IN THIS ISSUE:

Employees Matter: Helpful tips for CNAs

Communication Corner: How to handle yourself in social situations

News You Can Use: What people really want from work

Just for Fun: Job evaluations

Helpful Tips for CNAs Dealing with Death

For nursing assistants, death is one of the harsh realities of caring for the ill and/or elderly. And whether you’re a veteran in the field or have just started out, you may never “get used” to patients dying. You may experience a range of feelings and emotions. Oftentimes, losing the patients you care for can feel like losing a family member.

Although you may never get fully accustomed to dying patients, you can most certainly get fully acquainted with the signs and symptoms of impending death. By knowing the signs, you’ll not only better prepare yourself, but also provide better care to your patients during the final stages of their lives.

The remainder of this article will cover some of the most common signs of impending death, as well as provide some helpful tips for CNAs who must care for dying patients.

Signs of Impending Death

Loss of muscle tone. There may be urinary or fecal incontinence. The patient may experience nausea due to abdominal distension. The gag reflex diminishes or is absent and the jaw may sag due to relaxed muscles.

Poor circulation. The patient may experience lowered sensation and decreased sensitivity to pain and touch. If the patient's arms and legs start to feel cold, this is often a sign that the body is starting to fail. The skin on the extremities becomes cold and may appear mottled or cyanotic (blue-tinged).

Changes in respirations. The patient may experience rapid, shallow and/or irregular breathing, as well as difficulty swallowing.

Sensory impairment. The patient may experience blurred vision, and a dulling of all other senses.

Providing Quality End-of-Life Care

There are several things CNAs can do to help patients feel more comfortable and at ease. Take note of the following:

Limit handling and movement. Dying patients are often in pain or experiencing great discomfort. Rolling and turning the patient in bed will often add to this discomfort. If a patient must be moved, CNAs should be strongly encouraged to recruit help. With the help of another nursing assistant, safely and comfortably moving a resident becomes much easier.

Try to keep it comfortable. Keeping patients comfortable is probably the best gift CNAs can provide. Comfort is key in caring for a terminally ill patient. Try to maintain a quiet atmosphere, and be respectful. If you are caring for the person with another aide, don't spend a lot of time talking between yourselves, and above all, do not speak about the patient—even if you are convinced that the person cannot hear you and doesn't know what's going on in the room. If the patient loved music, it may be comforting to have a radio playing softly in their room. If they loved poetry, read them a poem or two. Sometimes, just being there, holding their hand and speaking comforting words is all they need.

Pay attention. Keep a close eye on your patients. Be sure to report any changes in the patient's condition to the nurse, who will often provide comfort measures that nursing assistants are unable to provide, such as suctioning excess respiratory fluids to ease breathing, and/or providing pain medication to ensure comfort.

Recognize your limits. If you are especially close to a patient, you may find it difficult to provide end-of-life care to them. It's ok to explain this to the nurse in charge. If it will be too emotionally difficult for you to deal with, perhaps you can be relieved by another CNA.

Remember, providing superior, quality care to someone during their last days on earth can be extremely gratifying. Nursing assistants are in a position to make this transition a comfortable and peaceful one—there may not be a more meaningful and important job.

“No act of kindness, no matter how small, is ever wasted.”

—Aesop

How to Handle Yourself at Social Work Functions

Work-related social functions can be very important to your job success. Functions such as employee picnics, holiday parties, and group get togethers are great ways to network and mingle with colleagues and company decision makers. Although these functions are off the clock, the way you behave at them can have a direct effect as to how you are treated and perceived when you do go back to work. You could be scrutinized on your social etiquette and conduct, which, whether it’s fair or not, could have an effect on your career as a healthcare professional.

Below are some helpful tips that will help you shine in social situations.

Follow the lead of your host or hostess. If you’re at a sit-down meal, you should wait for your host to ask you to sit down before taking your seat. If he/she doesn't ask you to sit, wait for him/her to be seated, then sit. During the meal, sit up straight and keep your feet flat on the floor or cross your legs at the ankle. As soon as everyone is seated, unfold your napkin and place it across your lap. If, at any point during the meal, you need to leave the table, place your napkin on your chair, folded loosely. Only after the meal is over should you place your napkin on the table to the left side of your plate (never on your plate). You should not push your chair back and cross your legs until the meal is completely finished.

