#orienting

[nemfrog]

In the Southern Hemisphere, how to find south without a compass.

Elementary map and aerial photograph reading. 1944.

Internet Archive

[body-langauge-blog]

Two Shots and Group Shots

Orienting and touching: “Touching, looking at, leaning, reaching, or pointing towards another person might also indicate intimacy, or the desire for it. Is the direction of this body language one-way, or reciprocated?” - John Sulers

[lisaaadoherty]

How to be an AWESOME Nursing Assistant!

SO, I finished my third day of on-the-unit orientation today and lets just say I got a lot of feedback on how I can improve. I wasn't able to handle a full patient load by my self at the pace that I needed to be going at, so they asked me to do another day of orienting. Needless to say, I was disappointed with how I had done (albeit, it was a crazy day), but I wanted to do better, so I decided to take all this negative criticism and turn it into a cheat sheet/guide for how to be an AWESOME CNA. Definitely turned my mood around and now I have a super handy cheat sheet of how to get through my shift! This is pretty specific to my unit and shift (days, 0700-1330), I am not sure if anyone else's hospital/facility works similar to this,  but there is some valuable information in here for all CNAs, so I thought I would share it! Hope this can help at least one person!

Tips:

Prioritize & time manage, don’t let your patients talk your ear off, find a way to politely excuse yourself/change the subject so you can move on to what you need to do so that you don’t spend too much time in there and get behind on your other stuff.

Lists are your best friend, make one at the beginning of your shift of everything you need to do and bring it with you when you go into a patient’s room.

Write down (the whole set) of abnormal vitals on a paper towel or something so you can hand it to your nurse so they can have it when they call the doctor)

Take your breaks!

Before you leave home:

Make sure you have everything you need: coffee, lunch, wallet, keys, ID badge, watch, pens, pencils, and highlighters (might want to get a pencil bag) as well as white board marker and sharpie, plenty of paper/note pad, hair tie, bobby pin, good shoes and socks. Maybe extra shirt or set of scrubs just in case. Band-Aids for blisters, extra socks, snack bars for breaks, tampons/pads. Key to locker!

Before you start shift: Phone, Assignment Sheet, Patient List, Phone Numbers.

Clock in (might start prepping before you do this though, since you have to wait seven minutes before your shift starts before you can clock in. Use the time before your shift starts to prep for your patients)

Print hard copy of assignment so you know what nurses and CNAs are assigned to what patients and what their phone numbers are.

Assign yourself to your patients on epic and print your patient list for this shift (cheat sheet!)

Write the name and numbers for your nurses for your patients down on your cheat sheet (patient list).

For RN’s phones, they usually break it up into four sections, the first being the rooms closest to the west elevators (39591), the second being closer to the main nurses’s station (39592), third, close to station and staff elevators (39593), and fourth closest to the staff elevators (39594).

For CNA’s phones, 39585 usually goes to left side of unit (closest to west elevators) and 39586 usually goes to the right side of the unit closest to the staff room and the staff elevators. Get your phone (clean it first!) (either 39585 or 39586), grab a battery, and assign the phone to yourself in the computer (make sure you do this right, have someone help you), sometimes this might already be done for you by the secretary.

Check the assignment board (white board), If you see on the assignment board “TC” by a patients room number, that means that the nurse is doing total care for that patient and that you do not need to do anything for this patient (but always check with the nurse and ask if she wants you to do anything to help out for that patient so that you guys are both on the same page)

Know who the charge and secretary are for that shift, as well as the unit supervisor/manager if the supervisor isn’t there that day.

Make sure you have copy of paper that tells you how many ccs every container of liquid is.

 While getting report:

Who needs Q4 or just Q8 vitals?

Who is their nurse? What room, what name, and any relatives around?

When did they have surgery/are they going to surgery later?

Know diagnosis and surgery. Know diet.

Ask about orientation and mobility (want to know if they are confused and what level of assistance they will need for ADLs, also, are they on strict bed rest? Can they ambulate by themselves? Or are they a min/mod/max assist/dependent/standby? Basically, how much help will they need getting up OOB and around.

Did they get up and move during the previous shift? Walk, stand, sit, dangle, what? Any problems during the night like nausea, diahrea, pain, or anything else?

How many drains? Foley? JPs? How many and where?

Have the previous CNAs been using sequentials on them or is that patient refusing it (check if they have an order for SEQs as well if not sure)?

Are they on any isolation precautions?

Do they have a PCA? Central or PICC line? How many IVs and where?

