Hawaii CNA common mistakes
Hawaii CNA · Understand the traps and how to avoid them.
Washes hands once at the start of a procedure and then skips hand hygiene when moving from a soiled task to a clean one (for example, after removing gloves, after touching the bedpan, or before handling clean linen or supplies).
Candidates memorize handwashing as an opening step of the skill rather than as a step that repeats at every transition, and under test pressure they treat it as already 'done'.
What to do instead
Practice the skill in segments and say the transition out loud each time: soiled to clean, gloves off, before and after resident contact, before leaving the room. Build a mental rule of 'every time my hands change what they are touching, they get washed or sanitized.'
Takes a blood pressure with the cuff over a sleeve, with the arm hanging down or held above heart level, and deflates the cuff quickly in a few seconds.
Candidates practiced on each other casually and never learned that arm position and deflation rate change the reading, so they focus only on hearing the sounds.
What to do instead
Use a bare arm, cuff about one inch above the elbow crease with the arrow over the brachial artery, arm supported at heart level, and release the valve so the gauge drops about 2 to 3 mmHg per second. Recheck an abnormal reading before reporting it.
Gives perineal care by wiping from back to front, or uses the same part of the washcloth for more than one stroke.
Candidates rush to finish a task they find embarrassing and don't connect wiping direction to moving germs from the rectum toward the urinary opening.
What to do instead
Wipe front to back, use a clean area of the cloth for each stroke, change gloves and cloth when they become soiled, and wash the perineal area last. Say the direction out loud while practicing until it is automatic.
Starts personal care without explaining what is about to happen, and leaves the door open or the resident uncovered while reaching for supplies.
Nervousness narrows attention to the mechanical steps, and the mannequin or partner does not react, so the candidate never feels the need to protect privacy.
What to do instead
Before touching the resident, state who you are and what you are going to do, close the door or pull the curtain, and keep the resident covered except for the area being washed. Practice narrating this opening every single time, not just when it is scored.
Responds to a crying, withdrawn, or grieving resident by saying 'Don't cry, it's not that bad,' changing the subject, or joking to lighten the mood.
Candidates feel uncomfortable with strong emotion and default to fixing or distracting rather than listening, and they may worry that listening will 'open a can of worms'.
What to do instead
Sit at eye level, acknowledge the feeling ('You seem really sad today'), pause, and let the resident talk. Do not promise secrecy and do not give advice; report what you observed to the nurse. Practice short reflective statements instead of cheerful redirects.
Corrects a resident with dementia who says her long-dead husband is coming to visit, insisting on the facts and repeating that he has died.
Candidates believe honesty is always the kindest response and do not realize that correcting a confused resident produces grief and agitation all over again.
What to do instead
Respond to the feeling, not the fact: 'You must miss him' or 'Tell me about him.' Redirect to a safe activity afterward. Never argue, quiz, or shame the resident, and never lie about something that affects their care or safety.
Performs range-of-motion exercises by pushing a joint until it stops, bouncing at the end of the movement, or continuing when the resident says it hurts.
Candidates want to complete the full count of repetitions and believe more movement means better care, so they push past the resident's signals.
What to do instead
Move slowly to the point of resistance and stop there, never bounce or force, and stop immediately if the resident reports pain. Report pain, swelling, or a new limitation instead of working through it.
Transfers or ambulates a resident without locking the bed or wheelchair wheels, without a gait belt, or by holding the resident under the arms or by the clothing.
Candidates concentrate on the movement itself and skip the setup, and grabbing an arm feels faster and more natural than applying a belt.
What to do instead
Run a fixed setup sequence before any move: lock the wheels, lower the bed, apply the gait belt snugly around the waist, stand on the resident's weaker side, and cue 'on three.' Never lift by the arms or clothing.
Says a confused or restless resident should be 'tied down' or 'restrained for safety,' or describes tying a restraint to the side rails.
Candidates inherit outdated folklore about restraints and have never seen a restraint-free care plan, so the idea feels like common sense.
What to do instead
Learn the least-restrictive alternatives first: toileting schedules, activities, pain relief, family presence, reduced noise, and safe room setup. Restraints require a physician's order, the least restrictive type, frequent monitoring, and release at intervals, and they are never tied to side rails. The resident or family also has the right to refuse.
Discusses a resident's diagnosis, behaviors, or family situation in the hallway, elevator, dining room, or on personal social media, or shares information with a caller who asks about the resident.
Candidates treat casual conversation as harmless and do not recognize that any identifying detail shared with someone who is not involved in care is a confidentiality breach.
What to do instead
Follow the rule that only staff involved in the resident's care get information, and confirm identity and need-to-know before discussing anything. Redirect family and friends to the nurse, keep conversations in private areas, and keep all resident information off personal phones and social media.