Monthly Archives: January 2012

Post-mortem care – prep for the journey

CNAs, whether working in hospital or long-term care settings are called upon to assist with post-mortem care.  If you’re not clear on this going in, perhaps a different career choice would be best.  Just sayin’.

Yes, death gives darn near everyone the heebie-jeebies, yours truly included.  Everyone’s reaction to death and corpses is individual.  What can be standardized is a competent, professional response to the practical need to prepare the body for 1.  family to spend time with the departed and 2. need to get things settled/cleaned/straightened before rigor sets in.  We’ve certainly come a long way since the time of the Black Death.

In the hospital, the nurse may supervise this care, or it may be performed by a couple of CNAs working together.  A CNA may also perform this duty solo, but usually this doesn’t occur, for the practical reasons that positioning is more safely accomplished with two or more workers, and that post-mortem care does an emotional/spiritual number on even the most grizzled, seasoned health care worker. 

Sometimes, the nurse needs emotional support.  He or she has supported the patient through efforts to save his/her life, then through hospice or “comfort care” and then the dying process.  The nurse has to be supportive of family/loved ones as well, and their reactions to the dying process.  Last but not least, the nurse is responsible for final charting, finding out which funeral service the family would like used, dealing with belongings, and supervising/performing post-mortem care according to facility policy.

So, what’s our role as the CNA in all this?  There are three areas:  rules of behavior/etiquette, rules of gathering supplies, and rules of post-mortem care.

1.  Rules of behavior/etiquette:

  • Watch your mouth! It is said that hearing is the last sense to go.  So keep it proper!  Plus, many hospitals only have a curtain between you and family members lingering outside the room, other staff, management, and passers-by.
  • It’s not about you, it’s about the consumer!  (Best business advice ever, courtesy of Joe Dirt.)  Nobody wants to hear how you handled the death of someone in your family.  They are having their own experience, save the stories and advice for another time and location. So STFU.
  • Be discreet!  If the family will be coming back into the room post-mortem to spend time with their departed loved one, put the body bag in a drawer or cupboard.  Bag up extra non-needed medical wastes (catheters, lines, drips, etc.) and get’em out of the room.  Lower the lights so things don’t look so stark.
  • Be realistic about time frames.  Post-mortem care can take 15-30 minutes to accomplish with a team of two or more, depending on how much there is to remove/clean, and how much bleeding/oozing is going on.  Keep the family informed so they don’t freak out on you.

Rules of gathering supplies:

  • 10 mL syringe for removing Foley cath
  • 60 mL Luer-lock syringe for removing stool/fecal management system (excellent product video from Bard – select the removal procedure video)
  • plenty of chux
  • paper tape (less damaging to skin)
  • drain sponges/gauze (needed along with tape for securing holes where lines used to be)
  • surgical scissors (find in procedure cart as needed) – needed for removing sutures holding in PICC, central, art lines (these are too tight to get at with trauma shears, which have blunted leading tips)
  • body bag with tags (usually 3 – for body, outside of body bag and for belongings) – to use per facility protocol (LTC – usually the funeral service brings this item)
  • bags for belongings if not already taken by family – don’t forget to tag them
  • clean gown
  • clean bed linen
  • basin
  • soap
  • water
  • wash cloths/towels
  • comb
  • EMPTY garbage cans with plenty of liners (don’t forget the biohazard bags – you’re gonna need ’em) – it just plain sucks to start post-mortem care with every waste can in the room chock-full!
  • did I mention – plenty of chux? OK.

Rules of post-mortem care:

Hopefully you had a good CNA textbook that covered this topic and you read it during your CNA course.  If not, might be a good idea to review it before taking a new position.  I highly recommend the following article:  Post-Mortem Care

Remember to put a chux down under orifices (or is it orifi?) on the side you are rolling the body to, because drainage happens.  This one piece of advice will hopefully save you a few post-mortem linen changes.

Remember, this is the patient’s (and their family’s) last experience with your facility, so make it a professional one.

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Random Surfing. . .

Well, this started out innocently enough as a schoolwork-avoidance maneuver – hopped on over to check out one of my favorite MD blogs Movin’ Meat to see what was new, and also to play one of my favorite videos ever, a computer visualization of Bach’s Cello Suite #1 Prelude, created by one of the elves at Google Creative Lab:

From there, I journeyed to the video creator’s website, which took me to his Twitter feed, and then on to a cool site called Colossal – An Art and Design Blog where I found the toy everyone should have – Makedo – Reusable Modular Pieces for DIY Projects.  Completely blows away Legos, K’nex and all the rest.  Check it out!

OK, back to work!

It’s been a week, y’all. . .

 

Sunday:  work NOC shift

Monday:  class until 1330.  sleep.  wake up, study for test on Wednesday.  Receive call from staffing with offer of extra shift, which ironically seems only to come when I need to study for a test or have an early school day coming up.  Rats.

Tuesday:  study in AM, IV medication skill checkoff at 1230, more wishful studying until the wee hours.  Another staffing call with offer of extra shift declined (are they just teasing me????)

Wednesday:  test at 0730 (nailed it!), practice med pass (they wouldn’t let me eat the practice meds which were actually Skittles– booooooo!)

