Caring: The Heart of CNA Practice

Caring: The Heart of CNA Practice

“Lots of times people think that nursing is just about caring, but caring comes from knowledge of science. We are science based.”

Porter and Chester Institute in Connecticut

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Caring: The Heart of CNA Practice

• Depending on the Kindness of Strangers

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“Who is here for me?”

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•“Whoever you are, I have always depended on the kindness of strangers.”

•Blanche Dubois

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Mum, 2002

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“Yes, we are supposed to treat the patients with compassion and dignity.  I think they use more the[word] respect and to be attentive to their needs and wishes.  They try, but they don't do a unit on it. … 

I think if you treat them how you would your own parents or want yourself to be treated, then you know what to do. ”

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Residents' Rights  

Residents’ Rights while Living in a Nursing Home

The rights of nursing home residents are codified in both federal and state statutes with the intent of further protecting each resident’s civil, religious, and human rights while they reside in a nursing facility.  

To be treated with

*consideration,

*respect,

*and full recognition of personal dignity.

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• Compassion is the wish for another being to be free from suffering….

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Matthew 7:12, Luke 6:31,Lev. 19:18 and 20 other the world religions

Therefore all things whatsoever ye would that men should do to you, do ye even so to them: for this is the law and the prophets." Matthew 7:12, King James Version.

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• Tenzin Gyatso: The Compassionate Life

• Usually when we are concerned about a close friend, we call this compassion, but it too is usually attachment…

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• True compassion is not just an emotional response but a firm commitment founded on reason. Because of this firm foundation, a truly compassionate attitude toward others doesn’t change even if they behave negatively. 21

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“You should expect that the person be kept as well as possible, well fed and hydrated, protected from obvious risks, and clean and comfortable.” 278-9

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• …the nature of for-profit businesses. No matter how caring their brochures may make them seem, they are businesses run by administrators beholden to the bottom line, a reality that can result in long-and short-term strategies not in a patient’s best interest…10

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• Get paid and don’t get caught.

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Wheelchair AND alarms…

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“The company will see that as a red flag.”

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“That happens.”

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Five Star Quality Care … an experience that is positive,

stimulating and filled with dignity…

emotional comfort... committed to the highest standards …

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Compassion: not a static state, not a destination to be reached, not a subject that can be taught.

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Compassion: a way of being in a relationship,a way of acting and interacting

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Tony’s Wāt Problem.

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Tony’s Wāt Problem.

A stroke landed Tony in his nursing home and in a wheelchair. He can’t walk and there is evidence of dementia, too. He lives in Wisconsin and believes he can see the Rocky Mountains from his west window.

Sometimes he is confused about what floor he is on, but usually he’s cheerful and sociable. He wanders, via wheelchair, throughout the facility, stopping to speak to whoever smiles at him and says, “Hi, Tony.” An aide has taken the handles of his wheelchair and moved him to the hallway of a wing he doesn’t live on. He asks, “Where are we going?”

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She says, “Your weight,” as she stops his wheelchair and sees that the scale has been removed.

Annoyed, she releases the wheelchair, steps around Tony, turns left and disappears into the shower room where lifts and other equipment are stored.

Uncertain about where he is, where she went and what she said, Tony says, “What?”

She speaks loudly from inside the shower room, “Weight!”

He, hearing wait, responds, “Wait for what?”

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Louder, now, assuming he can’t hear or isn’t trying to, she barks, “Weight! Weight!”

So Tony says, “Okay,” and he sits there cooperatively waiting until she comes out of the shower room with the scale that she’s had to search for and takes his weight.

Relieved now because he finally understands, he smiles at her. She thinks his smile means he’s enjoyed being querulous with her, so she doesn’t smile back.

Now Tony is more confused.

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…the desire to relieve suffering.

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Depression hurts…

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“You’re just like me. My memory is bad, too.”

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Milwaukee Journal/Sentinel

“She didn’t want me and myfriend saying [anything] inSpanish because it was a bother to patients and the other employees,” Lopez said.

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James Ryan, a U.S. Equal Opportunity Commission spokesman said, “We don’t consider customer preference as any kind of justification for any kind of discriminatory behavior.” Requiring employees to speak only English violates federal law…

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An attorney for St. John’s argued that Lopez’s charge should be dismissed.

“It was a matter of providing dignity and respect to the residents…by speaking a language that residents do not understand…a staff member may make a resident feel uncomfortable in his or her home.”

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“There is always a choice about the way we do our work, even if there is not a choice about the work itself.”

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• “And be present, fully present.”

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Being fully present…

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“The night nurse is so kind.”

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Residents' Rights  Residents’ Rights while Living in a Nursing HomeThe rights of nursing home residents are codified in both federal and state statutes with the intent of further protecting each resident’s civil, religious, and human rights while they reside in a nursing facility.  

*Always knock before entering a room…

*Wait for a response. 

*Knock even when the door is open…

*Privacy should always be ensured. 

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“What a fun bunch!”

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“That’s hard to tell…”

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• “The three-five minutes I chose to deal with Jessie rather than answer that call light were three-five minutes I could have been assisting Sally, three-five minutes that may have prevented her fall, three-five minutes I wasn’t there.”

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Compassionate CNAs

• Choose and agree to be there with the resident in a relationship.

• Relieve pain and provide comfort where that is possible.

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The Heart of CNA Practice

• Being fully there.

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• Access to CNAs while they’re still in training.

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…at the core of every single one of the world religions is the virtue of compassion, which does not mean "pity"; its Latin root means to feel with the other. Karen Armstong

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• The quality of mercy is not strain’d,• It droppeth as the gentle rain from heaven• Upon the place beneath. It’s twice blest;• It blesseth him that gives and him that takes.

• The Merchant of Venice

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• Being fully there…

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Those ten residents

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• Caring: The Heart of CNA Practice

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Caring: The Heart of CNA PracticeDepending on the Kindness of Strangers

by Caroline Court2009

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References Armstrong, Karen. The Great Transformation: The Beginning of Our Religious Traditions. Anchor Publishing, 2007. Armstrong, Karen. A History of God: The 4,000-Year Quest of Judaism, Christianity and Islam. New York: Random House, 1993. Court, Caroline. Mum, Alzheimer’s and Me: Staying Alive. Mequon, WI: Caritas Communications, 2007. Gyatso, Tenzin (the 14th Dalai Lama). The Compassionate Life. Boston: Wisdom Publications, 2001. Hart, Sura and Victoria Kindle Hodson. The Compassionate Classroom: Relationship Based Teaching and Learning. Encinitas, CA: Puddle Dancer Press, 2004. Lundkin, Stephen C. Ph.D., Harry Paul and John Christianson. Fish!: A Remarkable Way to Boost Morale and Improve Results. New York: Hyperion, 2004. Mace, Nancy L. M.A. and Peter V. Rabins, M.D., M.P.H. The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life. Baltimore: John Hopkins University Press, fourth edition, 2006. Moore, Marianne. Complete Poems. New York: Penguin Books, 1991. Shakespeare, William. The Merchant of Venice. New York: Washington Press, 1992. Steele, Dennis R. and Edward C. Watters III, M.D. Danger Zone: Unlock the Secrets of Nursing Home Medical Records and Protect Your Loved One. Severna Park, Maryland: Members of the Family LLC, 2003. Williams, Tennessee. A Streetcar Named Desire. New York: New Directions Publishing Corporation, 2004.

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