CNA Training Advisor Volume 12 Issue No. 9 SEPTEMBER 2014 Activities and exercise are critical to the well-being of your residents. People who regularly interact socially with others through activities and hobbies tend to be healthier, both physically and mentally, than those who become socially isolated. Recreational activities improve motor skills, social skills, thinking ability, behavior, and communication ability. Artistic activities such as arts and crafts help people relax, keep an alert mind, improve fine motor skills, and improve memory. All types of activities prevent boredom and loneliness, and promote choice and independence. CNAs can facilitate the safe, healthy enjoyment of such pursuits in a variety of ways, including fostering residents willingness to try new or modified activities, helping them find their niches, and carefully supervising their actions. This issue of CNA Training Advisor will discuss the myriad health benefits of physical activity, as well as provide examples of exercises that are tailored for nursing facility residents. It will also identify strategies for encouraging residents to partake in activities. Have a good day of training, and stay tuned for next month s issue of CNA Training Advisor, which will cover restorative care for residents after hip surgery. Safety tips for active residents Sometimes a resident s mood or symptoms can threaten their safety while participating in activities. Remember the following warnings and guidelines: No one with dementia, suicidal tendencies, cognitive impairment, or a history of violent behavior should use a sharp or pointed object unless under constant supervision. If a resident becomes anxious, angry, hostile, or frustrated during a game or mental activity, intervene with assistance or quietly redirect the person to another activity of his or her choosing. Quiz answer key 1. a 2. d 3. b 4. d 5. c 6. d 7. c 8. c 9. b 10. a Program Prep Program time Approximately 30 minutes Learning objectives Participants in this activity will be able to: Explain the benefits of being socially, mentally, and physically active throughout life Implement strategies for encouraging residents to participate in activities Identify the risks associated with different types of activities and ensure residents can safely participate Preparation Review the material on pp. 2 4 Duplicate the CNA Professor insert for participants Gather equipment for participants (e.g., an attendance sheet, pencils, etc.) Method 1. Place a copy of CNA Professor and a pencil at each participant s seat 2. Conduct the questionnaire as a pretest or, if participants reading skills are limited, as an oral posttest 3. Present the program material 4. Review the questionnaire 5. Discuss the answers SEE ALSO hcpro.com/long-term-care
CNA Training Advisor September 2014 This document contains privileged, copyrighted information. If you have not purchased it or are not otherwise entitled to it by agreement with HCPro, any use, disclosure, forwarding, copying, or other communication of the contents is prohibited without permission. EDITORIAL ADVISORY BOARD Product Manager Adrienne Trivers atrivers@hcpro.com Associate Editor Delaney Rebernik drebernik@hcpro.com STAY CONNECTED Interact with us and the rest of the HCPro community at HCPro.com Become a fan at facebook.com/hcproinc Follow us at twitter.com/hcpro_inc Email us at customerservice@hcpro.com Questions? Comments? Ideas? Contact Editor Delaney Rebernik at drebernik@ hcpro.com or 781-639-1872, Ext. 3726. Don t miss your next issue If it s been more than six months since you purchased or renewed your subscription to CNA Training Advisor, be sure to check your envelope for your renewal notice or call customer service at 800-650-6787. Renew your subscription early to lock in the current price. Relocating? Taking a new job? If you re relocating or taking a new job and would like to continue receiving CNA Training Advisor, you are eligible for a free trial subscription. Contact customer serv ice with your moving information at 800-650-6787. At the time of your call, please share with us the name of your replacement. CNA Training Advisor (ISSN: 1545-7028 [print]; 1937-7487 [online]) is published monthly by HCPro, a division of BLR, 75 Sylvan Street, Suite A-101, Danvers, MA 01923. Subscription rate: $159/year; back issues are available at $15 each. Copyright 2014 HCPro, a division of BLR. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, a division or BLR, or the Copyright Clearance Center at 978-750-8400. Please notify us immediately if you have received an unauthorized copy. For editorial comments or questions, call 781-639-1872 or fax 781-639- 7857. For renewal or subscription information, call customer service at 800-650-6787, fax 800-639-8511, or email customerservice@hcpro. com. Visit our website at www.hcpro.com. Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to the marketing department at the address above. Opinions expressed are not necessarily those of CTA. Mention of products and serv ices does not constitute en dorse ment. