Wade Turrentine Mr. Kucharik College Comp I 11/15/09 The Duties of a Certified Nurse Aide A Process Paper Being a Certified Nurse Aide (C N A) is an extremely rewarding experience. You discover a whole new side of yourself when you’re at work. It allows you to be able to handle many more somewhat disgusting situations by knowing that the person receiving this care is in need of it. This is due to the fact that they either can’t care for themselves or have a disease that inflicts limitations on their ability to know how to do it.
That is the main reason I had ultimately decided to become one. Being a C N A is more than what most people would think most C N A’s do. There are many processes involved in the job that most people either don’t know about or would rather not want to know about. The most important part of this job is the residents cleanliness and hygiene. How the C N A’s help with this is by creating shower schedules, changing linens, brushing teeth or dentures, taking them to the bathroom, regular check/cleaning of the genitalia, catheter checks/changes, shaving, and much more for each resident.
These duties each have specific instructions depending on the residents likes/dislikes and your facilities regulations. For the most part shower times are set up for once a week depending on how continent (ability to use restroom controllably) the resident is, and how good the residents skin is. One thing you don’t want to happen is for your residents skin to start breaking down because of over/under showering. To perform a shower you must first set up your shower room, never begin unprepared so as to not leave resident unattended. If they have to have a special shampoo or soap you must have that as well.
After your shower room is ready wheel a shower chair into the residents room and shut the door behind you, this provides privacy for the resident, then inform them it is time for a shower. You must then get the resident undressed and into the shower chair, a lift may be needed. Cover the resident with a sheet so they can remain discreet as you wheel them down the hallway to the shower room. Once in the shower room adjust the water to their likings, generally between 80-95 degrees. Make sure you use a washcloth to clean them entirely, if they are uncomfortable with you cleaning their “private parts” then you must let them do it for themselves.
After the shower is complete dry them off completely and then apply lotion all over their body. Get them dressed in the shower room unless a lift is needed. If this occurs you must keep them in the shower chair and wheel them back into their room where they will be dried and dressed. Linen changes will usually take place before the residents shower or when necessary. When the linens are changed between shower dates it’s usually because of blood, urine, feces, or any other hazardous substance is on the sheets.
For changing sheets you must remember their bed is nothing like yours. It can be an air mattress, have foam supports, be very thin or thick depending on residents need of back support. You must never leave wrinkles in the sheets as this can cause skin to break down or become irritated. To begin the linen change you must gather a fitted sheet, top sheet, soaker pad (used for the incontinent residents who cannot control bowel/urinary movements), a single blanket, and enough pillow cases to cover all the pillows used in the residents room.
When you have gathered your materials and are in the residents room you must inform them of what you are doing and if they are laying in bed you must ask them to sit in a chair while you change their linens. You will encounter angry residents who will fight this but you must be patient and inform them it is needed. After they are out of the bed or when you are ready to begin you must strip the bed and pillows and place all used linens in a bag that will be taken to the laundry room. The linens are folded a specific way, this is so they will never have to be shook open and gather germs/bacteria that is floating in the air.
Unfold the first fold of the linens then line up the middle crease with the middle of the bed. Tuck in the first side then work your way over to the other side and tuck it in. The pillow cases, and blankets must also be changed. When you are all done inform the resident they may get back into bed or that their bed has been made then dispose of the dirty linens in the laundry room. Brushing the residents teeth or dentures may seem like an ordinary task but there is more to it. You must use their preferred toothpaste or denture tablets.
The residents mouth must be cleaned at least two times daily. Usually in the morning and before bed, but you may have to perform this task more than two times depending on the residents liking/need of it. Brushing teeth is something you should already know how to do but dentures area different story. First you must strap on a pair of gloves and remove the dentures either from the residents mouth or the container in which they are kept in over night. Then use their tooth brush to gently cleans the false teeth until you feel they are ready to be put into the residents mouth.
