Transcript Long Term Care Nursing Assistant/ Home Health Aide Course

Nursing Assistant Course
• Upon completion of
this course, students
are eligible for the
Minnesota Nursing
Assistant Competency
Exam.
• Completion of course
includes completion
of 18 hours clinical
experience.
Unit One
Introduction to Nursing Assistant/
Home Health Aide
Upon Completion of this Unit
Students will :
• List personal qualifications of a Nursing
Assistant
• Discuss Productive work Habits for NAR’s
• Describe how federal and State regulations
are related to Nursing Assistant
Responsibilities
Objectives for unit one
• Define Ethics and Etiquette for the Nursing
Assistant
• Describe the Residents Bill of Rights
• Describe the Vulnerable Adult Law
• Describe Patient Self- Determination Act
• Discuss legal implications for the NAR’s
• Describe the need for individualized care
compared to institutionalized care.
List Personal Qualifications of
Nursing Assistants
• Behavior:
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Honest - will not lie
Patient- self controlled
Caring- feel concern
Courteous polite/respectful
– Dependable - reliable
– Sensitive - responsive
– Accountable for
actions/manage
assignments
• Positive Attitude
– of respect and dignity
towards individuals
– of pride in what you do
– of maturity/ control
your own emotions
– of cooperation and
team work
– of practicing high
standards
• Personal Health
– good general health
– free from back injury
or problems with
lifting
– good personal
hygiene, grooming
– clean neat appearance
– practice stress
reducing exercises
PRODUCTIVE WORK HABITS
The role of the nursing assistant is to
provide or assist with personal care for
residents under direct supervision of the
licensed nurse
Productive Work Habits
• Male and female nursing assistants care
for both male and female residents
• Nursing assistants are expected to care for
any resident in a facility regardless of
cultural, personal or ethnic differences
Organizational Chart
• A diagram showing levels and lines of
authority in a long term care facility
– Line of responsibility include the nursing
assistant being responsible to the charge
nurse who may be an LPN or RN.
Describe Responsibilities of
NAR’s
• Getting the job
– Must complete NAR
course
– Must pass competency
exam
– Complete interview
process including
criminal background
check.
Examining a job description
• A job description is a
detailed listing of
tasks and
responsibilities
expected of the
nursing assistant.
• Review copy********
Responsibilities include job
limitations
• DO:
– provide personal care
– measure vital signs
– practice safety
measures
– practice infection
control measures
– practice effective
communications
– assist residents with
ADL’s
• DO NOT
– give medications
– take doctors orders
– perform procedures
requiring sterile
technique
– perform procedures
not taught
– perform tasks
prohibited by facility
Keeping your NAR job
• Keep nursing assistant registration current
– work at least 8 hours in a long term care
facility every two years providing nursing or
nursing related services for compensation.
– Complete continuing inservice education, a
minimum of 12 hours per year.
– Notify Nursing Assistant Registry of name or
address change
– Report employment to the Assistant Registry
EMPLOYER EXPECTATIONS
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Focus on resident
Be on time
Be flexible
Avoid absences
No drug or alcohol use
Prioritize duties
Report illnesses
Write a job description for your
“job” as a high school student
Include:
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Position
Qualifications
Summary
Exposure category: What are the risks??
Position Relationships
Responsibilities
Team work Concept
• The goal is to provide
the best care for the
residents with
cooperation of the
entire staff of the
facility
• The NAR is usually
assigned to a specific
group of residents to
provide continuity of
care
Describe team approach in
Health care
• Nursing Assistants
work with other staff
members to provide a
team approach in
caring for the
resident. All work
together, support
each other to achieve
resident goals.
Members of the Team
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Resident
nursing assistant
licensed nurses
activity staff
occupational
therapist
• physical therapist
• housekeeping staff
Team members
• Licensed social
workers
• family
• clergy
• doctor
• volunteers
• laundry staff
• maintenance staff
Describe the purpose of
Resident care Plans
• The Care Plan:
– Is a written plan designed for each resident
– Is developed in a care conference where the
resident and family is invited to participate.
The care plan is reviewed and updated
periodically.
– Has long and short term goals defined and who
is responsible for goal implementation.
• The Nursing Assistant
is responsible to know
the content of the care
plan. If you have
difficulty
understanding
anything in the care
plan, it’s YOUR
responsibility to ask
the charge nurse.
