- Day 1: Assisting a Client with Swallowing Difficulties
- Day 2: Dealing with Challenging Behaviors
- Day 3: Communicating with a Client with Sensory Difficulties
- Day 4: Bathing a Client Who Has Mobility Problems
- Day 5: Dressing a Client with Dementia
- Day 6: Transferring a Client from Bed to Wheelchair
- Day 7: Recreational Activities – One Day Example and Description of the Activity
Day 1: Assisting a Client with Swallowing Difficulties
Description of Immediate Setting
I work in a nursing home center, which has 140 residents. As a health care assistant, I provide care to residents with their daily routines. Patients treat me well, gratefully accept help and listen to my advice. Given the individual health issues of each resident, they may face some challenges in activities that seem a simple and integral part of life for younger people. As of now, given the COVID-19 guidelines on nursing care capacity, 100 spots out of 140 are occupied. The patient-to-staff ratio is approximately four patients per employee. For example, on the first day, I worked with Mrs. Jones, 79, who has lived in a nursing home for three years. She developed good habits and daily routines and has many friends. Mrs. Jones does not have and has not had in the past addictions or serious health problems. She has type-2 diabetes, which is very typical for her age, and joint pain is being cured. For the first three years at the nursing home, Mrs. Jones had no issues with mobility and performing general activities of daily living (ADLs), asking for assistance only when she did not feel well. However, currently, every day, she requires more help with performing her daily routine and has a higher dependence level.
Routine of the Care Setting
As seen from the schedule above, my primary task is to assist the patients throughout their routine, paying specific attention to feeding and taking care of Mrs. Jones. As far as the activities for the day are concerned, I am assigned to reading, movie club, and the preparation for the quiz night.
Daily Living Tasks
Recently, Mrs. Jones has been experiencing swallowing difficulties and now needs assistance with feeding. Therefore, as her assistant, I took it upon myself to make sure she was eating well. So, during breakfast, lunch, and dinner, I follow a similar procedure:
- I greet Mrs. Jones, and I ask her if she is hungry right now;
- I help her sit and bring the food closer to her
- I make sure Mrs. Jones sits upright, chews well, and takes small pieces.
- I make sure that Mrs. Jones is careful, rinses their mouth after eating, and stays upright (sitting) for 30-60 minutes to avoid the possible ingress of food debris into the lungs.
- I can sometimes ask the patient to cough, as the lungs are protected from aspiration by coughing and vomiting reflexes.
- From time to time, I ask Mrs. Jones whether she wants more, and I feed her until she says it is enough;
- I help her clean up, check on her aspiration and whether she has anything stuck or bothering her;
- I clean up and escort her to others or her room.
The doctor has some guesses about the cause of the problem and is preparing a treatment plan for Mrs. John while I help her deal with the symptoms.
Communication with Stakeholders
Family members do not visit Miss Jones very often, but they are aware of her health. In addition, at the last meeting, the doctor had an in-depth conversation with Mrs. Jones and her daughter, and this conversation took place in my presence. I also assured Mrs. Jones’ daughter that I would take the best care of Mrs. Jones and inform her if necessary and about the process of treatment and recovery after stroke. Mrs. Jones’ daughter asked many questions about the causes and complications of post-stroke conditions, and the doctor was able to answer most of them, so she left our facility calm and satisfied with the service.
Challenges and Rewarding Aspects
The experience of communicating and caring for Mrs. Jones was very useful to me as I learned not to be afraid of difficult situations and realized that timely treatment and care to guide the treatment in most cases minimizes risks and results in complete recovery of the client. Mrs. Jones is an optimistic woman, and she helps me take care of her and tries to keep her calm and optimistic, which is very important for her recovery. Therefore, this experience gave me more confidence in my professional abilities and made me feel that my support is appreciated. The only challenge, however, concerned the specifics of communication with the patient who suddenly feels helpless. Since Mrs. Jones was used to being a self-sufficient woman, she now finds it extremely hard to seek assistance. Hence, I found it challenging to help her without making her feel miserable even though she did not show her emotions and seemed rather calm about the situation.
Day 2: Dealing with Challenging Behaviors
Description of Immediate Setting
As I have already explained, I work in a nursing care center where more than 140 people live and receive support. Currently, however, the capacity of the nursing home remains at nearly 100 patients with an error margin of ~ two patients who could be discharged from the facility for a few days due to family circumstances. The staff to patient ratio remains satisfactory, as more than 20 staff nurses are working with the patients. On day two, I worked with a patient named Mark, a 75-year-old man with a history of alcohol abuse.
