34 Katie Raines – My Discourse Community: Certified Nursing Assistant 

According to John Swales, “A discourse community is a group of people communicating with one another with common goals and interests.” (Swales, 1990). The discourse community that I chose to explore in this assignment is the community of Certified Nursing Assistants. This is my job at a nursing home that I currently work at in New Castle, Indiana. My focus of this discourse community is to display how CNAs communicate with nurses and their patients. Furthermore, John Swales speaks of six defining characteristics that I am applying to my own discourse community.

I. Has a broadly agreed set of common public goals (shared and clear purpose)

Our goal of Certified Nursing Assistants is to provide our assisted living in a warm, friendly environment. Our residents’ health care and emotional needs are our top priority. This means if someone needs Assisted Living support to help with daily tasks like dressing or grooming, or more extensive care from our Skilled Nursing team, we can help the residents live comfortably. In our Memory Care neighborhood, those who are experiencing memory loss can also find care catered to their unique needs. We understand that needs may change while the residents stay with us. That’s why we coordinate across teams to ensure the residents receive the most appropriate and best quality care possible. For example, teamwork in this community is improving the outcomes for patients. Us healthcare workers come together to develop a plan of care that is specifically towards the needs of the resident. We strive every day to exceed expectations, whether you live in the community for a short-term recovery or a long-term stay. This goal remains the same as a CNA whether you work in a hospital, a resident’s home, or in a nursing home.

II. Has mechanisms of intercommunication among its members (keeping in touch)

Certified Nursing Assistants need to interact with one other efficiently and continuously. Whether it’s asking for assistance with documentation or providing commands to save a life. As for me, my intercommunication usually happens face to face or through charting. A nurse can record all the patient’s medical history, prescriptions, allergies, physical examination results, and other details by using a chart. It is mandatory for Certified Nursing Assistant to record all of their activities. “You did not do it if you did not document it.” When I help a resident do something like go to the bathroom, move from the bed to a chair, etc., I must chart what I did with the patient then report the same thing I just charted to another Certified Nursing Assistant, nurse, or anybody higher up. Another type of intercommunication within my community would be texting. My boss texts me when a person calls off and they need someone to come in to cover that shift.

III. Uses its participatory mechanisms to provide feedback (feedback up the chain & down)

This is a text of how my boss texts me when she needs shifts covered or anything in general. She would normally call us, but she knew that I was in college at the time, so she texted me instead. What she said through that text message would normally be the same as what she would ask if it were a phone call. At the nursing home I work at we also are all in a group chat so that everybody can share their observations and feedback of what they think needs to be changed or the changes that are coming in the future. In that group chat they also provide feedback on the things we are doing well and the things that we need to work on.

IV. Utilizes and hence possesses one or more genres in the communicative furtherance of its aims (special document types)

A genre used in the Certified Nursing Assistant community is something called charting. Nurses provide critical information to the whole healthcare team through charting. Every element of a patient’s care, including the drugs given, the services rendered, and the procedures carried out, are detailed in a patient chart, which also serves as a legal document. We always must chart when a person does bed mobility and what time they done it. Bed mobility includes turning on their side or repositioning them in the bed. Another thing we have to chart is when a person transfers to/from their bed, chair, wheelchair, or standing position. We also must chart when a person puts clothes on and takes their clothes off. The main thing that we have to get charted correctly is when a person eats, drinks, or tube feeds. Another hugely important thing to get charted is when a person uses the toilet or bedpan, transfers on or off the toilet, cleanses themself, and changes their pad. One last thing that we have to get charted is when a person does their personal hygiene care and that includes when they comb their hair, brush their teeth, shave, apply makeup, and wash/dry their face.

V. Has some specific lexis (special vocabulary)

Certified Nursing Assistants do have a special language. In the healthcare system, there are several acronyms for various terms that are used to preserve accuracy and lower prescription mistake rates. As an example, “Room 40-2 Propranolol 40 mg PO QID”, this means that 40 milligrams of propranolol are needed to be taken orally four times a day and is the prescribed medication for the patient in room 40 in bed 2. The abbreviations in this field of work aids in a clear way because many prescriptions for medications are handwritten.

VI. Has a threshold level of members with a suitable degree of relevant content and discoursal expertise (mix of experts and novices)

For Glen Oaks in New Castle Indiana, we have a lot of different people that work there. Whether that is a Certified Nursing Assistant, a Registered Nurse, a Licensed Practical Nurse, an Occupational therapist, a Physical therapist, or the Administrator. Certified Nursing Assistants work under the direction of a licensed nurse to assist residents with activities of daily living. Registered nurses are responsible for the overall delivery care to the residents. A Licensed Practical Nurse provides care under the direction of a Registered Nurse. Together Licensed Practical Nurses and Registered Nurses make sure that each resident’s plan of care is being followed and their needs have been met. A therapist helps residents’ movement and manage their pain. Occupational therapists maintain, regain, or improve your independence using different techniques and equipment. Physical therapists provide care to people of all ages who have functional problems resulting from back and neck injuries; sprains, strains, and fractures; arthritis; amputations; stroke; birth conditions, such as cerebral palsy; injuries related to work and sports; and other conditions. An administrator is responsible for the overall management of the facility.