Think twice about what you order. When it’s time to order, let your boss order first and then order a meal for yourself that is comparable in price to his or hers. Pick a meal that is small and easy to eat. Try to steer away from sandwiches, shellfish, spaghetti, pizza or any other foods that are messy and may require a lot of handling. It is a good idea to drink water, tea, or juice, steering away from alcohol—even if your boss has ordered alcohol. Even if the food you are served is not cooked correctly or not to your liking, never criticize or state a dislike for a food that is served to you. You could be evaluated for your grace in such situations.

Be concise and thoughtful. While your boss and colleagues may engage in more casual conversation during a meal, remember that this is still work-related function. You should be prepared at any moment for your boss or peers to ask serious questions or discuss a serious topic. You will want to be as thoughtful and concise in your answers at the social function as you would while at work.

Lastly, at a work-sponsored event, meals and drinks are typically paid for by the company. Be sure to thank your host for the meal at its conclusion. A thank you note will be a nice touch as well.

“Good manners will open doors that the best education cannot.”

—Clarence Thomas

What People Really Want from Work

Every person has different reasons for working, and these reasons are as individual as the person. However, if there’s one thing we all share it’s this: we all work because it provides us with something we need. Whether it’s money, personal fulfillment, passion, etc., our work must adequately address what we want out of it. If not, we’re left with feelings of regret, dissatisfaction, and low morale.

By simply understanding what their employees want from work, employers can help boost morale and job satisfaction. After all, if healthcare organizations know what their employees want, they can do a much better job at meeting those needs. Below are some of the most common reasons why people truly want to work.

Meaning

The majority of employees need and work for money. However, that doesn’t mean that their jobs don’t provide them with personal fulfillment. Aside from collecting a paycheck, people often want to accomplish goals and feel as if they are contributing to something larger than themselves. Healthcare is probably one of the most meaningful professions an individual can choose. No matter what role an employee serves, if they are in the healthcare profession, they are helping to make the community safer and healthier. Now that’s meaning!

Respect

Employees want to be treated with dignity and respect. No one wants to put in a hard day at work, and feel that no one appreciates or respects what they have done. You can demonstrate respect with simple, yet powerful actions. A simple “thank you” goes a long way. Employers can also demonstrate respect by asking employees’ input on certain work issues that affect them.

Insightful Feedback

Employees want to know what they’re doing right. And while they may not like hearing what they need to improve on, if you do it in the right way, the will appreciate it, and grow from it.

Trust & Security

Employees want to feel safe—both physically and emotionally. Trust forms the foundation for effective communication, employee retention, and employee motivation Employees need to be assured that when they express their opinions and confide in a manager they won’t be betrayed or punished for speaking candidly.

Recognition

Never doubt the power of recognition! When employees know that the work they perform is valued and recognized, they will continue to walk through the door every day—most likely with a smile on their face. Whether it’s through verbal or financial means, be sure to recognize the peak performers at your healthcare organization.

Positive, Productive Relationships

Establishing fun, productive relationships can make all the difference at work. If employees enjoy one another’s company, they are much more apt to enjoy their workday. Encourage and foster these relationships with team building.

Remember, everyone has different reasons for working. One employee may work because she is fulfilling a personal goal, while another works solely for the paycheck. As employers and managers, it is our duty to understand and help ensure that these needs are being met—because if they’re not, employees will go to an organization that will.

Great Lines from Job Evaluations

We hope you never have to write these types of lines during a job evaluation at your organization!

1. I would not allow this employee to breed.

2. This associate is not so much of a has-been, but more definitely a won't be.

3. Works well when under constant supervision and cornered like a rat in a trap.

4. When she opens her mouth, it seems it is only to change whatever foot was previously there.

5. He would be out of his depth in a parking lot puddle.

6. This young lady has delusions of adequacy.

7. He set low personal standards and then consistently fails to achieve them.

8. This employee is depriving a village somewhere of an idiot.

9. This employee should go far, and the sooner he starts, the better.

10. Got into the gene pool while the lifeguard was not looking.