Observation Skills Required
• Use all your senses
when observing the
residents
– Listen to what the
residents says
– Look - observe
residents skin,
movements and
behaviors
– feel the residents skin
for warmth and texture
– Smell -changes in odor
It’s YOUR Responsibility to:
• Report accurately
• Record information
per facility policy
• Review copy of Care
plan/ assignment
sheet*********
Federal and State Regulations
related to Nursing Assistants
• OBRA 87 - In 1987 the Federal government
passed a law called the Omnibus
Reconciliation Act, which regulates the
education and registration of Nursing
Assistants.
• Federal Law also regulates care of
residents in long term care. Standards are
monitored by an annual survey process.
Ethics vs Etiquette
• Ethics are the rules and principles that
assist one to make decisions regarding
what is right and what is wrong.
• The Code of Ethics is a formal guideline that
governs the behavior of caregivers to
ensure the welfare of those individuals in
their care.
The Ethical Worker
– Promotes health, independence, safety and
quality of life for each resident.
– Respects the residents area as his/her home.
– Does not discuss personal problems with
resident and family
The Ethical worker
– Does not discuss facility issues with resident
and family.
– Does not share or discuss own personal
opinions regarding religious, political, cultural
beliefs or customs, or living or financial
conditions.
– Works within job description, know limitations
of job and self, seeks help, advice and
clarification when needed
The Ethical worker
• Maintains confidentiality
• Accepts no “tips” for service to the resident
• Accepts responsibility for job and own
behavior and
• Accepts constructive criticism and
suggestions graciously
Etiquette is:
• Good manners and maintaining a polite,
courteous, kind attitude to resident,
visitors, and other staff.
– Practice the “Golden Rule”. Do for others as
you would want done for you.
– Address others by preferred name.
– Knock on residents door before entering.
– Close door and privacy curtain.
– Ask family and visitors to leave when giving
personal care.
– Work quietly. Avoid unnecessary noise.
– Use respectful/appropriate language
– Never whisper outside a patients room.
Values
• The standards that assist one to make
decisions and guide ones behavior
– Personal values include:
– Culture, religion, education, rules, language,
lifestyle, belief systems.
Legal implications for Nursing
• Neglect: Failure to provide goods and
services necessary to avoid physical or
mental harm.
– Example: Failure to residents bed in low
position.
• Liability: Responsibilities according to law.
– Know standards of care & qualifications
Legal implications ( cont)
• Malpractice: Negligence is the basis for
mal practice.
– Court will decide
• Nursing assistants are responsible to work
within your job description and understand
legal guidelines.
THE BILL OF RIGHTS
• This Minnesota and
Federal law provides
nursing home
residents with the
same rights given to
all citizens.
Resident Bill of Rights
• This Federal law provides nursing home
residents with the same rights given to all
citizens.
– ALL MEMBERS of the health care team must
respect the Bill of Rights,
– Resident rights are preserved when the
nursing assistant uses skills which maintain
and protects the residents dignity
Residents have the right to:
• Be informed about
rights
• Exam state or Federal
survey reports
• Be accorded dignity in
personal
relationships with
staff.
• Be given in writing
their doctors name
and number
• Receive quality care
regardless of age,
race, color, ethnic
origin, religion,
marital status, sexual
preference or
handicap.
Residents have the right to:
• Receive
encouragement and
support in making
personal choices to
accommodate
individuals needs
• Be protected from
harm, both verbally
and physically
• Receive continuity of
care
• Refuse treatment
• Privacy during
procedures
• Be addressed by
name preferred
• Be informed of costs
and services
Residents have the right to:
• Confidentiality
maintained regarding
their medical
condition/care
• Be free from nontherapeutic chemical
and physical
restraints
• Wear their own
clothing, keep
personal possessions,
have own money
• Have family or
significant others
participate in care
conferences
• exercise citizenship
rights
Residents have the right to:
• Have assistance and
privacy in personal
communication
• Have personal
possessions treated
with respect and
safeguarded.
• Be informed of
diagnosis, treatment
alternatives and risks
• Be informed of
procedures in filing
complaints and
grievances
• Participate in
religious and political
activities
– Organize, maintain and
participate in resident
and family councils
• The residents Bill of Rights Must be posted
in an easy to see place in the long term
care facility.
