Welcome NursingAssistants.Net readers! This is the back up site to the main site which has been hacked! I'm working on getting that fixed. Please look around here for info for CNA's and those who care about their work!

Sunday, March 11, 2012

Spot Light: Range Of Motion

What is Range of Motion? The normal movement of joints.

For many residents, a lack of mobility causes stiffness in their joints. Their muscles shrink and become weak- this is known as atrophy. Gradually, the atrophied muscles become hard and rigid. The muscles shorten in this process, and therefore joint movement is affected. Pain, discomfort and disfigurement occur. These disfigurements are known as contractures. They are, almost always, 100% preventable.

Photobucket - Video and Image Hosting

It is up to nursing staff to maintain a residents range of motion (ROM). For residents who are bed bound, wheelchair bound or who cannot ambulate, it is even more important that range of motion exercises be done correctly and often enough. Many of the activities we assist with will provide ROM for residents…bathing, dressing, grooming activities in particular offer opportunities for joint movement- SO long we we think about what we are doing. When we’re giving a bed bath for example, it makes sense to lift each leg and put it through it’s complete ROM while washing and drying it. But I’ve seen CNA’s turn the resident to the side and wash/dry them from behind, thus eliminating this opportunity for good ROM.

To be effective, ROM exercises should be performed at least twice a day, and each exercise should be done at least five times. The quick, natural opportunities for ROM are an excellent way to enhance what we do, but it should never replace a full program. The only way to fully perform all the exercises, is during AM/PM cares, with a complete focus on this one activity.

Some residents will be able to help. They can move their joints without our help-this is called ACTIVE RANGE OF MOTION. The resident can perform almost all the exercises on their own, through a dedicated program or through normal activities of daily living.

Other residents can perform SOME portion of ROM, but due to weakness, pain, paralysis and the like, they will need limited amounts of assistance. Usually they can tell you exactly what you need to do. This is called ACTIVE ASSISTED ROM.

For most of the residents we deal with, PASSIVE ROM is the norm. These residents cannot assist with this, for many reasons. It’s important to remember that these ROM exercises do not strengthen the muscles; they prevent deformity and maintain movement.

A great way to make ROM a part of AM/PM care might include applying lotion to those body parts being exercised. The lotion is calming and relaxing, and this will help with ROM. Another good time is during a bath. If you note the resident experiences pain during ROM, ask the nurse about pain medications being given 30 minutes or so before the exercises are started.

If ROM is problematic to complete due to time restraints, ask your co workers if they too are having trouble. As a group, you all could seek ways to help each other. Or, seek the advise of the charge nurses. At one nursing home I know of, the aides simply did not have time to complete ALL the ROM for each resident. The aides met with the nurses, who went to the DON to get some ideas and guidance. The DON met with the Activity Director, who implemented an exercise activity designed to provide ROM to those residents the aides could not get to in the morning. The aides marked off who received ROM and who didn’t, and the Activity Staff provided the exercises as part of special “Massages” and other aptly titled programs.

Another nursing home I know of breaks up the ROM requirements for each shift. This means third shift does some of these programs- especially for those residents who are awake during their shift.

Creative minds can ensure that vital care is provided. Dedicate TIME for this very important skill…this task…this care. ROM should not be skimped on, ever.

Saturday, March 10, 2012

Staying Healthy At Work

The work we CNA’s do is HARD; some say brutal. The stress we put upon ourselves while performing our duties takes a high toll on our bodies. We have to take care of ourselves. And I mean that- especially at work.

Some of the things I do to make sure I’m ready and physically able to do my job are pretty mainstream, or so I thought. Lately I’ve noticed newer aides not bothering to do simple things that can make such a difference.

1) The usual items we hear about are par for the course: Eat right, exercise and get plenty of sleep! Easier said then done in today’s busy world. Family, friends, commitments, kids’ games and activities all keep us, at times, TOO busy to care for ourselves.

2) We use our legs, arms and backs for the vast majority of the tasks we perform. It makes sense to stretch these muscles before we use them. Before I go to work, each shift, I do some simple little stretches and exercises that really have helped me stay limber, and I believe they help me perform the lifts and other harsh aspects of this work without pain, and without injury. Please seek your doctor’s opinion before attempting these. The links take you to a site that illustrates how to do the stretches.






