Posted: 5/18/2018 5:17:13 PM

When All Seems Lost: Hopelessness in Patients

Perhaps one of the most challenging patient interactions nursing assistants face is providing care to someone who has lost all hope.

Patients give up for many reasons, but this primarily happens because treatments have not improved their health as they expected or because their diagnosis reveals that a cure is impossible. Despair can also be triggered by a permanent loss of a bodily function or even a loved one. Repeated failed attempts to get better and overwhelming grief or frustration can make them abandon hope and give up on life altogether.

For these patients, every single day is the same, mostly full of pain, discomfort, and disappointment. They feel that they are of no use or help to anyone and they consider themselves a burden to others.

Why is caring for a hopeless patient more challenging?

Nursing assistants must realize that caring for a hopeless patient is like fighting a battle whose leader has already surrendered, or like watering a withering plant. You want to keep going, but they won't take another step further. Seeing a patient in despair, refusing to move forward, is devastating and heart-breaking.

Hopelessness can strike anyone, but some patients tend to experience it more often. Those in hospice, nursing homes, cancer institutions, and intensive care units, or those in recovery rooms, experience many reasons that cause them to decide to stop taking steps to get better.

Why should hopelessness be addressed?

Studies show that when a patient gives up on their situation, they recover slower, get sicker, or die sooner than those who are steadfast in their efforts. Hopelessness is hard to prevent, but CNAs and other healthcare workers must never stop trying.

What are signs that your patient might be losing hope?

1. Saying these phrases:

a. “What’s the use?”
b. “No more treatments!”
c. “I just don’t care anymore. I give up.”
d. “Nothing good would come out of it anyway.”

2. Appearing sad

3. Refusing food, water, medications, treatments

4. Withdrawal from friends, family, and staff

5. Loss of appetite

6. Trouble sleeping, whether lack of sleep or spending enough time in bed but feeling tired

7. Mood changes

8. Feeling trapped in a situation or that nothing can be done, whatever the effort

9. Feeling that nothing good will happen or that life is not worth living anymore

When CNAs see these signs and symptoms in a patient, what’s the best thing to do?

If you observe any symptoms of hopelessness in a patient, here are some tips on how to help them cope with their negative emotions:

1. Be kind, compassionate, and non-judgmental.

Patients who are in despair about their situation experience an overwhelming sense of hopelessness, and CNAs and other healthcare workers find themselves having a hard time connecting with them.

The last thing these patients need is someone who passes judgment on them for having those feelings. Acknowledge that the patient is at their lowest moment and be sensitive to their situation.

2. Let them express their feelings.

When a patient’s words reflect their lack of motivation to go on, encourage a conversation where they can continue to voice how they feel, being careful not to give your personal opinion on the matter. Avoid using phrases like, “If I were you, I would . . .” or, “There’s a reason for everything.”

3. Show your support by conveying your presence.

Sometimes, saying nothing means a lot when providing care. Silence and just sitting beside patients while gently holding their hands can do more than giving them a list of things to do to overcome their hopelessness.

4. Be positive, but do not try to convince them to be happy or force them to be hopeful.

When patients lose hope, they are in emotional turmoil, and persuading them to smile or be happy is insensitive. Just let your positive vibes show that you sincerely care and that you want to do your best for them.

Posted: 5/11/2018 2:12:29 PM

Unlikely Places Germs Hide: Contamination in Hospitals and Nursing Homes


They are deadly, unrelenting, and become more difficult to kill by the day. We never see them with the naked eye, but we know they are there (and everywhere), because patients get new infections while receiving hospital treatment or being cared for in nursing homes.

Here’s the proof: According to the Centers for Disease Control and Prevention (CDC), about 648,000 patients every year acquire an infection during their hospital stay, and about 75,000 of these patients die. This fact only means that the bugs' existence in so-called unlikely places is real.

Nursing assistants play an important role in preventing the spread of microorganisms as they move between clean and dirty places in their day-to-day work. If you are a CNA, let the following be an eye-opener for you.

It is common knowledge that the ground and toilet are teeming with bad microorganisms. But in hospitals and nursing homes, nursing assistants should also be careful about other places germs hide:

1. Water

Where there’s moisture, microorganisms tend to multiply.

There are bacteria called Legionella that causes Legionnaire’s disease, a pneumonia-like illness where patients experience cough, shortness of breath, high fever, muscle pains, and headaches. Legionellae tend to grow in warm water and are spread through inhaled mist or contaminated water that accidentally gets into the lungs.

According to an article from the CDC regarding Legionairre's disease, nursing assistants should think about these places where legionella bacteria are found:

a. Shower rooms and sinks
b. Cooling towers or structures that spray mist to cool the air
c. Hot tubs that remain undrained after each use
d. Indoor and outdoor fountains and other water features
e. Hot water tanks and heaters
f. Large plumbing systems

Fungi, such as those that cause fusariosis, an opportunistic mold infection, were also found in showerheads, sink drains, and sink faucet aerators.

Softened water that is used in hemodialysis, where a patient's blood is run through a machine to be filtered, also tend to harbor bacteria.

