The ABC of CNA in Nursing Homes: Abuse, Burnout, and Coping

 

Certified Nursing Assistants (CNAs) are the backbone of patient care that does the daily activities like bathing, dressing for residents in the nursing homes. According to the Workplace Hazards Faced by Nursing Assistants in the United States: A Focused Literature Review, it is estimated that 1,420,570 people work as CNAs in the United States.

Do they face (A)buse? Yes

Do they (B)urn out? Yes

How do they (C)ope? By keeping silent? By taking action?

Despite the challenges CNAs often face, they have remained resolute in the discharge of their duties. 

The “A”- Abuse

According to a recent study by Xiao et al., CNAs are 23 times susceptible to aggressive behaviors      from residents in nursing homes than in other health care settings.Because most CNAs in nursing homes sometimes care for elderly patients suffering from dementia, they find themselves facing a barrage of verbal and racial slurs. It sometimes extends to physical or sexual abuse via sexually suggestive/ inappropriate behaviors. The sad thing about this is that it leads to emotional or sexual abuse.

But then, are CNAs not supposed to be protected from such abuses by nursing home management? How do Nursing Home Management handle such cases?  The response can sometimes depend on the type of abuse.

i)          Physical abuse: When a CNA is physically abused, it could be caused by a resident, coworker or a residents’ family members. Sometimes when dealing with patients with dementia, they become very aggressive and assault the CNA resulting in injuries and may need medical attention. A family member can get physical sometimes if he feels the care being delivered by the CNA is not satisfactory. Co-workers too are not left out. They vent out their frustration on colleagues.

ii)         Emotional abuse: This can be caused by residents, residents’ family members and co-workers through verbal insults, intimidation, manipulation which can cause symptoms like anxiety, depression, fear, low esteem and social withdrawal. The high stress and understaffed nature of Nursing Homes create hostile environments and psychological distress.

iii)        Verbal abuse: This can come in the form of any statement that is said to the victim to cause fear, low esteem and emotional pain. It can also be referred to as bullying. Residents make very rude and disrespectful remarks to CNAs when being cared for. Even though it is difficult, CNAs are not allowed to take the remarks personal.

The ‘’B”- Burnout

The different categories of abuse often have an emotional toll on CNAs, leading to burnouts. Mental health effects like post traumatic stress disorder (PTSD), depression and social withdrawal symptoms are prevalent among CNAs. A burn-out CNA often has grave consequences on a patient's care.

The “C”- Coping

Coping means accepting that abuse and burnout are part of the challenges of the job, but it does not have to control the individual CNA. Most CNAs in Nursing homes often stay silent as they often complain that no clear reporting system exists. There is a fear of losing their jobs and a culture of “staying strong” with the stigma of being perceived as weak when a report is made. One potential strategy to enhance CNA’s well-being is the implementation of self-compassion training. Self-compassion training offers the potential to improve a CNA’s well-being by reducing stress, depression, and anxiety with an enhanced emotional resilience. Mindfulness, humanity, and self-kindness are inclusive in self compassion approaches that help individuals cope with difficulties without harsh self-judgment.

To cope better there is need to be accessible mental health support for CNAs, combined with effective safety and de-escalation training. The ABC of CNA—Abuse, Burnout, and Coping is not just an “easy” acronym; it shows that caring for others begins with caring for yourself.