• A copy of the Bill of Rights must be given to
all residents or guardians upon admission
to the facility,
Procedure to resolve grievances
• The Bill of Rights gives residents the right
to voice grievances without fear of reprisal.
• When conflicts occur between residents
the main concern is safety,
• Report information regarding conflicts
immediately to charge nurse.
• State ombudsman services assist the
residents to resolve conflicts with
facilities.
Minnesota Vulnerable Adult Law
• A Minnesota law which provides for
protection of adults considered vulnerable
due to physical, mental or emotional
impairment.
• Protects adults who cannot help
themselves if they are hurt or misused by
others,
Vulnerable Adult Act
• Provides for safe
institutions for
vulnerable adults who
have been abused.
• Investigates reports
of abuse or neglect
• Includes person age
18 and over living in a
licensed agency
Define abuse:
• Abuse is non-accidental harm or
threatened harm to a residents health or
welfare
– Physical abuse: Conduct that produces pain or
injury and is not an accident
– Verbal abuse: Repeated conduct that
produces mental or emotional stress
– Sexual abuse: Any sexual contact between
staff and resident or client of that facility.
Define Neglect and exploitation
• Neglect is failure to provide the vulnerable
adult with the necessary food, clothing,
shelter, healthcare or supervision.
• Exploitation is the illegal use of vulnerable
adults person or property through undue
influence, duress deception or fraud.
Absence of financial management that
through neglect might lead to exploitation.
ABUSE and NEGLECT
• Reported immediately. Follow facility
policy.
– Confidentiality of reporter is protected
– No reprisal or retaliation to reporter if done in
good faith,
• Persons who do not report are guilty of a
misdemeanor and liable for damages.
Facility responsibility
• Maintain written
policies and
procedures.
• Keep records of
incidents of self injury
or aggression
between residents.
• Develop individual
prevention plans
Patient Self Determination Act
• This is a 1991 federal law which requires
federally funded health care facilities to
inform residents about their right to make
treatment choices.
• Residents must be asked if they have a
living will or a durable power of attorney for
health care.
Institutionalized Care Vs Individual
• Institutionalized care
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Task oriented
Depersonalized
Fragmented
One size fits all
Little involvement in decisions by direct care
staff
Institutionalized Care
• Schedule driven
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Nourishment offered at specific times
Meal times are set by the facility
Bathing is done according to facility policy
Toileting is scheduled
Sleep and wake times are scheduled
Residents expected to adjust to routines
Institutionalized Care
• Residents become bored, lonely and
depressed
• Staff rotates, caring for different residents
• Direct care staff has little involvement in
decision making
Institutionalized vs individual
• Individualized care ( resident centered)
– Caregivers are consistent
– Care is focused on resident choices, interests,
needs, life style, preferences and abilities.
Individual Care
• Resident centered-resembles living at
home
– Food is accessible at all times
– Food is served family style
– mealtime, bed time, activities are resident
decisions
– Activities occur spontaneously in addition to
planned
Individual Care
• Decision making is done by resident and
those who work closest with them, with
residents directing decisions
• Direct care workers have:
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More autonomy
Deeper commitment to residents
Flexibility
Involvement in care planning
Terminology for resident centered
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Snacks vs nourishments
Home vs facility
Music vs, music therapy
Family room vs. resident lounge
Pantry vs. nourishment room
Goal is to provide homelike atmosphere
Resident Centered care
promotes:
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Smaller home-like setting
Higher quality of life
Individuality
Privacy
Choice
Dignity
Respect
Independence
Developing a resident centered
environment
• Talk to residents, family and friends
• Ask questions
• Learn what dreams/accomplishments were
left undone
• Ask of resident had membership in any
organization
• Involve other staff to help provide
stimulating environment
• Let resident do as much as possible
NA Role in Resident Centered Care
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Listen to the resident
Treat residents as adults at all times
Maintain dignity of resident
Adapt work schedule to resident needs
Get involved in decision making
Participate in care planning
Have a role in housekeeping, meal service
and recreation
• Never assume needs of resident
HOME HEALTH AIDE
UNIT ONE
Introduction to HHA
• GOALS:
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Discuss history and goals of Home care
Describe Home Health Care Team
Discuss Role of Home Health Aide
Discuss Ethics and Etiquette in Home Care
History and Goals of Home Care
• Most people received health care in their
homes until the early 1900’s. Then hospital
care became more popular and practical
due to advances in medicine.
