Newest Review: ... a description of my typical working day: 6.45am, I am out of the door and on the way to my first call. I get there for 7.00am, and at this... more
Could you do it?
Health Care Assistant
Member Name: mdp97jes
Health Care Assistant
Date: 20/05/02, updated on 15/02/05 (14039 review reads)
Disadvantages: hard work
This piece is about working as a care assisstant in a nursing home, but most of the skills are tranferrable to hospital settings or home care services.
"Nursing Homes are care giving facilities developed to provide long term care to chronically ill or dependent individuals" (Carnevali & Patrick 1993 p163). As a care assistant in a nursing home my job involved caring for the residents giving them the assistance required to fulfil their daily activities. To show how I felt I contributed to the needs of the resident I aim to discuss what I did under the headings of Roper, Logan and Tierney's Activities of Daily Living. The Activities of Daily Living were devised by Roper et al in the late 1970's to enable nurses to get a broad view of a patients every day life, therefore gaining a full assessment enabling them to provide individualised care. There are 12 Activities of Daily Living;
~ Maintaining a safe environment
~ Eating and drinking
~ Personal cleansing and dressing
~ Controlling body temperature
~ Working and playing
~ Expressing sexuality
It is a well known fact that people are now living much longer. It was estimated that in the year 2000 there were a million people aged 85 or over. As the majority of Nursing Home residents are in this age bracket and are also more likely to have problems with many of the Activities of Daily Living, it is very important that care staff can meet their needs, making the residents life as comfortable and happy as possible. It has to be remembered that although the model is being followed, that each resident is an individual and care should meet his/her individual needs and not be generalised. Many of the activities overlap, so many problems fit into more than one area, in an effort to avoid repetition they will be discussed in only one area.
aintaining a Safe Environment~
"In order to stay alive and carry out the other activities of daily living, it is imperative that actions are taken to maintain a safe environment" (Roper et al 1990). As people get older their ability to maintain a safe environment is reduced, due to failing sight, hearing and mobility, confusion and ill health. In fact inability to maintain a safe environment is probably one of the most common reasons for admission to a Nursing Home. Care Assistants should ensure that the environment is as safe as possible for the resident, this can be done by paying attention to simple things that most of us probably take for granted;
~ ensuring that nothing is left on the floor for anyone to fall over, ie clothes, bedding, cups.
~ making sure that things are within reach so that the resident is not tempted to stretch to reach what they want.
~ checking that footwear is safe eg. fits properly, shoe laces fastenend.
~ cleaning up any wet floors straight away to avoid anyone slipping.
~ ensuring that resident is wearing glasses and hearing aids if they have them and that any walking aids are within reach.
~ see that the residents call buzzer is within reach and that they know how to operate it.
Confusion and disturbed behaviour are common problems for residents in nursing homes and this can pose great difficulties in maintaining a safe environment. "Wandering, incontinence, angry outbursts, stubborn denial that there is a problem and sleep reversal, being drowsy by day and restless at night are among the most troublesome forms of disturbed behaviour" (Shukla & Brooks 1996).
People who are confused are rarely aware of their confusion, they might admit to being a bit forgetful, but usually think it is other people who are confused, not them. It is important for the safety of all the residents that any confusion is kept to a minimum,
this can be done by keeping the resident orientated to the time, day and place, ensuring that routines are maintained and the environment kept as constant as possible. It is also important to try and reduce any anxiety as this can exacerbate the confusion. "A gentle reassuring touch can calm a patient better than words or drugs" (Shott & Finlay 1984). This will not work for everyone as some people do not like being touched.
Confusion is not a illness, but a symptom and a sign something else is happening.
"Communication is the process by which we transmit information to, and receive information from other individuals or groups" (Cormack 1985).
Communication can be verbal or nonverbal (body language). "Nonverbal behaviour provides us with clues to, not conclusive proof of underlying feelings. However research has proven that nonverbal clues to be more reliable than verbal clues" (Okun 1991). It is important to be able to recognise nonverbal communication and act upon it, for example if someone is uncomfortable, in pain or worried about something, these are all things that people want help with, but may not verbally request it. People who are worried or unhappy often want to talk, but do not ask as they feel they are wasting your time, but if you can recognise that there is something wrong and approach them about it they may feel happier about telling you. Inskipp stresses the importance of "accepting peoples feelings without trying to cheer them up, or deny or play down their feelings" (Inskipp 1988). "For many an elderly person pain is a constant companion" (Cormack 1985). Often they will not complain and suffer unnecessarily unless the carer recognises the resident is in pain.
