CNA Training Advisor Volume 12 Issue No. 11 NOVEMBER 2014 Sensory problems take many different forms. Some, such as hearing and vision disorders, can be the result of normal changes that occur during the aging process. Others, such as paralysis, may set in after trauma or a stroke. Communication problems have many causes, including chronic diseases, head injuries and trauma, and neurological conditions like strokes. Communication is an essential element of restorative care for individuals with sensory disorders, and as a CNA, you must be able to communicate with residents who have unique and varied conditions. In addition to communication, there are a host of therapies that providers use to reduce pain, quell stress, and facilitate the interpretation of sensory stimuli for residents with sensory problems. This issue of CNA Training Advisor highlights strategies for communicating effectively with residents who have a variety of sensory problems and reviews popular therapies used by long-term care providers to improve the experiences of these unique residents, including safety and implementation tips to help CNAs foster top-notch care delivery. Have a good day of training, and stay tuned for next month s issue of CNA Training Advisor, which will focus on ethical dilemmas. Tips for heat and cold treatments Therapies that incorporate heat or cold can be very effective for residents with sensory problems; however, because these elders can be especially sensitive to sensation, providers should tread with caution when administering treatments. Here are a few rules to keep in mind: Be sure the application is the proper temperature. Check the skin under the application every 10 minutes or according to facility policy. Leave the application in place for no more than 20 minutes. Follow all safety rules to prevent spills and falls. Quiz answer key 1. c 2. a 3. c 4. b 5. d 6. c 7. a 8. b 9. d 10. b Program Prep Program time Approximately 30 minutes Learning objectives Participants in this activity will be able to: Integrate practices that promote effective communication with residents who have a variety of disabilities and sensory problems Discuss an array of therapies commonly used in LTC settings to stimulate residents senses Apply essential safety precautions when helping administer heat and cold treatments to residents Preparation Review the material on pp. 1 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 November 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 Associate 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. 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Communication strategies Because communication, or the sharing of information and responses, can be verbal or nonverbal, it has the ability to foster understanding between people with many different backgrounds, experiences, and conditions. Most communication is done verbally (through spoken word). To ensure you are speaking to residents in a clear, comprehensible manner, choose your words carefully. Avoid using slang, words with more than one meaning, and those that the receiver may not understand. In addition to selecting your words with care, monitoring the tone and pitch of your voice is essential, as these components have a lot of influence on the meaning of your message. Nonverbal communication includes written messages, body language, and eye contact. You may be surprised to learn that nonverbal behavior has a powerful effect on how a message is received regardless of how alert a resident is. While words represent 7% of the meaning of a given message and tone of voice represents 38%, gestures, facial expressions, and other body language account for a staggering 55%. Adopting strong communication practices can be particularly important when caring for residents with disabilities. Many residents are admitted to nursing facilities because of physical or mental conditions that necessitate professional care. However, these residents are not that different from those without disabilities, nor do they wish to be treated as disabled. Though they may require some environmental alterations, they can do the same types of activities as other residents. In fact, many develop other talents and abilities in spite of their challenges. Show these residents respect, and emphasize their worth during interactions. Sensory integration Humans experience many sensations triggered by movement, touch, sight, sound, the pull of gravity, and body awareness. Residents with sensory integration dysfunction, also called sensory processing disorder, have difficulty taking in or interpreting sensory information. This condition has many negative effects on ADLs, self-esteem, behavior, and relationships. Residents with this disorder are also at high risk for injury. Sensory integration can help affected residents interpret sensory stimuli. Many believe the practice also forms the foundation for more complex learning. A sensory integration program focuses on stimulating three basic senses that provide essential responses and protective mechanisms for survival: Tactile: interprets pressure, temperature, pain, and touch Vestibular: promotes balance 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.
November 2014 CNA Training Advisor Proprioception: enables awareness of the body s position in relation to its surroundings Sensory stimulation Sensory stimulation is a term that describes the effects of a person s environment on the mind and body. Information enters the body through the eyes, ears, nose, mouth, and sensory nerves in the skin, then the brain interprets it. In long-term care, sensory stimulation refers to a restorative program in which providers deliberately stimulate residents senses through activities that are therapeutic, passive, and pleasurable. For example, a CNA may massage a resident s hands and arms with lotion or give a backrub. Sensory stimulation can relieve boredom, reduce stress, and improve behavior by distracting residents from conditions and problems that normally bother them. Snoezelen therapy Long-term care providers can use the surrounding environment to stimulate the primary senses of people with disabilities, such as advanced dementia. One example of this practice is Snoezelen therapy, also called multisensory stimulation environment therapy. A Snoezelen room is designed to be a safe space that soothes and stimulates residents senses without requiring the use of intellectual skills. Providers use various items in the room that engage the senses through lighting, color, sounds, music, scents, etc. For example, a CNA may use materials of assorted textures to stimulate the sense of touch. The only objective of the treatment is for the resident to experience pleasurable sensations, which release endorphins chemicals produced in the brain that reduce pain and improve mood in the body, thereby helping to reduce stress and enhance self-esteem. Some facilities have small groups of residents come to the Snoezelen room for 30-minute periods several times a day for activities that reduce agitation and help residents stay in touch with their environment (e.g., by listening to calming music, watching a slideshow, or holding something soft). Music therapy and animal-assisted therapy are also programs that stimulate the senses. Aromatherapy Aromatherapy is the use of essential oils to balance health and wellness. The scents stimulate the olfactory nerve, which