The role of CNAs (Certified Nursing Assistants) in the nursing care of the elderly is a vital one. CNAs are on the front line of patient care in assisted living and long-term care facilities. They spend the most time of any staff members with elderly patients and are with them throughout the day every day. They are the "ears" and "eyes" of the RNs (Registered Nurses), who help write patients' care plans and need the information provided to them by the CNAs to assess the progress of patients' care. In addition to taking vital signs, assisting patients with grooming and bathroom needs, and sometimes helping to feed patients, CNAs are in a position to be the first to note both subtle and significant changes in patients.
Elderly patients are certain to suffer joint pain occasionally if not chronically. Musculoskeletal disease, such as osteoarthritis, is the most common cause of chronic pain and disability in older people. Pain often creates a vicious cycle. Exercise keeps the synovial fluid in joints flowing for better mobility, but joint pain prevents exercise. Without exercise, the joints stiffen and pain increases. Joints can deteriorate to such a state that knee or hip replacements are necessary. Physical therapy is then necessary to get the new joint moving successfully.
CNAs Help Through Observing Signs of Pain and Distress
The first important way CNAs can help their patients is by observing for non-verbal pain signals given by the elderly as they work with them each day. If observed, the CNA needs to find the cause, either through observation or by talking with the patient about what is observed. If medical intervention is needed to relieve pain, the CAN reports to the RN on the patient's behalf. Non-verbal pain signals can include:
• Grimacing/wincing/rubbing spots
• Bracing/guarding a body part
• Changes in usual activity level
• Sleeplessness/restlessness
• Resistance to movement
• Increased agitation/anger/emotional display
• Decreased appetite
• Moaning/calling out/groaning
CNAs Help Through Simple Pain Redirection Techniques
Some techniques that help reduce pain or take the mind off it can be applied by a CNA without the need for written orders in the Care Plan. One is to assist the patient with better positioning. Helping the older person sit or lie in positions that promote or maintain normal muscle function can help. Changing positions frequently helps keep joints more mobile. Using a full length body pillow can help position a bedridden patient. Placing a pillow between the knees when the patient lies on either side can take pressure off the hips and spine for a better alignment. Gentle shoulder or back massage can decrease pain by soothing tense muscles and skin.
CNAs Help Relieve Pain Through Techniques Ordered in the Care Plan
Using heat and cold in massage has to be ordered by an RN or physician, but is then applied by the CNA. Applying cold numbs nerve endings, decreases inflammation, and reduces muscle spasms, thereby relieving pain. Warm lotion massage and a hot water bottle can reduce soreness and inflammation, increase blood flow to the joint and skin, and also relaxes the patient. Exercises for range of motion, maintaining flexibility and exercises to strengthen muscles around joints can be supervised by a CNA also.
CNAs Help Through Assisting in Emotional Care and Well Being
Depression is more common in people with arthritis and other forms of chronic pain. Redirecting a patient's attention through playing music, talking together, the use of humor and being a good listener are all pain relievers in their own ways.
The CNAs are vitally important for establishing a friendly relationship with patients, establishing comforting routines and treating patients with caring and respect. Older people who retain some control of their lives will be more cooperative and CNAs will be better able to help them with treatments designed to reduce their chronic joint pain.
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