Routine of Care Setting
During the day, my primary task is to assist Mark with the activities during the day and make sure he behaves well and socializes with other home residents.
Daily Living Tasks
Mark is 75, and all his life, he worked hard, had his own business, which now employs his nephew, and a good fortune. Mark has good prospects for recovery, but his mood is constantly changing due to the loss of the opportunity to work, and he does not have a metaphorical anchor that would allow him to feel part of the world, to feel needed. Mark sometimes feels that the staff is hostile to him, and the ban on alcohol was a difficult test in the first few weeks of his stay in the institution. Therefore, he could behave irritably or aggressively and be hostile to the staff who seized alcohol from him, as well as to other patients who seemed to condemn him.
One of the primary concerns when working with Mark is his inability to find common ground with the other residents. To address this issue, on day two, I place emphasis on encouraging Mark to take part in group activities:
- During breakfast, I come to Mark and carefully ask him about his plans for the day;
- If he is in a bad mood, I suggest he talks to me in private about what is bothering him; If he responds calmly, I suggest we take a look at today’s schedule and find an activity for him to enjoy;
- Once we choose an activity, together, we proceed to the game club to play cards;
- I gently suggest he join the group, and I ask him whether he would feel more comfortable if I were at the table too;
- We make an agreement that if he feels uncomfortable or angry all of a sudden, instead of yelling at the group, he comes to me and tells me why he feels irritated and angry;
- If needed, we seek counseling immediately after.
Communication with Stakeholders
When taking care of Mark, I make sure to maintain constant communication with the medical staff to improve his condition. I frequently collaborate with the therapist and physiotherapist to make sure that Mark receives the treatment he needs in order to minimize the irritable triggers to his anger issues and the risk of relapse. However, the most important communication takes place with the local clinical psychologist, as she provides me with explicit advice on how to talk to Mark when he is on the verge of violent and isolative behavior. Mark does not communicate with his family due to his past issues, and the only visitor he has is his 35-year-old nephew Aaron. I try to reach out to him and ask him to come for a visit once in a while when Mark feels especially lonely.
Challenging and Rewarding Aspects
Undeniably, Mark is an extremely challenging patient whose violent behavior and lack of interest in life make it hard for the nurses to take proper care of him. However, when exhibiting such behavior, Mark helps me explore new ways of connecting to reserved patients. While talking to Mark, I am interested in his life, and he often tells funny stories. He is happy when his sons visit him, and I try to keep them motivated. When answering the sons’ questions, I describe the positive changes in Mark’s well-being and how his psychological state stabilizes. He receives the grateful views of his sons and their support during these conversations. Mark is used to living a social life, but it was difficult for him to make friends. Over time, he became less suspicious and demonstrated improved socialization skills. Working and communicating with Mark gave me a better understanding of the problems of other patients at the facility.
Day 3: Communicating with a Client with Sensory Difficulties
Description of Immediate Setting
Currently, our facility has nearly 100 residents and accepts people with visual or hearing impairments. Our health professionals have developed unique programs to work with sensory difficulties. However, our institution does not have a sufficiently adapted leisure system, and people with sensory difficulties may feel excluded from the communicative process. On day three, I am assigned to assist Leila, a 73-year-old woman with hearing impairment. The challenge during this day is also caused by the fact that three nurses could not come to work due to health issues.
Routine of Care Setting
On day three, my primary task is to make sure that Leila feels more included in the activities planned out for the day:
Daily Living Tasks
Leila, 73, has a hearing impairment of medium severity, she reads on the lips, and I have to follow certain rules of communication for her comfort. Leila lives according to the same schedule as the other residents: she has breakfast at 9:00, then she takes a bath, at 11:00, Leila drinks tea with cookies and relaxes in her room. Later, she goes for a walk, has lunch from 13:00 to 14:00, and exercises in the evening. Leila does not participate in team games, but she has friends who also have sensory difficulties, so she does not feel lonely.
