The Ethics of a Hand Held: Small Decisions that Matter

 Normal food or pureed food? Water or juice? Bed raised or lowered? Positioned supine or lateral? Lights on or off? Every decision matters as a CNA, and every small detail can significantly impact the patient’s experience in a facility. For example, if you give a patient with swallowing difficulties or a compromised digestive system a plate of normal food, their odds of choking skyrocket. If a patient is pre-diabetic and you give them juice, you put them at risk of hyperglycemia. If a patient has a habit of moving around in their bed or cannot support their own weight and you raise their bed, they will suffer an injury far worse if they fall. If a patient has respiratory difficulties and you position them supine, breathing becomes much more of a struggle for them. If a patient has a tendency to develop migraines and you leave their lights on, their condition could worsen and make them more irritable. 


I know everyone talks about how important empathy is in patient care, but no amount of emphasis on it can ever be enough. The first step when you enter a patient’s room is to visualize yourself in their position, with their same health conditions. How would I like the bed to be positioned if I were sitting in their place right now? Would the volume of the TV be bothering me if I had the same illness as them? It takes empathy a step further into a situational version of empathy, where you act out the scenario in your head, except you switch the roles. That’s how I approached patient care, and while every CNA is different, that inherent sense of empathy is always there, regardless of the extent to which it is applied. 


Decisions as a CNA go beyond physical care, however. Oftentimes, patients will open up to you about their emotional struggles, their feelings of neglect by their loved ones, or their feelings about how scary it is to lose your body day by day. Humans are souls wound up in a physical being, and when that physical being starts to decline, parts of their soul hurt as well because that soul is losing ground to work in. When a patient talks to you about how much pain they are in, what is acceptable to say? Can you tell them everything will be alright? Can you tell them everything happens for a reason, even though no one deserves to be in pain? Can you give them the hope that their situation will get better, even though it may not? Where do we draw the line between empathizing with someone and lying to them? 


The hardest part of being a CNA, at least for me, was working with hospice patients. I normally handle death and aging well, but every time I entered the room of a patient in hospice, I would feel this tingling feeling in my legs, as if someone was gently pushing the back of my knees in so that my legs would collapse. Seeing their pale, clammy skin, the black line around their lips, the intense pain they are in, and the feeling of despair that surrounds them makes one question everything. Words will never be able to describe how those patients feel, and we will never know until we are in their position, waiting. I wonder if they relive all the memories of their life during those days that they are in pain. 


Every decision matters as a CNA, and to be honest, in every facet of life. Think once, twice, and three times before doing anything that can change how someone lives or feels. We are in a position of power over these patients, and it is imperative that we do not abuse that by making decisions for them that become harmful to them. It sounds incredibly cliche, but with great power does come a great responsibility. 

Comments

  1. EmmanuelPSeptember 14, 2026 at 9:13 AM

    Very insightful. Would recommend ALL aspiring CNAs to read.

    ReplyDelete

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