Chapter 1: The Nurse Assistant

Long Term Care: Care for persons who require 24-hour care & assistance Length of Stay: The Number of days a person stays in a healthcare facility Terminal Illness: A disease or condition that will eventually cause death Chronic: Refers to the fact that a disease or condition is long-term or long lasting Diagnosis: Physicians determination of an illness

Home Health Care: Care Provided at a persons home Assisted living: Facilities where residents live who need some assistance but usually do not require skilled care Adult Daycare: Care given at a facility during daytime hours; generally for people who need some help but are not seriously ill or disabled Acute Care: Care performed in hospitals and ambulatory surgical centers Skilled Care: Medical care given by a skilled nurse or therapist

Subacute care:
Care performed in either a hospital or a traditional nursing home

Outpatient Care:
Care usually provided for less than 24-hours for persons who have had treatments or surgery requiring short term skilled care

Rehabilitation:
Managed by professionals to restore a person to the highest level of functioning after an illness or injury

Hospice Care:
Care for individuals who have six months or less to live; This care provides Physical & emotional care and comfort.

Activities of Daily Living (ADLs): Personal daily care tasks such as bathing, dressing, caring for teeth and hair, toileting, eating, drinking, walking & transferring. 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: Choices, dignity, respect.

These are services commonly provided at LTCFs:

Assistance with personal care Physical, occupational, & speech therapy Wound care Care of different types of tubes & Catheters Nutrition therapy Management of chronic diseases
There are different models of LTC facilities:

Dementia and Alzheimers Units Assisted living wings

Medicare:
A federal health insurance program for people who are 65 or older, disabled or are ill and cannot work.

Medicaid:
A medical Assistance program for low-income people

Facts about Medicare:

For Adults over 65 or with disabilities Part A pays for Hospitals, Skilled Nursing and Hospice care Part B pays for doctors, medical services & equipment Part C allows private insurance to provide benets Part D helps pay for medications Rx. for treatment

Charting: Writing down important information & observations about the residents What are some typical NA duties?

Feeding residents Helping with toileting and elimination Assisting with mobility Keeping living areas neat and clean Encouraging residents to eat and drink Caring for supplies and equipment Making beds Helping with mouth care

There are some tasks that NAs are not allowed to do:

Giving medications Inserting or removing tubes Changing steril dressings Giving tube feedings

Remember: NAs are the eyes and ears of the healthcare team

Care Plan:

A plan developed for each resident to achieve

certain goals; it outlines the steps & tasks that the care team must follow. Remember:

Activities not listed in the care plan must not be

performed Some tasks are NEVER performed by a NA NAs must never honor a request to do something outside of their scope of practice

Chain of Command: Liability:

The line of authority in a facility that helps make sure that residents get proper health care. A legal term that means someone can be held responsible for harming someone else.

Scope of practice:
Denes the things that healthcare providers are legally allowed to do and how to do them correctly

Policy:
A course of action that should be taken every time a certain situation occurs

Procedure:
A method or way of doing a specic task

These are common policies & procedures:

All resident information is condential Residents care plan must be followed NAs only perform tasks in job description NAs report changes/observations to Nurse Gifts & money cannot be accepted from residents
Remember:

Ask questions or review your facilitys procedural manual

when you are unsure about care. If you do not understand a policy or procedure, ask questions until you understand it completely.

NAs can maintain professional relationships with resdents by: Being positive Doing only assigned tasks Keeping resident information condential Never discussing personal problems Not using profanity Explaining care Following practices NAs can maintain professional relationships with employers by: Completing duties Following policies & procedures Documenting & reporting Taking directions & criticism Being clean, neat and well groomed Being on time

Ethics: The knowledge of right and wrong Laws: Rules set by the government to help people live peacefully & ensure order and safety

Remember these guidelines for ethical behavior:

Be honest AT ALL TIMES Protect residents privacy Keep staff information condential Report abuse or suspected abuse of residents Follow the careplan and you assignments DO NOT perform any tasks outside your scope of practice Document accurately and propmtly Follow all rules on safety and infection control Do not accpt gifts or tips Do not get personally or sexually involved with residents or
their families

Omnibus Budget Reconcilliation Act (OBRA): A law passed by the federal government that includes standards for nursing assistant training, stafng requirements, resident assessment instructions, and information on residents rights. Cite: In a long-term care facility, this means to nd a problem during a survey. Residents Rights: Numerous rights identied in OBRA 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 his doctor, makes informed decisions about his health care.