Every few days, I measure the pressure for Leila and can talk to her at this time. When communicating with Leila, I make sure she sees my face, and I sometimes use sign language for word-by-word indexing. I also speak clearly, do not raise my voice, do not cover my mouth, and allow Leila to ask questions either in sign language or by writing questions in a notebook when I can’t understand the question. During my first meeting with Leila, I asked her to invite an SL interpreter, explaining that I had not mastered sign language. However, Leila refused and assured me that I could learn quickly.
On this particular day, we have an evening activity of a mini-improv show where the residents can show off their talents, and I want to encourage Leila to participate in the show. In the morning, before tea and biscuits, I come to Leila’s room to help her dress and wash. I say “Hello,” and after she responds, I do the following tasks:
- I ask whether she needs any help with dressing and washing, making sure she is able to read my lips;
- I help Leila come to the toilet and wait for her outside in case she needs any help;
- I ask Leila if she has any plans of attending tonight’s show and whether she wants to participate;
- I suggest Leila performs one of her favorite poems in sign language, whereas I can help others understand the content by reciting the poem;
- I know that Leila loves Byron’s poems, so I hand her an anthology of his most famous poems for her to choose.
- I make sure Leila understands me by using sign language and notes, if necessary;
- I escort Leila to the recreational area to have some tea and cookies;
- I go with Leila to watch some TV, helping her understand the content in case she does not see the speaker’s lips or has some issues understanding the speaker.
Communication with Stakeholders
I always reach out to Leila’s children in order to inform them of her well-being and the things she needs them to bring. The communication usually happens once a week, as they come to visit her on the weekend. I communicate with her therapist every day in order to modify or enhance the treatment course based on her well-being and concerns. I also make sure to communicate with other nurses during the shift handover to be up to date with Leila’s health status and emotional state.
Challenges and Rewarding Aspects
It is interesting for me to communicate with Leila – she has a polite and positive attitude towards me. She has lived in the institution for four years and is visited every month by her daughter, who brings Leila sweets and other gifts. Leila and her daughter communicate in sign language very skillfully. When I talk to Leila’s daughter, I make sure Leila sees my face well, which is very important in group communication. In general, Leila makes a very positive impression on me, as she treats people very well. However, I feel discomfort because I do not speak sign language at a high level, so I do not give up my exercises. I have an idea to invite a trainer to conduct weekly training for healthcare assistants, as 23 people with sensory difficulties live in our institution.
Day 4: Bathing a Client Who Has Mobility Problems
Description of Immediate Setting
Our nursing home facility has a successful architectural design with well-thought-out logistics for people with mobility problems, including soft floors, handrails in corridors, and transitions from vital areas such as the dining room, recreation area, and residential zones. We have bathrooms specially designed for people with mobility problems. The 35 residents of our institution have some types of mobility problems and need special attention to meet their needs. Considering the staff to patient ratio of an average of 5 patients per nurse, approximately two of my everyday patients struggle with mobility and autonomy in general.
Routine of Care Setting
Today, my primary goal is to help Jane, an 85-year-old patient with mobility issues, bathe and dress afterward.
Daily Living Tasks
Jane’s bathroom is equipped with a chair for the shower, which helps to ensure shower safety. These chairs are in the bathrooms of 35 residents with mobility problems. They have an ergonomic design, drain holes to prevent water collection, adjustable height, fixed armrests, and non-slip rubber feet. Chairs can also be designed for different weights and are easy to clean and store. However, I still need to assist her while she is taking a shower. So, when I enter the room in the morning, I say, “Good morning” and check if Jane is ready to bathe:
- If she is ready, I suggest helping her get to the bathroom or help her get into her wheelchair;
- Once we are in the bathroom, I carefully ask if she wants any assistance in undressing; if the answer is “yes,” I help Jane; if the answer is “no,” I tell her I will turn around and stay close in case she needs assistance;
- Jane takes a shower without my direct help because of the assisting equipment, but I continue to stay around to ensure her safety;
- Once Jane tells me she is finished, I help her get up because of the slippery floors;
- We come back to her bed, and I asks if she needs any help getting dressed;
- We pick an outfit for the day together, and I either hold Jane while she dresses or dress her myself, based on her answer;
- I help Jane go to the recreational area for some soup.
In the evening, following a similar procedure, I help Jane wash and change clothes before going to bed.