In some cases, ice and ice machines, flower vases, and even children's water gun toys have been found to be contaminated.

2. Touch surfaces

Healthcare workers such as nurses and CNAs often touch patients as a normal part of their daily routine, moving between places within the hospital or nursing homes. Patients and staff continually touch common surfaces. These surfaces become breeding grounds for microorganisms:

a. Bedside table
b. Call buttons
c. Bed rails
d. Door handles
e. Hard charts
f. Nurse station desktops
g. Countertops
h. Computer keyboards
i. Telephones

3. Shared equipment

When instruments or pieces of equipment are taken from one patient to another, germs can transfer that way, too. As a CNA, you are using digital tympanic thermometers, adhesive tapes, tape measures, and other supplies that are carried around, which are not regularly decontaminated. They are also potential carriers of harmful germs.

Microorganisms easily spread in healthcare settings because patients come and go frequently, and their germs are passed on as healthcare workers take turns caring for them. Without practicing infection control, these bacteria, viruses, and fungi spread and multiply, causing infections in patients who have weak immune systems. CNAs must not be complacent in thinking that “looking clean” means germ-free. On the contrary, they should be aware of seemingly harmless ways infectious microorganisms can be acquired.

Posted: 5/4/2018 9:54:09 AM

How to Build Strong Interprofessional Relationships as Nursing Assistants

Interprofessional relationships are formed in the healthcare setting when a group of healthcare workers collaborate with each other and provide services through a team-based approach. A team can consist of physicians, nurses, therapists, pharmacists, certified nursing assistants, and other disciplines.

How important is it to have healthy interprofessional relationships within healthcare organizations?

In terms of patient care, the ultimate goal is to achieve positive health outcomes. The team makes sure that the patient receives the best possible care and is free from further injury. On a more personal note, CNAs who spend 8 to 10 hours per day at work build strong connections with their colleagues as they target the same goals each day. That's roughly a third of their life as a CNA!

So, yes, interprofessional relationships matter and nursing assistants can be proactive in making sure that they are part of a productive and efficient team by following these simple tips:

1. Remember the basics.

Be honest and show respect. Sometimes, when the going gets tough at work, people lose their cool and become disrespectful and egotistic. Always keep yourself in check and do not be a part of this negative culture.

As part of building interprofessional relationships, seek to improve on how you relate to your colleagues. Treat them as unique human beings and let go of minor annoyances. When it comes to patient care, be honest and speak up, especially when patient safety is at stake.

2. Be the likable version of you.

Some say that it’s important to be nice to people at work. Others say being nice is too people-pleasing and not healthy. They prefer to just be themselves. Which of the two approaches will build strong interpersonal relationships?

Let's take the strengths from both sides: Be the likable version of you. Everyone has their lighter side. Show the best you. Keep your cool, and be cheerful, compassionate, and kind.

3. Actively participate in patient huddles.

During rounds at the beginning of the shift, or at any time the healthcare team gathers to discuss pertinent patient care, be an active participant. Listen well and, most importantly, contribute to the discussion.

When you feel that your voice is too small to matter, overcome that hesitation and be confident that all contributions paint a clearer picture of patient care and can lead to a better understanding of the treatment plan. Do not shy away from asking questions and for clarification.

4. Show appreciation for your colleagues’ efforts.

Make someone's day at work extra special (and less stressed) by lifting their spirits. Nothing eases a tired mind like receiving appreciative comments from co-workers. Practicing appreciation for others fosters a positive culture and builds strong interprofessional relationships.

5. Do your tasks individually, but think and plan as part of a team.

The care plan is great teamwork in writing. Use it as your ultimate guide when you provide care. Work closely with your nurse and consult with them over any confusing information.

6. Find a common interest outside of work.

Be it a charity drive, volunteering, or a being a part of a dog-lover group, connect with your colleagues in more personal ways. Friendships at work can also boost team efforts.

Strong interprofessional relationships enhance patient care and build a positive work culture. It gives each role meaningful purpose in the achievement of goals. Nursing assistants are a part of the healthcare team, and the connections they build are valuable.

Posted: 4/27/2018 3:17:20 PM

Should You Present Reality or Use Validation When Caring for Patients with Advanced Dementia?

Caring for patients with dementia causes you to wonder how the changes in your patient's brain can make them forget what has just happened or live in the past like they were their younger self.

In the advanced stages of dementia, the amount of time a patient believes has passed varies. Their present reality could be 5, 10, or 50 years ago, and the shift could happen at any moment.

For example, patients often insist on going home even if they are home, or they may be hurrying to go out and drive because their son, who is an adult in reality, needs to be picked up from the childcare center.

As a certified nursing assistant, you may have been in a similar situation. Did you present your patient with reality, by telling them that Jack is grown and that the patient has not been driving for years?

If you told the patient, “No, that is not true,” and pointed them back to reality, chances are your patient burst into tears, became angry or hostile, or withdrew from human connection altogether. If you are wondering why the patient reacted as negatively as they did, here’s a simple explanation:

The patient has no control over the changes happening to them, and they are not aware of this fact. They are trying to resolve unfinished issues of the past while finding meaning in life at the same time. They also want to restore balance and compensate for a lost bodily function or a loved one. Sometimes, it is their way of preserving their dignity and self-worth. Whatever the reason is, the patient's feelings must be acknowledged, and this is where validation helps.