As I went a little deeper into my research, I did an interview with Kendra Gentry. She was the teacher that taught me and got me up to where I am now as a Certified Nursing Assistant. I first started off by asking her about what is one of the hardest parts of being a Certified Nursing Assistant. Kendra stated. “The hardest part is, in my opinion as a CNA in a long-term care facility, tending to a person for months at a time, getting to know them and their family, and then showing up to work one day to find out from your coworkers that they have tragically passed away. It’s difficult and a little startling at first. Still, things become a little worse. There will be a new resident in the room after a week and then you realize that this is no longer “Gary’s” room, but it is now “Ruthie’s.” In addition to just going about your work, you will be providing care for the second resident in many of the same ways that you provided care for the first” (personal communication, November 16, 2023). As she explained, losing a resident is super hard and is very startling at first, especially going into that room with a new resident in it. Unless it is one of your favorite residents you usually don’t cry over them like you would if it was your family member. As for me, I was close to this one resident and sadly she had passed away, but her family really liked me and asked me if I wanted to come to the funeral. If I wasn’t asked to go, I probably wouldn’t have gone even though she was one of my favorite residents. But once a resident dies and a new one comes in you will have to make sure you don’t call the new resident by the other resident’s name.

The second question I asked was, “How do you handle difficult residents?” She answered with, “Anxious or in pain residents might become challenging. One of the patients I was taking care of refused to take her medicine. I asked her why she didn’t want to take the prescription, listened to her response, and remained composed and positive. She found it to make her feel more tired, which bothered her. Although I did my best to assist her, I acknowledged that the negative effect was real. I laid all her choices to her when she continued in denying. I made the decision to try again later after that failed. After 30 minutes, when she was feeling better, I returned and handed her the prescription. Had it been critical, I would have requested assistance from my supervisor” (personal communication, November 16, 2023). In my experience I have encountered the same thing. It is something that isn’t easy to deal with. I have had enough experiences with refusals that I have gotten more used to just coming back into their room later to see if they will do the things they refused to do before. As residents they have the right to refuse things like taking their medication, the right to refuse to eat, the right to refuse therapy, etc. All we can do is tell them the effects and if they still refuse, we can try again later.

The third question I asked was, “How long have you worked as a Certified Nursing Assistant and what do you like most about your job?” Kendra replied, “I have worked as a Certified Nursing Assistant for fifteen years. I started this job when I was a senior in High School. What I like most about this job is developing a relationship with the residents and their family. Together, we joke around and cry. I assist the elderly and weak but also acknowledge them with respect. I enjoy getting them to look presentable when I dress and/or shave them. For example, I go on daily walks with a resident who suffered from a stroke and needs extra time to do certain tasks. With the walker in hand, he wants to get up without assistance. I always take the wheelchair behind him just in case he needs to sit. With his leg affected by the stroke, he walks with every inch of his strength. It takes a while, but he is grateful and thanks me all the time therefore I feel like I’ve done something right each day” (personal communication, November 16, 2023). I have similar thoughts when it comes to thinking about what I like most about my job. Developing a relationship with the residents has always been a priority for me. I want them to feel as comfortable as they possibly can when I am around to help feed them, bathe them, put clothes on them, etc. There is this one resident that asks me every day when I work again just so it can be something that he can look forward to. Having that close bond or relationship with a resident can be equally as important to us as Certified Nursing Assistants as it is to the residents. The last question that I had asked was, “What is the overall job of a Certified Nursing Assistant, like what does a day in the life look like for you?” Kendra responded, “We assist patients with daily tasks including grooming, washing, and using the restroom. If individuals are unable to feed themselves, we do it for them. We clean up incontinent patients, prepare beds, and occasionally help nurses do operations like catheter insertions. We provide postmortem care, which includes cleaning the deceased and preparing them for the family to view right away. We record the help they provide, the amount of urine a patient takes, and their bowel motions. This has great significance for the insurance reimbursement that a facility obtains for the services rendered. We help raise patients in bed and move them from the bed to a chair, etc. I have known Certified Nursing Assistants who have caught stroke-like symptoms and low blood sugar symptoms and reported to a nurse before it got worse. We inform the nurses of anything that could indicate that the patient’s condition has changed. To be a Certified Nursing Assistant you must be strong since the work is highly physically demanding” (personal communication, November 16, 2023). All the things that she described are what we do daily. Somedays it can be very challenging depending upon the mood that the residents are in. I have delt with some very angry residents that just simply do not want to get up and do their daily routine at the time that I came in. Therefore, I try to come back later to see if they want to try it again. If they still don’t want to, I then go report it to someone higher up than me. I am also always telling the nurses if someone has a fever, a new bruise that I have never seen, or if they simply have a complaint about something hurting them.

In conclusion, even if we are at different skill levels, the Certified Nursing Assistant community may use a variety of communication techniques to accomplish goals, develop unique vocabulary, convey genres, and communicate with one another. Being a Certified Nursing Assistant may not always be an easy job, especially when the majority of the residents are refusing different things or when other coworkers aren’t getting along with each other. From working at this job, I have learned that nursing is not what I want to go into. I love my job as of right now, but I don’t see myself wanting to do this for a living. It gets emotionally and physically draining at some points, but I must push through each obstacle it throws at me. I am very glad I got to be a part of a vocational program that led me to getting a job like this. I knew I wanted to be in the medical field, but this job has taught me that where I want to be is not in the nursing field. Overall, the Certified Nursing Assistant is a good example and hits all the points of a discourse community.

References 

Gentry, K., personal communication, November 16, 2023

Glen Oaks, Charting, November 14, 2023

Standford, K., text message, November 17, 2023

Swales, John (1990). The concept of a discourse community. In Genre analysis: English in academic and research settings, pp 21-32. Cambridge UP.