Betty talks a lot about communication. There's a specific chapter in our book, _Essentials for Nursing Assistants_, on communication, in which one labels pictures with "message," "receiver," and "sender," accompanied by workbook questions so simple I realized I was overthinking their answers (example: which of the following is an example of communication? (a) giving a gift (b) driving to a friend's house (c) saying something to someone). Betty brings it up all the time, and, I am glad to report, in much more thought-provoking ways.
We talk a lot about Standard Precautions, which are certain procedures you follow in healthcare in which you basically treat every patient/resident (henceforth P/R) as though he or she could be carrying HIV or Hep. That is, gloves if you come in contact with certain bodily fluids, mask + protective eyewear if possibility of splashes, washing hands before and after doing anything with a patient/resident in his/her room... (You do specific precautions if someone has, say, TB, which is airborne, or measles.)
So some student logically asked whether we shouldn't just wear masks all the time. Betty said "No. If you put on gloves to take someone's blood pressure, or come in with a mask on to change sheets they've soiled, what message are you sending?" She went on to explain that it'll freak out a P/R as to how serious their condition is in the first case, and in the second, you humiliate them, because you're sending the message that you don't want to be in that room doing that task. "Learn how to breathe through your mouth or put a little vicks vaporub under your nose." Everything she tells us is centered around the safety and comfort of the care-recipient, and I'm certainly realizing that NACs spend more time with P/Rs than anyone else and likely affect the P/R's quality of life the most. Maybe not in hospitals. But this is certainly the case in longterm care facilities.
Our book mentions Maslow's hierarchy of human needs: a triangle the base of which is physiological needs (food, elimination, sleep), over which is safety, then love, then self-esteem, and finally, self-actualization, and gives examples of what NACs can do to meet each level of need a P/R has. While the ways in which NACs would meet physiological needs are obvious, Betty continually points out ways we're affecting the P/R's self-esteem. We'll likely be caring for the elderly, that is, folks who've spent their lives doing for themselves and others and are now forced to be helped and depend on others.
The main way we can accomplish this, she says, is to give the P/R choices whenever it is possible to do so without jeopardizing their care. "Mrs. Smith, we need to get you a bath so you can be clean and dry, but if that's not convenient right now, would you like me to come back at 9 am, or around 1 after you've had lunch?" She says this works wonders. It is also the main principle behind "Love and Logic," a parenting style my housemate's mother introduced us to, the goal of which is not explicitly to build self-esteem, but rather, to teach children how to make decisions and live with their consequences. The situation in a care facility is obviously different. The trick with L&L with kids is that if kids make a "bad" decision, their parents don't rescue them from the consequences. So it can't work exactly the same with Mrs. Smith--a NAC can't simply not perform care a P/R balks at. The L&L side effect I've enjoyed as a parent is how it calms me down to think through how to present a potential conflict as a choice, and I'm guessing that'll be invaluable on the job, as well.
Most of the things Betty has told us about communication I've "learned" at some point or another, but I hope to internalize it all, because it seems like I'd be a better friend, wife, and family member, as well as employee and co-worker, were I to make a habit of all of this stuff: get down on the person's level--sit, if you can; listen; make actual real eye contact and don't turn away when talking or "listening;" never, ever interrupt (I'm terrible about that); and with the elderly, especially, use a low tone of voice, since this could make the difference for them "between isolation and engagement." We also learned a little bit about resolving conflict in the workplace: ask to speak to the person, in private (eek! scary! but so useful.), be willing to hear stuff you don't want to, talk only about the specific event--don't generalize or psychoanalyze or try to make observations about somebody else's behavior patterns, be willing to agree to disagree, if necessary... I wish I'd learned some of that stuff before going to grad school and stepping on toes and later hiding from those whose toes I'd inadvertently stepped on. Ugh. This stuff is _not_ instinctive for most of us, I think--wish someone had explicitly taught it to me. Never too late, right? :/
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Hm...I think there are situations where a NAC can "simply not perform care a P/R balks at". P/R can refuse care, often even in contexts where some or all of their rights have been taken away and assigned to someone else due to a disability. Have you covered that yet?
ReplyDeleteIf I remember correctly, when I was an NAC, the way you had to document refusal was elaborate, creating work for the NAC *and* the charge nurse, so there was strong pressure to do your darnedest to make sure the P/R did not refuse care. This was also true if you worked overtime. Offering choices takes more time and we all had too many residents to attend to, so most of the people I worked with employed a combination of being directive with residents and lying in their charts. A couple NACs could be efficient enough to be, both nonhumiliating and thorough, but most could not. I know several NACs on swing shift who just never brushed anyone's teeth, ever, and consistently charted that they had, because they were too busy and most of the residents who weren't capable of brushing their own teeth were fairly out of it and didn't respond well to someone else offering to/insisting on doing it for them. This, of course, created the belief, even among well-intentioned charge nurses, that if I said I couldn't get it all done it was because I was less efficient than everyone else, when, in reality, I was only less efficient than two or three angel-machines who'd been at it for decades.
It sucked.