Now here’s the tricky part, you must put them in just right or the resident will not be able to push them up into their mouth and they’ll end up floating around in their mouth and might possibly end up asphyxiating them. Also, when in a double room make sure to use the correct toothbrush/paste with the right resident, you don’t want to use someone else’s toothbrush in your residents mouth. Taking a resident to the bathroom can be the easiest or hardest thing you will have to do. They will either fight you the whole time or be as helpful as possible, you generally want the helpful ones.
You must first take them into the restroom and get them situated onto the toilet so they’ll not make a mess on the floor or you. Then each resident will have a different pad, diaper, or just regular underwear. This is where it can get tricky, after getting their designated pair of underwear you must get it onto them while they are in a sitting position. You’ll be able to get it above their knees, then when they are done it’s time to clean. This all depends on whether they urinated or had a bowel movement. If all they did was urinate then you only have to clean the penis/vagina.
When working with females always wipe from front to back to prevent infection in the vagina. When working with an uncircumcised male you must pull the foreskin back, wipe the head and underneath the skin, and then pull the skin back to relieve pressure on the head of the penis. If the resident has made a bowel movement you will need to put on a pair of gloves, get their designated set of wipes, and squirt some ointment on them. Then you must get down to butt level and have them lift one side so you can get underneath them and wipe.
You need to try your hardest to make sure that all fecal matter is removed so as to not cause any infections or skin breakdown. After the resident has been cleaned stand them up, pull up their under wear, then their clothing, and now you can take them to wherever they want/need to go. Once you are done with the wipes you must dispose of them in the bathroom trashcan, throw your gloves in as well then tie it shut and dispose of it in the laundry room trash bin. Cleaning and care of the genitalia of the residents is one of the biggest responsibilities of the C N A’s. For males it all depends on being circumcised or not.
Being uncircumcised poses more of a challenge for the C N A, because of the constant cleaning of the foreskin and head. If this is not done the resident could be exposed to infection or give the resident a Urinary Tract Infection (UTI). Although this is one of the most important duties it’s surprising how little it takes to do proper care. Most of the time this will be done while taking the resident to the bathroom or when giving them a shower. It just takes a little more time to make sure that those areas have been properly clean and that there is no skin breakdown or no visible infection.
Care for catheters and changing them is a completely different level of responsibility. This is one of the hardest things a C N A will do because it takes patience and cannot be done sloppy or incorrect. You must be very precise with catheters so as to not injure the resident. There are two different kinds of catheters. Folly catheters, which are the ones that go inside the body up through the urinary tract and secured in the bladder by filling the end with a bit of saline. Now this is where you must be careful when moving the resident, because you could end up ripping the catheter right out of them.
When giving the resident folly cath-care you must be gentle as the entry site may be sensitive. For males you must clean the head and all around the visible part of the catheter. For females it’s the same concept just cleaning the vagina instead of the penis and the catheter tube as well. The second type of catheter is the condom catheter. This type is only used for men, hence the name, and is only used when necessary, such as at night or during activities. When giving condom cath-care you just have to make sure you don’t put the resident in any discomfort and check the skin regularly for breakdown of any sort.
Shaving a resident is a total necessity and option all in one. The male resident must have his face shaved every day, unless they have a specific “look” they like to have. Then you must trim, cut, and shave it to their liking. Even in females you must shave their faces when they need it, not every day but about once a week or so. Now not only do you have to shave their faces you must shave any part of their body that they ask you to. This can become an awkward situation but you must put yourself in their situation and then it makes everything easier.
All-in-all the rewards that come from being a C N A make your job worthwhile. The fact that you are able to help those who cannot help themselves is enough for most people to do this job. Not to mention the pay in some places is amazing. Most will look at this job as completely and utterly disgusting and degrading to the resident, but what these people don’t realize is that the residents are not able to do a lot of these things on their own and need help. That is what gives me the drive to do it and that’s why I chose this over any other part time job.