what 'caring' means to PCAs
what 'caring' means to PCAs
Plants & flowers conjure up images in one's mind. Using these images, we can describe some of the different personalities that share our days & nights in providing patient care
Nursing today is a very complex profession that requires teamwork and communication. In many cases, the nurse no longer is the primary caregiver to the client in the hospital setting. Today's nurse is often paired with at least one patient care assistant (PCA). Numerous terms are used today for these PCAs--they may be called care techs, nurse care techs, patient care techs or patient care partners.
The role of PCAs in most settings is to facilitate the role of nursing. Until the health care "redesign" of the past 5-10 years, they helped by providing basic care such as bathing and grooming. If properly trained, they assisted with taking vital signs.
However, PCAs currently perform much more advanced procedures. These procedures--often those that are performed by individuals with licenses--include phlebotomy and obtaining ECGs, as well as placing Foley catheters or nasogastric tubes.
Many health care professionals, including nurses, are concerned about the performance of these procedures by PCAs. There are inherent risks and complications to some of these procedures, as well as interpretive concerns. The amount of education and preparation varies across the country. This leads to additional concerns as to who is ultimately responsible for the actions of the PCA performing these procedures and the safety of the patient.
NURSING'S RELATIONSHIP WITH PCAs
To provide safe and effective patient care, nurses must use all of the resources available to them. In health care settings where nurses are paired with PCAs, this relationship must involve teamwork to be effective. The nurse is the licensed individual and has to establish a basis of communication with the PCA in order to follow the care being given.
Many nurses find this relationship difficult at times. They may ask themselves, "Why is this PCA doing this job?" or "They just don't seem to care about the patients, why are they in health care?" It should be noted that there are many wonderful PCAs in the health care arena, and that their job is often thankless and involves a lot of hard work. This may lead to frustration for the PCA, which manifests in his workplace attitude and leads the nurse to question why such an individual would hold this type of position.
A question often asked is, "Why does a PCA want to care for another person in the health care setting?" In other words, why do these individuals agree to work so hard, for relatively low wages, and perform the most intimate and difficult work of cleaning, bathing, toileting and feeding strangers? Some might say, "For the salary they are paid and the attitude they develop, let them work in retail."
But there are reasons deep inside that encourage PCAs to stay in this line of work.
Because of these reasons and because of the changes in the health care setting, it is important that nurses and PCAs understand each other better and try to forge the best relationship possible to work as a team and help patients achieve a higher level of patient care.
THE GARDEN OF CARING
The names of plants and flowers conjure up images in one's mind. By using these plants and flowers, we can describe some of the different personalities that share our days and nights with us in providing patient care. You will now meet Rose, Cactus, Sunflower and Daisy.
A Rose is a precious and valuable flower, and this Rose seems to read your mind and do things for the patient before you even ask her to. A Rose is dignified and therefore takes care of the patients in a dignified manner.
The patients love Rose, because this PCA shows deep love and affection toward them, as if they are members of her own family. Roses will share pictures of family and stories with the patients to further show their warmth and caring.
A Cactus is a plant of beauty and individuality, but also presents a hazard due to the sharp thorns it wears. Cactus is a hard worker, but thorny on the edges and often perceived as rude. Cactus may have difficulty communicating, due to differences in cultural background, language and/ or education.
But Cactus is a task-oriented worker. It is important with a Cactus to forge a relationship and communicate--in other words, develop teamwork strategies. If the nurse can recognize misperceptions and make a commitment to understand this PCA better, then their relationship and the patients' care will improve.
Oh the Sunflower! It grows tall and proud and beautiful. Imagine it standing tall in the garden ... but alone ... and then it withers and dies. Sunflowers are usually attractive and proud of their cultural background. They are often just passing through on their way through school to some final career (sometimes nursing, often not).
These flowers can be sharp and abrupt with patients; they feel as if this is just a job. The patients often feel the lack of caring, and this takes a toll on the nurse-PCA relationship and team building. Sunflowers can be difficult to manage and work with, but if the nurse can create a relationship with them and show an interest in their career goals, a more caring outcome may be obtained.
