LTC Dignity

jb2u, ASN, RN · Aug 22, 2006

Redzie,

I am sorry to hear about your first day. Sorry for you and the residents. Yes, there is a problem, in MY opinion, with the healthcare system as it stands today. I have some very opinionated reasons as to why it is and how to "solve" it. I've posted these on several other post.

One problem is, yes, cna's are normally very busy (IF they are doing their job, some "hang out" in the day room.). The other problem, as I see it, is the requirements to become a cna are WAY to low. Couple that with low pay plus a demand for cna's and what you get is some uncaring cna's who are there just to have a job.

This does not have to be your destiny though. Always, provide care with your heart. Your hands may do the "task", but let your heart lead you. I always talk to my patients, even the ones that are said to be "out of it." We are taught in nursing school that "hearing is the last sense to go!" I just feel that if I were in a bed, I'd want the person that came in there to clean me to treat me as a person and NOT a task. Talk to me, tell me what you are doing. Some pts don't even know what is going on. The cna just walks into the room and starts taking off the pt's clothes for a bath. Could you imagine someone just walking into your room and start taking off your clothes without first saying "ok..Mr/Ms. so-and-so, I am going to give you a bath now"?

Remember these experiences when you become a cna and then a nurse. As a cna, you can make sure that your pts receive outstanding care, and as a nurse, you can ensure that your pt receives outstanding care while at the same time making sure that the cna's don't neglect the pts. It is a battle, and of course, there are lazy nurses, too, but we can not change the world. We can make it a little better though.

Good luck to you with your future.

Sincerely,

Jay

chadash · Aug 24, 2006

Hold fast to your desire to deal with each patient with dignity.

lovingtheunloved, ASN, RN · Aug 26, 2006

I have just completed my 3rd week of 4 in CNA school. Today, was our first day of 3 days in an LTC facility where they allow us to come in and put to use everything we've been learning.
Although I have never stepped foot in a facility like this, I knew I would have to deal with "unpleasant" things, but I didn't realize how much, and they didn't prepare us. BM's were everywhere since it was first thing in the morning. But since I was new at assisting the CNA's, I was slow, gentle, nervous, and clumsy and the aides probably thought I couldn't hack it. But I was afraid of hurting someonw. Regarding the BM's, I did everything I could not to gag for fear of embarrassing the resident, so I thought of flowers and walking into a house at Thanksgiving smelling the great food cooking. I'm positive I'll get used to it and be more careful not to step in it in the shower, get it on my pants, etc. I'll go again tomorrow and try to do better.
Everything I'm learning in the program has a focus/basis for dignity. I didn't see a lot of that at this facility. They don't cover them good for privacy or warmth, because they are low on towels, they are wiping them fast and harsh, many residents would wimper a little because the CNA might have been hurting them a bit, they don't talk to them while showering or while doing anything, really; they say things out loud to me or to their coworkers with no regard that the resident can hear and has feelings, while I was showering a lady who had right side weakness, I asked her a few times if she was ok, and the CNA said, I can tell you're new, later, you'll just know that they are ok. I thought to myself "why would I EVER stop asking them if they were ok???!?!?!?"
So here's my question --
Do all or most CNA's become so complacent that they forget to be courteous or respectful? Or is it that they are just too busy? (These CNA's had 7-9 residents each - not sure if that's a lot or a little) Maybe it's just that they are with these residents every day and they know them so well, and I just saw too little to really know.
I just know that I am entering the healthcare field to make a difference in people's lives (first CNA, then LPN, then RN) and I don't ever want to become so complacent that I lose site of a patient's, resident's, or client's, dignity or feelings. Am I delusional? Maybe after my first day there, it's too soon to judge.
I would welcome and appreciate an insite to what it's like day in and day out, but also it would be good to hear other's first day impressions.

You know, there's the way it is in class and the way it is in the real world...dignity is not one of those things. So many CNAs are task oriented rather than person oriented. They think along the lines of "the butt needs to be washed" rather than "this PERSON is uncomfortable because they are soiled, I can help them by providing hygeine for them" And 7-9 residents is not bad at all. We went through a dry spell with staffing a few months back and for 4 months I had at LEAST 16 residents. Poor staffing is a bad excuse for bad care.

