Personal Care of Patients for CNAs and HHAs

Patients have the right to care, treatment, and services that safeguard their personal dignity and respect their cultural, psychosocial, and spiritual values. These values often affect the patient's treatment needs and preferences. By understanding and respecting patients and their values, healthcare workers can help meet patients' needs for treatment and services and protect their rights. When a patient has dementia or is not conscious, there is a tendency to consider them as objects instead of a person. These patient's privacy and rights must be protected. Patients have the right to participate in decisions about their care and set the course of their treatment. Patients have the right to considerate, respectful, nondiscriminatory, and compassionate care. Respect means valuing the patients' needs, desires, feelings, and ideas. Treat patients with common courtesy. For example, knock and wait before entering a patient's room, respond politely to patients, listen to patients, and remain compassionate. All patients have the right to fair and equal health care services regardless of:

• Race
• Ethnicity
• National origin
• Religion
• Political affiliation
• Level of education
• Place of residence or business
• Age
• Gender
• Marital status
• Personal appearance
• Mental or physical disability
• Sexual orientation
• Genetic information
• Source of payment

CNAs and HHAs can perform personal care services, including hands-on assistance and speaking directions in patient care tasks. CNAs and HHAs are supervised by an RN and follow a care plan developed by an RN. There may not be an RN or care plan in assisted living facilities. Personal care services vary based on care planning and state regulations. These services may include:

• Bathing
• Dressing
• Personal hygiene
• Transferring
• Ambulating
• Assistance with eating
• Activities of daily living
• Meal preparation
• Housekeeping chores

One goal of personal care services is to meet patient's needs while maintaining dignity and independence. Patients need to do as much as they can for themselves (Caregiving Basics, 2019). The patient may be slow in dressing, but the patient must keep dressing themself to maintain as much function as possible. When patients do not get up to walk, sit up, or use their hands, they lose function more quickly. Patients also benefit from exercise. If specific exercises are on the care plan, a CNA or HHA can coach a patient in doing a range of motion and strengthening exercise.

Patients deserve to make choices when they can. Let them choose what to eat, what to wear, and other activities if possible. Patients also need mental stimulation unless the care plan says differently. Some patients with dementia react badly to stimulation and changes in routine. This may be new people, new places, and different eating times.

Treat any laundry that has body fluids as if it is contaminated. Use disposable gloves to handle anything that has bodily waste. This includes tissue, paper towels, or diapers. Put the contaminated waste in a leak-proof heavy-duty bag, and tie it shut. Put the material in a second plastic bag. Follow local regulations for solid waste disposal. Most areas use normal trash pickup. Feces should be flushed down the toilet. Use a puncture resistance container to dispose of syringes, needles, and blades.

Use cleaning products recommended by your agency. If no recommended products are available, a bleach solution of 2 teaspoons per one gallon of water or ¼ teaspoon per quart can be used. Make a fresh solution every time you use it (Caregiving and Housekeeping, 2019).

Rules about assistance with medication vary by state and agency. Follow your agency's requirements. Follow your agency requirements and the patient's care plan about reminding the patient to take medication or put medication with the patient's reach.

RNs, PTs, or OTs will obtain assistive equipment as needed, but CNAs and HHAs may request equipment. Equipment that can be used to improve safety for workers and patients (Galinsky & Burnett, 2010):

• Hoist or lift
• Rolling toileting and showering chair
• Wheelchair
• Bedside commode
• Raised toilet seat
• Grab bars
• Adjustable bed
• Bed rails
• Lift chairs
• Walkers
• Canes
• Slip sheets
• Friction reducing devices

Healthcare workers must be trained in the use of these devices. Do not try to use equipment when you are not trained.

When assisting a patient to stand up, a high firm chair that has arms is easiest. A raised toilet may be used. A slide may be used to transfer patients. Use a lift if you are trained in the use of the lift. A gentle rocking may be used to assist the patient to stand.

When assisting a patient in moving, tell the patient what you plan to do. Allow time for the patients to do as asked. Do not pull the patient by the arms or legs. Hold onto the patient's trunk and hips. A wide waist transfer belt gives you a secure grip (Galinsky & Burnett, 2010).

When lifting, bend from the hips and knees. Keep your back and neck straight. Keep your feet shoulder-width apart. Stand as close to the patient as possible(Galinsky & Burnett, 2010).

To pull a patient up in bed, lower the head of the bed to flat. Have the patient raise their knees and assist in pushing up.

When working with a patient in bed, position yourself to not stretching, bending, or reaching (Galinsky & Burnett, 2010)

Devices that assist in caring for and moving patients are (Galinsky & Burnett, 2010):

• Lifting hoists
• Rolling toileting and shower chairs
• Grab bars
• Adjustable beds
• Raised toilet seats
• Slip sheets

Incontinence is not a normal part of aging or most illnesses. If incontinence starts, notify your supervisor. The incontinence may be due to something that can be treated. Emptying and changing urinary bags, as well as routine catheter care, is allowed.

