Nurses assess, CNA's collect data. CNA training is very task oriented, where nurse training is outcome based. And in NY, their workload is punishing and almost impossible to carry. Even a flowchart will likely be met with anger and skepticism unless you can get them involved with it from the beginning. I know my young students always appreciated getting asked for a brief narrative report about their residents. They hated flow sheets because they felt they were often redundant or confusing. If you add one, could you take one away? And end of shift is not a good time for a staff anxious to get off duty yesterday if not sooner. Could you consider adding 5 minutes to your team's break time as a reward for this "extra" work? To reduce goal confusion, perhaps your form could include 1-3 goal statements/term definitions at the top of the page? I am abit unclear as to what you want to accomplish. The task breakdown you have described, is what I taught to my LPN students, as they need to use ADPIE for careplans and nurse notes, and make nursing interventions. In my sphere of reference, my CNAs were responsible for basic ADL tasks, and that included making a task a valued and pt. specific interaction. In our secured dementia unit, these pt. specific goals were written into the nursing plan of care, and simplified into the CNA flowbook using a care card with check boxes. Good luck, I hoped I have helped at least alittle.
I have been a CNA for about 15yrs. I have worked in Alzheimer units where the ratio was 4:1. This was difficult but manageable. In addition I helped other CNA's and Alzheimer residents in the unit. A big problem we had in the unit was handling the behaviors which take away from the calm setting of performing ADL's. Now probably because of costs the ratio is higher. My experience in the general nursing facility population is that my ratio is about 14-15 residents, including Alzheimer residents. I run around like a chicken without its head. Controlled chaos. The nurses have 25-30 residents each to chart. Because of the high ratio, in my opinion, it would not be manageable to incorporate an idea that is creative and experimental. One needs to work slowly with an Alzheimer resident and it is not feasible because of the high ratio.
I am a CNA in a Nursing Home and we have little messages around telling us "Remember to ask me what I want to wear today" and were susposed to let our residents be as involved in the activity as they can be to promote their feeling of independence. From someone elses standpoint this is great, I would want my Grandma to have as much 1 on 1 and stimulating activities as possible. But does this even happen? In the real world sadley it does not. CNA's can be responsible to get as many as 12 to 25 residents up and dressed, teeth brushed, shoes on, teeth in, glasses on, ect. and down to breakfast by 0800. Your idea is ideal. But your CNA's will be thinking to themselves "thanks or requiring false documentation because all this, is never gonna happen.
Alzheimer Association of America in your local area would be a great start. They teach courses to nurses , Assisted Living managers and others which results in certification and focused training specific to dementia.
They chat in the office and sort of lazily walk around. Their attitude sucks and their work ethics are nonexistent. This is one of my reasons for wanting to implement some sort of documentation. There are teo CNAs with a float making it three fr a 15 bed unit. And this is a dementia unit so there arecertain qualifications that the residents must meet in order to stay there. These residents do not need a very high level of care like the residents I worked with in SNF. therefore, I know these CNAs do not have to work as much as that unit. But because of their laziness, I need to implement a documentation form so that they have some sort of accountability.
The first matter of business is for you is to address your attitude towards C.N.As. In order to impletment positive change and change the culture mutual respect needs to be established. It's something that appears, evident by your posts, to be lacking at your facility, and under your leadership.
I have been a CNA for about 15yrs. I have worked in Alzheimer units where the ratio was 4:1. This was difficult but manageable. In addition I helped other CNA's and Alzheimer residents in the unit. A big problem we had in the unit was handling the behaviors which take away from the calm setting of performing ADL's. Now probably because of costs the ratio is higher. My experience in the general nursing facility population is that my ratio is about 14-15 residents, including Alzheimer residents. I run around like a chicken without its head. Controlled chaos. The nurses have 25-30 residents each to chart. Because of the high ratio, in my opinion, it would not be manageable to incorporate an idea that is creative and experimental. One needs to work slowly with an Alzheimer resident and it is not feasible because of the high ratio.
Answer: I am a newbee CNA , i would like to know is working the day shift 6-2 is preferable or night shift 11-7am. THanks.
You want to implement change, then you better get the input of the staff. Don't they already do ADL charting?
Our CNAs carry around cue cards that informs them how to care for the resident. They sign it at the end of the day and hand it into the nurse.
If you feel your CNAs are lazy then talk with them.... wait.... are you a nurse? Because if you are not, then you should inform the nurse manager and let them decide if they are doing things incorrectly and then maybe you both can approach the CNAs with meetings.
BTW I hope you are able to form a more positive relationship with the staff.
wilbur's mom
66 Posts
Hi! I am a recently retired LPN and CNA instructor. Your goals are admirable and I have a few suggestions. My last two years at school, I had two classes of 11/12th graders all graduate with their NYS CNA certification. May I suggest you borrow or order a copy of your state's newest CNA training textbook. I think it important you first understand the scope of not only their practice within your facility, but also the scope of their training. Nurses assess, CNA's collect data. CNA training is very task oriented, where nurse training is outcome based. And in NY, their workload is punishing and almost impossible to carry. Even a flowchart will likely be met with anger and skepticism unless you can get them involved with it from the beginning. I know my young students always appreciated getting asked for a brief narrative report about their residents. They hated flow sheets because they felt they were often redundant or confusing. If you add one, could you take one away? And end of shift is not a good time for a staff anxious to get off duty yesterday if not sooner. Could you consider adding 5 minutes to your team's break time as a reward for this "extra" work? To reduce goal confusion, perhaps your form could include 1-3 goal statements/term definitions at the top of the page? I am abit unclear as to what you want to accomplish. The task breakdown you have described, is what I taught to my LPN students, as they need to use ADPIE for careplans and nurse notes, and make nursing interventions. In my sphere of reference, my CNAs were responsible for basic ADL tasks, and that included making a task a valued and pt. specific interaction. In our secured dementia unit, these pt. specific goals were written into the nursing plan of care, and simplified into the CNA flowbook using a care card with check boxes. Good luck, I hoped I have helped at least alittle.