sends messages to the brain, causing various physical and mental responses. Examples include incorporating essential oils into a massage and using scented candles. Many believe such treatments relax patients, reduce their pain, and boost their immune responses. Heat and cold treatments Heat treatments (thermotherapy or diathermy) and cold applications (cryotherapy) are used for residents with musculoskeletal conditions. Applications may be moist or dry, warm or cold. Moist applications conduct heat or cold better than dry applications. In moist applications, water touches the skin. In dry applications, no water touches the skin. Some dry applications incorporate contained water that allows the external component to stay dry, such as a hot water bottle. Dry applications may be used to maintain the temperature of moist applications. A localized application delivers heat or cold to a certain area (e.g., applying a cold pack to an injury), while a generalized application distributes heat or cold to the entire body (e.g., using a hypothermia blanket to reduce fever). Heat dilates (enlarges) blood vessels, bringing oxygen and nutrients to the area to speed healing and relieve pain, inflammation, and muscle spasms. Cold decreases the blood supply to an area and constricts (reduces the size of) blood vessels. Local cold applications relieve pain, prevent or relieve edema, and control bleeding. As a rule, cold is applied after an injury. Heat is applied later. Guidelines for using heat and cold applications Elders are very sensitive to the effects of heat and cold. Many experience abnormal sensations and have fragile skin, so it s important to take precautions when administering these treatments. 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 November 2014 Before using a heat or cold application, you should know the: Type of application Area of the body to be treated Length of time the application is to remain in place Proper temperature of the application Side effects to watch for Safety precautions to use Specific precautions include: Follow safety guidelines for checking the temperature of the application and monitoring the skin. An elder s skin will typically begin to burn at 115ºF, but this could vary. Apply standard safety principles if your hands will contact blood, moist body fluids (except sweat), secretions, excretions, nonintact skin, or mucous membranes. Strike chemical heat and cold packs, which are activated by this action, away from your face to prevent chemicals from leaking on you. Cover local heat and cold applications that contact the skin with a flannel cover, pillowcase, towel, or thin layer of foam. Point devices with metal caps (e.g., hot water bottles) away from the resident. Position residents comfortably so they can maintain a position for the duration of a treatment. Expose only the part of the resident s body that you will be treating. Remove metal jewelry, buttons, or zippers that could conduct heat or cold. Always avoid the use of heat to treat the abdomen if appendicitis is suspected. Always avoid the use of heat if bleeding or edema are present and in the first 48 hours after an injury. Never pour hot or cold liquid directly over the resident when adding it to a soak or moist treatment to maintain temperature. Discontinue treatment if the skin under a heat application is discolored or very red, or a dark area appears; if any of these occur, notify the nurse promptly. Discontinue treatment if the skin under a cold application appears cyanotic, blue, gray, pale, white, or bright red. In these cases, cover the resident with a blanket, and notify the nurse promptly. Moist hot packs Moist hot packs are commonly used on the back and neck, but should never be placed under the body. They are usually applied for 20 minutes. Reusable cloth hot packs are placed between dividers in a hydrocollator, a rectangular tank containing very hot water. Because of the high temperature, the packs must be sheathed by a special cover comprising multiple layers of terry cloth that serve as a barrier between the pack and the skin. To prevent injury when removing packs from the tank, use tongs. In some facilities, licensed therapists are the only staff permitted to administer hot packs. Know and follow your facility policies. Paraffin wax baths Paraffin may be used for treating the hands of residents with arthritis and joint disease before exercise. The wax is prepared by mixing one pint of mineral oil per five pounds of paraffin. The mixture is heated in a tank. Most facilities use 110ºF to prevent burns. To prepare, instruct residents to wash and dry their hands and remove any rings and metal jewelry to prevent conduction burns. Dip one of the resident s hands in the wax, then remove it. The wax will begin to harden immediately. Dip the hand into the wax again, adding another layer. Repeat as directed, or until a thick coat of wax builds up. Remove the hand and wrap it in plastic wrap or towels to maintain warmth. Leave the wax in place for 30 minutes, or as instructed, then peel it off and discard it. The skin will feel soft. The resident will also have more joint mobility and less pain for several hours. Some facilities do not permit restorative nursing assistants to perform this procedure. Know and follow your facility policies. H EDITOR S NOTE This issue of CNA Training Advisor was adapted from The Long-Term Care Nursing Assistant s Guide to Advanced Restorative Skills, written by Barbara Acello, MS, RN. 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.
NOVEMBER 2014 Volume 12 Issue No. 11 CNA Professor QUIZ Mark the correct response. Name: 1. Which of the following sensory problems is never the result of normal changes that occur during the aging process? a. Vision disorders b. Hearing disorders c. Paralysis d. Minor aches and pains Date: 6. Which of the following therapies uses essential oils to balance health and wellness? a. Sensory integration b. Music therapy c. Aromatherapy d. Diathermy 2. Which of the following should you do when speaking with residents? a. Monitor the tone and pitch of your voice to make sure residents don t negatively interpret your message b. Use slang to try to connect with residents on a personal level c. Use complicated diction to help residents improve their vocabulary d. Say whatever comes to your mind to fuel conversation 3. How much of a message is conveyed through body language? a. 7% b. 38% c. 55% d. 99% 4. You should treat residents with disabilities differently than you treat those without disabilities. a. True b. False 5. What is sensory stimulation? a. The effects of a person s environment on the mind and body b. A disorder that causes a person to have trouble taking in or interpreting sensory information c. A restorative program in which providers deliberately stimulate residents senses through certain therapies d. Both a and c A supplement to CNA Training Advisor 7. In which type of application does water actually touch a resident s skin? a. Moist b. Dry c. Vestibular d. Paraffin wax bath 8. After an injury, you should apply heat. Cold is applied later. a. True b. False 9. Before using heat and cold applications, you should know the: a. Proper temperature of the application b. Area of the body to be treated c. Side effects to watch out for d. All of the above 10. What is one condition that paraffin wax baths can be used to treat? a. Dementia b. Arthritis c. Edema d. Blood clot