CNA Community Advocacy Essay

The life of a CNA

Nurses are typically thought to be the thing that holds everything else together, but nurses have their own dependent known as a CNA. A certified nurse’s assistant and they are the ones holding everything together so that nurses can do their jobs. Their jobs can range from something as simple as walking a patient or resident across the room to administering CPR. I have been a CNA for two years now after receiving my certification when I graduated high school, I was offered a job at an assisted living facility after my graduation and have been working there ever since. The job is difficult, the hours are grueling, and yet somehow I see it as my third place. It is a place where I can discuss anything with my coworkers who have become like a family to me, we all depend on each other and keep each other afloat. Recently however things have declined due to new rules we have been told we cannot give any affection or compassion to our residents. It was specified that we are no longer able to hug them, tell them good night, that we love them, or offer any words of encouragement other than keep going. This greatly affects me and every one of my other coworkers, because I feel extremely strongly about this I have decided to advocate the right to show affection to our residents in this paper.

This is one of our past residents.

Quality of Life

Working in assisted living, our residents are generally geriatric patients- meaning elderly. They are brought to our facility when they can no longer care for themselves completely and there isn’t someone available to care for them properly. When they arrive they are thrust into an unfamiliar world with over 100 people they have most likely never seen before, there is a set schedule they are not accustomed to and suddenly people are entering their room all day and night to check on them. As many can imagine this is extremely over whelming to most residents, and can cause them to feel lost, disoriented, or even abandoned. Often many residents may develop depression at this stage or become angry because they do not understand. This is greatly amplified if the resident has a disease such as dementia, which is an illness usually seen in the elderly that causes their mind to deteriorate. “The Centers for Disease Control and Prevention estimates that 28% of assisted living residents are depressed.” – As stated in Depression in Assisted Living, by Josh Allen, RN. In is important for us to consider this and attempt to make the residents comfortable so that they can begin to feel at home. When we are not allowed to show how much we care for our residents they may feel isolated or hated, they may feel that we are angry or upset with them for not doing well enough. This may cause a severe setback in their settling in and cause a rift between us resident aids and the residents themselves.

Two residents I take care of- one in condos and one in the main facility.

Importance of Bonds

Someone who has never been a CNA or ever cared for someone who cannot fend for themselves could never understand the bond we have with our residents. “They are the Reason I Come to Work” is an article written by Mary Ball, PhD; Michael Lepore, MA; and several others about the staff to resident relationships and asses the quality of the relationships. They are important in that the resident needs to know someone is there, even if at first they do not know who that person is- a positive relationship can go a very long way. Gentle encouragement and kind words ensure the resident they are doing nothing wrong and that they will always have someone to come to if the need arises. Many don’t realize that as an aid I am one of the first faces a resident sees when they come into our facility, the first person to tell them it will all be okay and offer a shoulder to cry on, a hand to hold, and a smile to warm their day. Being unable to hold their hand our hug them or assure them that there is someone who cares is disarming. What else do I have to offer other than kindness and support? Not only does this affect new residents entering our facility, but also those who are already living there.

One of our residents in the dining room.

The bonds we have are already in place, our residents are happy to receive a smile and a hug, they cherish our visits and we are happy to make them happy. Many of our residents have Alzheimer’s and dementia and will often find their minds wandering into the past. They will sometimes remember the losses of their family members and be wrought with grief, sometime it will be the opposite and they will believe that person is still there and begin to panic as they look for them. Other times they confuse us with a family member. Some have no family whether they have all passed – or the family does not visit and to them, we are family. They tell us they love us and that they hope we don’t go like everyone else. Facilities are often known for residents having social deficiencies as discussed in the article Staff Perceptions of Residents Across the Long-Term Care Landscape.

They grow accustomed to showing us they care and we grow to love and care about them. This rule is like ripping that bond to shreds and leaving them without a care. It is tragic when we know we are being watched and have to decline a hug or not respond to an I love you, it’s like having my heart crushed when one of them cries and I cannot help by consoling them. “Social support has been recognized as having a broad range of positive effects on both the physical and psychological well-being of older adult.”- Quality of Life in Assisted Living Homes. This Gerontology article mentions the quality of life people receive in assisted living homes and how it effects them in a long term setting. I feel that our relationships with those we care for are positive and have mutual benefits, I fear that tearing away an aids compassion for the equation may cause a resident to become upset and confused; they may feel as though they have been abandoned by those that thought were the ones caring for them. Ultimately they could fall into depression and their health could deteriorate.

Lunch time in the cafeteria

Relationships

Not only is an aid’s relationship with a resident important, but so is the relationship with the resident’s family. While they appreciate being treated with respect, our bonds with the families also grow and shape themselves depending on our aid-resident relationship. If a family member sees us giving it our all and showing our love for their kin, they will often breathe a sigh of relief finding that their mother, father, grandmother, or grandfather is being well cared for. When an aid is unable to show they care for a resident the family often believes the aid is being rude or inattentive, they may spark distrust in the relationship and cause the family to have doubts about leaving their family member in your care. Trust is very necessary to keep everyone healthy and happy. Another thing that is prohibited in our new set of rules is crying. According to the Assisted Living Federation of America, around one-third of assisted living residents receive end-of-life care at the community they have made their home. This being said, when one of the residents passes away the CNAs are expected to clean them, dress them, and have the presentable for their family to see; all without shedding a single tear. This takes away our ability to show emotion, after caring for someone all week for months or years should give us the right to shed tears at their passing. It hurts very deeply that someone could ever tell us we are not allowed to cry for someone we care about.

