Home > Caregivers, Long-term care, Strategies > My Wish List for Nurse’s Aides

My Wish List for Nurse’s Aides

One of the largest groups of people I find myself working with in long-term care facilities (other than the residents themselves) is the nurse’s aides.  These are the folks who have the most contact with the residents; they provide the bulk of the day-to-day care, and are often the first to notice if something is wrong with one of their charges.  If I need to get information about how a particular resident is functioning, the aides are who I tend to go to.  And they’re the ones I try to spend a good chunk of staff education time with, although I have to admit that I often find myself spending as much time learning from them as I do teaching them.

Training for nurse’s aides will vary from state to state.  Although most programs tend to run from six to twelve weeks, I have seen courses as short as one month in length.  There is almost always a test taken before the trainee can actually begin work, with varying lengths of workplace-specific orientation.  Just as with any profession, there will be a large variance in skills and work ethic.  And, unfortunately, there is a large turn-over with many aides leaving for other jobs after only a few days or weeks, due in part to the low pay and high stress associated with the job.  But I have also encountered many aides who are truly inspirational in their devotion to their charges., and who obviously aren’t there just for what money they can make.

I have met quite a few nurse’s aides who go on to further their education in the medical professions.  Many of them become nurses, but a few go on to other related professions.  (In fact, I started out working as an aide back when I was in college — in the Dark Ages.)  On occasion, I have advised a young person, who is unsure about investing the time and money in a college education, to try working as an aide for a year or two to determine if this is a field they would be happy working in.  But there are other wonderful people who, for one reason or another, decide to remain an aide throughout their working life.  And I’ve met a few of these souls that I consider to be true heroes.

Nurse’s aide training can be very intensive, with students required to absorb a lot of information in a short period of time.  And most programs do a pretty good job.  But there are always things that will be reinforced after the aide actually starts to work.  I was fortunate, when I started working in a large hospital, to have two women (both probably old enough to be my mother) who took me under their wing and helped me learn the ropes.  Not everyone is as lucky as I was, and that’s a shame.  But, in my opinion, basic nurse’s aide training often doesn’t cover most of what should be known and understood by those providing care to persons with dementia — especially those in the latter stages of the disease.

I was recently reading a great book, called “Late Stage Dementia Care:  A Basic Guide,” edited by Christine R. Kovach.  In it, I found a list of skills that nurse’s aides should receive orientation/training in when starting work, and I had to give it a hearty endorsement.  In addition to basic skills like CPR, knowing how to take blood pressure, and how to change a bed, there are a lot of other things that should at least be touched on for those working in a dementia care unit.  So, with some additional commentary from me, here’s the list:

—  Decreased stimuli bath.  Often, a bed bath is done quickly and/or with vigorous scrubbing, both of which can be stressful for a person who has mid- to end-stage dementia.  A gentle, soothing, bath can serve the dual purpose of providing for basic hygiene, as well as helping to calm a resident who is frightened or over-stimulated.

—  Comfort dressing techniques.  This can include choosing clothing that is more comfortable, or more meaningful to the resident, as well as efficiently giving the resident just as much help as she needs without making her feel too stressed.

—  Comfort transfer techniques.  The same thing goes for moving a resident from bed to chair, or vice versa.  I can’t imagine many things more stressful than waking a person out of a sound sleep and immediately grabbing him under the arms and throwing him into a wheelchair.

—  Comfort bedding.

—  Comfort positioning.

—  Feeding techniques.

—  Dining environment interventions.

—  Meaningful human interaction techniques.

—  Massage

—  Sensory stimulation activities (including location of materials, how-to’s, and resident preferences)

—  Sensory calming activities

—  Experience with calm perseverence

—  Experience with terse perseverence

—  Experience with aggression

—  Experience with null behavior (defined by the author as being in a state of physical inactivity, with the eyes open but not focused on a particular event or person, and with no apparent purposeful activity.)

—  Experience with excessive somnolence.

—  Experience with group process difficulties.

—  Experience with delusions and hallucinations.

—  Experience with family support.

—  Experience with death and body preparation.

—  Experience with spiritual care

—  Wander guard system (will vary with different facilities)

—  Daily activity schedules

—  Daily assessment

—  Charting, or communicating with nurses and with aides on same/other shifts

—  Team meetings

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  1. October 24, 2012 at 10:32 AM

    I’ll try to pick up a copy of the book.
    I am an RN who is now practicing as an aide. Most of my clients have dementia and it is challenging.

    • October 24, 2012 at 11:01 AM

      I have to admit that I’ve had the book on my shelf for a couple of years, and am only now really getting into it. The first part of the book has to do with something that is dear to my soul — setting up a program in long-term care facilities for persons whose dementia has progressed past the point where they qualify for placement in self-contained dementia units (i.e., can no longer participate in group activities and require a higher level of care). I’ll be writing more about my thoughts on the subject today, I think.

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