– Family members cared for each other
– neighbors assisted with birth and death care
– Doctor visited people in their homes
History
• The home is returning as a place of choice
for health care.
– High cost of hospital care leads providers to
look for less costly alternatives.
– Fast growing elderly population may need
some care, but not all services of a hospital or
long term care facility.
– People prefer to be cared for in their homes.
Payment for Home Care services
• Provider coverage of health care services
is part of the decision where care will be
given.
– HMOs, health insurance companies and others
vary regarding their coverage of home care
costs.
– Coverage is usually for short term and
intermittent care
Payment sources:
– Medicare reimbursement requires the person
to be:
• confined to the home
• under the care of a doctor who certifies the need
for care
• needing skilled care
• receiving care from a Medicare certified home
health agency
Who receives home care?
• Newborn to people over 100 may receive
home care. Most fit into the following
groups.
– Chronically ill - have one or more chronic
conditions or disease and need assitance.
– Acutely ill - Need skilled care, sometimes high
tech for a short time.
– Terminal illness - death is expected.
– Developmentally/mentally disabled.
Referral Sources
• Hospital discharge planners identify needs
and evaluate sites for continuing care.
• Family members, friends, clergy, and others
often identify people at risk and need.
• Road to receiving home care is not always
straight or clear.
Goals of Home Care
• Assist to meet highest
physical and mental
function
• Provide service in
comfort of clients
home
• Promote client control
of health and lifestyle
• Encourage family
participation
Who is the Health Care Team?
• Home care services
are provided by an
expanding network of
community services.
– Home care agencies,
transportation
services, medical
equipment services,
public health services,
chore services, social
services &,senior
centers.
What does a case manager do?
• Case managers
assess the needs of a
client. They decide
and arrange services.
• Review care plans by
all team members and
assures client is
progressing
according to plan of
care.
What does a supervisor do?
• The supervisor makes the first assessment
visit to the client and directs client care.
• The supervisor makes periodic visits to
assess client and care being given.
• The supervisor instructs and supervises
the home health aide with client care.
The Supervisor is responsible to:
• Orient home health
aide to client and care
plan
• Instruct home health
aide regarding
specific duties
related to client care
• Instructs home health
aide on new
procedures
• Instructs HHA
regarding information
to be recorded and
reported
• Instructs HHA on
limitations of duties
• Provides HHA with
annual performance
evaluation
What is the role of the Home
Health Aide?
• HHA provide or assist client with ADL’s and
therapies according to care plan under the
supervision of the nursing supervisor or
case manager.
• A HHA will assist client with light
housekeeping tasks to assists client in
maintaining a clean safe environment.
Responsibilities of a HHA
• Complete combined nursing assistant/
home health aide course
• Complete state competency exam for
NA/HHA
• Complete additional training required by
agency such as first aid or CPR.
• Complete facility testing, evaluations and
required inservice training.
Home Health Aids
• Need to follow
agencies policies and
procedures
concerning
– personal hygiene
– Uniform and grooming
– transportation: use of
car for travel or to
travel between clients
Limitations of HHA
• Do not perform services for client unless
the agency has provided training.
• Do not perform sterile procedures
• Do not insert, remove or irrigate tubes
• Do not alter care plan without supervisors
approval
• Do not transport client or family unless
service is part of the plan of care.
Limitations of HHA’s
• Do not make financial transactions for
client
• HHA’s care for clients needs but does not
care for or assist entire family.
Important qualities of HHA
• Independent and
dependable worker
– There are no other
health care workers in
the home
– Well organized, uses
time wisely
– willing to follow
instructions
• Good problem solver
– Able to get the
facts,see the problem,
and make a decision.
• Flexible
– open to changing
hours and flexible
• Dependable
transportation
Qualities of HHA’s
• Good customer
service attitude
– Good communication
skills
• Adaptable
– Will have to adjust to
using skills in the
home environment
– will have to use a
variety of equipment
Ethics and Etiquette for HHA’s
• Schedules and activities follow the home
routine. HHA’s are guests in the clients
home.
• Cultural and religious practices will be
more evident in home vs public settings.
• Family members/significant others will
participate more in client care, respect
their role,