Clinicals

Monday and Tuesday began at 4:40 AM as I pulled myself from bed, put on Dallas Cowboy scrubs and drove up to Woodland Park, a Nursing home in Salt Lake City Utah. I worked as a CNA student with one of the staff CNAs, assisting her with the residents from 6:30AM till 2:30PM.

I don't think that I would want to work as a CNA in a nursing home as a career but it was a fascinating experience.

The work evoked a number of feelings and emotions. There was a joy that came from getting to know these elderly individuals and working with them. I experienced things that made me uncomfortable. There were many smells that challenged the nose and the stomach to a mortal duel and that hung in the air like a curtain to get on your clothes, in your nose and hair. Finally, I felt a tremendous sadness for most of the residents there, helpless, lonely and with physical bodies that were quickly deteriorating.

There were people of all walks of life residing there. A woman who had graduated from BYU in Archeology, a woman who had been an RN for 40 years, an interstate truck driver, many mothers and grandmothers. They are all now residents and roommates, brought together like a cruel class reunion of humanity in a semi-circle labeled "North Hall".

Day one: I was apprehensive. I had no idea what to expect. I was nervous and embarrassed about being asked to change a soiled "brief" or to shower someone. It turned out that I got to do all of the above.

I arrived and met our clinical supervisor in the lobby. His name was Art, he was an RN and he worked for the school not the Nursing home. His job was to work as a liaison between the students and the Nursing home. He gave us a tour of the facility and then assigned us different departments. There was the Rehabilitation unit for residents recovering from one thing or another. These residents were expected to be there for no more than 60 days.

Down the hall from Rehabilitation were two extended care units. These units were contained in one long continuous hall forming a long oval like a zero. The main dining hall and activity area filled the inside the zero. The zero was essentially cut in half with sets of double doors into North Hall and South Hall. Residents of North and South hall were lifers. There was no expectation of any of these residents leaving here accept through the receipt of a certified invitation to the great BINGO game in the sky.

The final unit at Woodland Park is a more critical care unit called the MAC Unit or the Acute Care Unit. These patients were no longer able to feed themselves and were on much more specific and specialized diets. These residents included those on ventilators and tracheotomy tubes.

I was assigned North Hall. As I made my way to the nurses station in North Hall, one of the CNA's rushed by and called out that she would be willing to take two students. Her name was Emily. I jumped in with her and we were off. She was especially busy Monday morning because one of here coworkers had failed to show up for work and the remaining CNAs were given additional residents for the day.

We went from room to room, rousing residents, changing their briefs and getting them dressed in wheel chairs for breakfast. There was not much time to spend with each resident initially, there was a schedule to keep. The residents reacted like any of us would. They were being suddenly awakened. Most are tired, sore, in wet briefs or just plain uncomfortable. They can’t move much and don’t feel well. I couldn’t blame them a bit if they wanted to more time to get going or more time to get their bearings. They were unceremoniously placed in their various types of chairs in the hall way where we would begin pushing them around to the main dining room.

They really are sweet people. All of them had specific tables and even more specifically, certain spots at these tables where they were to sit. There were people that worked the main dining area and took their “orders” but I was always flagged by multiple people to get this or that. That morning, two women had me cut their French toast. One woman wanted different syrup, two new small glasses, but not the Styrofoam glasses, the glass glasses, and a combination of cranberry juice and apple juice in one of the glasses. She then had me cut the French toast in pieces lengthwise, in pieces that were not too big but not too small and then open the new syrup and pour it on the cut pieces of French toast, but not too much and not too little.

One gentleman would have me get him his coffee. He was a happy man and would always say when something was done for him that “Boy there certainly is good service in this hotel!” I had the opportunity to help him quite a few times throughout my time there and I got to know him. He was, incidentally, known as quite a urinater. He was usually wet when we checked on him and he would frequently pee when we would turn him to his side while changing his brief. We would turn an adult pullup inside-out and tuck it around him, inside his brief, while changing him so that he wouldn’t pee on the sheet and his clothes. He had no legs below the knees and we would do a two person lift to transfer him to and from the bed and the wheel chair.

There was a lady who would stop me and tell me jokes like…. What did the monkey say after getting his tail stuck in the lawn mower? Well it won’t be long NOW!
I helped here find her clothing protector one day, not a BIB… the class instructors warned us, and helped her attach it around her neck for lunch.

We were assigned hall lunch tray duty on Monday. A large food container would be pushed down the hall and we would remove trays of food with slips of paper with the resident’s name, room number and dietary assignments. These were for the residents that either could not or refused to get out of bed and go to the dining room for meals. We would take the food in to them and help them get situated. This would mean that ten to thirty minutes later we would begin getting room light calls where the residents were finished and wanted the trays removed.

Room light calls were common and something that we, as students, could follow up on to help the residents with whatever they needed. There were call lights above each door and a central light board at the nurse’s station.

There was a little Asian woman who would slowly scoot backwards around the halls in her chair or sit in the doorway to her room taping a foot. I answered her call light one time. Through hand gestures and short bits of an Asian language, I determined that she needed to use her bathroom. I pushed the door open for her. She wheeled past me. I stepped inside and closed the door.

She rolled up to the hand rail next to the toilet and pulled herself to a standing position, she was all of 4 and one half feet tall. I, in what must have been an extremely slow and awkward process for her to instruct me on what she needed from me, helped her pull down her briefs and sit on the toilet. I then stepped out and gave her privacy. She was done 30 seconds later, indicated with another pull of the bathroom call light.

I knocked and stepped back into the bathroom. She, with some insistent pointing, explained that she needed a wipe from the package on a shelf. I gave her one and waited while she wiped herself and dropped it into the toilet. She then stood up with the help of the rail and I pulled up her brief and pants and then pushed her chair up behind her so that she could sit down. She would then navigate back out the door into the bedroom.

After this first bathroom trip with her, I must either have not have done too badly or she may just not have had much choice, she flagged me down two additional times to help her through the same process over the two days. I was also given the opportunity to assist in showering her.

Ohh the showers….., this was not something that I really got used to after only two days. I went home on both days with waterlogged shoes, although the scrubs seem to dry fairly quickly.

I helped shower at least four women and two or three men. There is something strange, eye-opening and depressing about an elderly person sitting slumped and naked in a shower chair, outwardly unfazed, unembarrassed or resigned to the lack of privacy or self sufficiency.

The shower chair is essentially a PVC pipe frame chair with a toilet seat and some thin textured rubber sheeting strung between the PVC in the back for a back rest.

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