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Statement of Purpose:
The purpose of this unit is to introduce the student to the California Code of Regulations, Division 5, Title 22, which regulates healthcare facilities, and to introduce the roles and responsibilities of the Nurse Assistant, including requirements for Nurse Assistant certification, professionalism, ethics, and confidentiality.
Please make sure you know the following terminology:
Terminology:
After completing the chapters for this module
Performance Standards (Objectives):
Upon completion of the two (2) hours of class plus homework assignments, the learner will be able to:
A) Roles and Responsibilities of a Certified Nurse Assistant (CNA)
Ch 1, pp 3-5
B) Title 22, division 5, California Code of Regulations, an overview of California-specific requirements are not included.
C) Requirements for nurse assistant certification California-specific requirements are not included. General requirements are located in Ch 1, p 11; Ch 10, pp 246-247
D) Professionalism-Ch 1, pp 8-10
E) Ethics and confidentiality-Ch 1, pp 10-20
long-term care (LTC)-the care given in long-term care facilities for people who need 24-hour skilled care.
skilled care –medically necessary care given by a skilled nurse or therapist.
length of stay-the number of days a person stays in a care facility.
terminal illness-a disease or condition that will eventually cause death.
chronic-long-term or long-lasting.
diagnoses –medical conditions determined by a doctor.
home health care-care that is provided in a person’s home.
assisted living-residences for people who do not need 24-hour skilled care, but do require some help with daily care tasks.
adult day services-care for people who need some help during certain hours, but who do not live in the facility where care is provided.
acute care –24-hour skilled care given in hospitals and ambulatory surgical centers for short-term illnesses or injuries.
subacute care-the care given in hospitals or in long-term care facilities for people who need less care than for an acute illness, but more care than for a chronic illness.
outpatient care- the care given to people who have had treatments, procedures, or surgeries and need short-term skilled care.
rehabilitation – the care that is given by specialists to help restore or improve function after an illness or injury.
hospice care-holistic, compassionate care given to people who have approximately six months or less to live.
Compare long-term care to other healthcare settings
People who live in long-term care facilities
REMEMBER:
Long-term care facilities are the residents’ homes. Nursing assistants can help residents feel at home by respecting their space and their privacy.
Define the following term:
activities of daily living (ADLs)-daily personal care tasks such as bathing; dressing; caring for skin, nails, hair, and teeth; eating; drinking; walking; transferring; and elimination.
These services are often provided at long-term care facilities:
Different long-term care facilities may offer different services
Define the following terms:
culture change-a term given to the process of transforming services for elders so that they are based on the values and practices of the person receiving care; core values include choice, dignity, respect, self-determination, and purposeful living.
person-centered care –a type of care that places the emphasis on the person needing care and his or her individuality and capabilities.
Think about this question:
The core values of culture change are choice, dignity, respect, self-determination, and purposeful living. What are some things an NA can do to promote these values as he works with residents?
Explain Medicare and Medicaid
Define the following terms:
Medicare-a federal health insurance program for people who are 65 or older, have certain disabilities or permanent kidney failure, or are ill and cannot work.
Medicaid-a medical assistance program for people with low incomes, as well as for people with disabilities.
Transparency 1-1: Facts about Medicare and Medicaid
Medicare
Medicaid
Explain Medicare and Medicaid
Residents’ long-term care is often paid for by Medicare or Medicaid. Under Medicare and Medicaid
Describe the nursing assistant’s role
Long-term care facilities may use any of the following titles for nursing assistants:
Describe the nursing assistant’s role
Define the following term:
charting-documenting information and observations about residents.
Describe the nursing assistant’s role
Nursing assistants perform assigned nursing tasks, such as
Nursing assistants also provide personal care, including the following:
The NA’s job also includes the following:
NAs are not permitted to do any of the following:
Some states allow NAs to give medications if they have completed an additional, specialized course for medications and meet the requirements of the individual facility.
REMEMBER:
Nursing assistants spend more time with residents than any other care team members. NAs’ observations are very important in making sure residents receive the best possible care. NAs are the “eyes and ears” of the healthcare team.
REMEMBER:
All residents are the responsibility of each nursing assistant. If an NA sees a resident who needs help, she must help—even if the resident is not on her assignment sheet.
