Monthly Archives: December 2011

Hey, if that CNA gig doesn’t work out. . .

…perhaps you should consider working for Press Ganey.

In all seriousness, it’s nice to know that their Client Improvement Manager, Jackie Weaver, has a CNA background. 

If you haven’t considered the impact of PG scores on how acute health care is delivered, might be a good time to learn more.  Many hospitals use PG to gather statistics from patients on the perceived quality of their hospital stay/visit.  It’s interesting that many of the items measured relate to areas within nursing staff control, such as the time taken to have a call bell answered, for example.

You can download the WebEx presentation, “Improving Patient Flow: Improving Patient Satisfaction” here  (Includes a link for installing WebEx Player).

Since census drives staffing, which in turn drives the extent to which nursing staff are called off or placed on standby, it’s interesting to learn a bit about the factors that drive patient flow and thereby staffing.

The presentation takes about 47 minutes to run – just long enough to give yourself a good pedicure! (Just one great multitasking suggestion. . .)

 

And now for something completely different. . .

When I’m not stressing about examinations or stumbling through a caffeine-powered night shift (or sleeping), I enjoy hanging out with my character trip-hazard of a cat. 

She’s a Maine-Coon style beastie I acquired about three years ago from a nice lady who stated that said cat was “trying to kill her mother.”  Since this sounded quite extraordinary, of course I had to adopt her. (Turns out the prior owner’s elderly mother had quite a lot of vision deficits – couple that challenge with a cat that insists on following your every move and enjoys being at your feet – and you’ve got a recipe for  disaster.)

Her hobbies include coughing up hairballs, hunting for spiders in closets and cupboards, sleeping, chasing squirrels, and planking.

Cat Planking the Couch

 But she has another life, it seems.  She becomes quite antsy in the morning if she isn’t allowed out, ostensibly to perform cat activities such as hunting and, well, eliminating in the neighbor’s barkdust garden.  However, she also apparently has quite the social life.  I’ve seen her zigzag across the neighborhood from house to house, where she waits patiently at patio doors until unsuspecting neighbors (her “regulars”) let her in for treats and company.

She’s vanished overnight, only to be found locked in a neighbor’s car (thank goodness it wasn’t August).  Additionally, she’s acquired a new bowl, given to her by her neighbors across the street (her favorite friends) when they put their home on the market and moved out.  Once, she accompanied the girl-child on a walk to a nearby grade school, and didn’t come home because she got too tuckered out to walk back (cats are sprinters, not marathoners).  When she was gone overnight, we put out the alert to all the neighbors to watch for her.  We located her the next day – crouching in the ivy median in the middle of the street near the school, patiently waiting for her hoomans to get a clue and come get her.  Bless the neighbors – after that incident, we went through a week of various folks showing up at our door with her, proudly proclaiming “Hey, I found your cat!”

But this evening was a first!  She came home with a small lump taped to her flea collar.  A quick snip of the ol’ trauma shears (yeah, I know, they’re so fun to use! – and not just for cutting those annoying non-IV gowns off patients admitted to our floor from the ER!) revealed a ziplock bag containing a note:

Creepy Cat Note

Oh for heaven’s sake, I thought – what flippin’ now??? 

With no small amount of trepidation, I called the number on the note, hoping it didn’t belong to the owner of a pet hamster or mouse consumed by my darling furball, or worse.  Instead of an ear blistering, I got a lovely chat about how much fun our cat is when she comes to visit their family (and their two macaws, who apparently don’t intimidate her in the least).  The writer of the note had been enjoying visits from her for about two years, and finally, curiosity got the best of him (lucky for him he’s not a cat, right?) and he just had to know about her “permanent” family.
 
I’m happy el gato has such a vibrant social life, and that we apparently live in the nicest neighborhood in the entire world (because there are other places where people might try to keep her permanently, take her to the pound, or worse) – but a bit concerned that she has more friends than the entire rest of the family put together.  But, I guess that’s a side effect of working nights, after all.

Amazing ICU FAQ site

This, ladies and germs, is simply the most amazing collection of intensive care nursing lore I have found on the web:  Notes on ICU Nursing

Just read it, even if you don’t work in Intensive Care – extremely interesting.

