The Certified Nursing Assistant (CNA) has many roles. One of the most important roles is to assist patients with activities of daily living (often referred to as ADLs). ADLs are simple activities that most of us do every day—feeding, toileting, bathing, and ambulating, among others—but for many patients these activities may present a unique challenge. The nursing assistant is responsible to know the best way to assist the patients with these tasks so they are done attentively, efficiently, and safely.
Many patients may need help with opening food packages or getting settled with their meals, but sometimes patients are unable to feed themselves at all. To assist a patient at meal time, wash your hands before you begin feeding. Sit at eye level and protect the patient’s clothing. Use a spoon to deliver bites and ensure the patient has completely chewed and swallowed the first mouthful before offering another. Offer fluid after every three to four bites of food. Try to interact with the patient while feeding him to make mealtime a more personal, interactive experience. Encourage the patient to complete their meal, but do not force them to eat if they refuse or become too full. If the patient has problems with the meal or refuses it outright, inform the nurse in charge.
Patients who have limited mobility may need to use a bedside commode or bedpan to go to the bathroom. If the patient uses a commode, ensure that it is locked and as close to the patient as possible to minimize fall risks. Have items you may need, such as toilet paper, close by before you help the patient to transfer. Allow for privacy, if possible, but leave the patient alone only if it is safe to do so. If the patient needs a bed or fracture pan, place a protective pad under the patient to protect their bed linens. If able, have the patient roll to one side, place the pan under his buttocks, and raise the head of the bed up so the patient is in a more natural “seated” position. When the patient is finished, lower the head of the bed, remove the bedpan, and cleanse and dry the perineal area. No matter how you are assisting the patient to toilet, never compromise safety and keep the patient’s dignity and privacy in mind at all times.
Immobile patients are often given daily bed baths to keep them clean. Several brands of bathing wipes and waterless shampoos, which your facility may use for cleansing immobile patients, are available, but many places still rely on regular soap and water. To give a partial bed bath, ensure that the water is of a comfortable temperature. Expose only the area of the patient you are cleaning, and dry it immediately after with a clean towel. Wash the face only with a wet washcloth. Using only the clean part of the washcloth for each eye, wipe eyes from the inner to the outer canthus. Wash the rest of the body using a small amount of soap on the washcloth. Turn the patient on his side to wash his back and the back of his extremities. When finished, apply warm lotion to the skin and offer fresh clothes and a gown. Always be on the lookout for signs of skin breakdown as you bathe your patient and report any suspicious findings to the nurse immediately.
Different patients need different levels of ambulation assistance. A gait-transfer belt is a common assistive device to help safely move patients from one spot to another. To use the belt, fasten it securely around the patient’s waist and stand directly in front of the patient with your legs slightly apart. Hold the gait belt with both of your hands, and help the patient to a standing position so his feet are positioned in between yours. When the patient is steady, move one of your hands to the side of the gait belt and another to the back. Walk with the patient while holding the belt in this position, either at his side or slightly behind him. If the patient begins to fall, do not attempt to prevent the fall or catch him with your hands. Instead, bend your knees and slowly lower the patient to the floor, protecting the head from injury and allowing the patient to rest his body against your leg. Call for assistance and stay with the patient; do not attempt to move him as this may cause further injury. Another type of ambulation CNAs frequently assist with are range of motion exercises. To perform range of motion exercises, the patient should be lying comfortably supine, that is, flat on his back. Begin by smoothly rotating each shoulder joint, and then moving it toward and away from the patient’s body—adducting and abducting. Support the wrist and elbow, and flex and extend the lower arms. Rotate the wrists and flex and extend each hand, finger, and thumb. Next, support the foot and ankle and flex each leg by bending the knees. Adduct, abduct, and rotate the legs at the hip. Support the foot at the instep and rotate, flex, and extend each foot at the ankle, and then flex and extend the toes. Never force or tug on any extremity that seems stiff or does not want to move. Report any unusual findings to the patient’s nurse immediately.