CNA Training Advisor Volume 13 Issue No. 11 NOVEMBER 2015 Many of us take free, comfortable movement for granted. As people get older, however, muscles gradually lose their strength, endurance, and flexibility. Joints also change, often becoming stiff and difficult to move. Beyond the fallout from the normal course of aging, many nursing home residents have experienced additional illnesses that further impede their mobility, such as strokes, fractures, and general weakness from chronic disease. Some residents may try to avoid movement due to these limiting and often painful conditions, but this is a big mistake. Lack of activity often worsens the changes that occur with aging or disease progression, and can trigger a host of new physical, psychological, and emotional problems. To avoid these grave implications, CNAs should help residents achieve and maintain their utmost level of mobility. For residents with higher capacities for physical function, this often means playing an active part in maintaining or improving their ability to ambulate, or walk. This issue of CNA Training Advisor discusses the CNA s extensive role in orchestrating a quality ambulation program, offering a number of strategies these important frontline staff members can apply when helping residents walk. Stay tuned for next month s issue on nutrition. Happy training! Study up to provide quality care To promote the effectiveness and safety of ambulation programs, CNAs must obtain the following information from their supervisor or a resident s care plan before helping the individual perform any planned walking activities: Whether colleague assistance will be necessary The resident s ability to ambulate and the distance of prospective ambulation The type of assistive device the resident will require for the activity, if any Quiz answer key 1. d 2. c 3. d 4. c 5. a 6. b 7. b 8. b 9. b 10. a Program Prep Program time Approximately 30 minutes Learning objectives Participants in this activity will be able to: Identify key elements comprising a quality ambulation program Apply tailored safety precautions when facilitating ambulation activities for residents who require common varieties of assistive equipment Discuss general techniques that promote safety and effectiveness during all resident ambulation events 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 October 2015 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 Adrienne Trivers Product Director atrivers@hcpro.com Delaney Rebernik Associate Editor 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. 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. Subscription rate: $159/year; back issues are available at $15 each. CNA Training Advisor, 100 Winners Circle, Suite 300, Brentwood, TN 37027. Copyright 2015 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 dorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. Ambulating, or walking, is an excellent exercise for keeping the body in good physical and mental condition. Physically, ambulation stimulates circulation and intestinal movement, keeps the muscles toned, and allows for fuller lung expansion. Mentally, a change of scenery and increased activity level can improve a resident s outlook and may result in a shorter recovery period following surgery and illness. Ambulation can also help: Prevent osteoporosis Reduce urinary incontinence, which, in many cases, stems from a resident s lack of means or mobility to make it the bathroom in time Relieve pressure on the body and skin, which can in turn prevent pressure ulcers Improve a resident s self-esteem and ability to socialize Because of these numerous benefits, an effective ambulation program can empower residents on many levels: helping them achieve their highest level of independence; improving their quality of life; and warding off the many physical, psychological, and emotional complications that can accompany immobility. Assessing the resident The first step in developing a successful ambulation program is evaluating a resident s specific walking abilities. Factors that your facility s physical therapist or physician will assess and that you, as the CNA, can continue to monitor during your frequent interactions with the resident include: Diagnosis and medical history Physical status (e.g., strength, balance, ability to bear weight) Mental status (e.g., motivation, aggressiveness, fear, predictability) Height and weight Level, degree, and location of pain while at rest and during ambulation activities Ability to communicate and understand verbal directions The necessity of assistive equipment Developing the program Once these areas have been evaluated, clinicians will work together to create an ambulation program designed around the resident s strengths and weaknesses. This program will become an integral part of the individual s care plan and require regular input from the entire team. As the frontline staff member with the most regular resident engagement, you may be privy to the subtle day-to-day fluctuations in an indi- 2 HCPRO.COM 2015 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.
