We’ve all been assigned to cranky, demanding rude residents/patients. You know them: Mean, belittling people who have elevated themselves above all others in level of need. Not just pillow fluffers, these residents demand strict attention to minute details not because the attention is necessary but because the resident believes they are entitled to it. Resident families can be just as hard to work with. I’m not sure who is worse: The demanding resident or the demanding family member. Regardless, here are 7 tips on working effectively with the Mrs. Cranky’s of the world:

1) CHECK IN
Check on the demanding resident 1st thing: Once you know you’re assigned to Mrs. Cranky, go to her room and check with her right away. Let her know you’re her aide.

2) DISCUSS PLANS and ADJUST WORK FLOW
Ask her if she has any special requests for today: Perhaps she wants her bath later in the morning; or she isn’t feeling well and would like to skip breakfast. Or maybe she has guests coming and would like to wear the hard-to-don red dress. By asking her what her plans are for the day, you are giving her a real say in how her day will go. Based upon her feedback, schedule your workflow to accommodate Mrs. Cranky’s needs. This does not mean you neglect your other residents.

3) SHARE YOUR WORKFLOW PLAN
It is perfectly acceptable to let Mrs. Cranky know that your other assigned residents have the same needs as she does. Make it clear that you are responsible to others and that you cannot cut back on time they need. You can say all this in a polite, professional and caring manner. Even further, I would let Mrs. Cranky know the order in which you will tend to her care. Give APPROXIMATE time frames. By doing this, you are alerting her that you hold your other residents’ needs just as high as hers.

4) ANTICIPATE NEEDS
Unless she is your first resident, check in with Mrs. cranky every so often. Anticipate her needs. Use your knowledge of her demands as a tool: If you know she usually rings the bell at 10am for bathroom use, be one step ahead of her and show up in her room at 9:55am to see if she needs the toilet…

5) TALK!
When performing actual cares for Mrs. Cranky, listen to her if she speaks. If she is rude or insulting you, let her know that this offends you! Tell her that her words hurt your feelings. By doing this, you put her on notice that you won’t stand for rude remarks and the like. Try to find some common interests to talk about- this shows her that you do have a genuine interest in her. Ask her about pictures she has; ask her where she has traveled in her life; ask her questions about HER LIFE in en effort to show your curiosity. If she answers your questions positively, GOOD! Keep aiming for this positive energy. If she continues to gripe and complain, remain quiet. Don’t ignore her, but ignore the negativity.

6) ASK POINTED QUESTIONS
If Mrs. Cranky seems upset or angry, while doing her care, ask her if something is bothering or upsetting her. Sometimes people are uptight or nervous about things and take it out on the nearest person. If she expresses sadness let her know she can speak with you about those things and offer to pass on her concerns to others as needed. Let her know she can trust you. If she is angry at her family, offer to speak with the nurse to see about a family meeting. If she is mad at other staff, listen but don’t give any feedback. Give her attention for her positive words and say little about her negative words.

7) FOLLOW UP! OFTEN!
During the shift,after her care is completed, check in with Mrs. Cranky. Again, ANTICIPATE her needs! When you take a break, let her know. By doing this you are letting her know you care about her. At the end of the day, if appropriate, check in with Mrs. Cranky one last time. Ask her if she needs anything. Ask her how she thinks her day went- and what could be done to make it better. When we ask people to help us with planning schedules and work flows, it’s amazing how much feedback we get! It’s always appropriate to say goodbye and other polite remarks.

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We’ve all experienced it.

We hate getting up on the days we have to work. We drudge thru the shift, barely able to turn a smile. We love the residents, but lately everything they do bothers us. We cringe when the nurse seeks us out. We hold some resentment towards our peers. And we really feel angry with management.

Job burnout is common among nurses and CNA’s. The work itself is very hard; the environment can be unforgiving. The workload can be unbearable. Add to this the low pay and low level of respect we get, it’s no wonder more of us don’t burn out sooner.