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. Physical activity Physical activity is an important part of a resident s care. It can: Reduce risk of heart disease. Help with weight control. Improve blood circulation. Decrease the risk of falls. Relieve symptoms of anxiety and depression. Help prevent and control chronic diseases such as high blood pressure, diabetes, and osteoporosis. It also lowers cholesterol. Improve gross motor skills and help residents maintain independence and ability to perform self-care. Strengthen heart and lungs. Improve mobility, balance, and coordination. Increase flexibility of joints and muscles, while preventing muscle atrophy and contractures. Improve self-esteem and quality of life. Improve strength and endurance. Keep people functional. Physical activity helps residents get up out of chairs, walk, eat, and bathe without assistance for as long as possible. These benefits are even more important for older and disabled people. Even very weak and frail people can improve their strength, endurance, and ability to do things by exercising regularly. Aged and disabled people often don t move much for long periods of time. When muscles are not exercised, they can waste away, or atrophy. When this happens, the muscles become small and weak. The muscles can also tighten up into deformities called contractures. When this happens, the muscles stop working. (See CNA Training Advisor s August issue for more information on contractures.) In addition, lack of exercise weakens the body and body systems. These problems lead to dependence on others, inability to perform self-care, and poorer quality of life. Promoting exercise and activities You are responsible for helping the people you take care of be as active, independent, and healthy as possible. Become a cheerleader for activity and exercise. Know how important it is to stay active, and try to motivate people to engage in some kind of activity or exercise every day. People have the right to choose their activities. You should never force anyone to do something he or she doesn t want to do but you can explain how important that activity is. Encourage residents to participate in activities and exercise in the following ways: 2 HCPRO.COM 2014 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.
September 2014 CNA Training Advisor Recommendations for regular physical exercise Type of exercise Aerobic exercise Benefits How How much (intensity) How long (duration) Thirty minutes to 1 hour. This time can be broken up into shorter 10-minute sessions with many of the same benefits of a longer session. Three 10-minute sessions spaced out over a day might be the best routine for an older person. How often (frequency) At least three times a week. Strengthens heart and lungs, increases stamina and endurance, helps with weight control, and improves circulation. Aerobic exercises include walking, dancing, and calisthenics. Lowimpact calisthenics, with no jumping, are safest. An easy exercise for an older person is marching in place. Aerobic exercise is based on increasing oxygen intake to stimulate heart and lung activity. For an exercise to be aerobic, it must increase heart rate and breathing above a person s normal rates (but not too high). Muscle building and toning (anaerobic exercise) Increases strength; improves appearance; increases mobility; improves self-care ability, coordination, and balance; and decreases the risk of falls. Lift light weights (start with onepound weights and increase slowly). Do muscle-toning calisthenics such as squats and leg raises. Gardening is a fun musclebuilding activity. Lift the weights or do the muscle-toning calisthenics in sets of eight repetitions, and repeat each set twice. Adjust the size of the weights to be able to perform all the repetitions without harm. It may be necessary to start with just two or three repetitions. Work up to 20 30 minutes. Start with just a few lifts or calisthenics, and increase slowly over time. Twice a week, or every other day. Always allow at least 48 hours between musclebuilding sessions. Stretching and range of motion (ROM) Increases flexibility, prevents injury, and helps the joints and muscles maintain or recover functionality. ROM gently moves the joints through all types of movement. Stretching pulls gently on the muscles. ROM and stretching can be active (done by the resident) or passive (done by a caregiver). Activeassisted is done partly by the resident, with assistance. Residents should do as much of the work as they can. Five minutes is enough for a postexercise stretch. If stretching or ROM is the only exercise being performed, work for 15 20 minutes (or longer) if possible. Every day, or at least five times a week. Tell them about some of the many emotional and mental benefits of socialization and activity. Emphasize that they can choose the activities they like and that they may stop performing an activity or participating in a social event whenever they wish. Find out what a resident likes to do. What hobbies does he or she enjoy? What kind of music or art? Encourage continued involvement in these things as much as possible. If you need materials for these activities, work with your supervisor to obtain them. 2014 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400. HCPRO.COM 3
CNA Training Advisor September 2014 If a resident has given up a hobby he or she used to enjoy due to poor vision or motor skills, see if there are adaptive devices that can help. A magnifying glass that attaches to a book or needlework frame can enable someone to see well enough to read or stitch. Sometimes a former hobby can be modified so an elderly or disabled person can still do it. If someone loves to sew but can t handle the tiny needle and thread now, perhaps he or she could manage the large tapestry needles and thick yarns used in plastic canvas needlework. Be creative! Bring residents with similar interests together. People who like plants might enjoy looking at each other s flowers or greenery and sharing knowledge, stories, and ideas about growing things. Help provide the items people need for an activity they have chosen. If they want to do a jigsaw puzzle, find a way to get them some puzzles they can do. Safety precautions When you are working with someone who has a physical