Last is the beautiful Daisy. This flower is quiet and subtle and grows freely. These PCAs are often very private, quiet and hard-working individuals. Tasks are done quickly and efficiently. Their style is similar to the Rose, but more detached. Daisy keeps her patients clean and well taken care of, but never crosses into their personal life, therefore avoiding any intimacy. Understanding these points will help the nurse's relationship with the Daisy and together they can provide excellent patient care.
Together, these vignettes impress upon us that the role and personality of the PCA is varied and challenging in today's health care setting. PCAs tend to "talk" through their actions, yet they "speak" a wealth of information on how they perceive caring for another. By understanding this reality, the nurse can create a better working environment with her patient care partner.
THOUGHTS ON CARING FROM PCAs
Patient care assistants are all unique individuals who possess different backgrounds, both culturally and educationally. This article is based on a phenomenological study at a large metropolitan hospital that examined these unique individuals and the phenomenon of caring as it related to their job. Interviews with PCAs were done in either written or oral form, depending on the educational background and desires of the participants. Nurses were invited to add their voice and the patients' voice by relating their perceptions of caring by the PCA.
Three major themes evolved from the study: 1) caring as a reflection of self; 2) caring as a relationship with another; and 3) caring with teamwork and communication. PCAs in the study described caring for other people as if they were giving service to someone. Their description was similar to that of caring for a family elder.
In the "caring as a reflection of self" theme, they regarded caring as physical, emotional and spiritual--a way of "giving back" and helping through their innate "goodness." Patients shared stories about their involvement with PCAs. In sharing stories about their contact with PCAs, patients showed that the self-image of the PCA is reflected in the care they provide.
PCAs have relationships with people on all different levels, as was determined in the theme "caring as a relationship with another." PCAs seem to form a symbolic bond with other individuals. This bond might revolve around the sharing of food or the exchange of gifts; these practices are often grounded in culture and tradition. The nurse might want to share lunch or give a token of thanks after a particularly difficult day to strengthen the bond with the PCA team member.
Last is the theme "caring with teamwork and communication." The components of teamwork and communication are necessary for success in any situation that involves delegation of tasks, follow-up and analysis. One does not work as well without the other, so they must exist and coexist. Caring standards such as prompt and courteous behavior toward patients, effective communication and a sense of protection of the patient are only achieved when the people providing the care are working as a team.
NARROW THE COMMUNICATION GAP
Communication skills take time to develop, but are far easier to accomplish when the relationship between the team is personalized and when the ice is broken. Some ways of narrowing a communication gap that may exist between nurses and PCAs include:
* Sharing with the PCAs your report on the patient's condition, what needs to be done and who will perform each task. Providing information on the patient's condition gives the PCA a greater understanding of what they are dealing with.
* Understanding that some PCAs communicate in a nonverbal manner or by their actions. They may do little extra things for the patient such as laundry or buying them a magazine. This is how they communicate in this setting.
* PCAs sometimes feel unsure about who is responsible for what, or are afraid to ask the nurse for help. Team members should sit down and discuss job descriptions for each other as well as review the nurse practice act, which clearly defines each individual's role.
WHAT DOES IT ALL MEAN?
Nurses typically go into this profession with a framework of caring and an inner drive that motivates them. PCAs' motivation for this type of work appears to be varied and widespread. PCAs do "care," but it appears that their caring behaviors often manifest through their humanistic nonverbal side.
Health care delivery today needs to be performed in partnership or through teamwork. Nurses are often overwhelmed with all of the care, teaching, medicating and treatment of patients. They need to have strong backup. PCAs hold much of the responsibility for hands-on care and need to be praised for the hard work they do.
Together, both the nurse and the PCA can provide excellent, safe, quality care to the patient. Sometimes nurses need to stop, sit down and communicate their needs while remembering that the PCA may have some needs too. Enjoy your teammate.
Debra Nogueras is assistant professor in the School of Nursing at Barry University, Miami Shores, and president of Nogueras Family Health Associates Inc., Miami.