Describe the care team and the chain of command
Define the following term:
assistive or adaptive devices-special equipment that helps a person who is ill or disabled to perform activities of daily living.
Resident care is provided by a care team made up of the following team members:
REMEMBER:
The care team revolves around the resident and his condition, treatment, and progress. All members should focus on the resident.
Define the following terms:
chain of command-the line of authority within a facility.
liability –a legal term that means someone can be held responsible for harming someone else.
scope of practice-defines the tasks that healthcare providers are legally allowed to do as permitted by state or federal law.
Transparency 1-2: Chain of Command
REMEMBER:
Each state has different laws, but some tasks are never performed by NAs. NAs never make diagnoses or perform procedures involving sterile technique, for example.
An NA must never honor a request to do something outside his scope of practice. Report such requests to the nurse.
Describe the care team and the chain of command
Define the following term:
care plan-a plan developed for each resident to achieve certain goals; it outlines the steps and tasks that the care team must perform.
Remember these points about resident care plans:
Tasks not listed on the care plan should not be performed. If an NA has a question about the care plan, or thinks something is missing, he should talk to his supervisor.
Define policies, procedures, and professionalism
Define the following terms:
Policy is a course of action that should be taken every time a certain situation occurs.
Procedure is a a method or way of doing something.
These policies and procedures are common in LTC facilities:
Think about this question:
What should an NA do if she is unsure about a policy or procedure?
Define the following terms:
professional-having to do with work or a job.
personal- relating to life outside one’s job, such as family, friends, and home life.
professionalism-behaving properly when working; it includes how a person dresses, the words he uses, and the things he talks about.
Compassionate-being caring, concerned, considerate, empathetic, and understanding.
empathy-identifying with the feelings of others.
sympathy-sharing in the feelings and difficulties of others.
tactful-showing sensitivity and having a sense of what is appropriate when dealing with others.
conscientious-guided by a sense of right and wrong; principled.
These points will help NAs keep relationships with residents professional:
NAs can have a professional relationship with an employer by
Transparency 1-3: Qualities of Great Nursing Assistants Nursing assistants must be
Think about this question:
How might an NA demonstrate each of the qualities listed in Transparency 1-3 during her work in a facility?
List examples of legal and ethical behavior and explain Residents’ Rights
Define the following terms:
Ethics-the knowledge of right and wrong.
Laws-rules set by the government to help people live peacefully together and to ensure order and safety.
List examples of legal and ethical behavior and explain Residents’ Rights
NAs should always follow these guidelines for legal and ethical behavior:
Define the following terms:
Omnibus Budget Reconciliation Act (OBRA)-law passed by the federal government that includes minimum standards for nursing assistant training, staffing requirements, resident assessment instructions, and information on rights for residents.
Cite (or a citation)-in a long-term care facility, to find a problem through a survey.
Residents’ Rights-numerous rights identified in the OBRA law that relate to how residents must be treated while living in a facility; they provide an ethical code of conduct for healthcare workers.
informed consent-the process in which a person, with the help of a doctor, makes informed decisions about his or her health care.
NAs should know these important points about OBRA:
Transparency 1-4: Residents’ Rights
Residents have a legal right to
The Nursing Assistant in Long-Term Care
Think about this question:
How can NAs work to protect Residents’ Rights?
To protect Residents’ Rights NAs should
REMEMBER:
Boundaries are the limits to or within relationships. It is important that NAs treat residents with warmth and caring, but NAs must not become personally involved with residents. Professional boundaries help support a healthy resident-staff relationship.
Think about these questions:
Would everyday decisions seem more important to you if many of your choices were taken away?
Why do you want to make your own decisions? How does this exercise relate to Residents’ Rights?
Define the following terms:
Abuse-purposeful mistreatment that causes physical, mental, or emotional pain or injury to someone.
physical abuse-any treatment, intentional or not, that causes harm to a person’s body.
psychological abuse-emotional harm caused by threatening, scaring, humiliating, intimidating, isolating, or insulting a person, or by treating him as a child.
Verbal abuse-the use of spoken or written words, pictures, or gestures that threaten, embarrass, or insult a person.
