Posted: 8/7/2020 11:39:22 AM

When Fear Grips You During This Pandemic

“Fear is a reaction. Courage is a decision.” - Sir Winston Churchill

This is the first line of text in a recent journal article entitled “Fighting fear in healthcare workers during the COVID-19 pandemic”. As terror spreads among workers in the health sector because of the raging SARS-Cov-2 infection, caring for patients has become even more challenging for healthcare staff.

According to the Centers for Disease Control and Prevention (CDC), pandemics can cause severe stress that can affect one’s physical and mental health. It can cause fear of catching the virus, being sick, and eventually giving it to your loved ones. There is also great concern over continuously providing care even with a lack of resources, such as when there is a shortage of Personal Protective Equipment (PPE). Stigma, which is the negative way people view a frontline worker who potentially has the virus, is another big stressor.

Overwhelming fear and anxiety can cause strong emotions, especially if you’ve seen loved ones or patients get sick or die because of COVID-19. If you find yourself crying, breaking down, and utterly scared, and you feel that you want to give up your job as a CNA, it is perfectly normal. It only takes a little chat with your colleagues to know that you are not alone.

Take a moment to yourself. Sit back and seriously attend to your thoughts and feelings before it can affect your job and risk your safety and that of your patient’s. Here are some ways to help you cope:

1. Acknowledge your feelings.

Your wretched emotional state during this pandemic is valid. Beating yourself up with guilt when you feel scared will only make things worse because it can distract you from safe patient care.

2. Assure yourself that you can handle this type of crisis.

Getting certified as a nursing assistant means that you understand the risk of being exposed to certain diseases as you care for patients. Also, your license is a reminder that your education and training has prepared you to avoid being infected and passing on the virus to others. By strictly following infection control protocols, you can safely carry on with patient care.

3. Ramp up your infection control habits.

This is not the time to be relaxed on handwashing and the proper use of PPEs. COVID-19 is highly transmissible. The main problem here is that the enemy is invisible so it is better to assume that the virus could be anywhere. Be on your guard at all times. Mind the way you wash your hands and what you touch afterward. Don't forget to wear a mask and other PPEs as applicable when seeing patients. Maintain social distancing. Avoid unnecessary social interaction and always follow agency policies for infection control to the dot.

4. Know that your service is invaluable and can save lives.

The COVID-19 pandemic is cruel to human lives and being in the frontlines doing patient care is considered heroic. You are instrumental in keeping the enemy at bay. Your help is precious and is greatly appreciated.

5. Take a break from news and social media posts that feature frightening COVID-19-related sickness and deaths.

Instead, be inspired by those who have recovered. Be encouraged by stories about the dedication of other frontline workers. Read about ways to boost your immune system, such as the benefits of a good diet and adequate hydration, and then promise to love yourself more.

6. Find creative ways to interact with your loved ones especially if you have chosen to or are required to isolate yourself.

The harsh part of fighting this contagion is that it may be necessary for you to be temporarily separated from your family to prevent transmission. Thankfully, there are now many ways to reconnect with them through technology. With video calls, for example, you’ll be able to see and talk to your loved ones without being physically near them.

7. Seek help.

This fight is not yours alone and there are many ways to find support. The CDC has a list of contact numbers that you can reach should you need someone to talk to in this crisis.

When fear grips you and your desire to help, remember that courage is not the absence of fear, but rather, it is merely choosing to move forward even if the road ahead becomes more frightening. Be proud of yourself as a CNA because you are indeed a hero in these uncertain times!

Posted: 7/31/2020 12:09:13 PM

How to Cope with Overly Difficult Patients

From time to time, nursing assistants encounter difficult patients, and one of the hardest to deal with is the demanding one. Demanding patients want you on your toes all the time and for themselves alone. They give orders that are either very difficult to do or impossible to perform given your time and effort. They want you to stay preoccupied even after your duty hours or make you do things beyond your role as a nursing assistant. Even the most seasoned CNAs find it very challenging to care for these patients.

Here are some tips to help make your work a lot easier when caring for patients with unrealistic demands:

1. Be consistent and firm.

Demanding patients can become relentless if they learn how to manipulate you to have their way.

