Callie is helping to train a new CNA who is coming to work on the cardiac unit. They are doing a room check to make sure that it has everything that is needed for the patient. Callie points out to Brian, the new CNA, that first, they look to see if the correct signs are on the patient’s room door. This patient is on oxygen and is on contact precautions, and both signs are on the door. They then use the hand sanitizer, which is immediately outside the room door, to clean their hands before entering the room.
Callie approaches the patient’s bed, says the patient’s name in a soft voice, “Ms. Brown,” and gently touches her arm. Callie asks the patient if she needs anything, and Ms. Brown raises her right index finger. Callie tells Brian that this means ‘no.’ Callie explains to Brian that since Ms. Brown has a tracheostomy and still uses a ventilator for part of the day, her healthcare team uses different gestures to make it easier for Ms. Brown and her caregivers to communicate with each other. Callie points to a picture chart on the wall next to the patient’s bed that has different gestures that are used with Ms. Brown and what each one means. Callie says that this also helps the patient’s family members communicate with the patient, family and healthcare team members know the exact meaning of each gesture, so there is no confusion.
After introducing Brian to Ms. Brown, Callie explained to the patient that they were checking to make sure nothing was missing from her room. First, Callie notes the bag-valve-mask on the wall next to the ventilator. Callie tells Brian that this must always be there. It is used to help the patient to breathe in an emergency. If it is ever found missing from any patient’s room who is on a ventilator, the nurse or respiratory therapist must be informed immediately.
Callie points to the sealed tracheostomy kit on the bedside table and tells Brian that it must always be there in case the tube in the patient’s airway falls out. The nurse and respiratory therapist check this every shift. However, if the CNA ever finds that this kit is missing or it has been opened and not replaced, they need to inform the nurse immediately. Callie also tells Brian never to remove any piece of equipment from a patient’s room, even if it looks like it has already been opened. Let the nurse know.
Brian asks what he should do if he finds the ventilator alarm sounding. Should he call the nurse and turn it off? Callie tells him to call the nurse immediately but not to turn off the alarm. Stay with the patient, stay calm, and let them know that their nurse is on the way.
When checking the other supplies in the room, Callie finds that there are no small-size gloves in the glove container. Brian wants to know if it's okay for someone with small hands to use the medium size gloves. Callie says that this is not a good practice. Every CNA should have properly fitting gloves so they can easily do care activities. Wearing the wrong size gloves could be uncomfortable for the CNA and the patient and make doing care harder. Callie reminds Brian that it is the CNA’s responsibility to make sure that all the supplies needed for patient care, such as gowns, gloves, and masks, are available.
Callie makes eye contact with Ms. Brown, tells her that they are leaving, and asks if there is anything she needs. Ms. Brown indicates that she wants the lights lowered. Callie does this and tells her the time when she will be back to check on her. Ms. Brown looks at the clock on the opposite wall. Callie explains to Brian that it is important to let the patient know that they are not alone and when they can expect to see their CNA again. This helps the patient to be less anxious. If, for some reason, the CNA cannot get back at that time, they should ask someone else, such as the nurse, to check on the patient or to find someone to check on them.