October 2015 CNA Training Advisor vidual s mindset and health that a care plan can t always anticipate or capture. For this reason, you should stay alert for any changes in condition that could jeopardize a resident s safety during ambulation. If you see something troubling, check with your supervisor before you attempt to carry out any planned activities. Preparing for the day s ambulation activities After familiarizing yourself with the scope of a resident s ambulation program and the specific tasks at hand, you should take the following active preparation steps before initiating ambulation activities: Wash hands Review the planned ambulation with the resident Ensure that the resident is properly dressed and is wearing shoes that are supportive and non-slip Assemble all necessary equipment Using mobility aids during ambulation activities Some nursing home residents may require an assistive device during important activities of daily living, including ambulation. Mobility aids are assistive devices specially designed to help residents who have a disability or injury ambulate from place to place. These tools help individuals perform activities that might otherwise be difficult or impossible. However, they can also pose serious safety risks if not selected or used appropriately. As a CNA, it is your responsibility to understand why your resident requires a particular assistive device, how it works, and what you need to do to ensure the individual is using it correctly. The following sections shed some light on the mobility aids most commonly used among ambulating residents. Walking canes Residents who require light assistance with walking or standing may use a walking cane. Canes can support up to 25% of the body s weight, but provide less support than walkers. Canes are available in a number of different designs. The most common variety is the standard cane, also called the candy cane. Another type is the four-legged cane, or quad cane, which has four legs that offer varying degrees of support depending on the width of their base. This kind of cane is most often used by residents with weakness in one leg. But while it provides more stability than its standard counterpart, it is also more difficult to maneuver in narrow places. To provide the most effective level of steadiness and comfort, a cane must be set at the correct height for a given resident. To determine this height, place the cane next to the individual and let his or her arm dangle beside it. If the cane reaches the crease in the wrist, it is at the proper height. If not, extend or retract it as needed. When helping a resident ambulate with a cane, advise him or her to take the following safety precautions: Hold the device in the hand on the stronger side of the body. Move the cane and the weaker leg together, followed by the unaffected leg. Alternatively, move the device first, followed by the affected leg, and finally the unaffected leg. Avoid looking down at your feet a vantage point that can cause dizziness or loss of balance. Walkers Walkers are used by residents who require a higher level of stability to ambulate safely. Some walkers have four straight legs. Others have wheels, either on all four legs or on just the front set. Promoting safety during ambulation with a walker is very important, as improper usage can increase fall risks. Share the following safety tips when helping residents ambulate with walkers: Ensure the walker is at the correct height. The hand grip area should be set at a level that allows the resident s hands to rest on it with the elbows slightly bent. Check that the walker s rubber tips are not worn. Stand tall, lift the walker, and place it about a step in front of the body so that the back legs of the device are even with the toes. If one leg is weak or paralyzed, move the walker first, followed by the affected leg, and finally the unaffected leg. Avoid pushing a rolling walker too far ahead of the body, which can disrupt balance. 2015 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 October 2015 Refrain from leaning on the walker when getting up or sitting down, as it could tip over more easily in one of these transitive positions. Similarly, avoid sliding any walker that is not equipped with wheels an action that can cause it to topple and injure the user. Keep both hands on the walker at all times for balance, use ramps with caution, and avoid stairs and wet surfaces whenever possible. Using other special equipment during ambulation While assistive devices may be instrumental in facilitating ambulation for residents who can bear a significant portion of their body weight, CNAs may need to incorporate additional equipment into care sessions with individuals who, though not bedbound, require more hands-on assistance to move. A gait belt is one tool frontline staff can use to help residents stay mobile while protecting their own physical well-being. A gait belt can assist residents who are partially dependent, have some weight-bearing ability, and are cooperative with transfers, which involve the movement of an individual from one area to another alone, with another person, or with the help of equipment. Before using a gait belt, verify the resident in question hasn t had recent abdominal or back surgery, or a history of abdominal aneurysm. To initiate ambulation with a gait belt, place it around the waist of the sitting or prone resident, making sure his or her clothing is completely under the device. Fasten the belt snugly, leaving just enough room to grasp it easily between the resident s body and your fingers. Inform the