I know my residents very well. I've worked with many of them for three years. They are still human beings who need the stimulation of conversation, to be treated like PEOPLE who are worth listening to. I know my residents, but they still surprise me with the stories they tell. They've done some amazing things. Think of it this way. You know your mama don't you? That doesn't mean you don't need to talk to her anymore! As far as asking them if they are ok rather than assuming, it's important. You don't KNOW anything. You guess, you think, you make the best assessment you can if the person can't tell you they're ok, but no one KNOWS except the person. It empowers them wheb you provide dignity and choice, and to let them know that THEY are in charge of their care.

I know I'm rambling, so I'll wrap it up with this. You seem very caring. You'll get the hang of it. It sounds like you have something to teach the CNAs you've worked with. And yes, you get used to the smell of poo.

chadash · Aug 27, 2006

One thing that helps, is when you walk into a patient's room, act as if you are a visiter in their home. Always address them directly, and if another NA begins to talk over them, just turn your conversation back to the patient. This is hard to do when you are the "trainee", but when you are onboard more, you might actually effect the attitudes of your fellow employees.

I think alot of the dignity issues are just good manners. But I also think some time should be taken in inservices to instruct on professional behavoir in the workplace.

BabyRN2Be · Aug 28, 2006

I have found that there is a big difference between the classroom and "the real world".

In the classroom: There are plenty of towels/linens.

In the hospital/LTC: We are told not to use too many towels/linens because it will short the next shift.

In the classroom: There is time for a perfectly made bed.

In the hospital/LTC: Get it done, fast. Who cares if it's not perfect?

In the classroom: Your patient is coherent, has good mobility and cooperative.

In the hospital/LTC: Your patient might be confused, has R/L sided weakness, and might spit/yell when you try to help because of problem #1.

You do need to adjust to "the real world", but don't forget basic dignity (covering, keeping a patient warm, privacy). I know that some of this gets lost d/t patient load and some people who are there because "it's just a job." I've always tried to place myself in their shoes...

I remember on my first job when the other CNA was being so rough with the patients when wiping their bottoms. I felt badly when she thought I wasn't doing it fast enough, she took over the job and the patient yelped when she cleaned them. All I could think of, "their skin is so fragile..." OK, I'm on the verge of rambling so I'll stop.

Remember to keep the compassion you had when you started. Try to take the time for a simple caring touch, even if brief. I know it can mean so much to those we care for.

Marie_LPN, RN, LPN, RN · Aug 29, 2006

Do all or most CNA's become so complacent that they forget to be courteous or respectful? Or is it that they are just too busy?

People being busy is a pathetic excuse for disrespect. I tried to put myself in that predicament mentally as much as possible, and yes, graphic. If i were only getting cleaned every 2 hours min, how would my sore red skin feel. That rough washrag, how would that feel going across prolapsed hemmrhoids? When i'm laying on the couch in the wintertime, doing nothing, aren't i cold? When my skin is dry and flaky, don't i need lotion?

My point is, we're all human, we all have needs and feelings, and just because we age doesn't me we should get less than what we deserve. The fact that you showed concern (and asked questions to youself) shows that you'll take your job seriously. The residents will appreciate someone who has their best interests (and dignity) at heart.

squeakykitty · Dec 20, 2006

As for dignity, how about that "high pitched talking to a 2 year old" type of voice tone I've heard used on elderly people in a nursing home. :trout: :madface: I wouldn't want anyone to talk to me like that at all, it's demeaning.

nurseangel47 · Dec 20, 2006

LOTS of great advice from the others in here. Ditto to what everyone said about preserving the dignity and respecting the patients.

You WILL find that a lot of CNAs are unwilling to deliver the quality of care that is required to do an adequate or standardized expectation of patient care. It is a sad fact. And for all of the reasons already mentioned above. That is why it is so difficult to deal with staffing issues in LTC facilities, esp.

My nursing cap is off to you for your high standards. I wish you much luck in nursing school. You sound as if you are a very caring, loving person.

We need more just like you in the profession. God Bless you.