Sexual abuse-the forcing of a person to perform or participate in sexual acts against her will; includes unwanted touching, exposing oneself, and sharing pornographic material.
Financial abuse-the improper or illegal use of a person’s money, possessions, property, or other assets.
Assault-a threat to harm a person, resulting in the person feeling fearful that he will be harmed.
Battery-the intentional touching of a person without her consent.
Domestic violence-physical, sexual, or emotional abuse by spouses, intimate partners, or family members.
False imprisonment-unlawful restraint that affects a person’s freedom of movement; includes both the threat of being physically restrained and actually being physically restrained.
Involuntary seclusion-the separation of a person from others against the person’s will.
Workplace violence-verbal, physical, or sexual abuse of staff by other staff members, residents, or visitors.
Sexual harassment-any unwelcome sexual advance or behavior that creates an intimidating, hostile, or offensive working environment.
Substance abuse-the repeated use of legal or illegal substances in a way that is harmful to oneself or others.
Neglect-the failure to provide needed care that results in physical, mental, or emotional harm to a person.
Active neglect-the purposeful failure to provide needed care, resulting in harm to a person.
Passive neglect-the unintentional failure to provide needed care, resulting in physical, mental, or emotional harm to a person.
Negligence-actions, or the failure to act or provide the proper care, that result in unintended injury to a person.
Malpractice-injury to a person due to professional misconduct through negligence, carelessness, or lack of skill.
Transparency 1-5: Suspicious Injuries
The following injuries are considered suspicious and should be reported:
Signs that could indicate abuse include the following:
Signs that could indicate neglect include the following:
Who is Vulnerable to Abuse or Neglect?
Some people are more vulnerable to adult abuse or neglect than others. They include the following:
All of these people have a few things in common that make them so vulnerable. They are often unable to stand up for themselves or to report abuse or neglect to others. They may not even understand that they have rights. Often these people can be much more demanding to care for, which increases the stress that caregivers have to deal with.
Caregivers may not have been properly trained to care for these particular people, and they may not understand why these people behave the way they do. Caregivers may also be overworked, tired, stressed, and unappreciated, on top of caring for someone who requires so much time and energy.
These are the people who most need your help and protection from harm.
They may not be able to speak for themselves, but the signs of abuse and neglect may speak volumes for them. Know how to recognize these signs.
Think about these questions:
Why are these people so vulnerable?
How are Residents’ Rights related to abuse, and to the NA’s responsibility to protect residents from abuse?
REMEMBER:
NAs must never abuse residents in any way, and must report any suspected abuse. Reporting suspected abuse is the law. NAs must follow the chain of command when reporting abuse.
Define the following term:
Ombudsman-is a a legal advocate for residents in long-term care facilities; helps resolve disputes and settle conflicts.
These are the typical tasks of an ombudsman:
Facilities often have Residents’ Councils, which exist for these purposes:
Define the following terms:
Confidentiality – is the legal and ethical principle of keeping information private.
Health Insurance Portability and Accountability Act (HIPAA) – is a federal law that requires health information be kept private and secure and that organizations take special steps to protect this information.
Protected health information (PHI)– a person’s private health information, which includes name, address, telephone number, social security number, email address, and medical record number.
REMEMBER:
HIPAA applies to all healthcare providers, including nursing assistants. Serious penalties can be imposed for not adhering to HIPAA’s guidelines.
These guidelines are essential to protecting residents’ privacy:
Think about these questions:
How does confidentiality affect an NA’s use of social media (Facebook, Twitter, Instagram, etc.)?
What would be an illegal use of social media (in terms of confidentiality)? A legal use?
Is everything that is legal also ethical and professional?
Careful, timely documentation is important because it
REMEMBER:
If an NA does not document care, legally it was not done.
NAs must follow these guidelines for documentation:
For computer/electronic documentation, NAs must follow these general guidelines:
Define the following term:
Minimum Data Set (MDS) – is a detailed form with guidelines for assessing residents in long-term care facilities; also lists what to do if resident problems are identified.
NAs should know the following about the MDS:
REMEMBER:
Incident -is an accident, problem, or unexpected event during the course of care that is not part of the normal routine in a healthcare facility.
All of the following events are considered incidents:
When making an incident report the NA should
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