Certified Nursing Assistants – the Quiet Heroes of Hospice

August 8, 2013
One of HCP's extraordinary hospice CNA's Sarah Jefferies (lt) with article author and office assistant Mary Finn.

One of HCP’s extraordinary hospice CNA’s Sarah Jefferies (lt) with article author and office assistant Mary Finn.

By Mary Finn, office assistant
Stop for a moment and imagine yourself near the end of your life. With any luck, you will be surrounded by loved ones and family members; but it is likely that you will also rely on a team of healthcare professionals for support.

Physicians and nurses will provide medical treatment, but the most intimate and personal tasks fall to a different, often overlooked group of caregivers; the certified nursing assistant (CNA). CNAs like Sarah, who has worked for Housecall Providers Hospice for over two years, are responsible for the daily practices that enhance patient wellness: bathing, feeding, turning the bedbound, changing linens, ensuring a clean and comfortable living space. While patient care is their primary duty, a nursing assistant is much more than just a “bath aide.” CNAs must complete an eight-week program endorsed by the Oregon State Board of Nursing, where they are trained to take vitals, assess and treat wounds, and to act as keen observers of any changes or problems in a patient’s health.

Sarah travels all over the west side of Portland visiting the adult foster homes, assisted living facilities and private homes where her patients reside. The individuals she cares for are certified to have six months or less to live, and are usually very fragile. Everyday activities can carry a high risk of injury. A nursing assistant must be acutely aware that, if they are not extremely careful in their caregiving, even they could cause harm to these vulnerable people. Of course, daily hygienic tasks must be performed.

In these incredibly intimate, and sometimes embarrassing moments, patients often look to their CNAs for emotional support. Standing under the warm water of a shower, people ramble about their lives, their fears, their regrets. They confess things to Sarah that they have never spoken aloud before. She listens without judgment, she tries to reassure them. For many people, it is not death, but the loss of ability that breeds anxiety. “It can be very hard, especially for patients who are cognitively intact,” says Sarah. “They’ll tell you how they used to be able to shower themselves, or use the bathroom, or change their own briefs. They grieve the loss of things we often take for granted.”

Like so many situations in hospice care, there are no magic words that will take away her patient’s pain; there is no “right” thing to say. The best she can do is carry on with a quiet, empathic professionalism. “We have to change your brief now; we have to make sure your skin stays dry.” There is a paradox at the heart of professional care giving. Sarah is witness to the most private moments of her patient’s life. She may work with people for years, earning their trust and affection and becoming close to their families and caregivers. And yet, she is a professional, and there is a necessary boundary that she must uphold.

The role of a hospice aide is to listen, to serve, to give care; but not to share. This distance is also a service; it allows patients and families to share their grief and anger, but not to be burdened with any of Sarah’s pain. And there is pain. One day, Sarah will wake up, check her morning messages and see that one of her patients has passed away. She will not visit their home, talk with their family and caregivers or hear their secrets ever again. She will grieve, but quietly.

There are other people who are dying; there are other needs to serve.    


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