Remember these important points about OBRA:

Sets the minimum standards for NA training Requires regular in-service for NAs Establishes state registry of NAs Includes increased minimum staff requirements Sets resident assessment requirements (MDS) Includes changes in survey process Establishes Residents Rights

Residents have the right to:

Quality of life Services and activities to maintain a high level of wellness Be fully informed regarding rights and services Participate in their own care Make independent choices Privacy and condentiality Dignity, respect, and freedom Security of possessions Be informed of and consent to transfers and discharges Voice Complaints Have visits

Neglect: Harming a person physically, mentally, or emotionally by failing to provide needed care. Active Neglect: Purposely harming a person by failing to provide needed care. Passive Neglect: Unintentionally harming a person physically, mentally or emotionally by failing to provide needed care.

Negligence: Actions, or the failure to act or provide the proper care, that results in unintended injury to a person

Psychological Abuse: Any behavior that causes a person to feel threatened, fearful, intimidated, or humiliated Verbal Abuse: The use of language which can be spoken or written that threatens, embarrasses, or insults a person. Assault: The act of threatening to touch a person without his or her permission. Battery: Touching a person without his or her permission.

Sexual Abuse: Forcing a person to perform or participate in sexual acts against his or her will; this includes unwanted touching, exposing oneself and sharing pornographic material Financial Abuse: The act of stealing, taking advantage of, or improperly using the money, property, or other assets of another person. Domestic Violence: Physical, sexual or emotional abuse by spouses, intimate partners or between other family members. Workplace Violence: Verbal, physical or sexual abuse of staff by residents or other staff members.

Involuntary Seclusion: Separating a person from others against the persons will.

Sexual Harrassment: Any unwelcome sexual advance or behavior that creates an intimidating, hostile, or offensive working environment; this includes requests for sexual favors, unwanted touching, and other acts of a sexual nature. Substance Abuse: The use of legal or illegal drugs, Cigarettes, or alcohol in a way that is harmful to the abuser or to others.

Suspicious Injuries:

Signs of abuse to report:

Fear of being alone Poor self-control Constant pain Threatening to hurt others Withdrawal or apathy Alcohol or drug abuse Anxiety / stress Low self-esteem Confusion, disorientation Resident inquires about questionable care Family member who do not allow resident to be alone with
staff

Signs of neglect to observe and report:

Pressure sores Unclean body Body lice Unanswered call lights Soiled bedding or briefs Poorly-tting clothing Refusal of care unmet needs relating to hearing aids, glasses, etc. Weight loss Dehydration

Some people are more vulnerable to abuse or neglect that others, they include:

Elderly Physically ill or disabled Mentally ill People with communication problems

Onbudsman: The legal advocate for residents; he helps resolve disputes and settles conicts. Condentiality: The legal and ethical principle of keeping information private.

Health Insurance Portability and Acountability act (HIPAA): a federal law that requires health information to be kept private, secure and that organizations take special steps to protect this information.

REMEMBER:

HIPAA applies to all healthcare providers All healthcare workers must follow HIPAA regulations no matter
where they are or what they are doing. Penalties may be imposed for not adhering to HIPAA.

Reasons for careful charting:

Ensures clear communication Legal record Protects NA and employer from Liability Provides up-to-date record
Guidelines for documentation: Write notes immediately after care Think before writing, be brief and clear Only write facts, not opinions Write only in black ink Draw one line through mistakes, mark error and initial Document as per care plan If it was not documented, legally it was not performed

Military Time:

Minimum Data Set (MDS): A detailed form with guidelines for assessing residents in longterm care facilities.

Why is the MDS important?

Helps nurses complete resident assessments accurately Details what to do if resident problems are identied Must be completed for each resident within 14 days of admission Must be reviewd every 3 months New MDS must be done when there is any major change in residents
condition

Incident: An accident or unexpected event during the course of care that is not part of the normal routine in a healthcare facility.

The following are considered incidents:

Falls Equipment broken or damaged Errors in care Small injuries Sexual advances or remarks Unsafe situations Blood or body uid exposure

Sentenial Event: An accident or incident that results in grave physical or psychological injury or death.

Remember these guidelines when reporting:

Tell what happened Tell how the person tolerated the incident State facts only Describe action taken Document outcome of action taken