The MAYO Clinic offers the following symptoms to consider:

Have you become cynical or critical at work?
Do you drag yourself to work and have trouble getting started once you arrive?
Have you become irritable or impatient with co-workers, customers or clients?
Do you lack the energy to be consistently productive?
Do you lack satisfaction from your achievements?
Do you feel disillusioned about your job?
Are you using food, drugs or alcohol to feel better or to simply not feel?
Have your sleep habits or appetite changed?
Are you troubled by unexplained headaches, backaches or other physical complaints?

So what does the average CNA do when he or she has had enough of work?
Sometimes a mental health day is just what a doctor would order. Taking a vacation works wonders as well. Just getting away from it all can refresh us and keep on an even keel.

If this isn’t helpful, there are other things we can do:

Sometimes it is helpful to simply transfer to another shift at the facility you work at. Many CNAs get bored with the routines of the shifts they work. A new routine, with new peers can change things up for CNAs.

Other times, going from full time status to part time can help if one can afford this. Just knowing you don’t have to work so many hours every week can really lesson the burdensome thoughts you have.

Other times no amount of days off and shift changes can take away the misery of being totally burnt out from work. Getting another job isn’t always an option, but if you continue to feel this way for more than a month or so, a new job might be needed.

Will a new job at a different facility be helpful? For those who are troubled by a particular facilities policies and rates of pay, the answer to this would be YES.

For those who are fed up with the physical demands of the job- lifting, pulling, tugging, pushing, transferring helpless people all day; watching the inevitable decline of older people day in and day out- a new CAREER might be in order. Nursing work is nursing work. Although many RN’s and LPN/LVNs don’t have the same job descriptions, the physical requirements will be the same. A career change would be something I would consider if I were not able to do the physical aspects of the job.

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What is Range of Motion? The normal movement of joints.

For many residents, a lack of mobility causes stiffness in their joints. Their muscles shrink and become weak- this is known as atrophy. Gradually, the atrophied muscles become hard and rigid. The muscles shorten in this process, and therefore joint movement is affected. Pain, discomfort and disfigurement occur. These disfigurements are known as contractures. They are, almost always, 100% preventable.

To be effective, ROM exercises should be performed at least twice a day, and each exercise should be done at least five times. The quick, natural opportunities for ROM are an excellent way to enhance what we do, but it should never replace a full program. The only way to fully perform all the exercises, is during AM/PM cares, with a complete focus on this one activity.

Some residents will be able to help. They can move their joints without our help-this is called ACTIVE RANGE OF MOTION. The resident can perform almost all the exercises on their own, through a dedicated program or through normal activities of daily living.

Other residents can perform SOME portion of ROM, but due to weakness, pain, paralysis and the like, they will need limited amounts of assistance. Usually they can tell you exactly what you need to do. This is called ACTIVE ASSISTED ROM.

For most of the residents we deal with, PASSIVE ROM is the norm. These residents cannot assist with this, for many reasons. It’s important to remember that these ROM exercises do not strengthen the muscles; they prevent deformity and maintain movement.

A great way to make ROM a part of AM/PM care might include applying lotion to those body parts being exercised. The lotion is calming and relaxing, and this will help with ROM. Another good time is during a bath. If you note the resident experiences pain during ROM, ask the nurse about pain medications being given 30 minutes or so before the exercises are started.

If ROM is problematic to complete due to time restraints, ask your co workers if they too are having trouble. As a group, you all could seek ways to help each other. Or, seek the advise of the charge nurses. At one nursing home I know of, the aides simply did not have time to complete ALL the ROM for each resident. The aides met with the nurses, who went to the DON to get some ideas and guidance. The DON met with the Activity Director, who implemented an exercise activity designed to provide ROM to those residents the aides could not get to in the morning. The aides marked off who received ROM and who didn’t, and the Activity Staff provided the exercises as part of special “Massages” and other aptly titled programs.

