Comprehensive Healthcare Assistant Study Guide: Red Cross Vaud Training

Professional Communication and Behavioral Attitudes

When interacting with beneficiaries (BS), the Healthcare Assistant of the Swiss Red Cross (AS CRS) must employ specific sensory capture strategies, which include the use of gaze, speech, and touch. It is essential to provide only one piece of information at a time and utilize guidance while strictly avoiding any infantilizing behavior. The caregiver should never put the beneficiary in a position of failure and must demonstrate significant patience. To manage difficult situations, diversion strategies should be used, and the caregiver must help create environmental markers (repères) for the person. In cases involving an agitated elderly person (PAA), the first response should always be to establish contact through visual connection, speech, and physical touch. For patients suffering from aphasia, the caregiver must take the time to listen without speaking for them, listening "with the heart." It is important to make links between the words they use, rely on the surrounding context, and listen until the very end of their expression. Caregivers should be patient, admit when they do not understand, maintain a calm environment, utilize non-verbal communication, avoid raising their voice, and reformulate questions into "yes" or "no" formats to facilitate a response.

When communicating with hearing-impaired individuals, four specific actions are required: attract the person's attention first, place oneself directly in front of them, speak naturally and clearly, and foster a calm environment. It is also crucial to verify that hearing aids are in place and functioning correctly and to use visual supports where possible. Regarding professional ethics, if an AS CRS is asked for information about a resident's friend while in public (e.g., during grocery shopping), they must politely refuse by stating they are bound by professional secrecy. Similarly, if a nurse asks an AS CRS to fetch a Dafalgan® medication, the assistant must refuse as this is outside their scope of competence. If a home-care client asks the assistant to perform domestic tasks like vacuuming or ironing instead of their scheduled care, the assistant should listen, refer to the care plan, negotiate if there is remaining time at the end of the intervention, and transmit the request to the CMS.

Vital Signs and Clinical Observation

The standard norms for vital signs are specific: blood pressure should range between $90/60\,\text{mmHg}$ and $140/90\,\text{mmHg}$. Respiration frequency should be between $12$ and $20\,\text{cycles per minute}$. Pulse rates are considered normal between $60$ and $100\,\text{pulsations per minute}$. Body temperature norms vary by measurement site, with axillary temperature typically between $36 - 37^\circ C$ and auricular (ear) temperature between $36.5 - 37.5^\circ C$. Indications for checking a beneficiary's temperature include the existence of a medical prescription, the person shivering, skin being hot to the touch, eyes appearing shiny, the face being red, unusual sweating, confusion, or other signs of infection. Observed signs of fever include shiny eyes, facial redness, skin warmth, headaches, sweating, sensations of heat or cold, shivering, confusion, and fatigue.

When observing urine, the Healthcare Assistant must note four elements: aspect and consistency, quantity, coloration, and odor. If urine appears to be "outside of the norms," the AS CRS must keep the urine sample, record the name of the beneficiary along with the date and hour, and notify the nurse immediately. Symptoms of a urinary tract infection include burning or pain during micturition (urination), frequent micturition in small quantities, strong odors, changes in color (such as pink or red), the presence of deposits, abdominal pain, and confusion. General physical observation should utilize four senses: smell, hearing, sight, and touch. For pain assessment, non-verbal signs include groaning, changes in behavior (agitation, irritability, aggression), facial expressions (clenched or pale), body tension or clenching, sleep disturbances, decreased appetite, and protective movements or pulling a limb away. Respiratory difficulties are signaled by fast or slow rates, irregular patterns or apnea, shallow breathing, respiratory noises, cyanosis, sensations of choking, anxiety, confusion, agitation, coughing, expectoration, the use of accessory muscles, or pain during breathing.

PDSP: Principles of Safe Patient Handling and Ergonomics

The PDSP framework involves five essential elements to be attentive to during the preparation phase: the environment, the equipment, the person, the time available, and the specific task. The five core principles of PDSP are Preparation, Posture, Grip (Prise), Movement, and Communication. Regarding the principle of posture, three key elements include keeping elbows close to the body, keeping knees bent, and having the feet spread apart. Additionally, the back must remain in a neutral position without torsion or flexion. There are four types of caregiver grips: soft (douce), solid (solide), close (rapprochée), and enveloping (enveloppante). Caregivers should create "handles" (poignées) using points of support.

Beneficiaries can be moved through three methods: sliding (glisser), rolling (rouler), or pivoting (pivoter). Caregivers utilize specific movements such as counterweight (contrepoids), front-back weight transfer, lateral weight transfer, and combined movements. In a lying position, the primary pressure points (points d'appui) are the back of the head (occiput), the shoulder blades (omoplate), the elbows, the sacrum, and the heels. To prevent pressure sores (escarres), caregivers must perform regular observation of these points, ensure hydration, perform effleurage, change the patient's position every $2$ to $3\,\text{hours}$, prevent moisture, and use auxiliary positioning cushions.