Communication with Stakeholders
Jane has visitors who come to the institution once a month – her daughter and granddaughter. They ask me questions about Jane’s health and well-being, and I give them detailed answers. I also offer Jane some leisure options during such conversations to make her feel more active and fun. Jane is worried about her weakness, so we have developed for her and other patients with mobility problems a set of exercises that they perform every day in their free time under the supervision of a coach. She also takes some vitamins and supplements, as agreed with her doctor.
Challenges and Rewarding Aspects
Communicating with Jane and her family is very helpful to me; by supporting Jane while bathing, I began to understand how delicate and vulnerable people are, regardless of age or gender. Sometimes, however, I feel the challenge of helping residents without imposing on their sense of privacy. I realize that sometimes Jane feels rater ashamed of others helping her get undressed, but she has no other choice but to seek assistance. For this reason, I realize how important it is for her to realize her autonomy and dignity.
Day 5: Dressing a Client with Dementia
Description of Immediate Setting
In our nursing home center, there currently are 15 people with dementia. Our doctors and nurses have developed a treatment program for different types and stages of the disease. Alzheimer’s disease associated with dementia is incurable; still, scientists continue to look for ways to stop the breakdown of nerve endings in the brain, which leads to the loss of some abilities and skills. On day five, both the number of residents and the staff to patient ratio remained the same. The focus of my shift was on Mary, a 93-year-old patient with dementia.
Routine of Care Setting
On day five, I am assigned to work with Mary, our patient of eight years, as she has recently had issues with dressing. Because of her progressive dementia, Mary has issues with weather perception and easily forgets to put on certain pieces of clothing. The schedule for the day is as follows:
Daily Living Tasks
I come to Mary’s room in the morning in order to help her get dressed for the day:
- I say “Hello” and ask her how she feels; if there are any concerns, I listen to them, measure her BP in order to pass the data to her physician;
- I ask her about her preferences on what to dress and check-in by asking what she thinks about the weather, whether she feels hot or chilly;
- Based on her answer, together we think about what to wear for the day;
- I ask Mary’s permission to help her get dressed; if the answer is “yes,” I prepare the clothes and carefully assist Mary;
- If Mari does not need my help in getting dressed, I suggest we create a checklist for dressing and say “check” every time Mary puts on a piece of clothing, so she does not forget to put on underwear or other clothes;
- I stay close to Mary in case she becomes confused with putting on clothes;
- After she is done, I check on her and ask whether she feels comfortable;
- If everything is good, we proceed to the recreational area.
The procedure is repeated in the evening when Mary needs to change clothing before going to bed.
Communication with Stakeholders
Mary’s grandson comes twice a month to talk to her and ask questions about her well-being, to which I give detailed answers. Mary can solve crossword puzzles, and she loves them very much, so her grandson brings her new crossword puzzles every time. Mary sometimes doesn’t recognize her grandson, but I keep reminding her that he is a close person she can trust. When her grandson is upset about Mary’s health and illness, I try to support him, and I always thank him for visiting because it’s hard for Mary to make new friends. Sometimes Mary remembers people from the past and tells us stories that her grandson enjoys listening to because he knows many of the participants personally.
I am always present during these meetings since this is part of my responsibilities. If Mary does not recognize her grandson or does not understand where she is, she should trust me through my nurse clothing and my communication skills. When Mary is scared, I explain the situation quickly and honestly and remind her that she can spontaneously forget some things.
Challenging and Rewarding Aspects
Communicating with Mary helped me take a different perspective on dementia and avoid some myths. For example, it inspires the belief that patients with dementia are aggressive. But aggression can occur only when the health care provider does not understand its causes – fear and concern about not understanding the situation. Therefore, prompt explanations and gentle, friendly tone help reduce the risks of aggressive behavior. Another myth is the complete loss of mental abilities, which is not true. People with dementia retain the ability to think logically; they only partially lose the ability to remember certain events and recognize familiar faces. Sometimes, of course, it is hard to remain calm when you need to repeat the same things over and over again or when patients react aggressively to your comments, so it is important to keep in mind that their behavioral response comes from the place of illness, not wrongdoing.
Day 6: Transferring a Client from Bed to Wheelchair
Description of Immediate Setting
Out of 100 patients currently residing in our nursing home, some use wheelchairs. A small part of these people cannot move due to complete loss of limbs mobility. The other part is people who recover after surgery or illness. Such people have working limbs but are temporarily using wheelchairs. On day six, I had to help William, who is 78 years old and had a stroke, move from bed to wheelchair. The workload was not heavier than usual, with an average of 5-6 patients per nurse.