Another nursing home I know of breaks up the ROM requirements for each shift. This means third shift does some of these programs- especially for those residents who are awake during their shift.

Creative minds can ensure that vital care is provided. Dedicate TIME for this very important skill…this task…this care. ROM should not be skimped on, ever.

Related posts:

1. Spot Light: Face, Hands & Butts?
2. Spot Light: Medical/Nursing Jargon
3. Spot Light: Culture Change and Break Rooms

In the course of any given shift at work, CNA’s come across words and abbreviations and diseases and conditions we have never heard of before. There are hundreds of terms to learn. In this article we hope to make this task a little easier.

First off, scan this list of common medical abbreviations. We use them with charting. We read them in the medical histories sections of patient charts. Do we understand what they all mean?

Abbreviations are well known in our work; each facility should have it’s own list of accepted abbreviations used in charting/orders. Without such a list, staff can use many different abbreviations, which are accepted but perhaps mean something else to each member of the team. Confusion can arise and patients can be harmed by misunderstandings.

Some terms we read are based on the human body. Terms associated with certain sections of the body are called descriptive terms.

All references to the body are made in relationship to the anatomical position. This refers to the standing forward facing body. A imaginary line is drawn down the center from head to feet which divides the body into two equal halves.

When we read the word MEDIAL it means the part is closer to to the line/center; LATERAL mean further from the line/center.
Your thumbs are more lateral than your pinky finger…

Imagine another line being drawn- this one dividing the upper and lower body into two halves. The line is right under the navel. When we read the term SUPERIOR it refers to above the line; INFERIOR means below the line.

Further, turn the body to face sideways. A line is drawn down the center, again. We’ll see terms called ANTERIOR, which means VENTRAL, towards the front. We’ll also see terms referring to POSTERIOR, or DORSAL, which mean toward the back.

The human abdomen is also divided into four sections, called quadrants. In your work you’re apt to read notes using these terms:
RUQ= Right upper quadrant
RLQ= Right lower quadrant
LUQ = Left upper quadrant
LLQ = Left lower quadrant
It’s pretty self explanatory where these sections are located.

There are many other forms of medical jargon to decipher. Understanding word roots, prefixes and suffixes can help this process a lot.

A word root is the foundation of a medical term.Word roots usually (not always) refer to the body part being described.
A prefix is added to the beginning of the word to change or add to it’s meaning
A suffix is added to the end of the word to change or add to it’s meaning.

Some examples of root words:
aden= gland
bronch=bronchi
chol=bile
crani=skull
dent=tooth
hem=blood
hepat=liver
hyster=uterus
my=muscle
nephr=kidney
pulm=lung
ur=urine

Some common Prefixes and sample meanings:
a=without (AFebrile or without fever)
brady=SLOW (Bradycardia or slow pulse rate)
dys=PAIN, DIFFICULTY (Dysuria or painful urination)
hyper=ABOVE, EXCESSIVE (High blood pressure or hyper tension, Hypothermia or high body temperature)
hypo=LOW, DEFICIENT (Low blood pressure or HYPO tension; HYPOthermia or low body temp)
pan= PANDEMIC (flu, Black Plague)
poly= MANY (polyuria or excessive urine)
post= AFTER (Post Operation, Post seizure)
pre=before, prior (Pre menstrual)
tachy= FAST (TACHYbradia or high pulse rate)

What medical terms can you associate with the above prefixes?

Some common suffixes:
ectomy= REMOVAL (hysterectomy)
itis=INFLAMMATION (bronchitis)
gram=RECORD (electrocardiogram)
emia=BLOOD (Anemia)
logy=STUDY OF (oncology)
oma=TUMOR (Fibroma)
otomy=INCISION (tracheotomy)
plegia=paralysis (Hemiplegia)
pnea=RESPIRATIONS (apnea)
scope=EXAM INSTRUMENT (stethoscope, otoscope)
scopy=EXAM USING A SCOPE (endoscopy)

What other medical terms can you associate with the above suffixes?