In Conclusion...

The CNA community is my third place because of the people in it and the atmosphere that surrounds it. I am able to express myself with people who share many of my common interests include our love of the healthcare field. Despite the facility being our place of employment, we are very much like a family in some ways. The residents mean everything to us and seeing them upset or down effects not only us but the other residents as well. Allowing us to show we care about them provides a necessary atmosphere of kindness and encouragement, this also gives the resident more confidence in themselves and those around them. This would also help to improve their physical and mental well being in the facility.

Photo Essay

The photos shown below were captured by me, my coworkers, or the residents family members. I have full permission to use them in my essay, to protect them and their privacy, no names will be mentioned. In these photos a small moment of their everyday life is being depicted, their personas are plain on their face. Their emotions are real and this is how them present themselves daily. My hope is that the reader will understand just how the residents feel about the facility, their neighbors, and caretakers.

Reflective Piece

One goal of English 201 was to give us the ability to research properly and learn how to use sources effectively. Although I believe these are skills necessary by this time I feel that this course can help someone learn how to do this. Although I was already competent in writing research papers I feel that this class has helped me improve my researching ability and how to better verify my sources. I now know new ways of finding sources and testing their viability.

I also learned how to better apply more sources to my topics and how to lace them into my paper. This made it simple to combine them with the information I provided to my own papers to give my works better scientific back ground and an all-around better foundation. Since my sources are now more trustworthy they often are easier to cite, making my work simpler to finish. These are skills I acquired while taking English 201. The class showed my options for using source I once did not think possible, now I have many other means of assisting my writings with a good bibliography. I also learned new ways of citing my work, such as hyperlinking. Although I had done so before, we covered it on a broader base so that we could understand how exactly this could be used. Our essays helped to make me more confident in my own writing abilities and allowed me to view a style of writing that usually is not my high point.

I am experienced in all types of writing due to a variety of English classes I took in high school therefore this class was mainly review. Many of the readings we were asked to perform I had already completed for other classes, such as They Say I Say, meaning it was very repetitive. Our reflective pieces were confusing in that they will drag out a topic and perhaps take it too far. I feel that my emotional writing and personal experience gives my essay a very passionate touch while my lack of interest in research may have dulled my essay from its potential.

Annotated Bibliography

Those I included:

@aplaceformom. "Assisted Living and Hospice Care." Assisted Living and Hospice Care. N.p., 2015. Web. 05 Dec. 2016. The blog is based on what occurs when a loved one is placed in a facility; how it affects the family and the resident themselves is discussed and different methods to make the transition better are offered. The quality of life for the resident is also questioned, but the main focal point of the essay is end of life care. Hospice care is outlined and explained for the informational purpose of giving families a glimpse of what is to come. This is to better prepare those who may just be considering hospice of palliative care for their loved ones, having this blog can help them cope by knowing they are not alone and that there are others to talk to in their dark times. They also mention the families grieving process and how hospice may or may not effect it.

Allen, Josh. "Depression in Assisted Living." Geriatric Nursing 36.1 (2015): 78-80. Web. This article highlights a residents point of view in an assisted living facility and how it affects their daily lives. It focuses on depression and how it is developed in nursing homes and assisted living facilities. It mentions the differences in men and women who develop depression and which gender is more likely to be diagnosed. The sign and symptoms are briefly explained as well as ways of being diagnosed. It is also mentioned that if left untreated, depression can cause sever health concerns in elders, especially those with already frail health. The fact that the symptoms could be confused for signs of dementia is discussed and the importance of finding out which is ailing the resident. This article is information for those caring for a resident or having a family member to offer useful knowledge to better their health.

Ball, Mary M., Michael L. Lepore, Molly M. Perkins, Carole Hollingsworth, and Mark Sweatman. "“They Are the Reason I Come to Work”: The Meaning of Resident–staff Relationships in Assisted Living." Journal of Aging Studies 23.1 (2009): 37-47. Web. The article focuses on the bonds of residents and staff as well as how they affect the facility around them. It explains how the residents and staff are benefited by positive social interaction, showing facts and statistics. Types of facilities and set ups are discussed as well as how they are run and the characteristics of each set up. Staff shortages and their effects are mentioned as well as the fact that the staff is predominantly made up of females. They also give an overview of how a negative relationship can cause depression and negative social events. The negative work events that could affect bonds and things that may place strain on the relationships are questioned as well.