resident in which direction you will be moving, always transferring to the resident s strongest side if he or she has one. Then stand in front of the individual, bracing his or her feet with your own. Use good body mechanics. Rather than using the belt to lift the resident, rock and pull smoothly in the direction you wish to go. Once the resident is upright, stand next to him or her and hold the belt in the back. For additional stability, hold onto the individual s hand that s closest to you. Always be alert to the possibility of the resident becoming weak and falling. If the individual starts to lose balance or fall while walking with the gait belt, continue to grasp the belt and lower him or her gently to the floor. General ambulation assistance techniques As a CNA, you play a key role in a number of areas related to facilitating ambulation regardless of how much help a resident requires. This means that you should implement appropriate safety measures as you assist residents with the tasks dictated by their personalized ambulation programs. Consider taking the following steps to promote success in this endeavor. Observe and report any improper or lack of use Ensure that devices are working properly and that residents are using them as intended. If you see that a resident is not properly using his or her device or has ceased using it altogether, report this decision to your supervisor. Doing so allows the clinician to speak to the resident about proper application, discuss why he or she may be resisting safe practices, and/or offer an alternative to continue providing quality care. Create a safe environment Nursing home residents can be weak, on pain medication, and in need of significant assistance to ambulate. The risk for falls and accidents is higher among these individuals, so it is up to frontline staff to help create safe, efficient living spaces and ambulation pathways. To ensure environments are ready for ambulation activities, keep the following points in mind: Before working with a resident, have a plan for dealing with any limitations in his or her space. Assess the size and shape of the room and look for safety hazards, such as narrow hallways, doors, and other items that may block your path. Prepare the area for movement. Rearrange furniture as necessary to position equipment effectively and allow the resident to move freely. Adjust lighting so you and the resident can clearly see your surroundings. Check the status of floors prior to ambulation, keeping a keen eye out for slippery spots. H 4 HCPRO.COM 2015 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 2015 Volume 13 Issue No. 11 CNA Professor QUIZ Mark the correct response. Name: Date: 1. What information should CNAs obtain prior to facilitating planned walking activities for a resident? a. Whether colleague assistance will be necessary b. The resident s ability to ambulate c. The type of assistive device the resident will require 2. Which of the following is NOT a potential benefit of ambulating? a. Improved self-esteem b. Fewer pressure ulcers c. Increased recovery time following a surgery d. Reduced risk of osteoporosis 3. When assessing a resident during the development of a personalized ambulation program, clinicians should consider the individual s. a. mental status b. level, degree, and location of pain c. diagnosis and medical history 4. If a CNA observes a change in a resident s condition that could affect his or her ability to walk, the CNA should. a. proceed with ambulation activities as planned b. incorporate a gait belt into planned activities as an extra safety precaution c. check with his or her supervisor before attempting to carry out planned activities d. sit with the resident until he or she is feeling up to the planned activities 5. Which of the following is a safety precaution CNAs should share with residents who use a cane? a. Hold the device in the hand on the stronger side of the body b. Always move the stronger leg first while walking with the cane, followed by the weaker one c. Look down at your feet while walking with the cane to avoid tripping 6. Which of the following is NOT a safety precaution CNAs should share with residents who use a walker? a. Avoid leaning on the walker when getting up b. Always slide the walker along the floor c. Keep both hands on the walker at all times d. Avoid wet surfaces whenever possible 7. A gait belt may be used for all residents. a. True b. False 8. How should a gait belts fit on a resident? a. Very tightly across his or her waist to ensure it remains secure during all ambulation activities b. Snugly, leaving just enough room for the CNA to grasp the equipment easily c. Loosely, so the resident feels comfortable and relaxed during the activities d. None of the above 9. CNAs should always transfer a resident toward his or her weaker side, if the individual has one. a. True b. False 10. Which of the following steps can CNAs take to help ensure an environment is safe for ambulation? a. Assess the size and shape of the room, keeping an eye out for any safety hazards within the space b. Ensure all furniture remains exactly in place during the activities to avoid upsetting the resident c. Dim the lights significantly to calm the resident d. Direct the resident down narrow hallways for an exciting change of pace A supplement to CNA Training Advisor