For a much more comprehensive resource for medical terms and descriptions, go to THIS SITE.

This resource also lists frequently used medical terms.

THIS SITE has an excellent graphics and descriptions of human anatomy.

HERE You’ll find a detailed list of anatomical terms frequently used.

Related posts:

1. Spot Light: Face, Hands & Butts?
2. Spot Light: Culture Change and Break Rooms

Much of the work we do is aimed at keeping our residents clean, dry, fed, toileted and hydrated. We focus on these things because it is OUR job. There are other things though, that often get lost in the daily shuffle. I work for an agency as a part time job (as well as a full time job at a rehab facility) and through my experiences here, I’ve seen a lot of rushed care and the results of it.

When working short, there’s a saying among aides: Face, Hands and Butts. FHB. This means that our time should be spent washing faces, hands and butts and the rest can go unattended. This isn’t ideal but it is the reality when we’re pressed for time.

Even when our units are well staffed I have seen some pretty poor quality cares that leave me wondering if some of us cannot put ourselves in our residents’ shoes…

No matter how short staffed, we must always consider resident dignity.

Complete bed baths, whirlpools and showers can be postponed.

Washing faces doesn’t mean simply wetting a wash cloth and wiping it over a face. It means using gentle soaps/cleansers. It means using another wash cloth dampened with water, to rinse off the soap. It means paying close attention to the eye areas, removing the residue and drainage we often see. It means making sure noses are clean and the area around mouths is clean as well. Shave the men.

Oral care MUST always happen- how would YOU feel if your teeth weren’t brushed???

Care must be given to underarms. They need to be washed, rinsed, dried. If needed, a light coat of deodorant is called for. Body odor is a major dignity issue for our residents.

Hands have to be washed. Period. Several times each shift. Nail care can wait, unless they are long and ragged or dirty.

Incontinent care has to happen. Buts and other areas MUST be cleaned. Period. No skimping here.

I can’t count the times I have witnessed residents being brought out with messy hair, or worse, with hair dos that are not becoming to them. Ladies like to look presentable. Imagine how you would feel with greasy, slicked back hair…it’s up to US to make hair look nice. Hair should be combed/brushed no matter what; if ladies’ hair is permed, a little spritz with some water often works wonders to bring back some curl.

Clothing choices? It usually doesn’t matter when it comes to staffing issues. Residents have clothes and we assist them with dressing. BUT what does matter is matching colors at best and avoiding clashes at worst: Striped shirts do not go with plaid pants! Just like an elegant fluffy blouse doesn’t go with sweatpants. Some of our male residents prefer to wear t shirts under their tops; and MOST of our ladies like to wear bras. Don’t skimp on this.

A quick note about briefs: For the residents who use them, we have to ensure they are correctly applied. The right size is paramount. Too big a brief is not only wasteful but a major cause of discomfort. Small briefs often lead to nasty red marks in the groin areas. Make sure the brief is centered, and the front portions are pulled up enough to allow for movement. Don’t let the brief bunch up anywhere.

Residents who use wheelchairs need special attention for comfort AND skin issues. This is a no brainer but I have seen countless times, bunched up shirts in the back and sides. Pants that are wedged up in front. We need to make sure these things don’t happen. Take the time to pull down tops once a resident is positioned in their W/C; fix the wedgies and pull down the lower parts of pants. Make sure the resident is seated properly and is comfortable.

As much as most of us don’t like providing less than ideal care, we can do so on shifts where we just don’t have time. Assignments are often increased with two or three residents when there’s been a call out. Always check with the charge nurse about your priorities when staffing is an issue. Better yet, ask the nurse for a meeting with all the aides on the shift, to plan ahead for those times.

Always consider safety, comfort and dignity. Some will say not always in that order, either.

Related posts:

1. Spot Light: Culture Change and Break Rooms