Skittles
Image via Wikipedia

then 2 hours fitful sleep in back of Suburban until Supervised Skills class from 1400-1600 (let’s face it, some of us need more supervision than others).  I can now administer a PPD Mantoux test to a hotdog (oooh, the power!).  Needles are awesome.  Leave it to the Danes to invent the insulin pen.  Just like Legos, these devices are 1.  awesome and 2.  fabulously expensive!  Go home, collapse into comatose state until time to go work NOC.  Under the extensive influence of PO caffeine, chase call lights until everything settles down around 2300 or so, then go on IV-pump pruning mission (yeah, let’s hoard unused pumps in rooms).  Honestly, I felt like the Grinch, slithering behind the booms in the patient rooms, swiping unused pumps.  And I took the last can of Who-hash, too. . .

Example of ICU room with booms for mounting IV pumps and other useful devices

Thursday:  class at 0800 (mandatory clinical orientation for med-surg) – spent sleeping (I had to guess at this by looking down at the resultant drool patches on front of my scrubs.  Woke up in time to contribute brilliant (if unsolicited) commentary during 1230-1330 time management class.  Errands until 1500, then unconsciousness. . .

Friday:  Huzzah!  School cancelled for the day due to widespread flooding in the area (not neat for folks whose homes and businesses flooded, however.  More note-card usage and reading.  Made a Crock-Pot of chili con carne but unfortunately used the packet of chile de arbol (apparently a hot cousin to cayenne pepper – oh dear) instead of regular chile (Anaheim?).  Still deadly hot even after the addition of peanut butter, more canned tomatoes, more tomato sauce, 3 glasses of milk and one yogurt.

Saturday:  still to be written.  More reading.  More coffee.  Work NOC tonight and tomorrow, starting crazy-ass scheduled week all over. . .

Am I crazy? 

Imma gonna take your pumps beeyotches. . .

2009 National Nursing Assistant Survey

Just in case you were wondering, there is a study that supports the common knowledge that the nursing home CNA position is not a high-paying position.  (Really?) 

Excerpts from This Study’s Discussion Section:

…CNAs are low-income workers (GAO, 2001) and add that years of experience do not translate into substantially higher wages. Although the median hourly wage is above the federal minimum wage, total family incomes for CNAs nationally indicate that more than half are within the 200% poverty level. Previous studies indicate that low wages do contribute to turnover and the need to work additional jobs or overtime (Harris-Kojetin et al., 2004). Moreover, working long hours may contribute to mistakes, affecting resident safety and quality of care. Strategies that increase CNA income and also meet growing care demands, such as career lattices that enable CNAs to take on additional responsibilities and receive higher wages or career ladders through which CNAs can advance in a career path (e.g., pursuing a nursing degree), may help stabilize staffing and increase the supply of licensed nurses.

Receipt of Public Benefits

A substantial proportion of CNAs are poor or near-poor. This study finds that one third of CNAs reported receiving some kind of means-tested public assistance. Moreover, our results indicate that CNAs access public assistance at higher rates than the general population…These findings may suggest that the use of public assistance is supplementing low wages for at least some working CNAs. Additional descriptive information from the NNAS allows for assessment of which CNAs are receiving which types of public benefits. For example, controlling for age, children, and wages could provide greater insight into CNAs’ receipt of benefits.

Health Insurance

Uninsured workers can adversely affect nursing home staffing stability. More than 40% of the uninsured CNAs in this study did not participate in their employer’s plan because they could not afford their share of the premium.

Injuries

Our study and others have found that more than half of CNAs incurred at least one work-related injury within the past year, rates that exceed those for almost any other profession (Hoskins, 2006). Although three quarters of the injuries in this study did not result in loss of work time due to the injury, the difference in mean and median number of injuries and time lost suggest that there is a small subgroup of CNAs with a much higher injury rate and/or more severe injuries. High injury rates and insufficient or no health insurance and sick benefits may jeopardize CNAs’ financial stability and commitment to their job or field; it may also adversely affect nursing home staffing stability…Lack of equipment (e.g., for lifting and transferring residents), lack of training on the proper use of equipment, lack of training on managing resident behaviors (e.g., combative or aggressive residents), and working short staffed are some of the reasons for CNA injuries.”

Link to the PDF document for further reading:  http://aspe.hhs.gov/daltcp/reports/2009/NNASeb.pdf

When you must get to or from work and it’s icy/snowing

While this snow stuff is lovely, it can make driving a bit hazardous. Snow over black ice is the worst – makes all my redneck bravado evaporate like the alcohol wipe trail on a diabetic patient’s finger when you’re performing a blood sugar check.

Three items can make you safer –
1. Quick-to-put- on cable chains
2. Contractor’s black garbage sack (for kneeling on while putting on chains)
3. Fisherman’s gloves – fabric with non-slip waterproof surface – allows finger movement and terrific grip

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Link to purchase gloves (they are pretty inexpensive online or check local outdoors or work wear stores: Wells Lamont Work Gloves on Amazon

Advice for Working the Night Shift

I found this piece on working the night shift when I first learned I’d be working nights. Although the intended audience is the English physician (“Junior Doctor” – such a delightful term – do they wear child-sized scrubs?) the advice given would be helpful for anyone preparing to work nocs. Working the Night Shift: Preparation, Survival and Recovery

Oh dear Lord, help me – the new school term started today. . .

Well, it’s back to feeling utterly befuddled and stupid – that’s right, the new nursing school term started today. 

On the bright side, however, I was actually awake for a Monday morning lecture (after just coming off work – third shift of three days in a row) so I think that’s a good sign.  I may learn something this term!

I think I had better work some extra hours this term – so I can afford tutoring. . .