Completing Vital Signs
With a thorough job task analysis,
I can evaluate the specific details of daily tasks to be completed by a
certified nursing assistant. The specific task I will be will analyzing is
conducting vital signs, this includes temperature, pulse, and respiration for
The main objective of collecting
vital signs is to make sure each patient is maintaining all healthy bodily
functions. Conducting vital signs show the current output of all of the “vital”
pieces and parts of the body. Vital signs can also serve as a point of
reference for healthcare professionals to see if a patient’s condition has
improved or not. Another important objective is to correctly document the vital
signs so that they can be easily accessible.
Assistant (Employee) Questionnaire:
What is your job position?
My position is a certified nursing
What are some examples of specific
tasks you complete throughout a daily basis?
When I first come to work I am
expected to help each patient out of bed and use the bathroom. If the resident
prefers to take showers in the morning this is also added to the morning
routine. I then help the resident to groom themselves (hair, teeth, skin) and
get dressed for the day. Following this, I can begin to take the resident’s
vital signs (temperature, pulse, respiration) for the day. After completing all
these morning tasks, it is important to document and record everything
performed. Throughout the rest of the day, my job entails mostly supervision
and help with transfers, walking, and assistance to and from activities.
What are the specific steps
involved in taking a patient’s vital signs?
First, I need to introduce myself
to the patient and identify that my hands have been washed. I then explain the
procedure to the resident and that their vital signs will be taken. It is also
important at this time to pull the curtain/close the door to provide for the
patient’s privacy. The first vital sign to be taken is temperature; I correctly
turn on an oral digital thermometer and gently insert the bulb end of the
thermometer into the patient’s mouth under their tongue. The thermometer is
held under the tongue until the time has ended and it beeps. I then read and
record the temperature displayed on the screen. The thermometer needs to be
cleaned with an alcohol pad after this if a protective sheath is not used. The
next vital sign completed is the pulse. First, I have to locate the radial
pulse by placing two fingers on the thumb side of the patient’s wrist. I count
their pulse for sixty-seconds and record the number counted. Lastly, the
patient’s respiratory rate is taken. It is best to try and take this when the
patient is unaware, for example, while reading their pulse, if possible. This
is because typically if a patient knows you are watching them breathe, they
will breath faster than their normal rate. The respiratory rate is then
recorded, as well. An often-forgotten last step is to wash hands after any and
all interactions with patients.
Do you ever encounter a patient who
does not want their vitals taken? If so, what do you do in that scenario?
Yes, all of the time. In that
moment, I try and explain to the patient how important their vital readings are
to their health. If they are still refusing treatment I am required to leave
the patient and inform my supervisor that the patient refused treatment. This
information is always documented.
What are the necessary materials for
completing vital signs?
For the type of vitals I perform,
the only material needed is the oral digital thermometer. The pulse and
respiration tasks do not require any additional equipment. However, if
performing additions vitals such as oxygen levels and blood pressure, a finger
pulse oximeter and a blood pressure cuff may be required.
Is it ever difficult to see a
patient’s respiration and/or find their pulse manually?
Yes, this happens on a daily basis.
If a patient has small breaths it can be hard to see each individual breath. In
this case, I can either ask another nurse to come in, or it can be easier to
focus on their nostrils, rather than their chest to better see the respiration.
For measuring the patient’s pulse, it can be especially difficult with geriatric
patients who have smaller and weaker veins. In this case, if the radial pulse
cannot be found I usually move to their neck to find their carotid artery and
measure their pulse this way.
Nurse (Supervisor) Questionnaire:
What specific events concern you
most as a charge nurse?
When working it can be quite
concerning to me when a patient is rude or abusive to my staff. We often
encounter patients who do not want to be in an assisted-living facility and
lash out their anger to the CNAs. When this occurs, I am in charge of all
documentation, but also to try and calm the patient down. This can be
especially difficult with Alzheimer’s patients who are just truly confused and
are not in the right state of mind.
What qualities are you looking for
when hiring a certified nursing assistant?
The first quality I look for in new
potential employees is their personality. We have a lot of patients dealing
with depression as a side effect of medical conditions and medications. So,
when a CNA walks into a room with a positive attitude and a smiling face it can
make a huge impact on the patients’ day. I also look for confidence in an
employee. When working one-on-one with patients and performing certain tasks,
like transfers, vital signs, and range of motion exercises, my employees need
to be 100% confident in their education and their skills.
What do you feel is the most
important task fulfilled by your CNAs?
I think the biggest tasks my CNAs
do is documentation. While helping the patients and monitoring their activities
is extremely important and is 90% of their job, the other 10% is often
forgotten and is so important. If an incident occurs because the patient fell,
but it was undocumented, it can be detrimental to the patient’s future health.
This may be an extreme example, but it just shows the importance of documenting
everything that happens to a patient.
Communication: Nursing assistants need to be able
to communicate with patients and help them to not only understand what
procedures might be done but to also communicate well with their peers and
Organization: Quite often, nursing assistants are
helping multiple patients and documenting multiple different occurrences
regarding multiple patients. Having good organizational skills is essential to
have a successful workday.
Compassion: Healthcare professionals of any
type that have patient interaction almost always need to have an empathetic
personality. Often patients are scared and having a caring nurse or doctor can
make all of the difference. CNAs have a high amount of personal patient
interactions, and a compassionate nurse can often make strong and trusting
relationships with patients.
Basic Medical Education: CNAs are not expected to know
everything about the human body and all its functions, however, they are
expected to have a basic understanding and be able to see when a bodily
function may not be working properly and address the issue. CNAs are also
responsible for taking vital signs and must understand the different ways to
take a patient’s pulse from multiple areas.
CNAs must show
leadership qualities as they are working with patients directly. If they are
not confident in their work and cannot show leadership in their daily tasks,
they will most likely not succeed as a CNA.
CNAs often work
alone with patients without supervision, especially in-home healthcare
settings. This requires the CNA to be able to work alone, all while maintaining
their time management and organizational skills.
A CNA must always
be aware of their surroundings. Often a CNA can be aware of the first signs of
a stroke or a heart attack and can save a patient’s life. Being aware of
surroundings can also be important in spotting abusive situations. Elderly
abuse, whether intentional or not, is highly prevalent in nursing homes, and
CNAs must be able to be spot these abusive situations.
to Record Results
Pads/ Protective Thermometer Sheaths