Unrealistic demands that are unmet usually lead to negative emotions and behaviors in the patient. They can easily become angry, frustrated, and aggressive, which is another problem in the making. Be consistent in things that can and cannot be allowed. Giving in to their unworkable demands encourages them to repeat their manipulative behavior.

2. Try to meet them halfway.

Rather than being pressured to say 'yes' to the patient, you may try to compromise. If in any case that you cannot meet their demands, tell the patient what you can do for them instead. If they want four things at the same time, and you can only deliver two, tell them which two things you can do for them. This way, they do not feel that they have been ignored and completely turned down.

3. Offer choices.

Giving alternatives is another workaround in this situation. A patient may want a certain type of branded food product. You can offer them options from what's available. This way, their needs are still met.

4. Set boundaries.

Drawing the line is equally important when dealing with demanding patients. They can ask you to come during your day off or order you to run errands for them that are not part of your scope of practice as a nursing assistant. Politely but firmly decline and briefly explain that you will do your best to help them within the boundaries of your role as a CNA.

5. Don't take risks that can endanger your career.

Some patients can be so insistent, that CNAs become compelled to oblige even if it breaks rules and regulations. Never ever trade a temporary tension relief for your license. Always stay in the safe zone.

6. Add in more empathy.

Being on a sickbed or being dependent on others for some aspect of one's health is a big stressor. One way for difficult patients to relieve such stress is by trying to meet their needs in their own standards, sometimes at the expense of the staff. They may act aggressively and lash out at the people around them. Try to be more understanding and kind however difficult this may seem.

7. Control your emotions.

Patients who are overbearing with their needs and wants tend to be rude at the same time. And as such, staff who interact with them feel disrespected and likely to react unprofessionally. It helps to maintain your calm and still be compassionate.

8. Work on your communication skills.

An assertive and honest way of communicating with the demanding patient can help relay your message without appearing uncaring. Although at times it feels like your voice is too weak to be heard, remain dignified, and hold your ground by using a gentle but firm tone of voice when talking to the patient.

9. Ask for help.

If all else fails, consider asking for support from your nurse or nurse manager, who can speak with the patient on your behalf. An authority figure can help pacify the patient and reinforce boundaries.

Dealing with patients who have unrealistic demands can put a strain on a CNA's desire to help. This is one of the challenges of the job, which in time, can give you a rich experience and make your work a lot more rewarding.

Posted: 7/24/2020 10:52:41 AM

The Covid-19 Pandemic is a Stark Reminder that Hand Hygiene is a Must

Using our hands as we work is one of the most common ways to spread deadly microorganisms, especially if we relax on the golden rules of hand hygiene. Even with frequent campaigns that promote handwashing, caregivers sometimes become complacent and skip this very important procedure.

Covid-19, the novel disease that caused the ongoing pandemic, is very contagious but there are several ways that are proven effective in reducing the rate of infection. One is through hand hygiene. Yes, it cannot be stressed enough that frequent cleaning of the hands is essential in curbing the infection, which in turn, can save lives.

Since the first case of Covid-19 in the US earlier this year, health organizations have been particularly strict with hand hygiene protocols. This most stringent requirement is necessary because SARS-CoV-2, the virus that causes Covid-19, is primarily spread through small droplets that come out of the patient's lungs and nasal passages as they breathe, sneeze, or cough. These droplets stick to surfaces and thrive for hours and even days. Infected individuals can also spread the virus as they unknowingly touch their faces, or cover their mouths when they cough and sneeze and then proceed to handle surfaces as they go about their day. In both cases, SARS-CoV-2 gets transmitted from person to person and the cycle of infection continues.

There are two ways to practice hand hygiene as a caregiver. One is through thorough handwashing using soap and water. Here are some FAQs for you:

1. Why is handwashing effective in reducing the spread of SARS-CoV-2?

Using soap, scrubbing the hands, and rinsing with running water kills and physically removes the microorganisms.

2. Do we need antibacterial soap for handwashing?

No. Any soap will do. Remember that SARS-CoV-2 is a virus and its fatty coating is easily destroyed by the grease-cutting properties of soap.

