Dr. Germ: first encounters

I’ve always felt immersed within clinical education, all the experiences throughout the four years I’ve participated in medical courses in high school. However, I have never actually come into contact with any patients. Being a training professional and also a minor poses this situation: clinical practice is limited by the formalities of law, as most facilities prohibit minors working with patients. 

Fortunately, through the Clinical Nurse Aid program, I’ve been able to learn skills regarding geriatric care, and complete my state board training at a rehabilitation and long term assisted living facility. Before actually stepping into the facility, I had imagined that caring for elderly patients would be the same as caring for anyone else, just requiring a lot more caution regarding sensitivities and care focused around comfort. After my first day of care within the nursing home, I had the realization that care is not generalized in any way, but rather differs from patient to patient. Each experience that I encountered within the same day, even in the same hall, differed greatly from the other. 

In class, and during lab training, all of the learned skills were practiced on mannequins. Mannequins that weighed around 50 pounds, with rubbery limbs and appendages that would occasionally pop off. And while these mannequins were sufficient in learning how to perform skills, there were lapses in reality, with no response or compliance from an immobile doll. Before attending rotation, I anticipated that this would be a significant change, but I never really had perspective into how unpredictable patient care could be. 

The hall that I was assigned to shadow an already-certified CNA included both long term care and rehabilitation patients, meaning that a few residents could perform few activities of daily living, with assistance nonetheless. Working on the mannequins in practice meant that performing these activities was based solely upon my abilities, however, actually performing these skills did not go as smoothly. It took me about three rooms to adjust to the fact that many residents would refuse care in the middle of an activity, or some would experience immense pain and need a break. Some would express their frustration loudly, or simply tell staff present to leave the room, nonverbal residents pressing the call light as a signal they wanted to be left alone. I was terrified that I had been too abrasive with my actions, or that I was worsening the resident’s condition, but the CNA I was assigned to shadow ensured me that the activities that might seem painful to the resident are performed for the improvement of their condition. Some residents were the opposite, however, expressing thanks that they had extra help from students, or asking questions about myself as they now had another person to listen to them. 

CNA work is difficult, not just in a physical sense of working with a completely or partially immobile, but also considering that you’re having to intrude on a resident’s privacy, helping them in their most vulnerable situations such as using the restroom or bathing. There is also a somberness to spending time in a hall of long-term care residents, these are people who will most likely spend the rest of their lives within that hall. In healthcare, there is a glorification of the field based on the fact that medical professionals have the potential to cure a patient, or treat them so that their condition improves. In geriatric care, working with eldery patients, it can be a bit sobering that the care being provided is done to make the resident comfortable, because improvement of their condition is not as likely. 

Even though mornings at the nursing home can be a source of anxiety for me (How many showers will I be assisting, will residents become upset with me?) I feel grateful for being able to partake in this experience. Most people would obviously not volunteer to help clean someone after they’ve used the restroom, however learning that it is an immense help to the residents, and seeing how much they appreciate the help of the CNAs has made me realize how important the job really is. For anyone entering the medical field, or wanting to participate in patient care, it would be immensely beneficial if they worked in a nursing home to experience the unglamorous duties of patient care but to also understand the importance of these duties and how they positively impact patients.