Aspiring CNAs should pay close attention to this section and the other two sections on Residents Care, as these questions will make up almost 50% of your CNA exam questions. CNAs will often work with residents in long term care facilities, and these patients need more than just physical care, they need psychosocial care as well. This section focuses on the following skills:
Emotional and Mental Health Needs
Psychosocial care skills include the emotional and mental needs of the patient. It involves providing care, emotional support, and encouragement to the patients. The CNA is responsible for paying close attention to the mental and emotional disturbances or changes in the patient. The patient may not verbally express emotional problems and may appear agitated, depressed or quiet. The CNA should be able to identify such behaviors and take prompt actions to relieve the patient’s distress. The CNAs should update themselves on the various mental conditions and their symptoms, which will help identify any such symptom in the patient.
Emotional disturbances such as agitation due to worsening health conditions or long hospital stays can be alleviated by treating the patient with kindness, respect, and compassion. Providing consolation and encouragement will also go a long way in improving the mental health of the patient. The CNA should interact with empathy with the patient. For instance, offering condolences when giving bad news will provide emotional support to the patient. By providing enough emotional support and encouragement, the CNA can help the patient accept their health conditions and also cope with them better.
However, for some patients, it may not be so easy to accept aging or other illness-related painful conditions. They may find it difficult to cope with their health condition or the treatment and may feel depressed. The inability to spend their time with their family at home may also take a toll on their mental health. They may experience loneliness and feel abandoned. In such cases, the patient may also have tendencies to commit suicide. Such patients often eat alone, avoid taking their medication or appear gloomy and isolated. The CNA should be aware of such behaviors and moods and promptly report them so that early intervention can be implemented before the depression gets worse.
Dealing with a patient with depression is sometimes difficult, and the CNA should deal with such patients kindly and with consideration. They should be able to talk, listen, and ensure the patient that they are there for them. Encouraging patients to participate in activities they enjoy is another way to encourage optimism in the patient. Praising the patient for their achievements is another way to improve their self-esteem and outlook towards life.
Cultural and Spiritual Needs
The CNA often comes across patients belonging to different cultures. It is important to be aware of the patients’ cultural beliefs and behaviors as they may have certain expectations from the healthcare team. The patients may also have a different way of viewing their illness. For instance, a patient belonging to African culture may believe that seizures have a supernatural cause and may refuse to accept medications or hospital treatment. He may refuse to accept the scientific explanation of the condition and may demand a shaman to perform a healing ritual. Another example can be an Asian patient who would involve family members in the plan of care. This behavior is different from the western culture where individuals prefer to remain independent of others and do not want to involve their family members in the plan of care.
Some patients may use prayers, amulets, and herbs to ward off evil spirits that cause pain and suffering. The CNA should view such behaviors in the light of the patient’s cultural beliefs and should not dismiss them. Accepting and respecting such differences will ensure that the CNA treats the patients with dignity.
Other than cultural differences, there may be noticeable spiritual differences that can affect the way patients view their lives. Spirituality is the highest level of human needs and refers to the ability of a person to connect with something larger than themselves, a higher power or a supreme being. A spiritually healthy person will find hope in the future. On the other hand, a person with spiritual distress may find the future hopeless. In such cases, the patient’s health may deteriorate faster too.
The patients should be given the freedom and opportunity to engage in spiritual practices if they so desire. The CNA should build a rapport with the patients, to understand their spiritual needs. The CNAs should not judge the patient and instead show respect towards any religious or spiritual activities that may differ from those of the CNAs. The CNAs can also share their own spiritual views that may inculcate hope and confidence in the patient. However, they should not impose their beliefs on the patient. In case the CNA is uncomfortable about participating in any rituals, they should report it to the supervisor, who may then intervene and arrange for a volunteer to assist in the ritual.
Like other people, patients also have a right to express their sexual needs and the need for intimacy. The CNAs should ensure that these needs are not ignored. According to the facility protocols, the patient should be provided with opportunities and privacy to express their sexual feelings. Sexual needs include love-making, affection, cuddling, caressing, or touching. The CNA will be able to address the sexual needs of the patient better if he/she is aware of his/her own sexual needs. The CNA should ensure that they do not make the patients uncomfortable when they express their sexual needs. They should not judge the patient and instead work with the awareness that aging does not end the sexual desires of a person.
However, any unwanted sexual advances made towards the CNA should be confronted and explained to the patient that they are unacceptable. The patient may display affection according to the common social etiquette. However, if the patient is flirting with the CNA, and defends such behavior as mere teasing, the CNA should inform the patient to stop such behavior immediately. The best practice is to be as specific as possible so that the patient does not repeat that behavior. Even if the patient is under the influence of medication or has an altered mental state, any sexual advances should be reported immediately to protect yourself and others.