There are many barriers to communication, including hearing loss, visual problems and speech disorders. "Some deafness is inevitable as we grow older and in som
e cases complete hearing loss may result from degenerative changes in the ear" (Wright 1984). To make sure the resident who is deaf or hard of hearing understands as much as possible the carer should face the person, speak clearly, find out if they hear better on one side than the other, make sure that they the resident has understood what was said. Hearing aids should be used correctly if the resident has one. "All professionals who provide care to hearing aid users should know how to assist them in inserting their ear moulds and adjusting the volume control to a comfortable level" (Carnevali & Patrick 1993).
Vision is used a great deal in communication, watching the person speaking to us gives us a lot of information about what they are saying and we also use many visual forms of communication, letters, newspapers, television, books etc. A person who has visual problems can feel very isolated. They can be helped by the carers talking to them clearly, keeping them informed about what is happening around them, reading their letters to them and helping to write replies and if their is any spare time carers could read to the resident if they are interested either in the news or a book. For residents who wear glasses it is important to make sure that their glasses are kept clean and worn at all times, except in bed.
Speech is often affected by strokes or Parkinsons disease, this can be very frustrating for everyone as the resident has difficulty communicating their needs. The carer needs to be very patient and encourage the resident to take their time when trying to speak, reassurance is important, if the person gets upset it makes speech even more difficult. Observation of nonverbal communication can be very useful in interpreting what the resident wants. Writing down what they want can be encouraged for some residents, but this ability is often affected by strokes, Parkinsons, arthritis and visual problems.
This is something that most of us do without thought or effort, but as we get older the lungs become less elastic, so breathing becomes more of an effort. Many people also suffer damage to their lungs and suffer from respiratory diseases. "Pneumonia is the fourth leading cause of death in the elderly" (Carnevali & Patrick 1993).
Being breathless is very distressing and tiring for the resident. The carer can help in many ways, firstly by providing reassurance, helping them to find a comfortable position which makes breathing easier (usually upright and supported), allowing them to move around in a wheelchair if they find walking to much of an effort (it is important to keep as mobile as possible to prevent secretions settling on the chest and exacerbating the problem). It is also important that carers know how to use oxygen, inhalers and nebulisers if the resident should need them. "A good nurse can help someone to get his breathe freely and get his breath in more ways than one, not least by caring for him in such a way that it restores or reinforces the way he sees himself as a worthwhile individual who is respected and valued by others" (Ashworth 1976).
The carer should observe residents for signs of breathlessness and distress and report them immediately so that the problem can be acted on to prevent unnecessary distress, ill effects or further complications.
~Eating and Drinking~
We all need to eat and drink in order to survive, but many older people lose interest in food, this maybe because they are ill, depressed, attention seeking, afraid of poisoning or put off by a bad experience eg. choking. "The elderly person often has less appetite for food; there is usually less physical activity so there is not the same requirement for the energy foodstuffs" (Roper et al 1990). Problems with senses often make food unappealing. "Many older people experience a diminution in the
sense of smell and taste, which of course makes food insipid" (Cormack 1985). Also if you cannot see what you are eating it is not as appetising. Some medication reduces the appetite or can make you nauseous.
Many residents may need help with eating and drinking, due to arthritis, strokes or visual problems. Help needed can range from cutting up tough foods to spoon feeding. It is important to find out the resident likes and dislikes, there is nothing worse than being made to eat something you dislike, especially if your appetite poor anyway. Some residents may need plate guards to prevent food being pushed off the plate, carers should ensure these are provided. If a resident has suffered a stroke or has problems with their hands, it may be possible to get adapted cutlery, so they can still be independent, it is quite degrading being dependent on someone feeding you, and it may mean that they will eat better. Carers need to be aware of anyone who is diabetic and know what they can eat, as often they will ask for things they cannot have. Awareness of religious beliefs is important eg. Muslims do not eat pork, Hindus are vegetarian and Jews prepare food in a certain way.
To ensure that residents can eat properly carers should check that any dentures are clean and that the resident is wearing them. Dentures can often become uncomfortable, making chewing difficult, discomfort should be noted and efforts made to get the dentures altered.
