CAREGIVER BLOG - (CNA, STNA, PCA, HHA)

Posted: 9/17/2018 1:02:32 PM

Stop Brain Fog Before It Starts!

Brain Fog.



Before we define it, let’s describe it.

You probably experienced it yourself as a nursing assistant. Do you remember the last time you worked extra hours from the night shift and got just a few hours of sleep, only to be called in to cover the afternoon shift? You wake up, add an extra shot of espresso to get the boost you need and drag yourself to work.

At the beginning of the shift, you absent-mindedly smile at everyone you pass in the hallway, not paying attention to whether they are a coworker, acquaintance, or your best friend.

You join the patient huddle at the beginning of the shift, but absolutely nothing is registering. You desperately try to jot down points and tasks but you just can’t make sense of it. You tell yourself that you’ll catch up later, but you feel like you literally left your brain at home. You can't focus, your thoughts are cloudy, fuzzy, or worse, blank. You have difficulty finding solutions to simple problems, like forgetting what switch turns off which light.

What is brain fog?

According to Gayatri Devi, MD, a psychiatrist and neurologist at Lenox Hill Hospital in New York City, brain fog happens to people who are overworked, excessively multi-tasking, lack adequate sleep, or those trying to remember or analyze too much information.

If you experience a foggy head way too often and have other abnormal signs and symptoms, get yourself checked out. It could be a symptom of a medical condition such as lupus, multiple sclerosis, or fibromyalgia, whose manifestations are complex.

According to clinical psychologists, a person with brain fog will have fatigue, poor concentration, confusion, and difficulty performing tasks. In short, if you have a fuzzy head, your mind is not functioning as well as it should!
If you are working as a CNA and brain fog is slowing you down, here are some smart tips to manage:

1. Know the possible triggers and address the problem.

If the probable cause of your foggy head is not disease but stress, the common way to manage it is to take a break. With brain fog, your brain is in overdrive. Let your brain process, shut down, and reboot.

Catch up on sleep, but do not oversleep (ironically, oversleeping also causes brain fog).

If your tasks become overwhelming, stop a minute, prioritize, and cross off unimportant tasks from your to-do list. Learn to delegate and work with your team so that you do not feel burdened by overworking.

2. Whatever you do, do not commit a medical error.

Of course, making a mistake is often not a choice. And no one wants to be in this position, where an unclear mind results in compromised patient care and safety.

If you feel that you are so out-of-focus that you have trouble performing your tasks, it is better to stop and ask for help. Tell your nurse, validate information, perform self-evaluation, and double check everything.

3. Eat a healthy diet.

You skipped a meal because your schedule was pretty hectic. Bad idea . . .

Blood sugar is brain food, so working with low blood sugar is like running your car on empty—you just can't use some of the car’s features and risk stalling in the middle of the road.

It’s the same with brain fog caused by lack of food intake. The blood sugar you do have is used for more important functions for your survival, like breathing, blood pressure and such, and the allocation to process which switch turns the light on has to wait.

4. Keep yourself hydrated.

You should also be sure to drink enough liquids to enable brain processes. Adequate hydration is like oil in a machine’s gears. Dehydration equals mental fuzziness and worse. It’s that simple.

CNAs have a lot on their minds every day, and being overwhelmed can bring about a ripple effect, causing brain fog. Know when to take a break, and be humble enough to ask for help. Take care of yourself. Your job is not an easy one, so prevent common triggers. You don't have to experience brain fog (and risk of committing medical errors).


Posted: 9/10/2018 11:41:37 AM

Decontamination and the CNA: Working Against Microscopic Enemies

A clean environment is good for patient health, but because most patients have weakened immune systems, cleanliness is not enough. CNAs must perform decontamination at specified times to rid surfaces of harmful bacteria, viruses, and fungi that cause infections.



Harmful microorganisms abound in hospitals, nursing homes, and other health care settings, and these microscopic enemies come from different sources including from workers and patients alike. They cause hospital-acquired infections (HAI), or diseases contracted within the timeframe a patient was receiving care in a hospital.

If you hear about an outbreak with a fancy name like Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Acinetobacter baumannii, or Pseudomonas aeruginosa, this is a raging battle with bacteria that are very difficult to kill, even with the most powerful antibiotics. They also survive on surfaces for a long time, even after thorough cleaning and decontamination.

You see, the war with these invisible enemies is all too real!

