a working nurse & mother of twins

While I love working part time as a nurse, full time as a mom, and very part time as a CNA instructor, some days everything collides and life gets hard. Today was one of those days. I should’ve known it would end this way because life never goes as planned when David is out of town. He had a deposition to attend in Tucson and is gone overnight. Since its Tuesday, I had a nursing shift today and a CNA class tonight.

It wasn’t supposed to be a problematic day. The girls were going to daycare as usual, and since David was out of town I hired our favorite babysitter weeks ago to watch the girls for my class. I dropped the girls off, got to the hospital, and then 10 minutes into my shift I get a call that one of the girls is throwing up. I thought “you’ve got to be kidding me”. The girls haven’t really been sick (like throwing up sick) ever and it had to happen on day when David was out of town and I had a double shift.

So I left work, short staffed, and picked up my girls. Surprise, surprise, the other one had started puking too. Let me tell you, dealing with TWO puking kids is no cake walk. Thankfully I am a nurse and can handle the smell and mess but that doesn’t make it easy. In the meantime I had to see if there was a replacement for my class tonight or whether I just had to cancel it. Turns out I had to cancel which I felt terrible about because my students start observations in clinics next week and I really had a few more things I needed to teach them before throwing them into that situation.

Thankfully the girls seemed to be perking up a bit before I put them to bed. Here’s to a better day tomorrow and David coming home.

Unfortunately, not every patient you’ll come in contact will recover and leave the hospital, nursing home or long-term care facility. While these are not the situations you wish to dwell on, it’s imperative to hold a strong understanding of how to deal with patients who are facing their own mortality. Of course, there is no way to fully understand what the patient is going through, but by learning the five stages a patient likely goes through when dealing with their upcoming demise, you’re able to better adjust your level of care and communication to help make their last days filled with peace, happiness and empathy.

The Five Stages of Dealing with Dying

Although you’ll cover this topic in greater detail within your CNA training course (certified online nursing aides will also read about this topic), the following is considered the top five stages a human experiences when they come face-to-face with their mortality.

  1. The Denial Stage – Denial is the mental state of not accepting the inevitable. Many patients who are cognitively able to understand what’s happening to them do not wish to accept the fateful news from their physician. For example, your patient cannot accept the fact that she has a terminal condition. After learning such news, it’s not uncommon for a person to put away the reality of a situation until they’re better capable of handling such news. It’s not uncommon for a patient to slip between denial and acceptance throughout their final moments on Earth.
  2. The Anger Stage – Often times when dealing with the reality of death, patients become angry. While they are not angry at you, they often take out their frustration and anger on those who are closest to them at the time, the CNAs. It’s important to understand that anger is often the interpretation of deeper feelings, such as fear, frustration and resentment. While their anger may seem to be directed at you, they’re likely not angry with you, but rather with the situation. During these moments you must remain fully compassionate, kind and understanding.
  3. The Bargaining Stage – It’s not uncommon for a patient who’s dying to try to bargain for more time on earth. While this is obviously not a productive way to extend their days in this life, it is an opportune time for the patient to take care of unfinished business. Your responsibility during this phase is to simply be there to listen. Pay attention to what they say and if you can help in any way, do so.
  4. The Depression Stage – Many patients who discover their days truly are numbered begin to become depressed. Depression within the dying process can take on two primary forms: (1) Grief over past losses, grief over unfulfilled dreams and disappointments within their life, and (2) preparing for the forthcoming losses. The depression phase is essential for the patient to come to terms with their reality. Now is not the time to try and cheer them up. Rather, sit and listen. Try and tell them you are grateful to have them in your life and to know them. You may be the only human the patient has to speak with during his last days. These are precious moments. It’s not uncommon for the patient to begin to disconnect with reality as his present situation is too difficult tot deal with. Be supportive during all of the individual stages within the depressive state.
  5. The Acceptance Stage – For many patients, this is the final stage in dealing with their upcoming death. After all is said and done, the only actual choice a patient has is to accept the inevitable. It’s important to realize that acceptance of death does not mean they are happy, but rather are living in the moment and realizing there is nothing they can do. As a CNA, you must strive to support this stage. Do everything you can to support the natural mental flow to the state of acceptance, as it’s here the patient is truly calm and relaxed.

As a Certified Nursing Assistant, there are a variety of medical facilities in which your services are needed. While hospitals and small health clinics are considered the most obvious employment choice, if you’re looking for a challenging work environment filled with as many joys as difficulties, then a employment within a long-term care facility may be your ideal choice. Also referred to as a nursing home or nursing facility, these institutions are designed to care for people who need constant medical attention, but are stable enough to live outside of the confines of a hospital.

