From Observation to Insight: Patterns in Patient Behavior

 CNAs spend arguably the most amount of one-on-one time with patients, especially in the long-term care facility setting. For that reason, nurses rely on CNAs to serve as a liaison between patients and themselves, so that any reports of changes in condition reach the nurse, and aren’t lost in translation. That is why it is important that CNAs are vigilant of any changes in patient condition and behavior. I talked about nonverbal patients in a prior post. Those patients cannot verbalize to the CNA or nurse what issues they are having, and since the CNA is closer to the patient, the CNA has to take matters into their own hands and recognize the smaller signs of discomfort. 


For example, a patient who is normally alert suddenly does not recognize their family members. This could be a sign of delirium. Delirium can indicate a urinary tract infection, a bad reaction to medication, or even onset of dementia. Another example is a patient that stops talking and refuses to get out of bed. Those are classic signs of depression, extreme fatigue, or uncontrolled pain. If a patient pushes away food or refuses to drink water, that could mean they have difficulty swallowing, or even that they are having mouth pain from dentures that don’t fit. It is small signs like these that can point to a much larger issue, and it is our job to recognize those signs and communicate them to a higher authority. 


I often saw CNAs who would label any patient behavior as “normal”, but what really is “normal”? We do not know what the patients were like before they came into the facility, so how can we discern what their version of normal is? If the patient always showed signs of memory loss, even before they started living at the facility, then memory loss is not something we need to report, but if that memory loss was sudden onset, we have to recognize that and report it. That is why it is so important to get to know your patients, and to talk to them as much as you can. Moments with them are ephemeral, which is definitely a flaw in the way facilities are designed. You may not have the same section of rooms multiple nights in a row, so your patients are constantly changing. This is hard on the patients as well, as they never get a chance to get used to a specific CNA, because they change every 12 hours. That is the most important reason why we have to vigilantly watch for any changes in behavior; moments with them are fleeting, so we have limited time to catch anything before shift change. 


We can take lessons from CNA and apply them to our personal lives as well. Changes in people’s behaviors always indicate a change in their being. If your friend starts acting odd one day, wouldn’t you ask them if they are alright? Similarly, we have to show the same attention to detail to our patients. I’ve said this before and I’ll say it again: every little thing matters. 

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