Routine of Care Setting
One of the tasks I need to complete today is to help William get transferred from bed to chair. This is a rather complex procedure that requires skills and experience and takes place in several stages. Considering the routine for the day, this procedure needs to be done before 9 am:
Daily Living Tasks
At the beginning of my shift, I visit William, greet him, and wonder whether he is ready to get up:
- If he is ready, I come to his bed and roll his cart next to it;
- I help William take a sitting position on his bed and suggest he spends a few minutes to get used to the position and see if he feels well;
- To move, I place William on his side, facing the cart, and then I place one hand on the patient’s shoulder and bent his knees;
- I moved the patient’s legs off the edge of the bed and used this impulse to help him take a sitting position;
- I moved the patient closer to the edge so that his feet touched the floor;
- I make a turn, putting a belt on the patient’s knees that he could grab during the turn. Supporting the patient’s leg, I help him get up and move to the wheelchair.
- I ask the patient to touch the armrests and adjust the seat.
Communication with Stakeholders
William has several visitors, a daughter with children comes to him every two weeks, and a son comes to him every two weeks. After the stroke, William’s children visited him more often, and now they are worried about his condition. William is also worried and nervous, although he tries to hide his feelings. Fortunately, if he follows the treatment plan, William has a good chance of a full recovery, but he will use a wheelchair for some time before that.
Challenging and Rewarding Aspects
Moving a patient from bed to wheelchair has always seemed to be the most difficult practice. However, after I completed this task a few times, I felt more confident and understood that this is a simple skill. Moreover, I see that patients feel very grateful when someone helps them move around and feel like functioning adults. Seeing how people with limited mobility opportunities continue to interact with others is the most rewarding feeling, as they are not guilty of losing their ability to physically connect with society.
Day 7: Recreational Activities – One Day Example and Description of the Activity
Description of the Immediate Setting
Our nursing home center is a large facility with a spacious seating area and a cozy courtyard with a walking park. Our center also has a gym and a board games area, so our residents have many options for recreational activities. They can also spend their free time in their rooms where no one will disturb them. However, from time to time, our residents need brighter emotions (Spangler et al., 2019). Therefore, we have a tradition of celebrating birthdays for those patients who consent and have the opportunity to participate in the celebration. The center’s current population of 100 people, celebrating birthdays and holidays, is a chance of feeling alive and connected to their lives. We organize public celebrations two or three times a month because not all residents like to attract attention. In terms of planning this activity, the staff-to-patient ratio is not as important, as every resident becomes a part of the party-planning committee, whereas nurses curate the process and help patients bring their ideas to life.
Routine of Care Setting
On day seven, the center’s schedule differs from the usual outline, as the majority of free time for the day is dedicated to the party planning:
Daily Living Tasks
On day seven, I am assisting a group of three patients: Linda, John, and Christine, who are volunteers for creating a karaoke activity for the party:
- During the activity planning, I ask patients who have any ideas whether they need my assistance in supplying and organizing something;
- Linda, John, and Christine pitch their idea of karaoke and wonder if we have a sound system to bring to the party;
- I assure them we will bring the system and ask them to create a list of songs they want to include in the catalog;
- I ask the facilities manager to bring the sound system;
- I go around and help Linda and others collect songs for karaoke activity;
- During the final stage of planning, we make a soundcheck, and I proceed with helping residents get dressed and groomed for the party.
Communication with Stakeholders
Prior to every party, I consult with therapists and other medical staff on whether it is appropriate. I also create a list of patients who may need additional assistance during the party or even skip the party. Other nurses and I, along with patients, inform family members about the party, and they are free to visit as long as they are healthy and welcomed by the residents.
Challenges and Rewarding Aspects
Undeniably, creating a party that would satisfy every resident is a nearly impossible task, especially concerning their unrealistic suggestions for the activities. However, seeing how happy they are once the party is started makes me realize that even one smile on their faces is worthy of my efforts. Hence, it motivates me to commit even more to my job and make sure every resident at the facility feels at home.
Reference List
Spangler, D., Blomqvist, P., Lindberg, Y. and Winblad, U. (2019) ‘Small is beautiful? Explaining resident satisfaction in Swedish nursing home care’, BMC Health Services Research, 19(1), pp. 1-12. doi.org/10.1186/s12913-019-4694-9