As a certified nursing assistant, you are very hands on with your client. You are responsible for the very basic needs of your client including his or her mobility. As the primary caregiver of the client, one of your duties is the safety of your clients when transferring them from bed to chair, bed to stretcher and vice versa. Strength is not only necessary, but also the proper and safe transfer techniques so you’ll not be physically strained. Proper transferring will not only benefit your client, but also yourself.
Before the transfer, here are the general considerations a CNA can follow:
- Plan the transfer well. Determine the sequence, space used, number of assistants necessary, the skill and strength of the CNA, and the assessment of the client’s capabilities and tolerance.
- Make sure your equipment is complete and ready and safe to use.
- Remove unnecessary obstacles from the area used for transfer.
- Explain the transfer to the client and assisting personnel, including specific directions of their participation.
- Always support and hold the client, rather than the equipment.
- During the transfer, explain to the client what he or she should do step by step.
For the equipments to be used, the CNA may keep this in mind:
- Walking belts for transfer provide the greatest safety since the CNA can grasp the belt to control the movement of the client during the transfer.
- Slings, lapboards, bath blankets, pillows and nonskid shoes may help in facilitating efficient and effective transfer.
- For bed to wheelchair transfer, position the chair parallel or on a 45 degree angle to the bed, depending the ability to walk of the client. Ensure that the wheelchair’s brakes are locked, the footplates are removed, and the bed brakes are also locked.
- For bed to stretcher transfer, position stretcher parallel to the bed, lock the stretcher and the bed brakes.
- For a mechanical or hydraulic lift, use a frame, canvas strips or chains, and a hammock or canvas strips.
- Assuming that the client is capable of sitting, place the bed in the lowest position with the client’s feet resting flat on the floor.
- Ask or assist the client to: move, sit at the edge of the bed, slightly lean forward from the hips, place the stronger foot beneath the edge of the bed, and the other foot forward. Place the client’s hand on the bed or on the CNA’s shoulder to push while standing.
- The can stands directly in front of the client, leans forward from the hips, knees and ankles, and assumes a broad stance, placing one foot forward and one foot back.
- Encircle client’s waist with arms and grasp the transfer belt at the back.
- Assist client to stand and move together toward the wheelchair.
- Assist the client to sit. Ensure that the client’s legs are placed against the chair.
- Secure client’s safety. The back of the client must rest well on the chair, feet are on lowered footplates and seat belt is applied as required.
- Lower the head of the bed until it is flat or until the client can tolerate.
- Raise the bed until it is slightly higher than the surface of the stretcher.
- Pull the drawsheet out from the both sides of the bed and roll it as close to the client as possible.
- Move the client to the edge of the bed and position it parallel to the bed.
- Transfer the client to the stretcher by asking the client to flex his neck and to place arms over his chest during the transfer. In unison, press the body against the stretcher, pull drawsheet against the client, flex hips, and pull client towards the CNA and the stretcher.
- Ensure client comfort and safety. Raise side rails and fasten safety straps.
The following precautions should be observed when taking an oral temperature:
- Do not take temperature if patient has had a cold or hot drink or after smoking (take it after 30 minutes)
- Do not take temperature by mouth when the patient is:
- Do not take after oral and nasal surgery
|1. Clean the digital thermometer’s tip with cool, soapy water, or wipe it with 70 percent isopropyl alcohol.
||To remove germs or bacteria
|2. Choose the right or proper thermometer. The American Association of Pediatrics recommends using a digital thermometer and stay away from the use of mercury thermometers, which can be toxic. Choose a digital pacifier thermometer if the patient is a child between 3 months and 4 years old and a regular digital thermometer for children over 4 years old.
||Mercury may be fatal if inhaled and harmful if absorbed through the skin. Around 80 percent of the inhaled mercury vapor is absorbed in the blood through the lungs. It is harmful to the nervous, digestive, respiratory and immune systems. Exposure to mercury can cause tremors, paralysis, impaired vision and hearing, insomnia, attention deficit, and developmental delays during childhood.
|3. Have the patient at rest (seated or lying down) and place the thermometer under the patient’s tongue and ask the patient to keep mouth closed for three minutes or until the thermometer beeps and his temperature appears on the digital screen
||The average oral temperature for children ranges from 97.6 to 99.3 degrees Fahrenheit (36.4 to 37.4 degrees Celsius). While an adult’s normal temperature is 98.6 degrees Fahrenheit (37 degrees Celsius); an elderly person’s temperature could be as low as 96.8 degrees Celsius (36 degrees Celsius).
|4. Record the temperature of your patient and always clean the digital thermometer’s tip with cool, soapy water, or wipe it with 70 percent isopropyl alcohol before placing it back on its holder.
||To minimize the spread of organism to clean areas
CNA SKILLS: Purpose of Handwashing
- To cleanse hand
- To avoid contamination, after touching any patient or contaminated surface
- For aesthetic reasons
|1. Turn on water to a comfortable temperature
||Avoid contaminating faucet by using paper towel when turning in and off faucet. If faucets are controlled by foot pedal or elbow levers, disregard paper towel
|2. Wet your hand and apply enough soap to make heavy lather, rub vigorously, using one hand first and then another. Wash thoroughly for one (1) minute for each hand.
|3. Rinse under running water
|4. Repeat procedure no.2 for another hand
|5. Clean fingernails with orange woodstock
||Pay special attention to fingernails
|6. Rinse well under running water, allowing water to run over arms first, then hands flow off tips of fingers
||Upper portion of arms isles contaminated than the hands and fingers
|7. Dry hands well with hand towel or paper towel, beginning with the upper elbow downward to the hands
|8. Turn off water
||Use hand lotion if desired for chafing
In our everyday lives, we get to use all our senses in just about every day. We get to use our sight in choosing what color of dress would suit us, our sense of hearing to hear news around the world, sense of smell to savor the aroma of our mother’s new dish, sense of taste to know what makes up a local dish, and sense of touch to express our love for our love ones. But for those who are in the health care profession, the use of their senses is much more than that. They are used to observe any deviations that may put the patient’s life at risk. Being a Certified Nursing Assistant, it exactly asks you to do that. After all, you are the constant presence during a patient’s stay in the hospital. You spent almost all your working hours with them while meeting their needs. If anything happens, you are the first person to know or notice it. This is what it takes to be a CNA, having appropriate observation skills.
That is why a good or appropriate Observation skill is a must and come as very handy when working with patients. There are two things that a Nurse Aide should learn how to observe, and these are:
- Subjective Observation
- Objective Observation
Subjective observation is made up of everything that the patient had said to you. You take on what he said and that is where you make your observation on what he really feels or what he needs. A nurse aide can be considered by a patient to be his confidante, thus, he would readily tell you about everything. It is up to you to sort out what needs to be reported to the nurse without putting the patient’s privacy at risk. It is also important that when reporting subjective observation, the nurse aide should make an observation and not an assumption. She should report what he only hear and observe and not to make his own diagnosis. However, subjective observation, no matter how it came from the patient himself, cannot be measured and cannot be the only thing to rely on when making observation. Thus, the use of objective observation comes in. This is where you make use of all of your senses. You look out for any signs of bed sores on your patient’s skin, you smell for any signs of foreign odors such as the need to change diapers, you listen for Pulse as you take the blood pressure, and you feel for any signs of lumps on the patient’s skin. These things can be measured and can really tell the patient’s actual condition.
When using your observation skills, it is important to keep it accurate and to do it on a timely manner. After all, time is precious and should not be wasted just like life. So if you want to be a good CNA, then what it really takes to be one is a good observation skill.