or mental disability, the risk of injury or harm during an activity increases. Remember the following activity-specific safety guidelines and warnings: Arts and crafts: The tools in a craft project can be dangerous if used improperly. Scissors, knives, sewing needles, knitting needles, and other sharp or pointed objects can cause cuts, punctures, and eye injuries. Cooking projects: Stoves and ovens create a risk for burns. Microwave ovens carry the risk of steam burns. Hot foods and liquids can cause serious burns if mishandled or spilled. Small household appliances, such as mixers, can be a source of electric shock or injuries. Knives, scissors, and other cooking utensils can cause cuts and punctures. Games and mental activities: If a mental activity or game is too difficult for someone, he or she may become frustrated or angry. Sometimes a person will act out this anger or frustration with unpleasant or inappropriate behavior or speech. Self-esteem and confidence might be reduced, and people may become anxious or depressed as a result. H Special spotlight: Autism Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. There is often nothing about how people with ASD look that sets them apart from other people, but those with ASD may communicate, interact, behave, and learn in ways that are different from most other people, which can sometimes translate into obstacles to care for healthcare providers. Because of the unique symptoms, experiences, and personalities of individuals with ASD, a broad spectrum of resources is required across the lifespan. However, in a 2011 study, CMS identified a particular gap in information and services for transition-age youth and adults with ASD tools that are essential for helping individuals reach their full potential for a fulfilling, productive life. This is because efforts surrounding ASD diagnosis, treatment, and support are largely targeted at children as research indicates that early intervention treatment services can improve an individual s development. Because families of adults with ASD are encouraged to help their loved ones choose living arrangements based on their skills and symptoms, people with ASD that reside in long-term care facilities often require intensive, constant supervision. The lack of tailored research and services for adults with ASD makes the support they receive at these facilities, such as interactions with CNAs, essential. If you work with residents who have ASD, vigilance can help you be sensitive and attentive to these residents unique needs. People with ASD often have problems with social, emotional, and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with ASD also have different ways of paying attention or reacting to things. People with ASD might also: Have trouble relating to others or not have an interest in other people at all Appear to be unaware when people talk to them, but respond to other sounds Be very interested in people but not know how to talk or relate to them Have trouble expressing their needs using typical words or motions Lose skills they once had Sources: CDC.gov, NIH.gov, CMS.gov. 4 HCPRO.COM 2014 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.
SEPTEMBER 2014 Volume 12 Issue No. 9 CNA Professor QUIZ Mark the correct response. Name: 1. Some benefits of social activities include: a. Reduced boredom, loneliness, and depression b. Decreased balance and coordination c. Reduced risk of heart disease d. More free time for caregivers 2. Some benefits of physical activities include: a. Better self-care ability b. Slower thinking ability c. Increased strength and flexibility d. Both a and c 3. If a resident doesn t want to do any activity you suggest, you should. a. insist that the resident participate because it s for his own good b. respect the resident s right to refuse, and offer another activity he might enjoy more c. tell your supervisor that the resident is uncooperative d. tell the resident you are upset with him for refusing 4. Active-assisted range of motion stretching exercises are performed: a. Completely by the resident b. Completely by the caregiver c. By a therapist or nurse d. Partly by the resident, with help from a caregiver 5. Residents shouldn t perform muscle building and toning exercises more often than. a. once a month b. once a week c. twice a week d. every day Date: 6. When muscles are not used: a. They can waste away or atrophy, becoming small and weak b. They can tighten up into contractures and stop working c. Neither a nor b d. Both a and b 7. You can encourage a resident to participate in activities by. a. choosing an activity for her b. telling her that she will be punished if she doesn t participate c. emphasizing that she can choose an activity that she likes and stop participating when she wishes d. bringing her to an activity that is convenient for your schedule 8. If a resident can no longer do a formerly loved hobby (e.g., due to poor vision or motor skills), what can you do? a. Nothing. It s not your place to advise residents about their hobbies. b. Tell the resident that the hobby would be too difficult for her now. c. See if there are modifications that can be made to the hobby, or adaptive devices that the resident can use. d. Insist that the resident continue trying to do the original hobby without making adjustments. 9. Since people can become frustrated when working on a puzzle or other mental activity, it is best to avoid activities that require mental exertion. a. True b. False 10. If a resident doesn t want to participate in an activity, you should explain how important the activity is rather than forcing her to do it. a. True b. False A supplement to CNA Training Advisor