I was thinking about an unsung hero in the hospice care team— the Certified Nurse’s Aide, the CNA. Of all the staff the CNA becomes, in so many situations, the closest person to the patient and family.

The CNA comes into the house or nursing facility and generally spends the longest time with the patient. Often the patient shares more with the CNA than with their own family members. We are so open and vulnerable when someone is giving us a bath, changing our bed, truly in our personal space. During that personal time the barriers seem to go down. 

In the months before death we can talk and share who we are, our most private and personal thoughts, thoughts we may not share with anyone. The routine, the familiarity, the soothing comfort of a bath brings healing to the spirit. Being naked with someone, that vulnerability, tends to create a bond, a trust.

As death approaches and we actively withdraw, sleeping more and talking less, the comfort of our CNA “friend” is reassuring and actually pleasant as we distance ourselves from this world.

Nurses, social workers, even chaplains come and go but our own CNA we can count on, will be there with his/her gentle washing, soft touch, and quiet reassuring manner. A great listener, an easy hand is often the best medicine. It can set the tone for the rest of the day. 

As I write this a thought occurs to me. “Maybe hospices aren’t sending the same CNA to the patient.” Is it like so many agencies that are not using primary care nursing, they aren’t using primary care CNAs? Please don’t tell me that thought is true, that agencies send a different CNA to a patient, that one CNA isn’t assigned to a particular patient for the duration of service.

End of life care is about comfort care, about providing not just physical care but emotional, mental and spiritual care. It is about support and guidance through one of the most challenging experiences of our life.

Our goal as we work with patients and their families is to neutralize the fear that comes with approaching death. Our goal is to provide stability and guidance during a time of confusion and uncertainty. Part of providing that stability is to create a relationship with the care providers, the RN, CNA, SW, and Chaplain. A relationship based on consistency of caregivers and established routines. It is those features of care that provide an anchor in a time of uncertainty.

Our CNA’s in end of life care provide a steady anchor. I salute you!

Something More about...  The Hospice CNA: An Anchor in the Time of Uncertainty

When a hospice CNA spends time with families and patients, questions about the dying process will come up. This is where good education comes into play. A more sacred experience can be had when everyone knows what to expect. Be sure to give your CNA's the tools they need to support their patients during this time of uncertainty.