CNA is short for a certified nursing assistant. A CNA works closely with patients in a hospital or any medical setting but needs the supervision of an RN to perform her duties. A CNA requires adequate knowledge of different nursing procedures, duties that RNs and LPNs perform daily. They must also possess efficient CNA skills to properly help their patients to recover from their condition. These skills are learned from special training, and to get CNA training, you must enroll in an accredited training facility, a learning center, or a college that offers CNA courses.
Basic Skills to Pass the Test and Do Your CNA Job Well
CNAs are required to perform basic nursing skills. Since a CNA is the closest member of the team to work with patients, she must possess the right skills set and the proper attitude in completing any task. She must remember important aspects of nursing procedures, including proper execution of the task, using the correct materials (if materials are needed), the correct time or timing, and the proper attitude.
CNA skills are taught foremost in CNA training, where instructors demonstrate what has to be done and then conduct a CNA practice exam. This is a graded practical exam that evaluates when a student has learned and what she still needs to learn to perfect a certain skill.
Here are the basic nursing skills that CNAs are mostly required to perform daily in a traditional hospital setting. There are further skills that CNAs need to master in other units or medical areas, and these are mostly covered during employee training.
One of the most important ways to prevent the spread of disease is proper handwashing. In a hospital setting, it’s not just about using soap and water; it’s about taking time scrubbing the entire hand, including areas like in between the fingers, at the back of the hand, and under the fingernail beds. Handwashing is also the foremost part of any CNA skills test.
Indirect care is any kind of intervention that does not involve face to face interactions with patients. This is where a CNA's communication skills shine as she talks to the patient's immediate family on how to care for the patient. For example, instructing the mother of a patient how to properly care for her daughter's surgical wound at home.
Measuring blood pressure
Blood pressure monitoring is done by using a BP apparatus and a stethoscope. The cuff of the BP app is applied to the patient's upper arm, and the stethoscope listens to his pulse. The blood pressure of a patient has to be checked every shift and sometimes monitored more frequently. Mostly, BP readings are taken before treatment or before taking any medication.
Measuring body temperature
Body temperature is measured using a digital or a mercury thermometer. Taking a patient's temperature is very important to assess for fever, any reactions to drugs or medication, and to take note of a patient's recovery. Temperature readings are taken every shift before medications are given and before treatments and surgical procedures.
Measuring and recording pulse
Taking the pulse is placing your index finger and the middle finger at the back of the patient's inner wrist. The pulse is taken one full minute and is recorded every shift before medications are given and before a procedure or surgical procedure. A pulse rate that's slow, fast or erratic must be reported right away.
Measuring and recording respiration
Respiration is the rise and fall of the chest in response to breathing. Counting a patient’s respiration in one full minute is important to assess breathing and to evaluate any changes as well. Along with recording the respiration, the CNA also notes how deep or how shallow the patient’s breathing is. She also considers difficulty in breathing and gaps in a patient’s breathing, which should be reported right away.
Measuring the output from a urinary bag
Every shift, the patient’s intake and output is monitored to check for any problems with the urinary system. The number of glasses that the patient has taken is the input, while the number of times the patient has urinated is an approximation of his output. Taking the output from a urinary bag is simple. A suitable measuring container is placed at the bottom of the urinary bag, and then the bag is drained. The contents are measured and are also checked for any discoloration, cloudiness, blood, etc.
Ambulation with a gait belt
CNAs help patients recover from their condition and to walk and move safely. One of the most common tools to help patients move safer with assistance is a gait belt. This is a thick belt worn along the waist (or along the patient’s center of gravity) made of very durable material with a handle at the back for the CNA or the RN to hold safely.
Patients may have problems feeding themselves like in the case of an elderly patient with a poor hand and eye coordination. A CNA assists elderly patients eat their meals and may also teach the patient's immediate caregiver how to do it. Another case is feeding a patient attached with an NGT or a nasogastric tube, a direct tube from the mouth to the stomach. A special formula is administered, and the CNA ensures that the food is warm, that the NGT tube is in place before feeding, and feeds the patient in the correct position.
Patients may be unable to perform personal hygiene tasks, and one of these is oral care. The CNA will help the patient brush his teeth, gargle, or floss his teeth. If the patient is unable to walk or too weak to go to the bathroom, these may be done at the bedside. If the patient can walk, a CNA assists the patient move carefully to the bathroom sink and assists him instead.
Mouth care with dentures
Patients with dentures need special mouth care, and a CNA can help. A patient may have upper and lower dentures, and this should be cleaned using proper cleaning solutions. As with mouth care, a patient who can move to the bathroom or sink may be assisted by the CNA.