CNA Job Description – Long Term Care Facilites

These institutions may also be referred to as assisted-living communities, residential care facilities or group homes as many patients live in the facility full-time. When you work as a CNA within a nursing home, you are dealing with residents, and not patients. While technically the same, these two terms are vastly different, and therefore, your approach to patient care must also be different. Did you know that the average stay for a patient in a nursing home (or long-term care facility) is seven months to two years? Because of this unique amount of time spent with patients, CNAs are given a golden opportunity to not only provide outstanding care, but truly transform the health and happiness of their patients.

It’s not uncommon for people to stay in a nursing home for a few days or a few weeks, whichever is needed for them to regain their emotional and physical health through various rehabilitation treatments. Most often, residents of a nursing home are classified into categories.

Short Term Residents

As its name suggests, short term residents are those who stay in a nursing home for a small amount of time, typically less than six months. Often these patients are younger than the typical nursing home resident and are generally admitted directly from a hospital. The primary goal when dealing with short term patients is to follow the patient care guide to ensure they receive the type of treatment and care necessary for rehabilitation.

Because many nursing homes throughout the country have cultivated large sub-acute care units, which are specialized departments designed to treat acute conditions and illnesses, the percentage of short term residents is on the rise.

Long Term Residents

These residents are those who consistently stay at a nursing home facility for longer than six months. As a CNA, you’ll work directly with long term residents to support their overall patient care plan while providing them with the necessary quality of life to support mental and physical health. Your primary goal when working with long term residents is to help each one live a full and independent life, which may be more of a challenge than you would originally anticipate. However, with great challenge comes great reward. Many CNAs become close with long term residents and become an integral part of not only their patient care, but also their life.

*Note: Those of you reading my blog that are not currently CNA students but are interested in becoming CNAs can research CNA certification today.

In order to receive your certification in nurse assisting, you must become well-versed in what’s known as Standard Precautions, also referred to as Universal Precautions, when it comes to safeguarding patients from infectious diseases. While working throughout a health care facility, you’ll come in contact a host of germs, viruses and bacteria that if not checked and monitored could result in a mass outbreak within the facility, or worse, within the community. Therefore, one of the most important steps you, as a CNA, can take to prevent the transmission of infectious diseases is to follow the 10 standard infection control precautions as outlined by major health organizations and hospitals.

The 10 Standard Infection Control Precautions

The following 10 precautions are considered universally applicable for all CNAs, and medical staff in general. While your specific employer may feature an expanded version of these precautions, consider the following list applicable unless otherwise noted by your employer.

  1. Wear Disposable Gloves – These gloves are an essential aspect to the sanitation and protection of your patients and yourself. Never touch a sick patient or their belongings without wearing these protective gloves.
  2. Wash Hands and Surfaces – Immediately after your hands and surrounding environment becomes contaminated with bodily fluids, was these areas and surfaces thoroughly and with the provided sterilization solution. It’s essential to keep your eyes open for potential contamination so they may be treated immediately.
  3. Wear Protective Clothing – It’s imperative that you wear protective clothing, such as masks and gowns, when dealing with highly contagious individuals. However, your employer may require such protective gear when dealing with those who are not known to be contagious as an act of precaution.
  4. Eliminate Sharp Objects – After utilizing sharp objects, such as needles, you must immediately discard such objects in the designated bio-hazard container. Never place a used object on a counter or table, as this can easily transmit harmful germs and viruses.
  5. Cover Open Wounds and Cuts – If you have a cut or open wound on your body, you must thoroughly protect these entrances into your body with a sterilized bandage.
  6. Clean Bodily Fluids Promptly – Do not let blood or other bodily fluids rest for longer than required. Immediately upon noticing any bodily fluids on or around the patient, clean, disinfect and sterilize the area according to the requirements set forth by your employer.
  7. Handle Soiled Linens Carefully – When changing linens ñ especially soiled linens ñ wear protective gear and handle with great care. A myriad of germs and viruses thrive in linens, therefore it’s imperative to be mindful when dealing with such fabrics.
  8. Secure Contaminated Articles – Prevent spreading disease and illnesses by securing contaminated articles of clothing and other belongings as quickly as possible.
  9. Proper Waste Elimination – Make sure to place waste materials in a leak proof and air-tight container provided by your employer. Wear protective gear while handling human waste and other bodily fluids.
  10. Resuscitation Masks/Bags – Always have resuscitation masks and bags within arms reach when working with hospital and nursing home patients.