Old school cna

[patriciawardlow]

I have several questions about cna work today versus 20 years ago. There are so many things that are different. Let me start off by saying I have been a cna since 09/1997. I was trained In a LTC facility that suggested the resident can hit you and there is nothing you can do. I think being a cna contains a growth process in all spectrums. I later found out, no you don't hit them of coorifice but that your approach counts and you can lovingly hold their hand in a kind, gentle and on the offense way, so that they won't feel tempted to hit you. Not hold them down, no but lovingly hold their hand gently and ask them how they are doing. I understand completely that it makes perfect sense to them 99% of the time if they understand what you are doing. Anyway, my rants are geared more toward the things that I learned as common sense.

1) doesn't raising the feet all the way above the heart drain the edema?

2) isn't it better for them to be laid down in bed without a brief rather than in one? I mean after all ISNT air the best thing for a red, chapped irritated bottom?

3) where is the preventive practice of pain management? My nurses wait until my residents are crying before they will disperse PRN pain MEDS.

4) I shaved my residents head the other day because there were multiple layers of dander under his hair from not being washed. I work evenings and all showers are given on days, I also shaved his mustache because of the food build up in it. Now that his filth can be seen hopefully it will be mange? Idk. Also know that they were HIS CLIPPERS in HIS DRAWER.

5) Is half doing a half cleaning of incontinet care on a resident acceptable because he is combative?

6) also isn't shaving cream acceptable to use for incontinent care especially if there is no available peri wash?

[ktwlpn, LPN]

When I first worked as a nursing assistant 34 years ago -(YIKES-34 stinking years!!!)-. there was no such thing as "universal precautions". We did not have gloves or any disposable products at all. Yep-I cleaned up great piles of steaming dung sans gloves. I had to clean the poop off the cloth bed pads BEFORE we sent them to the laundry. With a long handled scrub brush. I got paid THREE dollars an hour.

I'm not sure what the point of your post is-

#1-sure.

#2 -trends come and go. We don't use briefs in bed...Unless the resident desires this or the person is a super heavy wetter or the moon is in retrograde Venus.

#3-PRN meds are closely monitored and regulated- We MUST attempt non-medical interventions and document their effect PRIOR to giving a med. However-regular pain assessments ,scheduling pain meds regularly and moving up the ladder to stronger meds as needed is preferable to allowing a resident to suffer.

#4-I HOPE you received permission from the resident and/or family to shave this guys head and moustache. That is a dignity issues.He has the right to have a full head of hair and 'stache.Staff are required to care for it adequately. More then one job has been lost over this type of thing.

#5-Direct care and combative behaviors are challenging.What would you do? Hold the guy down? I hope not. You do what you can, reapproach later, try offering snacks, trade him with another staff member who has a better rapport. Work WITH the nursing staff so they can document appropriately and help find a solution.

#6- Plain soap and water is preferable for peri care. It takes a little more time then grabbing that can of shaving cream,doesn't it?

[spiderslap]

How do you suggest cleaning a combative person? Other than simply giving it your best shot, im really curious what ideas you have. Holding someones hand and being as sweet as possible is not going to cut it in most situations. If someone is that upset at something im trying to do, i feel worse about forcing them to do something if its making them so stressed and anxious that they fight you. Cnas are often understaffed and it can be hard for them to get everything done, let alone force an adult to keep their pants down against their consent. I have never heard of putting shaving cream down there....i definitely wouldnt be allowed to shave someones head, probably just clean it the best you can, but not give him a new style altogether. The other questions you asked are more up to the particular nurse or facility.