3. Do we wash with hot or cold water?

The temperature of water for washing and rinsing is not much of an issue. What is more important is how the hands are washed. For thorough cleaning, all surfaces including the palms, between fingers and the fingertips, the back of the hands, and the areas beyond the wrists must be scrubbed and then rinsed with running water. The procedure for proper handwashing takes about 20-30 seconds. If it took less than 20 seconds to clean your hands, it only means you missed some spots or did not effectively remove microorganisms. After washing, use a tissue paper to turn off the tap and dispose of the used tissue properly in the trash.

4. Is it important to dry the hands after washing?

Yes. Microorganisms thrive better in moist places, so drying the hands with a paper towel is important.

5. How often should I wash my hands?

Frequency depends on what you intend to do. The better question to ask is when to clean your hands. Perform handwashing before and after patient care procedures. No touching of the face and nose during this time, too. Do it also upon entering your workstation and immediately upon going home. We wary of coming in contact with high-touch surfaces such as doorknobs and other handles, the toilet flush, bed rails, bed frames, moveable lamps; meal trays, bedside table, equipment such as blood-pressure cuffs, handphones, and money.

6. If handwashing is too inconvenient, what else can I do to practice hand hygiene?

The other way of maintaining hand hygiene is through the use of hand sanitizers, so always have one to carry with you. As an alternative, you can also use 70% isopropyl or ethyl alcohol. Scrub the sanitizer or alcohol thoroughly all over your hands and allow to air-dry. Do not use a paper towel to dry.

If you are providing direct patient care, always strictly follow institutional policies on hand hygiene especially when using personal protective equipment.

The effects of Covid-19 on the nation is devastating, but the world will keep on turning no matter what. For this stark reality, front-liners like caregivers must do whatever it takes to carry on helping patients while protecting themselves against this novel disease.

Posted: 7/7/2020 11:34:41 AM

Bullying in the Workplace

It doesn’t take much effort to make a google search about personal experiences of bullying in healthcare. The search will churn out several hundreds of pages. Reading each account is discouraging to the point of horrifying.

Here is some trivia about workplace bullying in general and in healthcare:

In the US, the prevalence of bullying in the workplace is 72%

About 37 million workers in the US have experienced bullying

More than half of bullies are a rank higher

72% of employers deny or discount that bullying is happening in their institution

One in every five of registered nurses and nursing students have been physically assaulted

More than half of registered nurses and nursing students experience verbal abuse in a given year

The most common victims of violent injuries are psychiatric aides, nursing assistants, and registered nurses

The information above tells us one story: Nursing assistants are in the bottom of the ‘food chain,' and there is a big chance that they will either be victims of bullying or will be a witness to bullying behavior.

Here are forms of bullying to watch out for:

1. Signs of verbal abuse are yelling, criticizing, and talking negatively about a co-worker within hearing distance

2. Deliberately damaging another employee’s work or reputation

3. Pushing and shoving and other signs of physical assault

4. Overworking a colleague and setting unrealistic goals for them

5. Highlighting mistakes and withholding due recognition

6. Exclusion or isolation

7. Mobbing

8. Intimidation or gossip by mouth or through emails, texts, or social media

9. Not giving due credit

10. Withholding valuable information

If you have experienced any of the above as a victim, here’s what you can do:

- Examine the situation with objectivity. Is it because you are being too sensitive? Does it happen only once in a while? Is it possible to just turn a deaf ear to it when it happens? If you answer no to these questions, then follow the next steps.

- You have to have a word for the aggressive behavior. Call it bullying, harassment, or lateral violence to legitimize your experience. It confirms that bullying is indeed happening to you.

- Seek behavioral services and support. Your experience as a bully target can have life-changing consequences, probably for the worse.

- Recognize the effects of bullying on you. Being a target of bullying can cause you much physical, emotional, mental and even financial stress.

- Use other means to get the bully’s attention away from you. Try gratitude and compliments for starters. Maybe a ‘Thank you very much for your help’ can dissipate the hostile looks. Do not overdo it though.

- Take time to off to heal and recharge if needed. The stresses brought about by bullying can take their toll.

- Confront the bully in private. It may be a good idea to have a colleague with you to support you. Take this chance rather than letting the situation continue. The idea is to help stop the vicious cycle of bullying.

If all else fails:

If you decide to make a brave stand and take this several steps further, you have to prepare for the worst. The result may or may not turn in your favor. In any case, be prepared to be reassigned to a new department or change employment altogether.