Mouth care for an unconscious patient
Oral care for the unconscious patient involves a different approach. A CNA uses a strong antibacterial mouthwash and some cotton balls to clean the patient's mouth and teeth. Brushing is also an option, but the CNA takes care that the patient does not accidentally swallow the toothpaste and water. Some use suction with a suction tip catheter to remove water and dirt as soon as the procedure is done.
Toileting with a bedpan
Female patients on bed rest and those who cannot move to the toilet to urinate are asked to do so in a bedpan. If the bedpan is made of metal, it should be warmed first before it is offered to the patient. The CNA also makes sure that the bed is protected with a plastic cover and a drawsheet over the area where the bedpan will be positioned. For males, a handheld urinal is used. A CNA also takes this opportunity to clean the patient after urination to prevent infection.
Hand and nail care
A CNA provides hand and nails care by removing nail polish and scrubbing the nails, especially before a major operation. Hand and nail care are initially done by soaking the hands in warm soapy water and afterward, scrubbing it lighting and then rinsing. The hand is further patted to dry, and moisturizing cream or lotion is applied.
Foot care is done the same way as nail and hand care. The CNA also soaks the feet in warm soapy water to soften the skin and the cuticles. Nail polish is removed, and the nails scrubbed. Special attention is given to the soles of the feet, and cracked heels and soles are cared for with a soothing moisturizer.
Transferring to a wheelchair
Patients are moved from one area of the hospital to another using different equipment, and one of these is the use of a wheelchair. A CNA assists patients transfer from the bed to the wheelchair and from the wheelchair to the bed. A CNA considers safety foremost by locking the wheels when the wheelchair is on standby.
Change of position in bed
Patients, especially unconscious patients, should change position frequently to prevent bedsores and to keep the blood from pooling in one area. A CNA uses proper techniques to hold the patient on his shoulders and the hips to move him from a supine position to a side-lying position and then moves the patient to the other side after two hours.
Changing an occupied bed
A part of most CNA essential skills training is changing an occupied bed. An unconscious patient is unable to get out of bed for the CNA to change it, so she has to change the bed while it’s occupied. This is a task that requires step by step movements with special care on the patient’s affected areas, injuries, and any attached equipment like an IV line, a respirator, and many more.
Perineal care: female
Perineal care should be done daily, especially to patients that are unable to get up, go to the toilet, and do it themselves. Post-operative patients are the most common patients that need perineal care to prevent infections. The perineum is washed while in bed as the patient sits on a bedpan.
Perineal care: male
Male perineal care involves cleaning the shaft of the penis and washing the entire perineum. A male patient also sits on a bedpan as this is done, and usually, if the patient asks for a male nurse, then a female CNA may consider this request.
The catheter must be cared for to prevent urinary tract infections. This is done using an antibacterial solution. Also, during catheter care, the CNA assesses that the catheter remains properly inserted and is flowering properly.
Partial bed bath
A partial bed bath does not include hair care. The CNA uses special protective covers on the bed as she gives the patient a partial bed bath. The patient remains covered, showing only parts that need to be cleaned. After the partial bath, the patient is helped into clean clothes or a clean patient’s gown. After the bath, linens are changed using the techniques in changing an occupied bed.
Dressing a resident with a weak arm
A patient with a weak arm may not be able to properly dress, and a CNA must assist with an appropriate hospital gown to protect the weak area.
Applying elastic support stockings
Elastic stockings improve blood flow back to the heart. This is a special form of stockings that are highly-elastic and very tight. A CNA assists patients who are unable to wear this on their own.
Body positions: supine, prone, lateral, Sim’s, and Fowler’s
A part of any CNA state exam is distinguishing medical terms regarding different body positions. The supine position is when a person is lying on his back; the prone position is when the person is lying on his abdomen. A lateral position is when a person is lying on his side with both his legs together. In Sim's position, the person is lying on his side with one of his legs flexed. A Fowler's position is when a patient is on a semi-sitting position in bed or on a chair.
Range of motion exercises (shoulder)
The range of motion exercises on the shoulders is performed to assess the movement in the area and to improve blood circulation on the shoulders, back, and upper arms as well.
Range of motion exercises (elbow, wrist)
ROM exercises on the elbow and wrist improve the blood flow to the area, removes pain and loss of sensation, and assess the movement along the area as well.
Range of motion exercises (hip, knee, ankle)
ROM exercises on the hips, knees, and ankles assess the movement of the lower extremities and to improve blood flow and enhance sensation along with the areas.
CNAs need to learn proper interpersonal skills to interact with their patients well. Good interpersonal skills also help CNAs work with other members of the health team towards the wellness and health of a patient.