Archive for the 'Skills' Category

Earlier Patti shared an article for nursing home management to pay attention:
Keeping Unions Out: It’s Now or Never

The article she linked to implores management to take action to become more employee-friendly. There are some issues that management might not be able to change. Health insurance for staff is a BIG issue. Affordable and practical insurance is needed.

SEIU’s Andy Stern is calling on US to help him advocate for this important need. He will be testifying before Congress and will be sharing worker stories about health insurance, the lack of or inability to afford.

When I think about what’s wrong with health care, I think of Jacqueline.

It’s one thing to talk about our broken health care system, but Jacqueline lives it every day. For 19 years, she’s worked as a nursing home CNA in Wisconsin. Short staffing in her unit means skipped treatments and longer waits for her patients. And a lack of equipment and supplies puts the strain on the entire facility when things get busy.

Unbelievably, while Jacqueline spends her life providing care for her patients, she can’t afford it for herself or her family. The coverage her employer offers costs too much on her salary.

This has to stop. Congress needs to hear how this crisis is affecting real people. Share your story: http://action.seiu.org/page/s/memberstories

Next week, I’m going to Capitol Hill for a Senate roundtable on fixing health care. It’s one of three roundtables that Senator Max Baucus is holding to hammer out the final details of a health reform bill.

If you’ve got a story to tell, now is the time to do it. Do you have health insurance? If not, why not? Does your employer offer it? Is it too expensive for you to afford? Have you held back on seeing a doctor or other health care needs due to costs? Let Andy know.

Parts 1-4.

Video 3 and 4 here, from the series.

I found these videos at YouTube and thought it would be a good resource. I’m including them here in two posts…

Transfer Techniques p.1 of 4

Video Two from the series.

Transfer Techniques p.2 of 4

Two resources for CNA’s and other direct care workers for learning.

Self study articles from the state of Oregon’s Community Nursing Tools site; these are all in PDF:
Aspiration
Challenging behaviors – Part 1
Challenging behaviors – Part 2
Constipation
Dehydration
Documentation guidelines
Fall prevention
Infection control
Influenza
Medical terminology – Part 1
Medical terminology – Part 2
Medication safety
Pain management
Pneumonia
Quality care – without restraints
Your body – changes through the years

And this, ABUSE PREVENTION TRAININGS, again, in PDF. Facilitators Guides for each module are available as well.
Module 1: Person-Centered Care
Module 2: Identifying Potential Signs of Abuse & Neglect
Module 3: Abuse and Neglect – Defining & Reporting
Module 4: Stress Triggers and Trigger Busters – Life Influences
Module 5: Stress Triggers and Trigger Busters – Job Challenges
Module 6: Stress Triggers and Trigger Busters – Client Behaviors
Module 7: Stress Trigger Signals
Module 8: Active Listening
Module 9: De-escalation – Conflict Resolution
Module 10: De-escalation – Client Behaviors
Module 11: When Abuse Happens
Module 12: Active Communication – Learning Circle

Check with your supervisors first, but note CPR guild lines are changing.

NEW YORK (AP) – You can skip the mouth-to-mouth breathing and just press on the chest to save a life. In a major change, the American Heart Association said Monday that hands-only CPR – rapid, deep presses on the victim’s chest until help arrives – works just as well as standard CPR for sudden cardiac arrest in adults.

Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.

“You only have to do two things. Call 911 and push hard and fast on the middle of the person’s chest,” said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.

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.

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.

Continuing on the theme of online resources for CNA’s, Patti gathered several links to sites that offer continuing education opportunities. These are not free and pricing is a bit prohibitive for individual CNA’s. Facilities can certainly afford some of this though.

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The Dept. of Veterans Affairs has an excellent online tool kit for a FALLS PREVENTION program. It’s available for free, and full of good ideas. CNA’s are a vital part of their program!

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The National Association of Health Care Assistants has been around for many years; it’s an excellent CNA advocacy group and offers individual and facility memberships. Through this group, CNA’s have an opportunity to engage in a professional course designed to further their knowledge and skills with caring for the elderly.

Description
The Geriatric Care Specialist Program is a 10-module correspondence study course for certified nursing assistants. This course is designed to assist nursing assistants with enhancing their knowledge and skills in the field of geriatric care. The certification expires annually. To maintain certification, submit annual verification that 12 hours of in-service have been completed, along with $5 renewal fee.

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Syllabus

Module One
Anatomy and Physiology

Module Two
Age Related Disorders

Module Three
Geriatric Urinary Incontinence

Module Four
Pressure Ulcers, Wound Healing, and Skin Care

Module Five
Caring for Residents with Dementia

Module Six
Psycho-Social Needs of the Geriatric Resident

Module Seven
Communicating in Long Term Care

Module Eight
Restorative Care

Module Nine
Observation, Reporting, and Documentation

Module Ten
Survey Process and Federal Regulations
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Go HERE for more details.