Nursing assistant skills

Nursing assistant skills are the set of learned tasks used in helping residents or patients with activities of daily living (ADLs) and providing bedside care--including basic nursing procedures--under the supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN).

Overview
The nurse assistant must not only be very skilled in the actual procedures being performed but must also be able to make quick observations of a patient's condition and report that information back to the nurse. Due to time constraints, nurses often do not spend large amounts of time in the room with individual patients, the nursing assistant is known as the nurse's "eyes and ears".

A nurse assistant must also have a strong grasp of emergency procedures and be able to stay calm in stressful situations. They must be able to initiate a Code Blue and be certified in CPR.

Patient Rights
It is the job of the entire health care team to make sure that a patient's rights are always adhered to, these include, but are not limited to the right to privacy and dignity while care is being given, the right to be informed of their care plan, the right to be included when making their care plan, the right to accept or refuse treatment, and the right to confidentiality of their patient information.

Universal Precaution
Proper hand washing is an important part of nurse assisting. It is the first step in preventing the spread of germs. Hand washing must be performed both before and after contact with a patient. Hands that do not appear soiled can still spread disease. It is important to wash hands even when using gloves as they do not provide an absolute barrier to the transmission of disease.

Gloves should be worn as needed, such as when exposure to bodily fluids is likely, when perineal or fingernail care is given, or when the patient is infected with a pathogen that is spread by direct contact (such as MRSA).

Ambulation
Ambulation assistance is a set of techniques for helping patients to walk. One example is the use of a gait belt or transfer belt for patients who cannot stand on their own. The gait belt is put around the patient's waist and enables the assistant to lift the patient safely without straining his or her back. It can be used to help patients get in and out of bed, get up from a chair, or enter a walker.

Walkers help the elderly get exercise. Many elderly patients cannot walk on their own due to osteoporosis or other conditions. Exercise promotes movement, helps with circulation, helps the patient heal faster, be in better health, and ultimately have a longer, happier life.

Applying antiembolic stockings
An antiembolic stocking is a device that is used on patients under observation for (or at risk for) circulation problems. It is a high sock which applies pressure on the legs to prevent blood clots. It may also have a hole on the top or bottom of the foot for comfort, and easy access to the feet, so that the nurse assistant doesn't need to remove the sock every two hours to check circulation.

Bedpan use and output measurement
A bedpan is a device that is placed under patients who are unable to get up and use a bedside toilet or go to the restroom. It is used to catch all of the urine and feces. The patient must be properly wiped and cleaned after elimination to prevent infection. The color, odor, consistency, and amount of urine is often measured and recorded. If a bowel movement has taken place, that is noted along with any significant characteristics of the stool.

Oral care
Denture and mouth care is very important in providing proper hygiene for patients. Teeth must be cleaned in the morning and after each meal. This will help prevent tooth decay or gum conditions that could lead to tooth loss. When providing oral care, it is important to check the patient's teeth, lips, mouth, and tongue for bleeding and discoloration, sores, odor, cracking, or coating, and to report unexpected observations to the nurse immediately.

Dressing
For the dependent patients dressing is not an easy task. In fact it is very difficult and needs to be done properly. The best way to ensure that it is done right is to dress the weak side first so that the patient can help with their strong side, and to undress the strong side first so they can help undress the weak side as much as possible.

Feeding
Patients must not be overassisted in feeding or they may stop helping themselves. Assistance should be confined to those parts of the task they cannot accomplish for themselves. For example, a patient who cannot load a spoon but is capable of conveying it to his mouth should be assisted only in loading the spoon. He should convey it to his mouth himself, even if it would be faster for the assistant to do this for him.

Hair care
Providing hair care will help patients feel good about themselves. Long-term-care facilities may have a salon where residents can have their hair done once a week just as they would at home. Hair must be maintained every day as well. Hair should be brushed from roots to ends, and care should be taken to avoid irritating the patient's scalp.

Bedmaking
Bedmaking as practiced by a nurse assistant is a skilled task that must be performed precisely. The bed must be wrinkle-free to prevent bedsores, which not only cause discomfort to the patient but can cause serious health problems, and the open end of the pillow case must be facing away from the door to prevent an infection control issue. There are specific bedmaking techniques for use when a bed is occupied by a patient.

Nail care
Nail care is important to ensure that Bacteria do not enter the nail bed and cause serious infections in elderly patients. It is helpful to soak nails for at least five minutes to help loosen dirt and germs that are lodged in nail beds.

Bedbath
Due to lack of staff, patients may only get a full bath once or twice a week; on other days, patients get bedbaths. This involves cleaning the underarms, torso, and perineal areas.

Serving water
Fresh ice water should be offered frequently (at least once every 8 hours) to promote hydration. It is important to encourage drinking, because it is not unusual for elderly patients to be unaware of thirst and thus be easily subject to dehydration.

Positioning
Positioning refers to a set of techniques for changing the posture of a bedridden person in order to avoid health problems such as bedsores. Many states require that bedridden persons be checked and repositioned at intervals of two hours or less.

Range-of-motion exercises
If not exercised, joints gradually lose their ability to move. Nurse assistants must be able to assist patients in performing a series of range-of-motion exercises that flex the joints of their arms, wrists, legs, fingers, hips, and feet. This aids circulation, prevents arthritis and stiffness, and speeds recovery from such conditions as strokes, seizures, and falls.

Vital signs
Vital signs (such as the patient's temperature, respiration, blood pressure, pulse, and level of pain) are often taken and recorded at least once a day depending on the physician's order. Increasing temperature can indicate infection or other disorder, decreasing temperature can indicate shock or decreased cardiac output; increasing blood pressure may require medical treatment and special diets while decreasing blood pressure may indicate shock or hemorrhage; and irregular, weak, fast, or slow pulse can indicate heart problems. If a patient's vital signs have changed significantly within a short period of time, a double check for accuracy may be warranted. Any unusual findings should be brought to the attention of a supervising nurse or doctor.