Fluid intake is more important than food "one suffers more acutely, more quickly from lack of fluid than food" (Cormack 1985). Often it is difficult to get the elderly to drink adequate amounts as they worry about being able to get to the toilet, or being incontinent, confused residents can forget when they last had anything to drink, so carers can have a difficult job to persuade them to drink. Offering drinks at regular intervals and being available to help with toileting can help
to encourage fluid intake.
Difficulty swallowing (Dysphagia) is often the result of a stroke and can make eating and drinking difficult if not impossible. Residents with this condition may need liquidised diets and careful observation to ensure that they do not choke. Others may need to be artificially fed through Nasogastric or Gastrostomy tubes, although care assistants cannot administer the feeds they need to be able to recognise any problems with the machinery or reactions in the resident so that they can be quickly rectified by the qualified staff.
This is an activity that everyone has to do, but for elderly people it can cause many problems. There are two sorts of elimination, urinary and faecal. Some of the difficulties experienced by the elderly are frequent urination, incontinence, constipation and retention of urine. Urinary incontinence is "any uncontrolled leakage of urine at any time" (Ouslander 1981). "Constipation is one of the most common complaints of older people" (Carnevali & Patrick 1993).
In order to prevent the distress and complications that can be caused by incontinence carers need to encourage frequent toileting, 2 hourly for those most at risk. Carers should encourage the residents to ask if they need assistance getting to the toilet and, or help with clothing and must not ask people to wait if they ask for the toilet as this leads to upsetting accidents and discourages the resident from asking for help and causes anxiety.
Residents who are incontinent should be helped to clean themselves and get into dry clothes, some may use pads to prevent soiling of clothes, these should be checked regularly to prevent sores. Many residents will be upset if they are incontinent so need reassurance and help to prevent it happening again. Incontinence is caused by weakening of the bladder muscles or failure of the brain to recognise the signals that the bladder is full
, regular toileting can help to retrain the bladder in some cases. Some residents may be catheterised to avoid incontinence or to relieve urine retention, carers need to know how to care for the catheter in order that they can teach the resident or carry out the care themselves, this must be done daily to prevent infection.
Constipation can be uncomfortable, painful and distressing, it is often caused by reduction in mobility and changes in eating habits. Carers can help by encouraging mobility and a high fibre diet. Medication is often the only way of easing the constipation, so checking that the person takes their medication can also be helpful. Some elderly people get very concerned about bowel habits, reassurance that a daily bowel movement is not essential can be useful.
~Personal Cleansing and Dressing~
"Elderly people may have increasing difficulty in managing some of the physical activities involved in cleansing and dressing" (Roper et al 1990). Some residents need help with all aspects of cleansing and dressing others will need little help, perhaps just washing their back or unfastening fiddley buttons. Again some residents are reluctant to ask for help and will neglect hygiene rather than ask, on the other hand others will allow carers to do everything for them when they can manage themselves. It is important for carers to assess what people can do for themselves in order to maintain some independence or avoid neglect of hygiene needs.
There are aids to help with bathing and showering, eg. hoists and chairs, but carers must be instructed in their use before using them for a resident. When using the equipment residents should be told what is happening, it is quite frightening being lifted up in the air and swung round even if you are expecting it, so reassurance is also important. Water temperature must be checked, many elderly people cannot tolerate hot water.
If the resident has a regular r
outine it is useful to try and stick to it, ie if they like a bath at night rather than in a morning, or if they have their hair washed on Sundays and Wednesdays, it gives them a sense of control and security. At all times privacy must be maintained eg. bathroom doors closed, body kept covered as much as possible, knocking before entering a room. Attention must be given to cleaning of the perineal areas, although this can be embarrasing for the resident, if they can do it themselves it is less distressing. Nails are often over looked and can become very dirty, they need to be cleaned and cut regularly.
According to Roper et al (1990) 74% of people over 65 and 87% of people over 75 are toothless, the majority of others have gum disease and caries. Mouth care is very important and so often neglected. dentures need to be removed at night and soaked, then cleaned before they are put back in the mouth. Residents with their own teeth need to be reminded or helped to clean their teeth. For resident who are being artificially fed regular mouth care is needed as the mouth becomes very dry and sore.
~Controlling Body Temperature~
"Elderly and immobile patients feel the cold more readily" (Roper et al 1990). This can be helped by providing blankets and wearing layers of clothing. Making sure windows and doors are closed prevent draughts. "Body temperature falls at night" (Roper et al 1990) so carers need to make sure the resident has enough bedding to keep them warm.
