Emotional and Mental Health Needs Study Guide for the CNA

General Information

As a Certified Nursing Assistant (CNA), you are expected to care for all aspects of your client’s health, including mental and emotional health. Mental health covers any mental disorders (including, but not limited to, schizophrenia and personality disorders); emotional health covers both emotional disabilities and simple emotional well-being.

Because all clients are different, mental and emotional healthcare may vary from one client to another. While some require extensive treatment and care regarding mental health, others only need emotional support and encouragement. Always be sure to put time and effort into your client’s mental and emotional health, as these aspects of health are pivotal in driving healing and recovery.

Mental Health

Mental health needs greatly vary between clients. As a healthcare practitioner, your responsibility lies with administering care and paying close attention to clients to determine any changes in mental state, identifying any triggers for increased mental agitation, and ensuring that clients are treated adequately. For instance, suppose a mental health client grows increasingly agitated at a particular time of day. Part of your job as a CNA is seeking out potential causes and rectifying the situation.

Performing adequately in this area of medicine requires some basic knowledge of the mental health field. To prepare for assisting mental health clients, conduct a basic review of common mental maladies and disorders, including their common causes, onsets, symptoms, and treatments. While your expertise will be primarily medical rather than psychological, this will be invaluable in properly assisting clients and peers.

Common Mental Health Concerns in Patient Care

Dementia

As a CNA, you will likely encounter many clients with dementia, especially if you work with an older population. Dementia is a non-specific term that causes impaired memory, judgment, reasoning, attention, and communication. While many adults will experience dementia, it is not considered a normal part of aging. Understanding the unique needs of clients with dementia is crucial to doing your job well. Reducing distractions, issuing simple instructions, and providing limited choices are all ways you can help prevent additional frustration and confusion in a patient with dementia. Because some forms of dementia are reversible, you must report any new client confusion or impairment to the nurse or doctor in charge.

Sundowners syndrome

Sundowning is not considered a disease but rather a set of symptoms that regularly occur for clients with dementia in the late afternoon or evening hours. Expressions of sundowners include:

• Increased confusion

• Anxious behavior

• Aggression

• Wandering

• Suspicion

• Making demands

One out of five people with Alzheimer’s dementia experience sundowners, so it is vital for the CNA to be on alert for such behavior. While sundowners can not be prevented entirely, there are things family and medical professionals can do to help. They include:

• Limiting loud noises in the evening

• Offering relaxing evening activities such as cards, music, or reading

• Keeping areas well-lit until it’s time to sleep

• Provide reassurance and reminders

• Not arguing or telling the patient they are wrong

Depression

Clients in a healthcare setting are at high risk for depression. Loss of physical or cognitive function may lead to feelings of helplessness, anxiety, and sadness. As a CNA, your role is to provide a listening ear and encouragement while also watching for signs of new or worsening depression. Excessive sleep, lack of appetite, and disinterest in self-care or favorite activities may indicate your client is depressed and should be reported to a supervisor immediately.

Emotional Health

Like mental health, emotional health is not typically marked by physical indicators. Ensuring a client’s emotional health requires regular observation and some amount of intuition regarding behaviors and emotions. Without careful observation, a client’s emotional needs may not be met.

Common Emotional Health Considerations

Maslow’s Hierarchy of Needs

Before you address a client’s mental health needs, other basic needs must be attended to first. Abraham Maslow created a framework to understand client needs and motivation in 1943. His Hierarchy of Needs organizes human motivation into five categories, typically depicted as a pyramid.

The bottom of the pyramid is physiological needs, which include food, water, shelter, and clothing. Safety and security needs follow, which include financial security, feeling safe in your home and community, and having a sense of control and predictability in life. Social needs involve relationships and feelings of community, belonging, and acceptance, while esteem needs focus on feelings of self-worth, respect, and accomplishment. The highest point of Maslow’s hierarchy is self-actualization, which he described in the following way:

It may be loosely described as the full use and exploitation of talents, capabilities, potentialities, etc. Such people seem to be fulfilling themselves and to be doing the best that they are capable of doing. They are people who have developed or are developing to the full stature of which they are capable.

Knowledge of Maslow’s Hierarchy of Needs is essential to anyone in the healthcare field, especially those providing direct patient care. A CNA should understand that a client’s emotional and mental health needs can only be fully addressed once their physiological and safety needs have first been met. For example, a client who is hungry and tired will be less engaged in social activities, or a client who is stressed about paying bills may not be able to focus on personal growth.

The Five Stages of Grief

Clients who have received a difficult diagnosis or are close to death may act out in ways that aren’t typical of their personality. The informed CNA will understand the five stages of grief, as outlined by Elizabeth Kubler-Ross in her 1969 book, On Death and Dying. Kubler-Ross theorized that all people, when presented with death or a significant life change, will go through the following phases:

• Denial

• Anger

• Bargaining

• Depression

• Acceptance

Though every client will likely exhibit at least one of the stages of grief in reaction to difficult news, they may not experience them all, and they also may not occur in the order that Kubler-Ross has laid out. For example, a client who has just received word that they only have six months to live may initially be in denial, become depressed, and then accept the news. A client who recently became paralyzed may become angry and never truly reach a state of acceptance.

Client Emotional Health and the CNA

As a CNA, your role is to support the client in ways that are appropriate to your position. Examples include active listening, providing choices, and offering encouragement. You are expected to be an informed source for clients and peers, but remember your limitations in this field. While you are a medical professional, you should not take the role of diagnostician upon yourself, nor should you answer in-depth questions and concerns regarding treatment and medication. These questions should be accepted and referred to the client’s physician.

Hospital stays can be frightening for anyone and particularly difficult in situations requiring extensive treatment or without clear answers or causes. As a CNA, your primary purpose is to assist clients and physicians—part of this is caring for your client’s emotional well-being and acting as a source of support and strength during a difficult time.

While you are not expected to step into the role of nurturer, friend, or family member with your clients, you should maintain some bedside manner and treat clients with kindness, respect, and, above all, compassion. Offer support or encouragement when it is sought or consolation when it is requested.

Many clients will be alone when bad news is delivered or will not yet have relatives in the room when a favorable prognosis is announced. Both circumstances require some amount of emotional support or emotional commiseration. This support may be as simple as smiling and saying congratulations when good news is delivered or expressing your condolences and sorrow when the information is unwelcome.

All clients require a degree of support and assistance in all areas, including mental, emotional, physical, and, in some cases, spiritual. No one area should be ignored if you are to provide excellent customer care and fulfill your role as a CNA.