Let’s begin by differentiating between cleaning and decontaminating.

CLEANING is a method for removing visible dirt such as dust, soil, oil, and food particles as well as the germs that come with these contaminants. It also involves keeping the environment free of clutter so that the surroundings look organized and spotless. It is an essential step before decontamination.

DECONTAMINATION, on the other hand, is a process of making materials or surfaces safe to be touched and handled. It is a way to significantly reduce (called disinfection) or even totally kill (called sterilization) harmful microorganisms.

Decontamination of the environment is important to prevent the spread of deadly microorganisms that cause infections. But, learning how to decontaminate can be tricky.

For example, you see a blood stain high up on the wall. It was cleaned a long time ago, but the stain remained. The stain came from blood, and you have the feeling that you need to remove it completely, as it is a source of infection.

The truth is, it could be a risk if it came in contact with a susceptible person, such as a sick elderly patient. But what are the odds that that patient (or even staff) can reach that high?

Also, the possibility of it infecting anyone is truly small because it is only a stain and not fresh, and the surface has been dry and untouched for a long time. The stain, even though it is blood, is therefore not a major hazard.

Now, let's consider the phone in the nursing station. It is sparkling clean because you made sure of it yourself when you wiped it earlier during your shift. There are no sick employees who could have touched the phone.

You might be thinking that the phone is already germ-free and doesn’t need to be decontaminated. However, it is an item that is repeatedly used by different people who have been in different places. The surface may look clean, but it could be teeming with microorganisms.

Remember that the enemies are microscopic—looking clean does not guarantee zero contamination.

This is where decontamination comes into play:

1. First, review your agency policies on how often you need to decontaminate. Some surfaces must be decontaminated regularly, such as bed pans and stethoscopes. Refer to the manuals and use their recommended product features to disinfect surfaces.

2. Next is to identify surfaces that need regular and frequent decontamination, such as the floor, kitchen tops, urinals, door knobs, and toilets. These surfaces have the highest microbial counts.

3. Use the right materials and disinfectants.

a. Some liquid disinfectants may damage or discolor equipment
b. Avoid chlorine-based solutions when cleaning metals because they cause rusting

4. Take note of contact time or the time that a disinfectant should stay on the surface before it is wiped off or prior to the item being used.

5. Ensure that PPEs, or personal protective equipment, are worn at all times.

Some cleaning materials are so strong that they damage regular latex hospital gloves, so CNAs must use more appropriate household gloves when cleaning and disinfecting.

Decontamination is a necessary part of infection control and you as a nursing assistant must meticulously carry out these procedures to prevent hospital-acquired infections in patients. Not only is the patient’s safety at stake, but yours is as well. These invisible foes should never accompany you home!


Posted: 9/3/2018 9:21:50 AM

Nine Critical Rules to Live by as a CNA



1. Patient safety comes first.

It’s true that maintaining a patient’s wellbeing is the reason why you have a job as a CNA, so keeping patients free from injury is your first priority. So, go ahead and prepare their snack, but never leave them unattended or without protection if they are at risk for falls. Keeping patients safe is as simple as locking the wheels of the bed and removing clutter.

2. Nurture your compassion.

Compassion is the essence of caring. Without this important aspect, work as a CNA becomes just doing the job and is no longer truly patient “care.” Ironic, isn't it? Don't let the difficult periods harden your compassion, and always be sensitive to your patient’s needs and feelings.

3. Practice confidentiality like your license depends on it.

Social media can be fun, for lunch breaks and locker room get-togethers. Of all the topics to talk about, forget any conversations about patients with others not directly participating in their care, even behind closed doors.

Never be confident that “anonymous” pictures of undressed patients will not be leaked or shared online. This is a crime and authorities have ways to trace it back to you. Your license to practice might be taken away permanently.

Be specifically wary of seemingly harmless ways of sharing patient health information, such as improperly discarding paperwork containing patient details or showing the chart to the patient’s best friend without their consent.

Confidentiality is one of the golden rules of CNA practice, so keep this in mind always!

4. Document, document, document!

The importance of proper and timely documentation cannot be overemphasized. If you did not document the vital signs after taking measurements, they might as well have not been done at all.

Observe current documentation practices and never falsify information. Say no to the urge to record a normal heart rate, for example, because you are pressed for time and the patient has always had normal values anyway. These bad habits spell trouble for you AND your patient.