JBirdAngel · Jan 13, 2007

you asked if you were delusional, and i just wanted to point out that even if everyone who responded had said that you were wrong, even if everyone in your class / work place said you were wrong and just to do it fast etc., you would still not be delusional, we are most definatly, regardless of job, training, etc. we are to love others :)

just because people who are supposed to be, call themselves, or called by others "experts" doesnt make them experts, or even right.

defiantly keep that love of others :)

- jason

dorselm · Jan 13, 2007

I also just completed my 3 wk training for the CNA program. Yesterday was my first day of the "real world". It was sooooooo crazy and scary. But one thing I can tell you is that the floor that I work on is fast paced( because it's the skilled floor) but the CNA's all treat the residents with respect. We must knock when entering the room. No matter how much they curse and get mad we still have to respect them. But then being that the 7-3:30 shift gets 10-12 pts, the 3-11:30 shift gets 12 pts and the 11-7:30 shift gets 20 pts, uh yeah, patient care sometimes is not the best. Yesterday, my first day and there was soooooo much drama going on that I didn't even have time to sit with the person orientating me to see how charting is done. It's okay though because we had to do it in CNA class so I know how. We had two new people admitted, one discharged, one transferred to another floor and another who fell. We had to have all 10 of our patients up and out of their rooms by 12:30. Top it all off, we had a CNA staff meeting from 7-7:45! The nurses did not pass the breakfast trays which were ready at 7:20. Then before I could go with the CNA who was orientating me, another CNA pulled me to take care of this young girl (27)who had a stroke on her left side but she thought she could do everything like she used to. She thought she could just get up and walk and fell about 6 times since she's been at the facility so I had to sit with her and help her get dressed. I could not let her out of my sight because she would try to walk. Her roommate was an old lady with dementia and she had to go to the bathroom really bad. She told me that she normally goes in the bathroom in the room and I believed her. I tried to put her in her wheelchair to put her in the bathroom and she almost fell. She was so scared of falling. She could not walk or stand up. I realized I would not be able to get her on the toilet so I called for help. After the CNA came and got her they took her to the big bathroom where the shower is and they got her toileted, bathed and dressed there. I was so embarrassed. I should not have listened to the patient. I feel like I'm slow as molasses. I literally fear transferring people. I always asks someone to help me and I know that by the time my two wk orientation is over, I better know how to transfer pts on my own or I'm in trouble. However, as far as patient care goes, I smile at all who I meet. While I'm bathing them I ask as about their families or what they used to do for a living. I try to keep them warm and I allow them to do as much for themselves as they can. I don't care how many patients I get, I'm never going to lose the respect for them. It's hard work though. Yesterday I came home with a sore back and swollen feet. I only got one break and that was lunch which was a 1/2 hr. We get two 15mins and one lunch. My orientee said she doesn't take breaks and because she barely eats, she doesn't take a full lunch. My dumb butt didn't ask for a break so I was on the verge of passing out yesterday but it won't be like that next week. I am not going to kill myself trying to get all of this done. Breaks are needed. I can't go 8 hrs with no time to recoup. It was crazy.

nurseangel47 · Jan 13, 2007

As vitally important as less patients per nurse ratios need to be addressed, the "powers that be" also should consider and act upon the outrageous ratios of CNAs to residents or patients. I have worked a lot of LTC as a nurse and have never felt that my team of CNAs ever had a fair or safe assignment. Period. They mostly did what they could humanly accomplish and I think they, too, felt guilty they couldn't get all done for their folks that needed doing. Some of them shouldn't be CNAs, their heart isn't in it. Others, however, obviously do care a lot and chose this line of work for a reason. Either an extra large compassion for others, or as a prereq. to nursing or some other health care industry choice. Unfortunately, I, too have witnessed first hand the lack of empathy resulting in less than delicate care on the part of these aides. And, too, unfortunately, the highersup in the chain of command at the facilities are too concerned about possible legal repercussions and covering their behinds regarding those politics, rather than being concerned and proactivist for their residents. A shame, you bet. We need more cnas like yourself. To be gentler, kinder, and calmer around these frail old people. They deserve at the least, a better standard of care in their everyday lives. Better pay for the cnas, more cnas per unit per shift to have more time to do a better quality job!

Don't know why we (cnas and nurses) insist on being treated this way hence letting our patients/residents be treated this way, also! I wish we could all stand together, unite 'til the end, insist that things be made right, that we were all treated with the dignity we should afford our charges!

:angryfire