A raised body temperature is a sign of illness and should be reported. Residents can be cooled using fans, wiping the face with a wet cloth and removing extra bedding. Care must be taken that they do not get too cold.
As people age mobility is often reduced, due to pain, stiffness, limb weakness, respiratory difficulties, lethargy etc. "Falls are common in the elderly; 1 in 4 over 65 years will fall in the subseq
uent year and 5% will result in a fracture" (Shukla & Brooks 1996). Carers need to accompany residents who are unsteady on their feet or lack confidence when walking. It has to be ensured that any walking aids eg. zimmer frames or walking sticks are used. Confused residents often forget that they are unsteady, unable to walk, or use a walking aid therefore need extra observation and reminders. In conditions such as Multiple Sclerosis or Parkinsons disease the residents ability to walk varies from day to day, from being fully mobile to dependent on a wheelchair. Rheumatic problems such as Arthritis are common in knees and hips, making walking very painful if not impossible. "Rheumatic disorders are very common - up to 40% of elderly people have this disorder" (Shukla & Brooks 1996). Other residents may be fully mobile, but spend long periods sitting as there is nowhere to walk to, carers should encourage them to walk around for short periods, to prevent the consequences of immobility eg. pressure sores, chest infections and thrombosis.
Despite careful observation falls do happen, on finding a resident that has fallen the carer should not attempt to move the person until they have been checked by a qualified member of staff, who may decide to call a doctor or ambulance if they suspect fractures, head injuries or internal injuries may have occured. Following a fall the resident will need close observation for signs of pain, level of consciousness, vomiting and anxiety. Reassurance is very important, as is keeping them informed of events and making them as comfortable as possible without causing further trauma. Accident forms should be completed.
All carers should be taught how to lift and transfer residents to prevent unnecessary falls or damage to the carers themselves.
Pressure sores are the main result of immobility in the elderly. "Pressure sores may be of the superficial or deep skin type and are associated
with immobility and a general deterioration in the physical / mental condition of the elderly person" (Cormack 1985). "Nearly all pressure sores are due to unrelieved pressure, usually in relatively or totally immobile patients" (Garrett 1991). Pressure sores can be prevented by regular relief of the pressure eg. walking, standing, changing position. Residents who are bedbound or unable to turn themselves in bed need regular changes of position, the most at risk need to be turned 2 hourly. "At risk patients can be managed with regular turning" (Shukla & Brooks 1996).
Residents should be regularly assessed for their risk of getting a pressure sore, using either the Norton or Waterlow scoring scale. Areas of the body at risk of sores, eg the bottom, hips, knees should be checked daily for any signs of redness or breakdown of the skin. Changes in the state of existing sores should be reported. Areas prone to pressure areas should be kept clean and dry at all times.
~Working and Playing~
Most people would probably say that the elderly do not work or play, but they need to kept occupied as much as anyone else. "We should not underestimate the problems that boredom and the lack of mental and social stimulation can have on the health and wellbeing of any person young or old" (Garrett 1991).
Residents should be encouraged, but not pressured, to take part in organised activities and outings. Many like to watch particular programmes on television, so carers should ensure that the residents television is on and that they can change channels. Others enjoy sitting and talking with other residents or to staff and relatives, often talking about the '?old days'. "In the last few years an ever increasing interest has been shown in the uses of reminiscence therapy" (Garrett 1991). Any activity is a relief for boredom or a distraction from the present. "Whilst people are enjoyin
g themselves they often forget about their current aches, pains and symptoms" (Garrett 1991).
Sexuality is "those aspects of the human being that relate to being , boy or girl, man or woman. An entity subject to lifelong dynamic change. It reflects our human character, not solely our genital nature" (Garrett 1991). For most residents expression of sexuality is shown in the way they dress and present themselves. Ladies may like to have their hair done and wear makeup and jewellery, whilst men may want to wear a shirt and tie and have a splash of after shave. It is important that residents are allowed to wear what they choose and are helped to apply makeup or set their hair, as well as expressing sexuality it make them feel good.
Maintaining dignity is also important some residents would be very embarrased at anyone seeing, them bathing or not fully clothed. On the other hand there are residents who may not keep their bodies covered or wander around without clothes in their confusion, this should be discouraged and the person made decent to maintain their dignity and to avoid upsetting other residents or visitors.