I do three sets of 10- if you haven’t stretched in a long time, do less.

3) One thing I always have on my person is my own GAIT BELT. I don’t use the ones work provides; I prefer my own since I take care of it. Actually I have three belts- and it’s important to wash them between shifts. Think of all the germs that come into contact with these things! I have a small can of Lysol spray in my locker and every so often I use it on the belt…to kill the germs.

4) When I am working, I ALWAYS CARRY a small bottle of hand sanitizer. The stuff comes in sprays and pen form now too. I use it A LOT. I work with an aide who will rub it all over her face every so often- and she never gets sick! I use it every time I touch a door knob, or answer the phone. Some of my peers think I’m a little crazy about this- but I rarely get sick. I use it liberally and purchase several trial size bottles at Wal Mart.

5) Staying hydrated. A big one for me. Where I work it’s dry and the air is filtered, so little fresh, outdoor air comes in. I used to not bother drinking water cause I didn’t think I had time. I always felt thirsty and my throat hurt due to the dryness. I don’t care for straight water; but I do like Vitamin Water- which comes in many flavors, is very low in calories and tastes good. I get them at Wal Mart for less a dollar each and only buy them for work; I bring two or three bottles with me.

6) Eating at work can be challenging. We all know that our breaks are often interrupted, or short to begin with. It’s important to bring your own meal with you unless the facility provides them. Even then, I would opt to pack my own lunch. I know a lot of aides who skip meals altogether. That isn’t healthy. I pack a small lunch: A sandwich or pita wrap; some fruit, a granola type bar…keep it simple. Yogurt with nuts is good; a medium size salad can fill me up as well. I try to incorporate the major food groups: Meat, veggie, fruit…protein and the like.Premade pasta salads are very good as well.

7) Vitamins. A lot of people take them. Many or a few or even one. We each have our own needs and desires with this stuff. I take a multi vitamin AND lots of extra Vitamin C: We are exposed to a lot of germs and viruses every day. It’s important to stay well nourished and the food we eat should provide us with all the daily requirements…however, there are some vitamins that don’t absorb well due to medications or lifestyle habits. It’s important to seek medical advice before embarking on any vitamin regime.

8) Finally, I always have on my person, a bunch of things that might be needed (and from experience, have indeed BEEN needed!)…A small bottle of Tylenol/Advil/Bufferin or whatever pain reliever works; some TUMS, a little bottle of IMODIUM; band aids…all travel size bottles or packages- that fit neatly in my bag or in the glove compartment. One never knows when the headache from you-know-where will come along; it’s good to have some relief on hand.

Job Interview Do’s and Don’t's

Whether your a brand new or a seasoned CNA there will be times when you have to look for a job. We get many inquiries about this process and it’s a hot topic in the email lists as well.

For the sake of space here, this article is assuming you have located employment opportunities and have sent out resumes, made phone calls and have secured an interview at a nursing facility.

Now what?

First things first. Your appearance is absolutely vital in a successful interview. The old saying, “First Impressions can be the Last Impression” is very true.
You want to dress conservatively- you’re trying to sell YOURSELF so it’s very important to get this right.

You want to give a good first impression. You should dress neatly and appropriately:

No jeans and tee shirts; no short skirts and skimpy tank tops; underclothing mandatory
No open toed sandals or sneakers or Crocs
Limited jewelry and other accessories
Clean, wrinkle free clothing
Hair pulled up and kept out of your face
Fingernails neat, trimmed and CLEAN

While a suit is not called for in interviews for CNA work, a pair of black slacks and a blouse would be appropriate. A really nice pair of black or dark blue jeans might be alright if they are paired with a shirt that is buttoned and well fitting. Stay away from low waist style pants; stay away from dark colored underclothing as well. If possible, underclothes should not be visible to anyone. There is no other way to put it: wrinkles are equated with laziness. Iron your interview outfit!

Clean shoes that compliment the outfit and fit well are always good choices. I advice against wearing those Crocs to interviews; they are comfortable to wear at work but entirely not professional for seeking work. Sneakers are not recommended for job seeking activities of any sort.