What is validation, and how can it help confused patients in the advanced stages of dementia?

Validation is agreeing with a patient’s “reality” to reduce their anxiety and prevent stressing them unnecessarily. It focuses on empathy and listening, and also provides them with a means to express themselves as well as reminisce. It works with the idea that people are unique and valuable, and as such must be treated and respected as individuals.

A patient who says, “I want to go home,” may be feeling scared or tired, so they look for the comfort and safety of their home of 60 years ago. To use the validation technique, a CNA can ask:

“Are you uncomfortable?”
“Are you cold?”
“Do you miss home?”
“Tell me about Des Moines.”

If they insist on picking up little Jack from daycare, the nursing assistant can use validation by saying, "Ok, I’ll go with you, but let’s wait for a few minutes because I have to finish making the bed in the other room. Can you tell me about your son, Jack?”

Using validation is avoiding confronting the patient and arguing with them. It lessens their pain instead of adding to it.

So, does validation always work? Most of the time it will, but there will be moments when the plea to go home or meet with a relative from afar persists. But remember that you have still empathized with your patient and gave them worth as a person.

Posted: 4/21/2018 8:55:19 AM

When Calling the Authorities Means Saving a Patient’s Life or Preserving Their Dignity

One of the most remarkable roles of a certified nursing assistant is being a patient advocate, in other words, acting in the patient's best interest and ensuring their safety and well-being. Like a plot twist in a novel, sometimes healthcare facilities such as hospitals become a setting of abuse and other similar cases, requiring a CNA to do what’s necessary and call the proper authorities for help.

Nursing assistants must keep a keen eye and have the guts to the make very important call to report a problem or ask for assistance. Refer to the Q and A section below to know when to contact the right agency.

1. Question - What cases should be reported to the proper authorities?

Answer - CNAs must report to the proper authorities if they suspect or witness the following: abuse or neglect of children, older people, mentally ill or developmentally disabled persons, long-term care facility residents; patients who are suspected victims of human trafficking; and the use of alcohol or illicit drugs by healthcare workers while providing direct care to patients or those driving a vehicle that transports a patient.

2. Question - When should I call the police?

Answer - When there is a criminal act such as rape, physical assault, or battery, or if the unlawful act results in an immediate, life-threatening situation, calling 9-1-1 or law enforcement is mandatory.

3. Question - I have a school-aged patient who confided to me that every time that she acts like a ‘bad girl’ her mother would beat her, make her skip dinner, and keep her in her room for hours. Do I need proof before I report?

Answer - No, you don't need concrete proof before reporting. Contact local Child Protective Services (CPS) as long as you have a strong reason to believe that a young patient is harmed.

Child abuse is inflicting physical, sexual, or mental harm on a patient below 18 years of age. Child neglect is failing to meet the child's needs (food, clothing, shelter, education, or healthcare), abandonment, or the condoning of abusive acts done on the child. When you suspect child abuse, follow institutional policies and state laws regarding reporting procedures.

4. Question - I have reason to believe that my elderly patient is being abused and exploited by her daughter by controlling her finances, like signing checks for her. Which agency should I call?

Answer -Elder financial abuse is the illegal or improper use of an elder’s money. If you have strong reason to believe that any form of elder abuse is happening (such as financial exploitation), inform your institution’s point person and follow agency policies. The process usually involves contacting Adult Protective Services or calling the local elder abuse hotline.

5. Question - I saw a colleague post an unconscious patient's photo online. Is a HIPAA violation reportable?

Answer - Yes. A HIPAA violation is a federal offense where a person or an institution breached the confidentiality of a patient’s health records and information. If a colleague breached the HIPAA rule, report the incident to the supervisor, your organization’s HIPAA compliance or Privacy Officer, who would file the report to the Office of Civil Rights (OCR). If the breach was committed by the institution itself, you may bypass the officer and directly contact the OCR.

6. Question - Which cases of CNA/nurse practices should be reported to the appropriate regulating body?

Answer - Any situation where a fellow CNA or a nurse’s practices or behavior at work is unsafe, incompetent, or unethical, which can put a client at risk for injury.

Examples of these circumstances are: providing care while under the influence of illegal drugs or alcohol, practicing with a fraudulent license, misconduct, performing tasks beyond their scope of practice, falsifying information and documentation, and verbal, physical, mental, or sexual abuse of clients.

For RNs and LPNs, the regulating body to contact is the state board of nursing. For CNAs and other unlicensed personnel, contact the state’s Health and Human Services, Public Health, and in some states, the board of nursing.

CNAs face a dilemma when confronted with situations where there is a need to report to the proper authorities. It is therefore essential to document observations properly and always refer to institutional policies and state laws regarding reporting procedures. Many of these cases require mandatory reporting, and failure to do so may have legal consequences. Above all, remember to prioritize the patient's safety and well-being.

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