Everyone requires sleep, but not every one needs the same amount. Many elderly people have problems sleeping, they seem to wake often or have difficulty getting to sleep. "The older person sleeps for a shorter period than the young and it is more broken by periods of wakefulness" (Roper et al 1990). Shott and Finlay (1984) say that insomnia results from being separated from one or more of six facets;
~ Loving contact
~ Physical comfort
~ Regular exercise
~ Peace of mind
Carers can try and ensure that residents are not separated from these facets as much as possible, for example making sure they are comfortable, that they are warm enough, listening to any worries they have and gi
ving reassurance. Other factors that prevent sleep and can be controlled by carers to a certain extent are noise, light, routines and toileting. Carers need to know what the residents usual bedtime routine is eg. what time they like to go to bed, if they have a drink, if they like the light leaving on or have the door open or closed. These may all sound simple, but it helps the resident to be settled and to sleep better. Residents should be checked regularly during the night, taking care not to disturb them if they are asleep or try to resolve any problems of those that are awake. Ensuring that the resident can reach their call buzzer will give great peace of mind and help promote sleep. Provision of commodes next to beds is another way of relieving anxiety for the resident who is worried about getting to the toilet during the night.
Night time is often when people with problems and worries like to talk, carers may also have more time to listen during the night and should be understanding and allow the person to express their fears and worries. "A sympathetic listener last thing at night is invaluable" (Shott & Finlay 1984).
Having a nap during the day should be encouraged to prevent residents becoming over tired, it also helps to pass time, but if someone seems unusually drowsy it may be cause for concern and should be reported.
Death affects the daily lives of the elderly more than any other age group, be it the nearing of their own death or death of those close to them. "For the elderly there is the realisation that they are approaching the end of the lifespan and they are made aware of this by an increasing number of deaths in their peer group" (Roper et al 1990).
Many residents are admitted to nursing homes as a result of their partners death. "The death of an elderly spouse often means the loss of a previously coping partnership the two having compensated for each others
difficulties and disabilities" (Garrett 1991). In this situation their grief may be aggrevated by having to leave their homes and possessions. Everyone copes with bereavement in different ways, some see death as inevitable and often a relief of suffering, therefore cope well, whilst others are devastated and lose their own will to live, deny the death has occured or become confused, some may never recover from a bereavement. Bereavement means "to be robbed of something valued" (Garrett 1991). Carers need to be sensitive to the persons needs and willing to listen, if they wish to talk about the deceased person it should be encouraged as often it helps the healing process, memories of the good times often ease the misery. There are thought to be four stages to grief. "An initial stage of numbness is followed by a period of restlessness and pining, a time of anger comes next often directed at helping professionals" (Waltis & Martin 1994). Carers need to understand that grieving is a long process and should not expect the person to recover after a week, it can take months or years. "Helping people cope with grieving is part of preventative health care" (Copperman 1985).
For some residents their own death is frightening, others may feel it is inevitable and do not worry about it. Death can be painful, distressing, drawn out, sudden or peaceful. Terminal illness can be very distructive and bring out a lot of emotions in the resident and their family. Emotions include anger, depression, denial and fear. During a terminal illness the resident may suffer a lot of pain, lose weight, lose control of bodily functions, even lose consciousness. The carer should ensure that the person is kept as comfortable as possible and has their hygiene and nutritional needs met as well as emotional needs. The care given must show that "you matter because you are you; you matter to the last moment of your life, and we will do all
we can to help you die peacefully but also to live until you die" (Saunders 1976).
At times of bereavement the carer may be of great support to the residents family and should offer help if needed whilst respecting the privacy of the family.
The job of a care assistant is very important. They usually have the most contact with the residents and are involved in all activities of daily living. Often care assistants will be the first to notice changes in a resident, which need to be reported to qualified staff. Also care assistants are usually the ones who residents approach with worries as they do not like to bother the qualified staff, all worries should be taken seriously and acted on if necessary.
More reviews in the field of Profession / Occupation
- School governors
- "On Yer Bike!"
- New CCNA as at April 2002...
- Once upon a time...................
- Knitty Noras and Baby Walkers
- Dreadful course materials, Zero support, but happy to take your cash!
- Not for everyone
- There's always going to be a need for carers
- Looking into doing Community Care Work? Read this first!
- An insight into my customer service experiences