Gaugler, Joseph E. "Staff Perceptions of Residents across the Long-term Care Landscape." Journal of Advanced Nursing 49.4 (2005): 377-86. Web. Staff perceptions are focused on for this source and their goal is to find out how the staff feel about the long-term care patients. The study was performed as a set of interviews in which they discussed the person's individual feelings for the residents and the knowledge of their care. It included five nursing homes, five assisted living facilities, and sixteen family care homes selected randomly in the United States. The interviews were both face to face on over the telephone. They were conducted with the staff, residents, resident’s families, and administrators. Staff who were married reported better bonds with residents’ families and great staff cohesion. They discovered those who worked with patients who had more physical and mental disabilities exhibited more knowledge. The results showed it was important to examine staff relationships with the residents’ families and that enhance relationships with residents will affect their well being.

Mitchell, Judith, and Bryan Kemp. "Journal of Gerontology: Biological Sciences Index to Volume 54A." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 55.2 (1999): 117-27. Web. This source examines all the contributions to a senior’s health in an assisted care facility. Instead of focusing on one aspect of their quality of life they look over all the things effecting them and their environment. This includes their mental, physical, and social well-being. Family involvement is also delved into and what a difference it makes in the resident’s mental health and stability. The four main points discussed here are health status, social environment, facility characteristics, and social climate. This study involved 201 residents from 55 different facilities. Their quality of life was measured by age, health status, social and family involvement as well as facility characteristics. The results found that a resident benefits from positive social interaction and relationships.

Those I chose not to include:

Bitzan, J. E., and J. M. Kruzich. "Interpersonal Relationships of Nursing Home Residents." The Gerontologist 30.3 (1990): 385-90. Web. Unlike other studies that focus on the staff, this study focuses on the residents themselves. Mentally competent patients were questioned regarding their interpersonal relationships they have while in the facility. They hoped to discover the positive and negative effects of the relationships and just what they mean to the residents. The study itself involved 332 mentally competent residents in 54 nursing homes. Aspects of their daily lives were studied such as their relationships with staff, family, friends, and other residents in and outside of the home itself. The results showed the importance of having a friend they can trust during activities, this betters their quality of life and gives them more confidence in themselves during activities and often causes them to be more involved in the facilities social environment. Residents who are more involved tend to be less likely to become depressed and have a better quality of lives than those who socially isolate themselves.

"Care Options at the End of Life." National Institutes of Health. U.S. Department of Health and Human Services, July 2016. Web. 05 Dec. 2016. The article talks about hospice care and different options for setting up end of life care. It also differentiates palliative care and hospice care, why and how they are initiated. All the ups and downs to each form of care as well as the information on each are mentioned and explained to provide background information. They provide personal stories to offer different perspectives on each in real life situations. This source is likely used to inform families who may be facing options such as these so that they may come to a consensus on what the next option for their family member is going to be. Information like this will help families better understand the different programs that go into end of life care and how they work, this will make such a hard decision just a small bit easier.

Ersek, M. "Investigating the Educational Needs of Licensed Nursing Staff and Certified Nursing Assistants in Nursing Homes regarding End-of-life Care." American Journal of Hospice and Palliative Medicine 16.4 (1999): 573-82. Web. This discusses the emotional needs of the care staff regarding end of the life care and grieving. They gave phone interviews questioning workers about this particular subject in order to discover how they deal with the death of a resident and their mental health after such a tragic event. They used these interviews to determine just how much knowledge the staff had about end of life care as the facilities sometimes show lack of knowledge in such things as well as skills in doing such. Other things that may cause difficult end of life care include communication errors, conflicts with doctors, and families. These can cause more emotional distress then necessary in an already difficult time, having the skills and knowledge necessary can lessen the blow for families and staff as well as the resident.

Sumaya-Smith, Isabel. "Caregiver/resident Relationships: Surrogate Family Bonds and Surrogate Grieving in a Skilled Nursing Facility*." Journal of Advanced Nursing 21.3 (1995): 447-51. Web. The focal point of this article is staff to resident relationships. They talk about surrogate bonds and how they benefit residents, as well as how they are formed and why. They briefly touch on the belief that those is this line of work are lacking emotional bonds and grieving, but this was quickly disarmed as they remarked that some had witnessed the staff having positive bonds and grieving for a resident. Having positive bonds can lessen the blow of a resident’s death for the family and the entire facility. This can also provide the family with the knowledge that their loved one was well cared for, it may give them solace to know someone can empathize with them and give them even the slightest support during their grieving.

Tellisnayak, V. "A Person-Centered Workplace: The Foundation for Person-Centered Care Giving in Long-Term Care." Journal of the American Medical Directors Association 8.1 (2007): 46-54. Web. This source talks about a person-centered workplace. It is a study to depict how the managers shape the rest of the facility and how it effects the other workers and residents. It discusses how they are the primary role leaders and how much they matter for everything in the facility to work out correctly. The apple supposedly doesn’t fall far from the tree which means how the administrators treat the caregivers is often how the caregivers treat the residents. If administrators treat staff like dogs and work them without a care they may influence the staff to become cold and careless to those they care for. This can cause conflicts between residents and workers or residents families and the facility, which can cause distrust among them. If there is too much distrust between them, distrust can form between the resident and the worker and possibly cause their health to deplete.

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