5. Have a positive attitude.

Don’t get us wrong. You can feel tired, annoyed, or frustrated while working. Any CNA could attest that, in this job, these emotions occur fairly often.

Having a positive attitude means accepting that bad experiences can offer important lessons. It’s also about training yourself to feel strong and confident, even amidst challenges.

Better said than done, you might say, but look around you. There are some people who seem to handle everything smoothly. What do they have that sets them apart from the rest of us? A positive attitude!

6. Always refer to the care plan.

Even if you feel confident in your duties or the tasks are routine and repetitive, regularly check the care plan for updates. This smart move ensures that you and other staff are on the same page.

For instance, you could’ve missed the order about a repeat urine collection because you didn’t check the care plan. Where would this carelessness have potentially led? Delayed laboratory tests and results as well as delayed treatment.

7. Know your agency policies and state laws.

Rules are rules and when you break them, you reap the consequences—as mild as receiving a warning or as serious as jail time. Ignorance of the law is no excuse, so if you’re unsure about a process, check with your institution's policies and be sure to obey state and federal laws.

Luckily, rules and regulations exist not only to give you consequences but also to protect you as a worker. If you become a victim of bullying, for example, learn to use these policies to your advantage.

8. Appreciate the value of teamwork.

Patient care is a combination of individual tasks, but it is always a group effort in the end. Learn to work effectively with others, especially your nurse. Always give feedback and be willing to accept constructive criticism. Offer support to coworkers and don’t hesitate to ask for help when needed.

9. It's not just about knowing your patients, but knowing yourself and continually working to improve.

Looking back after years of service, you may ask yourself, "How did my life change because of this job? What did I learn? Did I become a better person, more attuned to the realities of the world and more aware the fragility of life? Do I value more my life, health, and relationships with others?"

As you can see, your work is not just a way to pay the bills. It is ultimately a way to grow as a person and to appreciate the importance of health.

Nursing assistants are valuable workers in the healthcare industry, and patients depend on them. If you are a CNA, be proud to be one and always remember these golden rules to live by!


Posted: 8/24/2018 4:04:42 PM

Is There Room for Humor in Patient Care?

Your sense of humor is one of the most powerful tools you have to make certain that your daily mood and emotional state support good health. - Paul E. McGhee, Ph.D.



In simpler terms, laughter is the best medicine, as the age-old saying goes.

Dr. McGhee, current president of The Laughter Remedy in Wilmington, Delaware, has done extensive research on laughter and health. His studies have proven that humor has numerous benefits for our daily lives.

Of his many contributions to this field of research, one that proves particularly interesting for CNAs, is the study of the practical application of humor in the healthcare setting, which might lead you to wonder: Is there a place for humor while caring for patients?

When you work in healthcare, where bad news and sickness are constant, it’s natural to think that humor has no place whatsoever.

In fact, in some carefully chosen situations, making patients laugh is awesome, because it can lift spirits, ease pain, and help both patients and staff alike cope.

Humor softens the isolation experienced by both patients and staff.

When healthcare workers such as CNAs make a patient or their family smile, they lighten the dark and heavy mood of sickness and disability. When good humor is used sensitively, it can establish a trusting connection between the patient and the healthcare team.

Humor shows the funny side of people, but it takes practice to deliver a good joke. It’s been said that acting in a drama is way easier than being a standup comedian, and there’s a lot of truth to this. When you cry, people easily cry with you. But when you try to make them laugh, you risk raised eyebrows, an awkward silence, or hurt feelings in return.

There are so many aspects to consider: the type of audience, their collective interests, the mood of the occasion, the spontaneity of the delivery of the joke, and the overall ambiance. Ask any comedian, and they can attest to the challenge of making people smile or laugh.

In as much as we'd like to focus only on the benefits of humor, we cannot apply it for everyone in the healthcare setting, because it also has a dark side.

When done insensitively, funny remarks can hit hard and wound raw emotions. After the joke that went horribly wrong, the trust you built with patients or colleagues can crumble.

In healthcare, using humor to lighten the mood is extra-challenging, whether the joke is on the patient or not.

Imagine a physician giving the bad news to her patient that his cancer is in the advanced stages, who suddenly hears people laughing in the hallway. Although it does not concern the patient, it still can be distressing, as their emotions are (understandably!) sensitive at this time.

In moments like this, any kind of humorous remark, however well-intentioned, can be truly hurtful.