Some of the jargon might be unfamiliar if you’re not used to caring for the sedated/intubated/restrained, but if you ever might float to the ICU, or are curious about full-time work in one – look, just give it a visit. You won’t be disappointed.

How can the CNA help spot skin breakdown?

OK, so a big part of the CNA’s job involves butt-wiping.  There, I said it!  Although both nurses and unlicensed assistive personnel (uh, aides and CNAs) will often receive derision from others not working in health care concerning this aspect of providing patient care, perineal care butt-wiping ain’t no joke, friends and neighbors.  Allow me to trot out the evidenced-based, well, evidence:

In *Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Chapter 12 discusses Pressure Ulcers: A Patient Safety Issue:

Pressure ulcers remain a major health problem affecting approximately 3 million adults.1 In 1993, pressure ulcers were noted in 280,000 hospital stays, and 11 years later the number of ulcers was 455,000.2 The Healthcare Cost and Utilization Project (HCUP) report found from 1993 to 2003 a 63 percent increase in pressure ulcers, but the total number of hospitalizations during this time period increased by only 11 percent. Pressure ulcers are costly, with an average charge per stay of $37,800.2 . . .Given the aging population, increasingly fragmented care, and nursing shortage, the incidence of pressure ulcers will most likely continue to rise.

Preventing pressure ulcers has been a nursing concern for many years. In fact, Florence Nightingale in 1859 wrote, “If he has a bedsore, it’s generally not the fault of the disease, but of the nursing”4 (p. 8). Others view pressure ulcers as a “visible mark of caregiver sin”5 (p. 726) associated with poor or nonexistent nursing care.6 Many clinicians believe that pressure ulcer development is not simply the fault of the nursing care, but rather a failure of the entire heath care system7—hence, a breakdown in the cooperation and skill of the entire health care team (nurses, physicians, physical therapists, dietitians, etc.).

CNAs are on the front lines of this battle in long-term care facilities everywhere, and while we are outnumbered by RNs in the acute-care setting, our role in detecting skin abnormalities is no less vital.  So how can we best help our residents/patients avoid developing pressure ulcers?

  1. Be vigilant about skin issues when caring for patients with:  diabetes mellitus, peripheral vascular disease, cerebral vascular accident, sepsis, and hypotension.
  2. There’s no “one and done” – a pressure ulcer, according to this source, can develop in 2-6 hours – so keep watching out for skin changes at each peri-care session and/or brief change.
  3. Avoid using hot water, and use only mild cleansing agents that minimize irritation and dryness of the skin.
  4. During skin care, avoid vigorous massage over reddened, bony prominences because evidence suggest that this leads to deep tissue trauma. Skin care should focus on minimizing exposure of moisture on the skin.
  5. Follow turning/repositioning schedules as delegated.

This publication also addresses the incidence of pressure ulcers in more darkly pigmented skin: 

**The Stage I pressure ulcer may be more difficult to detect in darkly pigmented skin. A quality improvement study in several nursing homes found that by empowering the nursing assistants with education (skin assessment), use of pen lights to assess darker skin, mirrors, and financial reward, the researchers were able to reduce the Stage I pressure ulcers in residents with darkly pigmented skin.

So how about it?  Share your comments, including your skin integrity promotion techniques below!

*Hughes, R. G. (Ed.). (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: US Department of Health and Human Services Agency for Healthcare Research and Quality.

 **Rosen J, Mittal V, Degenholtz H, et al. Organizational change and quality improvement in nursing homes: approaching success. J Healthc Qual. 2005;27(6):6–14. 21, 44. (41 ref) [PubMed: 17514852]

The Brain Sheet

The CNA “brain sheet” serves two primary purposes:

  1. document care performed on your shift
  2. assist in providing a comprehensive report to your relief

If you’re a hospital CNA, you need a place to keep notes about your patient load – like who’s vented (on a ventilator) or not, who has a Foley, and other important things.  You can note which patients are due for baths/showers on your shift, what CBG’s are due on what frequency, and other useful details (who’s A&O, who has a PITA family, special/additional needs, how many staff needed for bed-to-chair or commode transfers or for turns, etc.).