Do they need to be repositioned Q2hr (lots of times for pts on bed rest or dependent patients who are un able to turn themselves, need to make sure they get repositioned every two hours- always chart this!

Does this person need lift team to get up OOB?

NG tube?

Tolerating food/liquids ok, whats the situation on that.  

Do they have PT? can find that in computer.

Beginning of shift: Morning vitals!

Go in and introduce yourself and tell them what your plan is for the day while you take vitals and get them set up.

When in a patients room for morning vitals, check to make sure they have supplies in there for a bath, tooth brushing, change of sheets and gown, and any extra supplies like chucks or wipes they might need.

Update boards with date, your name as well as nurse’s name for that shift as well as both of your phone numbers (you should have these written down/printed out from the assignment list)

Check room see what supplies they have for bathing, changing bedding and gown and other things they might need like chucks or briefs or wipes or whatever.

Ask if they would like some washcloths/towels to wash up for the morning. You cannot force them to bathe, but we want to strongly encourage it. Also want to make sure they brush their teeth, comb hair, etc. once again, not forced, but we want to strongly encourage it- keeps them clean and gets them up and moving for the day.

Let them know that breakfast will becoming at around 8/830 (check make sure this is right) and clear off space on their side table for it. Make sure they are safe. Let them know that you’re gonna come back with towels and gowns and bedding and that you are going to get them up and walk or up to a chair, whatever they can do to get moving. We want them up and moving. Timing it with pain medicine helps, but not always possible, still need to do it though.

When they get up OOB to walk and stuff, this is a good time to get their teeth brush, wash them up, and change them, as well as toilet them, even if they can only just sit in a chair, its good for moral and spirit to get them up and clean.

Really important to make sure they have extras of the supplies they need and to know what they have in their room so that you don’t have to go in and out to get stuff. If you know you’re gonna do something (like bath or change bedding), go into their room first, and see what supplies they have already so you don’t bring extras.

After meals:

Look at meal tray, calculate % of meal eaten as well as fluids intaken. Always calculate and chart this BEFORE YOU LEAVE THE PATIETNT’S ROOM WITH THEIR TRAY! Other wise you will forget, unless you write it down, but still.

When charting P.O. and % of meal eaten for breakfast and lunch, you need to make sure that you chart the breakfast totals before 0900 and the lunch totals before 1400.

Before you leave for lunch:

Let your nurses know that you are leaving for lunch. Let other CNA know as well and give her your phone so she can cover you. Might also want to let secretary and charge know as well.

Middle of shift (this can go anywhere):

All drains need to be emptied (and charted that they were emptied) before 1400.

Before you leave shift:

Empty laundry and trash in each room

Make sure I&Os for each patient are accurate and reflect the total intakes and outputs for your shift (see above). Also make sure urine outputs are charted in correct section of chart (foley or no foley). Make sure all other bowel, emesis, or urine occurances, are documented and charted. If total urine output is less than 240ml for the entire 8 hour shift, you need to let your nurse know. (make sure this is the right number first! Pretty sure its <30 ml/hr you need to let the nurse know). At end of shift, you need to make sure that I&Os for each patient are correct and in the chart (total liquids at meals and water/drinks/ice/smoothies in between- try and chart these as you go), as well as % of meal eaten and bowel movements for that shift. If they have no bowel movement, you still need to chart “0” under occurrence I believe so that the doctors know.

Always make sure you comment on what urine/stool/emesis looked like under CAN observations as well as the amount (different location) (if immeasurable, put under section for immeasurable).

Make sure you got all vitals and charted them all (chart as you go, write down any abnormal vitals (the whole set even if it is just one number) so you can hand it to your nurse)

Make sure you completely fill out their ADLs under CNA observations. Always fill out as much as you can.

Make sure you unassign yourself from all your patients.

Clock out!

Other:

Need to recheck a patient’s vitals when they get back from a procedure, always, even if you just got them an hour ago.

New admit:

pull together an admit kit before they get there, see if you can get a mini report from the nurse to see what you might need ie. measuring containers for foleys and drains if they have any (remember, they all need their own individual ones, and they all need to be labled!).

once they are settled, get the first set of vitals and check with the nurse to see what the plan is. Do they need to be Q4? Probably. Do we want to get them up OOB? What is their diet? And other restrictions/things I need to know about).

Do a belongings list and print it (ask Liza or someone how to do this) and then have patient sign it and give it to Liza, it will go into permanent medical record.