Traditionally, state-tested nurse aides will perform 10% of what they are trained to do in the field. Again, we have an identity issue afoot. Like everything else in humanity, people will act according to how they perceive themselves. Nurse aides should see themselves as the healthcare foundation, particularly in long-term care. This isn’t a mere theory, but is fact-based.
We have discussed the relationship between Maslow’s Hierarchy of Needs and the nurse aide discipline. Maslow’s theory is a nursing standard and one of the primary determiners of care priorities. Yet, nurse aides, according to their job descriptions, are directly responsible for every level of Maslow’s hierarchy to varying degrees. Nurse aides lay the foundation for effective care.
Secondly, what nurse aides are trained to do during their certification process makes the case entirely. Of course, part of the training that is strongly emphasized is safety, a specified level of Maslow’s Hierarchy. Hence, it is the nurse aide’s job and duty to keep the resident or patient safe. This overlaps with the LPN or RN priority of “safety first” depending on the circumstances. The primary nursing (LPN and RN) priorities are frameworks that they apply to types of circumstances. There are the ABCs (Airway, Breathing, and Circulation), safety, and Maslow’s Hierarchy. Except for the ABCs, aides have an equal stake and responsibility. However, since CPR and the Heimlich maneuver are within the aide scope of practice, aides even have a stake in that priority to some degree.
What is being said here follows: there is very little functional difference between aides and licensed nurses.
In order for state-tested aides to be certified, they have to pass a rigid hands-on skills test proctored by an RN. This is the case for Ohio, and most states are similar. The skills have a strong emphasis on safety, but also instruct on the proper way to assist with meals, oral hygiene, and a host of other ADLs (activities of daily living). ADLs are the foundation of good health. Oral health is important for keeping bacteria in the mouth balanced. Not only can excessive bacteria in the mouth cause tooth decay and gum disease, but the bacteria can spread to other parts of the body and cause infections in vital organs. In addition, some medications make people susceptible to oral infections leading to other infections like endocarditis and pneumonia.[1] Good nutrition is fundamental to everything regarding health, and poor oral health leads to a reduction of nutritional intake for several reasons.
Excess bacteria causes food to lose its taste, and lack of oral care can cause eating to be painful. Also, the way an aide performs meal assistance can determine how much a resident or patient eats, especially if they have dementia or other cognitive disabilities. Whatever these ADLs are, they also supply an opportunity for companionship. Friendship is a valid and needed ADL. There are many instances within the care venue where people have no friends and few advocates. If Maslow’s Hierarchy is a standard for healthcare, and it is, we may point to the belongingness and love level within the category of Psychological Needs as an important ADL performed by aides. The two levels of Basic Needs are safety and physiological needs. The two levels of Psychological Needs are belongingness/love and esteem needs. Even if a resident has a family, it may not be a loving family. Hence, aides supply love in the gaps where families are not present or able, and may be a detriment to the resident’s well-being. In most states, any type of healthcare worker is a mandated advocate.
In addition, maintaining the dignity of a resident or patient is strongly emphasized in mandatory training that qualifies an aide to take a state test. In all circumstances, these same standards should exist for RAs (resident assistants [non-state-tested]) as facility protocol. Maintaining the dignity of a resident or patient falls under esteem needs in Maslow’s hierarchy. How a resident is dressed and groomed speaks strongly to esteem needs. Residents in LTC will define their own esteem by how they are treated. If their dignity is maintained, they will think they have value as a living being.
In conclusion on this point, the nurse aide is the point person on the Maslow priority of care. The Maslow priority of care sets the stage for the LPN and RN disciplines. The examples here are vast, but suffice to say that the effectiveness of medications and other treatments depend on good nutrition. Also, if a resident does not feel loved or valued, there will be no motivation to participate in treatments or medication therapy. This can lead to additional care and subsequent costs when the process of care breaks down resulting in a downward spiral. In other words, allopathic methods are piled on in an attempt to compensate for the lack of basic care and lack of preventative methods. For certain, nurse aides are on the front lines of prevention; they own that venue almost entirely. No discipline in the healthcare industry prevents unnecessary employment of additional care more than the nurse aide. If they are used according to their full scope of practice, unnecessary care, unnecessary nurse hours, and unnecessary costs will be slashed demonstrably.
The nurse aide, as we have seen, has a prominent role in prevention. Much more could be discussed here, but obviously, good aide care prevents a host of conditions like pressure ulcers, podiatrist issues, and infections of all kinds. However, increasing the efficiency of nurses does not stop there. Nurse aides also have a direct role in LPN/RN care. They can obtain vitals, check glucose (with additional certification), check and record I/O (input and output), change ostomy utilities, perform catheter care (prevention of infection), and perform range of motion and ambulation exercises (forms of physical and occupational therapy). It should be added that good aide charting is critical to effective RN care plans.
Nurse aides, even when their scope of practice is realized on a cursory level, have a dramatic impact on the efficiency of licensed nurses, not to mention that nurse aides are also an extension of the nurse’s five senses. Quality of care is dramatically increased, while cost of care is dramatically decreased.
If that isn’t enough, adding holistic care to the nurse aide scope of practice has not been visited to any significant degree. In some sense, the nurse aide scope of care is holistic; that is, their discipline concerns care for the whole person (physically, spiritually, and emotionally). Holistic treatments for relaxation are effective and for the most part unregulated. Due to staffing shortages, anti-anxiety and behavioral medications are often administered when the expertise of an aide to divert, calm, and supply companionship would suffice. Consequently, the side effects of anti-psychotic drugs and other medications are added to the care plan resulting in more cost and more time. Of course, this example is merely a microcosm of the overall downward spiral of cause and effect. Holistically speaking, the aide can supply companionship in the milieu of care as well. Loneliness is a known killer.
Nurse aides lay the foundation for effective nursing care. Their discipline is mostly holistic which prevents the need and cost of acute care to significant degrees. Their role in increasing the efficiency of nurses is immeasurable. Their scope of practice includes the basic needs of physiology, safety, and security; psychological needs of belongingness, love, and the esteem of being valued. Though their role is primarily holistic, they also perform key roles in acute care.
Their role is vital, but the benefits of their care are only realized if they know who they are and what they are called to do.
[1] Mayo Clinic. (2021). Oral health: A window to your overall health. By Mayo Clinic Staff. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475
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