Seek institutional policies and follow protocol on how to handle these situations. Bigger institutions have an officer in charge to handle conflicts and hostile behaviors.

When you are bringing the issue up to HR or higher management, be careful not to tell a story of emotional torments because there is a possibility that your story may be interpreted as just an over-reaction. The Workplace Bullying Institute recommends making a business case. Present how the person and the behavior are lowering morale and productivity.

Bullying is a problem that has plagued healthcare for many years. It is quite disheartening to know that as we care for patients, there is much incivility happening in the background. The unending loop of bullying must stop. Although at the individual level the fight is difficult, the higher management must be pro-actively involved to impose a ‘zero-tolerance’ policy and take other concrete steps to address bullying.

Posted: 6/15/2020 4:17:01 PM

How to Protect Your Patients and Your CNA License

The revocation of their license is one of the harshest consequences in a CNA’s career. When you are stripped of your license, you’re technically not a CNA anymore and cannot work as one. Other than the headaches and heartaches you endured before the Board of Nursing (BON) arrived at this decision, the future becomes not so promising, too. Since it is a symbol of safe practice and trustworthiness, a nursing assistant who lost their license looks like they’ve let those good qualities go.

Once your CNA license is revoked, it will be hard to convince the certifying Board of Nursing that you did not mean to cause harm or damage, or that the unfortunate event does not reflect you as a person.

And they rarely reinstate licenses. Most of the time, the decision is final or you need the help of a lawyer. It’s also difficult to re-enter the nursing field due to your marred work history. It will be challenging to convince future employers that what happened was either an accident or single occurrence. “I’m sorry, it won’t happen again,” doesn’t cut it.

The consequences do not end there. Your ego, source of income, and other opportunities are damaged as well.

Of course, no one wants to end up in this situation and it doesn’t have to happen to you! Be aware of the following behaviors that can lead to the revocation of your license:

Lying, cheating, falsifying documents, or omitting vital information when applying or reapplying for certification - Dishonesty and falsification are grave offenses that can strip you of your license in a flash. These offenses mean two things: 1) You do not meet the minimum requirement to safely practice as a CNA, and 2) you intentionally deceived the certifying body, the Board of Nursing, and disregarded patient safety. Examples of this offense are providing false training documentation, getting licensed illegally, or failing to disclose previous criminal charges or prior disciplinary actions in your application or recertification.

Performing procedures beyond your scope of practice - Even if you’ve seen it done so many times, you think you can perform a procedure with your eyes closed, do not do it unless you are certified to do so.

Working under the influence of alcohol or illegal drugs - This precaution is for the obvious reason that patient safety is at stake when your brain is foggy because of mind-altering substances. Under the influence, your decision-making is faulty, so you are likely to make mistakes or cause accidents, prompting patient injury and potential legal problems for you and your employer.

Also, diversion, or stealing medications from a patient and using them yourself, is a serious offense. Be aware that you don't need to use illicit drugs to get into trouble. Mere possession of illegal substances can lead to the loss of your license as well as your job.

Mishandling patient information - "What happens in Vegas, stays in Vegas" can apply to your interactions with patients, too. Whatever happens with a patient should not be discussed with anyone unless they are part of the team that provides their direct care—even if the patient is famous or known to the person.

Never take pictures of patients without their consent or share their photos or information over social media. When you do, you don’t just disregard the patient's right to privacy, you can cause them great inconvenience and damage to their reputation.

Patient abuse - Every now and then, we hear horrific stories of CNAs who abuse their patients. Abuse is never right, whether you’re a CNA or not. This type of wrongdoing will not only strip you of your license but also put you in jail for a very long time.

Criminal acts - Intentionally harming patients or stealing from them are just some examples of crimes committed while working as a CNA, and they are sure ways to end your career as one.

Negligence leading to patient critical harm or death - Patients’ lives must be protected at all times and if you fail in this regard as a nursing assistant, it's like throwing away your license for good. Not all negligence cases lead to this consequence, but it is a likely scenario if a patient's legal counsel has strong evidence of your oversight. So, always keep patient safety a priority.

Every CNA license comes with pride in the fact that nursing assistants do awesome work caring for patients. It is proof of competence and safe practice. Treasure your hard work, career, and commitment to patients, and protect your license!

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