The wearing of jewelry is a matter of personal preference. It’s a choice we all make. Other than wedding bands, most of us can go without wearing most other pieces. Keep in mind a simple bracelet and necklace are fine; stud earrings too…but ditch the spike pendants and eyebrow and nose rings. Take them out. They serve to distract people and this is the last thing you want during an interview. Also, remember that the work CNA’s do often leads to situations where jewelry can get lost or damaged (along with the earlobe or nose).

Fingernails are what patents see first- trust me. So do interviewers. You want neat, trim nails that are CLEAN. You don’t want polished, glossy shiny nails. You don’t want acrylic nails either. Okay you might want them, but infection control experts tell us germs love the long fake nails.

Now that we’ve covered WHAT NOT TO WEAR portion of the interview, lets move on to the other things:

If this means you have to leave your home an hour beforehand, then do it. It’s best to plan for accidents and other traffic problems. It’s best to be prepared for this and time your arrival for the interview a good 30 minutes before. Sit in your car and wait if you must. Enter the facility 15 minutes before the scheduled appointment.

Treat everyone you encounter with professionalism and kindness. That receptionist or secretary or maintenance man may offer his or her opinion of you to the boss. It will count.

Don’t let the employer’s casual approach cause you to drop your manners or professionalism. You should maintain a professional image. Don’t address the interviewer by his or her first name unless you are invited to.

Don’t chew gum or smell like smoke. In fact don’t smoke for a couple hours (at LEAST!) before the interview. Keep your cell phone in your car. You don’t need to check for calls/texts at this important time!

Sit straight, smile as often as you can, maintain eye contact but don’t stare the interviewer down, lean forward but not invading the interviewer’s space. Sit still in your seat; avoid fidgeting and slouching. Be aware of your body language.

Don’t be shy or self-effacing. You want to be enthusiastic, confident and energetic, but not aggressive, pushy or egotistic. Usually just being yourself is sufficient. Relax.

Don’t ever BAD MOUTH previous employers or bosses. Word travels fast between facilities.

Questions and The Right Answers
Expect to be asked many questions. Expect to be politely scrutinized.

When did you leave your last job and why?
How long have you been out of work?
What did you like most and least about your last job?
Do you prefer working independently or as part of a team?
Why do you want to work here?
What do you expect to experience in this job that you did not experience in your past jobs?
How do you feel about evening work? Weekend work?
Why should we hire you?
Are you considering other positions at this time?
How does this job compare with them?

Listen carefully. If you feel the question is unclear, ask for clarification.

Pause before answering to consider all facts that may substantiate your response.

Always offer positive information; avoid negativity at all times.

Get directly to the point. Ask if listener would like you to go into great detail before you do.

Discuss only the facts needed to respond to the question.

Focus and re-focus attention on your successes. Remember, the goal is not to have the right answers so much as it is to convince the interviewer that you are the right person.

Be truthful, but try not to offer unsolicited information.

Some questions YOU might want to consider asking, when the interviewer asks you for your questions: Besides the usual questions about pay, hours, benefits and other tangibles, consider these questions:

Could you explain your organizational structure?
Can you discuss your take on the company’s Mission Statement? Workplace Values? How does the CNA fit in?
How would you characterize the management philosophy of this organization?
Do you know what Horizontal Violence is, and how it applies to nursing departments?
What is the rate of turnover for CNA’s? If high, ask why. Then ask what you can do to make this better.
What condition is morale in on the unit you might be assigned to work?
How long have some of your best CNA’s been employed by this facility?
How do you define the “best CNA”? What is this title based on?
Are there opportunities for advancement for CNA’s? A career ladder, for example.
What does the facility offer for continuing education opportunities?
Why should I accept a job offer from you?
Why do you work for this facility?

…these are tough questions and perhaps only seasoned CNA’s would feel comfortable asking them. To me these questions are worthy of being asked, and answers should be frank and honest. A negative response, as in “I don’t know” or “Why are you concerned with such things” would lead me to believe this facility doesn’t respect the aides who are employed there.

Most of work because we have to. We need a paycheck. But we love to help people so we choose this special line of work- nursing. The hands on care giver is the least respected, lowest paid person in the health care field. The one thing we can do for ourselves is work for facilities that indeed respect US through actions and words and policies. Since most of us spend a great deal of our time at work, why not work for the facility that treats us best? We can find this place through the right people and by asking the right questions. We can raise the standards we’re willing to work by!