Hygiene Standards and Infection Control

Hand disinfection using hydroalcoholic solutions is indicated in specific circumstances: upon entering and leaving a patient's zone, after touching something dirty, before performing a clean act, and after removing gloves. It is a misconception that hands must be washed after five disinfections; modern formulas containing water, alcohol, and glycerol are gentler than soap and do not leave the skin feeling "sticky." However, a combined washing and disinfection of hands is mandatory if biological fluids are present. Gloves cannot be disinfected because the material becomes porous when exposed to disinfectant, allowing microorganisms to pass through to the skin. General hand washing is required upon arrival and departure from work, after using the toilet, after contact with biological fluids, or when visible dirt is present.

Intimate care requires strict hygiene: the water must always be changed before starting, hands must be disinfected and gloves worn, and cleaning must proceed from the cleanest area to the dirtiest. Specific towels and gloves must be used for the lower body. For intimate care in bed, security is maintained by working at hip height, washing the bedside table before and after, and drying the skin meticulously. Comfort is ensured by asking the beneficiary about the water temperature, closing windows, and preserving modesty (pudicity) through curtains or towels. Economy in care is achieved by preparing all materials in advance to avoid back-and-forth trips, not overfilling basins, and organizing help from colleagues beforehand.

Nutrition and Digestive Health

Food is composed of seven key components: Calcium (essential for bone and tooth formation and strength), Vitamin C, Lipids (which provide energy and heat to the body), Fibers, Carbohydrates (providing energy and heat), Proteins (the builders of cells), and Water (which hydrates the body and transports nutrients and waste). To prevent false routes (aspiration) during meals, the AS CRS should serve food that is either hot or cold (not lukewarm), position the beneficiary with their head slightly forward, adapt to their rhythm, sit facing them, provide a calm environment, use thickened drinks, and avoid mixing textures or using small bits of food. For meals in bed, the assistant should raise the backrest/pillows, offer hand washing before and after, and ensure everything is at hand.

Constipation is categorized by hard, rare stools, bloating, abdominal pain, strong odors, and confusion. Non-medical management includes encouraging hydration, favoring high-fiber diets, and promoting mobilization. Diarrhea management involves hygiene measures, favoring rest, increasing fluid intake, and a specific diet including white rice (or cooking water), well-cooked potatoes, and fiber-free options like bananas, well-cooked carrots, or apple compote. In cases of suspected hyperglycemia, an AS CRS should not offer sugar; interpreting these signs is outside their competence. Only qualified nursing staff can perform capillary glucose tests. Signs of hyperglycemia include changes in character, headaches, fatigue, paleness, hunger, sweating, trembling, dizziness, and blurred vision.

Clinical Documentation and Patient Safety

The "Dossier de soins" contains critical information including the life history (histoire de vie), care plan, care card, advance directives, support projects (projet d'accompagnement), medical files, and written transmissions. Written transmissions serve to facilitate professional reflection, clinical follow-up, and individualized care. Clinical reasoning follows four steps: 1. Data collection, 2. Reflection, 3. Action, and 4. Evaluation. Restriction measures (mesures de contrainte) require a doctor's validation under specific conditions: the person is in grave danger (or risks others' safety), the behavior is not due to remediable causes, and other less restrictive measures have failed. Examples of non-tolerated constraints include bed rails (if used improperly), attachments (belts/vests), Zewi sheets, locked doors, or tilted geriatric chairs. Allowing two bed rails is considered a restriction measure and is only permitted briefly if the caregiver must move away. Tolerated measures include anti-fugue bracelets, alarm mats, and presence sensors.

Specialized care procedures include the application of compression stockings; if a beneficiary is already out of bed, they must be laid back down with legs elevated for $10 - 15\,\text{minutes}$ before the stockings are applied. Regarding animation in EMS (medico-social establishments), the entire team participates in activities designed to provide markers, entertainment, and the maintenance of intellectual or manual faculties.

Aging and End-of-Life Complications

Physical changes related to aging include the alteration of the five senses, decreased sexual hormones, changes in skin/integuments, decreased intestinal transit, potential incontinence, increased blood pressure, decreased muscle mass, and joint system alterations. Psychically, cognitive functions decline moderately, with short-term memory and learning capacities being less performant, and reaction times increasing for complex problems. Socially, aging often involves the loss of roles (such as parent or worker) and the loss of loved ones. Dehydration in the elderly is marked by skin dryness, the "skin fold" (pli cutané) sign, dry lips and tongue, dark urine in small quantities, fatigue, and disorientation.

Alitement (prolonged bed rest) can lead to numerous complications: pressure sores, constipation, loss of appetite, muscle wasting, joint ankylosis, urinary stasis, circulatory and respiratory troubles, sleep disturbances, depression, and social isolation. End-of-life care involves managing respiratory difficulties, dehydration, pain, anxiety, and spiritual distress. Comfort care for feverish or terminal patients includes refreshing the person, changing damp clothes/sheets, providing rest in a calm environment with dimmed lights, and ventilating the room effectively.