The bottom line is, humor can ease difficult interactions between staff and patients. But healthcare workers should be careful not to use it without a clear lead from the patient, as patients take jokes in different ways and can be hurt easily.

But, if you think you have a gift for making people laugh and feel good about themselves, employ it while providing care and consider it a skill that can really improve a patient’s wellbeing.


Posted: 8/20/2018 5:39:05 PM

Before Saying “I quit!”: 7 Powerful Tips on How to Work with a Bully Nurse

Nursing assistants are at the bottom of the healthcare food chain. Given their place in the hierarchy, CNAs can often be the target of bullying.



Take the case of Fiona, an assistant to Nurse Vicky. Here’s a peek into what her life was like while working with her nurse:

Fiona goes to work early to avoid bumping into Vicky. It’s ironic, because Vicky should be the first person that Fiona looks for to prepare for her shift. But Fiona chooses to avoid her nurse because she starts the day ranting about Fiona’s “poor” quality care.

In huddles, Vicky lies about Fiona’s “mistakes,” later assigning her the most difficult and back-breaking tasks. She refuses to help Fiona, even when patient safety is at stake.

Nurse Vicky’s bullying consists of verbal attacks, sabotage, back-stabbing, and intimidation, especially to emphasize Fiona’s inefficiencies.

Fiona is just one of many nursing assistants who are mistreated by their nurses. Victims of such bullying undergo severe stress that in time results in physical, mental, and emotional suffering. Their misery can make them ultimately quit the work they love and abandon the job that pays the bills.

Amidst zero tolerance agency policies to workplace hostility and the call to create and sustain a culture of respect that is free of bullying, hostility against CNAs still happens.

If you are reading this because you believe you are a victim of bullying, read on and keep these powerful tips in mind:

1. Practice mindfulness.

Observe how you and your nurse treat each other. Is she bullying you, or just stern while correcting your errors? Do you insist on doing things your way, or are you uncooperative? Or, maybe you are indifferent to her solutions to patient care challenges.

Ask yourself if you are being overly sensitive to remarks. Not all difficult working relationships are a result of bullying. Check whether you are reacting out of fatigue or are currently overwhelmed by personal problems. Being aware of your own actions and feelings can help you adjust to and understand the situation, not to allow hostility to happen, but to realize that incivility can be partially subjective.

So, if you are burnt out and your nurse starts to see only your mistakes, it's time to do self-checks. But, if after reflection you can say that you're clear of these self-destructive behaviors, do the next necessary steps below.

2. Be kind to yourself.

If the bullying is unrelenting and affects your ability to care for patients, start doing something about it.

The first step is refusing to accept the blame that it’s your fault you are being bullied. In fact, it might be that you’re being targeted because you’re good at your job.

Protect your self-confidence by reminding yourself that you are a good person who just wants to do their job properly. Focus on your accomplishments and your patients’ kind words.

3. Accept constructive criticism.

Bully nurses may tone down their hostile behavior if they see that you are intently listening to what they are saying and able to find the lesson in their harsh words.

Acknowledge their efforts if they are trying to teach you something and thank them. For situations such as this, never underestimate the power of gratitude.

4. Keep a diary of all bullying episodes.

Like documenting patient records, keep an accurate account of every incident of bullying and harassment by writing down details such as the date, time, triggers of the hostile behavior, and the conversations in quotes. Include a list of witnesses if possible.

5. Take a stand and let your bully nurse know that you find their treatment unacceptable.

When bad behavior persists or gets worse, do not put off telling them that their conduct is unacceptable. You can talk to them in private, taking with you a trusted colleague for support, if needed.

6. Put on a protective shield.

By this we mean knowing your rights and following agency policies and state laws on how to deal with aggression in the workplace.

It also means making a plan to protect your career as well. Ask to be reassigned to another nurse or unit, and if necessary, request to be transferred to another branch or department.

7. Never hesitate to seek help.

Know what support is available and determine who are right people to help you. When the management addresses your case, do your best to present the facts calmly and clearly, providing your documentation.

Explain how the incidents negatively affect your ability to work and how your experience puts patients at risk.

Bullying has wreaked havoc on many nurse-CNA work relationships, causing the victim nursing assistant to quit their job altogether. These cases shouldn’t end like this! There are ways to deal with bully nurses, and CNAs must do their best to stand up to hostile behaviors as well as protect themselves and their careers.


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