Use color and/or highlighting to make important details stand out.  If your facility doesn’t provide a “brain sheet,” make your own format, including the following categories:

  1. patient’s room number
  2. code status
  3. nurse name and phone/pager number
  4. respiratory status (V=vent, T=trach, NC=nasal cannula and so on. . .)
  5. elimination status (F=Foley cath, U=urinal, BSC=bedside commode, BRP=bathroom privileges, etc.)
  6. capillary blood glucose (CBG) check information if that’s within your scope
  7. bath/linen change done or needed
  8. oral care schedule (vented or trached patients)
  9. turn schedule (dependent patients)
  10. notes for the next shift

If you get floated to another unit or floor suddenly, this is nice to have, as it can be handed off to the lucky person who gets your patients after you leave.

Being a Great Follower

Getting the shift off to a smooth start can make the difference between a “why, oh why didn’t I call in today” day and a decent work day/night.  Being organized and walking the unit briefly before shift change is key.  Hopefully your facility offers some overlap during shift change to facilitate this. 

Why should a CNA walk their unit before getting report?  Because nothing says “It’s my Friday and I’ll crap on the next shift if I want to” like a soiled utility room (that’s the “hopper room” to y’all from LTC) filled with bags of garbage and linen for YOU (lucky oncoming shift person) to take to the garbage/laundry chute, or if truly unlucky, the dumpster out back and/or the dirty laundry room.

If you can quickly identify what’s not done that should be, you might be able to guilt/bully/threaten collaborate with the offgoing shift to work together to fix deficiencies, rather than figuring out how to clean everything up yourself.  Or, if you’re blessed to be following a rockstar who never leaves you hanging, it’s a great time to exchange gossip compliment him/her on how great he/she is!  (Who doesn’t like to be appreciated?) Or, you might be able to help with an end-of-shift transfer or discharge (who schedules these, anyway?) to reduce your coworker’s stress level.

Bottom line – most of the time it’s up to you as the CNA to resolve challenges person-to-person.  If you think the oncoming charge nurse has time to help you resolve things, you’re probably dead-ass wrong, mi amigo!  So put on your big-girl (boy) scrubs and work to help the person you’re relieving end the shift right.

Oh great, another CNA/nursing student blog. . .

I’ve become somewhat addicted to reading nursing blogs.  There are many great ones out there, and I’ve posted some links for those of you who’d like to see some of my favorite reads.

However, there’s little on the interwebs for CNAs, whether working in LTC, home care or acute care (hospitals).  A quick Googling of the terms “CNA blog” will yield sites touting vocational-school programs, but little from actual CNAs.  Wouldn’t it be great, I mused, to have a blog that would allow sharing assistant-related lore, whether mine or from commenters.

So, in the interest of:  a) giving me something to do when I can’t sleep (which is pretty often, since I work NOC shift, b) providing a writing outlet since my nursing program is pretty much multiple-choice test-oriented and c) hopefully providing a positive addition to the body of CNA-related work knowledge out there – I am launching this blog.

Frankly, I don’t have the stick-to-it-iveness to spend a year cooking all of Julia Child’s recipes , or even spending a year watching the movie made about the blogger who spent a year cooking all of Julia Child’s recipes (are you freakin’ kidding me????) so don’t expect a lot.

And, since I’m a relative newcomer to the field, I’m not going to even pretend to be an authoritative resource on all things CNA.  There are many folks who’ve worked multiple years and decades more who can speak with much more gravitas about how to take care of sick and/or aged patients/residents.  I hope some of them come here to comment!

**So, here we are, almost 2 years later.  I’m now a new grad RN, learning the hospital ropes all over again.  This blog has had almost 7,000 views, which frankly is about 6,900 more views than I thought it would ever generate.

My chief struggle as a blogger has been finding my blog identity.  A blog is like a career, in that it develops as one stumbles along blindly; some blogs never get where they are going, because a destination is never identified.  A life without focus is unfocused, a donut with no hole – is a danish.   Seriously, though, I do think I’ve found it at last – a cooking blog with just a dash of healthcare worker whimsy.  So, dear readers, bon appetit and a tu sante!