ASIDES: Enough Already, With The Cell Phone

Cell phones are a wonderful addition to our lives. Communicating quickly with family and friends is a good thing most the time.

However, at work, in nursing, they are fast becoming a nuance. I see many nurses and aides who constantly check their cells for messages; or who are texting someone. Right in the middle of patient care! Or a residents’ mealtime!

Message to CNA’s:
Cell phones no longer interfere with most medical equipment. This is no excuse to use them while we are working. Surely any message can wait until a break. Nothing is more aggravating than watching your co-worker drop everything they’re doing to TEXT someone. Or to check a call. Not only is this aggravating, it’s very unprofessional.

Message to management:
What is YOUR policy on this? Where I work we are not allowed to carry our cells with us on the units. Equipment problems are not the stated reason either. Rather, common courtesy and professionalism are cited. Cell phones take time and attention away from resident care; residents and co workers perceive the use of cell phones during care as rude (IT IS!). Staff are allowed to use their cells on their breaks only, and in the break room only- not in patient care areas.

ASIDES: Oooh That Smell

If you’re a smoker, you’ll want to read this article. If you’re not, you should still read this.

At work smokers take their breaks and usually light up. Having that cigarette often relaxes us and keeps us even keeled. Many facilities are now smoke free- no smoking on the actual grounds of the property or within certain distances from the buildings. BUT most allow staff to smoke inside their vehicles. This is a privilege and not a right. Be grateful when you can.

One thing is noticed often by smokers and non smokers alike: After you have smoked, YOU SMELL like cigarettes. It’s the natural course of events here. The smell gets in your hair, your uniform, your skin. And your breath. It’s not a nice thing to smell.

Do yourself and everyone else a favor: Clean up after a smoke…when you come back inside, WASH your hands first of all. Then brush your teeth or at least use some mints or gum. Some aides I know also do a little more: They use the hand gels to help rid their body of the scent. How? They simply rub the gel in their hands and before it dries they quickly rub it all over their arms, neck and uniform top. It works wonders. One aide actually briefly runs her gel soaked fingers through her hair as well.

Other aides wash up and then use a lotion with a light scent, to cover up the odor. At a local nursing home down the road from me the staff use the unscented Febreeze-like spray over themselves- this is probably the best thing I have seen yet, that really works.

Residents and patients can get nauseated when they smell cigarette odors. Others may become agitated because they WANT to smoke but cannot. Either way, it’s gross and no one likes the smell. So be considerate of others.

ASIDES: Answering Phones

It would seen pretty simple- at work the phone rings as you’re walking by the nurse station. The unit secretary isn’t there. You answer it. You’re polite and take messages, right?

Let’s have a better look at this. When the phone rings we should make every effort to answer it as soon as possible. This doesn’t mean we get up and leave whatever it is we are doing at the moment. It does mean, if we’re close to the phone and NOT busy with resident duties we answer it.

A good greeting goes a long way when it comes to phone calls. It shows respect and dignity towards the caller.
When taking a call, take a deep breath AND SMILE before picking up the phone. The smile will come across to the caller.

“Hello –ABC Unit, this is Suzy speaking. How can I help you?”
Such a simple sentence. Yet a lot of information is shared with the caller.

The unit is identified.
The name of the staff answering the phone is known.
And an offer to help is made.

Many times the call is for a nurse who is often busy and not anywhere near the phone. Instead of running all over the unit to locate the nurse, and keeping the caller on hold, or waiting, take a message. Ask who is calling; a phone number where they can be reached, and ask for a simple description of what the caller needs/wants.

I don’t waste my time looking for people who get calls. No matter what I always run into them eventually and usually within the hour of a call. Depending upon the policy of your employer, you may simply leave a note near the phone with calls received and it is up to staff to check. At my work we have a notebook next to the phone where messages are recorded, and it is UP to EVERY staff to check this log for calls, INCLUDING the nurses. No one runs around looking for anyone.

There are times though, when a call is very important. Anytime a call is from a spouse, a child, a babysitter, a school, a hospital or parent of a staff, we should take a message and LOOK for and relay the message to the staff. Usually these calls are of an emergency nature. Every effort must be made to get the message to the staff who the call was for. It is up to management to vet out habitual family calls during work hours that are petty and non-emergency in nature. At the time these calls come in however, each of us cannot decipher this.