Care and Reporting Skills

The “N” in CNA stands for nursing and you’ll need to have a solid handle on a number of nursing skills if you want to pass the CNA written exam and the skills test. Beyond just passing your exam, you will need a variety of skills to help promote the function and health of your patients. The four key areas you will need to be knowledgeable in include personal care skills, psychosocial skills, restorative skills, and recording/reporting. These subject areas comprise almost half of the questions on the CNA written exam. If you’d like to brush up, take one of our CNA practice tests.

Personal care skills

Keeping patients hygienic is important for their health and a major component of CNA personal care skills. Older patients will have dryer skin, meaning while they may need less bathing, they still require a daily partial bath to keep their perineal area and mouth clean. Partial baths help avoid the buildup of harmful bacteria and also removes sweat and body odor. There are many important personal care activities a CNA must administer to patients:

• Bathing. As a CNA, providing bathing helps prevent disease. Keep an eye out for abnormalities and skin breaks which can lead to bedsores. Always keep safety in mind from the temperature of the bathwater to choosing a gentle soap.
• Oral care. Some patients may require assistance with oral care, and this is also important for maintaining their health. Proper care of teeth and dentures can prevent tooth decay while cleaning the mouth of a comatose patient can keep their airway free of debris.
• Comfort and sleep. Some patients may struggle with sleeping in new surroundings. As a CNA you will need to be aware of sleeping patterns and excessive napping that may signal other health disorders. Pain and discomfort can also impact sleep, or patients may not acknowledge or recognize their pain. These, too, are things a CNA will need to watch for.
• Using the bathroom. As patients get older they may need assistance getting to the bathroom or lose the ability to fully control their elimination of body waste. You’ll need to make sure patients keep up a healthy routine of using the bathroom to help them avoid accidents and maintain proper protocol for cleaning the patient, handling urine and stool, and using any necessary equipment like a bedpan or a commode.
• Nutrition. CNAs must assist patients in getting proper nutrition with a balanced diet and proper hydration as part of the patient’s care plan. As patients age, they may lose their appetite as they have diminished senses of taste and smell. You’ll be tasked with encouraging independence in a patient’s diet by working with them to make healthy choices, presenting food and drink in an appetizing fashion, and providing social interaction. You may also need to assist with feeding some patients.
• Grooming. You will quickly learn as a CNA that hair care is extremely important. Well-groomed patients tend to have a more positive outlook. Beyond hair care, a CNA will also need to know how to shave a resident and provide proper nail care and skin care. You’ll need to be aware of a patient’s medical history in some instances before providing grooming services. For example, patients with diabetes may require special nail care.

Psychosocial skills

From the outside looking in you may see CNAs and other members of the healthcare team focusing mostly on restorative skills and assisting with personal care and activities of daily living. Equally important, however, are the psychosocial skills necessary to be an effective CNA. Psychosocial skills can be grouped into four categories.

• Sexual needs. Love, affection, and intimacy are all components of a person’s sexual needs. These don’t disappear with age. As a CNA you must understand the guidelines and norms and manage relationships with patients accordingly. While it’s acceptable to have someone express affection, you must be specific with residents as to when they’ve crossed the line by flirting or breaching other norms of etiquette. 
• Spiritual needs. Supporting a patient’s spiritual needs is another important component of a CNA’s work. Spirituality is often thought of only as organized religion, but it can take on many forms where a person connects with something they feel is larger than themselves. You can support patients by communicating with them about the important aspects of their spirituality and showing respect for their traditions.
• Cultural needs. People from different cultures may experience and react to the world differently than what you’re used to. This extends to their health, wellness, and interpersonal relationships. As a CNA you will need to understand and communicate with patients in the context of their culture to effectively care for them. Work to understand their viewpoint and the role it plays in their life and avoid being openly dismissive of beliefs that may run counter to your own.
• Mental health and emotional needs. There can be challenges for older patients that can impact their mental health and emotions. Being moved away from home, losing loved ones, and adjusting to the physical aspects of aging can take their toll on a person mentally and emotionally. As a CNA you can support your patients by demonstrating compassion, caring, and kindness in your interactions. You can also be proactive by monitoring changes in their mood – intervening where necessary to lift their spirits or encouraging your patients’ loved ones to visit regularly.

Restorative skills

As a CNA you will need to have restorative skills to work with patients on preventing complications such as immobility. These skills are important for helping patients maintain their independence. A CNA may have to provide encouragement to patients who are lacking the motivation to ambulate, setting back their rehabilitation. Encouraging, assisting, and recording patients’ progress are all key restorative skills for dealing with patients.

Helping patients maintain their mobility in all of their body’s systems is critical to maintaining function, independence, and a feeling of self-worth. Mobility is critical for each of the body’s systems – circulatory, digestive, musculoskeletal, and respiratory. When these systems aren’t used enough or used properly, it can lead to issues like pneumonia, blood clots, muscle atrophy, or pressure ulcers (bedsores). Patients may have mental or emotional issues that are causing this, and as a nursing assistant, you’ll need to assist them physically as well as with social, mental, and emotional support to help them maintain mobile joints and properly functioning systems.

CNAs will also assist the residents or patients with range of motion exercises and record and report the patient’s activity and progress. There can be a wide variety of abduction, adduction, flexion, and extension motions you will assist patients with. You may also need to help immobile residents by lifting, moving, or transferring them as part of their care plan. Be sure that you use proper body mechanics and know proper protocol for using assistive devices as necessary. Do not be afraid to ask for assistance if you don’t feel capable of properly moving or positioning a patient. 

While much of your restorative skills focuses on mobility, there are other aspects of health maintenance that a nurse aide must be skilled in as well. These skills include taking vital signs and knowing how to take and record a patient’s pulse rate, temperature, respirations and blood pressure – otherwise known as a patient’s vital signs. These clinical skills must be followed precisely, as small errors in taking a patient’s temperature or pulse rate may cause you to falsely identify, or fail to identify, a serious health issue.

The following links will provide more detailed information about the necessary restorative skills you will need to know as part of the residents care portion of the CNA exam.

• Measure and record radial pulse
• Measure and record respirations
• Measure and record weight
• Measure and record the height of a patient 

Recording/Reporting

Careful data collection and proper reporting are the final piece of the puzzle when it comes to personal care skills. If your activities and the patient’s progress are not recorded properly, you may be endangering their life.

As you spend a significant amount of time with your patients throughout the day you have opportunities to discuss any changes in their health or mood. You can also use your observational skills to notice any changes in their activities or behavior that might be a sign of larger issues. When reporting on a patient’s health status, be sure to use the patients’ words wherever possible for accuracy. You can always ask the patient to repeat or clarify a statement that you didn’t catch the first time. 

Items to report include:

• Changes in weight
• Changes in vital signs
• Dizziness
• Weakness
• Changes in behavior
• Coughing
• Vomiting
• Diarrhea
• Constipation
• Spitting up blood
• Edema
• Signs of abuse, neglect, or any other unverified concerns that you may have for a patient’s wellbeing

When recording patient data in written form, be sure to use a dark ink (blue or black) and write legibly. Record findings promptly – waiting too long to report will likely lead to less accurate information. Also, be certain to sign your name and title to each report.