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Tip of the week: CNAs share their tips on how to care for residents with dementia

Contemporary Long-Term Care Weekly, March 13, 2008

With more elderly people developing dementia and eventually needing nursing home care, the staff in many facilities face the increasing challenge of caring for these residents.

Your certified nursing assistants (CNA) provide the most direct care to residents suffering from Alzheim-er's disease and other types of dementia. Those CNAs have the daily challenge of helping feed, bathe, dress, and interact with residents with this devastating condition.

So when researcher Nanette A. Kramer, PhD, and her Columbia University-based team set about looking at how to improve the quality of life of those with dementia, they turned to people experienced in providing those residents with help--CNAs.

"They were amazing. Nursing assistants really have faced a tremendous number of challenging situations that are way beyond what their training prepared them for," says Kramer, who led the research project that ultimately resulted in publication of a manual Speaking From Experience: Nursing Assistants Share Their Knowledge of Dementia Care.

Caring for people with dementia can be stressful, difficult work. "The nursing assistants often came up with well-suited, creative, and sensitive solutions to these problems," says Kramer.

CNAs speak out

The researchers ultimately interviewed 42 CNAs who work at the Cobble Hill Health Center, a large nonprofit nursing home in Brooklyn, NY, providing professional care to residents with dementia. They tape recorded and videotaped interviews with the CNAs and compiled their wisdom and advice into the Speaking From Experience manual.

Each CNA had many ideas on how to work effectively with residents with dementia. "[But] not everyone knew everything," Kramer says about the ideas CNAs had for coping with the wide range of symptoms that residents suffering from Alzheimer's and other dementias can experience. So the researchers decided to compile all of the ideas for the CNAs to share with others.

The top 25

The CNAs were asked about the different approaches they take to working with residents with dementia. Their ideas included 25 basic suggestions (see the list below). These are explored more fully in the manual, which also includes quotations from the CNAs.

For example, the CNAs advised caregivers to learn what is special about each resident and respond accordingly. "People without experience in dementia caregiving often assume that persons with dementia are all the same--[that] they are old and they are confused," according to the manual. "Experienced caregivers know that this isn't the case at all . . . It takes time and effort to learn what is special about each resident on your assignment and to figure out how to put that knowledge to use."

"Every resident is different," one CNA told the interviewers. "One is nasty, one is lonely, one is confused . . . You have to think about how each one is different." For example, one resident loves children, and her CNA frequently talks to her about children when she wants to reach her. Another resident likes hot food, while another doesn't like the feel of cold deodorant, and yet another is afraid of the elevator. That knowledge can be valuable to a CNA caring for that resident.

The CNAs had many suggestions ranging from not arguing with or contradicting a resident to staying calm and relaxed. "Everyone knows there's no one thing that works all the time. But the lesson is, don't give up. If one thing doesn't work, there are other things you can try," says Kramer.

From CNA to CNA

Speaking from Experience gives voice to the knowledge of CNAs. "Nursing assistants are traditionally so underestimated and so undervalued. What they had to say was just incredible. They said it better than anyone else could have said it," Kramer says.

Because the lessons are best imparted when taught by one CNA to another, Kramer says she hopes the use of the manual will empower CNAs. Research shows that people learn best from their peers, she says. However, most training materials for CNAs are not created by other nursing assistants.

As well as compiling suggestions about how to care for residents with dementia, the researchers also asked staff about the pressures they find most stressful or difficult, as well as what they find most rewarding about their jobs.

Issues such as encountering resistance from residents whom they try to help and taking care of everything that needs to be done in a limited amount of time are some of the CNAs biggest stresses. Other stresses include dealing with illness or the death of residents, or when residents showed no reactions at all.

But CNAs said they experienced many positive and rewarding aspects to their work. Receiving satisfaction from helping others and being appreciated for their work were among these rewards. CNAs said they received the most positive feedback from the residents themselves, who were often affectionate or let them know how much they meant.

The project that led to publication of Speaking From Experience was funded by a grant. The other collaborators on the project included Michael C. Smith, PhD; Janice Dabney, ACSW, director of social services at Cobble Hill Health Center; and Tony Yang-Lewis.

Editor's note: For more information about Speaking From Experience: Nursing Assistants Share Their Knowledge of Dementia Care, contact Nanette A. Kramer at nk105@columbia.edu.

Twenty-five ways to help residents with dementia

Certified nursing assistants (CNAs) are some of the most experienced people in providing care to persons with dementia. They spend time with them--talking, listening, and helping.

The following is the list of suggestions from CNAs when researchers asked them about their work and what advice they had for others who work with residents with dementia:

1. Learn what is special about each of your residents, and respond accordingly.

2. If the resident you are trying to help is uncooperative, leave and try again later.

3. Help the resident get to know and trust you.

4. Try to be understanding of each resident.

5. Try to have patience with each resident.

6. Don't argue with or contradict residents.

7. Use touch whenever appropriate.

8. Keep a calm, even-tempered, gentle manner. Speak softly.

9. If you feel the need for help from other staff, don't hesitate to ask for it.

10. Place yourself and objects you want noticed in the resident's line of vision.

11. Give yourself time to become good at the job.

12. Let yourself feel good about the special work you do.

13. Realize the limits of dementia. Don't try to make a resident do things he or she can't.

14. Get factual information about dementia. Inservice seminars, special training courses, books, pamphlets, videotapes, and manuals are all sources to help understand the disease process.

15. Maintain a respectful attitude in your relations with each resident.

16. Show each resident that you like him or her.

17. Try to give each resident choices.

18. Speak slowly, clearly, and simply.

19. Simplify tasks for residents.

20. Encourage residents to do more when appropriate.

21. Use logic if you think a resident can relate to it.

22. Engage residents in reminiscing if he or she seems able to and is interested in doing so.

23. Explain to residents what you are doing and what you plan to do.

24. Be prepared for sudden changes in your residents' moods.

25. If a resident becomes agitated, try to distract him or her.

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