Devices that can help with toileting are:

• Grab bar
• Raised toilet seat
• Bedside commode
• Bedpan
• Urinal
• Disposable pad, brief, and undergarment
• Plastic mattress cover

You may be assisting with a bowel/bladder training regime. That usually includes toileting every 2 hours. If that is too often, start with every 3-4 hours. Rushing when there is an urge may result in incontinence.

The following actions are not allowed:

• Applying a condom/Texas catheter
• Manual disimpactions
• Douche
• Enema
• Ostomy care

For hearing impairments, face the patient and speak clearly. Use short sentences. Repeat yourself as needed. Do not shout. Touch the patient to get their attention. Keep background noise to a minimum (Helping with Disabilities, 2019).

For visual impairments, make sure the lighting is good. Do not move furniture around. Keep clutter off the floors. Use black and white clocks and telephones. Large numbers and letters are easier to read. Keep glasses close and clean. Mark knobs and devices with dots or tape to identify where to turn or push the knobs. Use the back burners and turn the handles toward the stove to stop accidental spills (Helping with Disabilities, 2019).

For speech impairments, keep a pencil, pen, and paper close. Do not talk for the patient. Do not talk in front of the patient to another person as if they cannot hear what you are saying (Helping with Disabilities, 2019).

For loss of a limb or use of a limb, assist as needed. Ask the patient what they want to be done for them or review the care plan. Do not over assist the patient. The patient needs to maintain as much function as possible. They also need to maintain their self-respect. Elevating an impaired limb will help reduce swelling (Helping with Disabilities, 2019).

Bedsores are also called pressure sores, decubitus ulcers, or pressure ulcers. Bedsores are painful and hard to heal. When blood vessels get squeezed between a surface and bony areas, a sore happens. Typically, people would feel the pressure and move. Some patients are not able to move or do not feel the pressure. Rubbing and friction also cause sores. When parts of the patient's skin are pulled across a surface, rubbing and friction can cause sores. Continued exposure to wetness causes bed sores. It is important to keep the remove urine and feces.

To prevent pressure sores:

1. Keep the skin clean and dry
2. Encourage moving and getting out of bed
3. Provide a well-balanced diet
4. Offer fluids frequently, 6-8 cups every day, including Jell-O, sherbet, soup, and popsicles
5. For patients who cannot move themselves:
   1. Reposition every two hours if the patient cannot move themselves
   2. Use foam mattresses or special beds
   3. Pad bony areas with pillows when positioning
   4. Use a pillow under the calf or special padding to keep heels off the bed when laying on the back
   5. Position correctly in the chair
   6. Pad hands open with a rolled washcloth

Pressure sores occur in four stages (Pressure Sores, 2019):

1. The skin becomes warm and red in the area covering the bone. This redness does not disappear after 15 minutes of pressure relief, and there is no break in the skin.
2. An open wound appears in the form of a blister, which is red and painful.
3. The skin breaks and the wound drains through the top layer of skin. The area surrounding the wound or blister is red, but the sore is no longer painful.
4. The wound opens down to the muscle or bone and continues to drain. If the wound is not open, it may be covered by a black scab. The area around the wound will continue to be red.

If the patient needs help eating, treat him like an adult, give him choices, do not scold him for not eating or spills, and do not rush mealtime. Encourage independence. Sit the person up with the head tilted slightly forward to help to swallow. Make sure dentures and glasses are used when eating if needed. Provide finger food if using a fork and spoon is hard. Cup your hand over the patient's hand to assist with eating. Bendable straws are useful when someone is drinking in bed. A thin sponge or nonslip pad will keep the plate from sliding around. Using divided plates or plates with rims helps in scooping food. Larger spoons and forks are easier to use.

When feeding a patient, sit on the strong side if the patient had a stroke. Tell the patient what you are feeding him. The patient may need to be reminded to chew and swallow (Help with Eating, 2019).

If the appetite is poor or the patient refuses to eat, turn off the TV and reduce other distractions to help the patient focus on eating. Use smaller portions and limit the number of things on a plate. Appetite may improve when mealtime is enjoyable. Check tooth pain, mouth pain, or denture problems if the patient suddenly stops eating.

If the patient chokes easily or has trouble swallowing, check the care plan to see if you can feed the patient. If you are approved to provide tube feeding, following your employer's policy and procedure.

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• Caregiving Basics. (2019). National Caregivers Library. Visit Source.
• Galinsky, T., & Burnett, G. (2010). Strains, sprains, and pains in home healthcare: Working in an uncontrolled environment | | blogs | CDC. NIOSH Science Blog. Visit Source.
• Healthy transfers. (2019). Na. Visit Source.
• Help with eating. (2019). National Caregivers Library. Visit Source.
• Helping with disabilities. (2019). National Caregivers Library. Visit Source.
• Personal care: Grooming and dressing. (2019). National Caregivers Library. Visit Source.
• Pressure sores. (2019). National Caregivers Library. Visit Source.
• Toileting and incontinence. (2019). National Caregivers Library. Visit Source.