Transcript CNA Unit_2x

Unit 2
On the Job:
Being a Nursing
Assistant
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Objectives
• Spell and define terms.
• Identify the members of the
interdisciplinary health care team and
the nursing team.
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or duplicated, or posted to a publicly accessible website, in whole or in part.
2
Objectives
• List the job responsibilities of the
nursing assistant, explain how the
Nurse Practice Act affects nursing
assistant practice, and discuss the
importance of working within the
established scope of nursing assistant
practice.
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or duplicated, or posted to a publicly accessible website, in whole or in part.
3
Objectives
• List the federal requirements for nursing
assistants working in long-term care
facilities.
• State the purpose of evidence-based
practice.
• Identify common nursing care delivery
systems and briefly describe each.
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or duplicated, or posted to a publicly accessible website, in whole or in part.
4
Objectives
• Describe your facility’s lines of authority
and discuss the five rights of delegation.
• Explain why good time management is
a key to successful nursing assistant
success and describe methods of
organizing assignments to make the
best use of your time.
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or duplicated, or posted to a publicly accessible website, in whole or in part.
5
Objectives
• Describe the importance of good human
relationships and list ways of building
good relationships with patients,
families, and staff.
• Discuss professionalism and explain
why projecting a professional image is
important.
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6
Objectives
• List the rules of personal hygiene and
appropriate dress.
• Describe ways to prevent physical
illness and relieve stress, and the
importance of a healthy mental attitude.
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7
Interdisciplinary Health Care Team
•
•
•
•
•
Patient
Members of patient’s family
Physician
Nursing team
Other specialists
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8
The Nursing Team
• The nursing team consists of:
– Registered nurses
– Licensed practical (or vocational) nurses
– Nursing assistants
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9
The Nursing Team
• The nursing team provides skilled
nursing care
• RNs plan and direct nursing care in
cooperation with the physician’s orders
• All members of the team provide direct
patient care
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10
Regulation of Nursing Assistant
Practice
• Legislatures write laws (statutes) that
determine the scope of practice.
• State regulatory agencies write
regulations (rules) based on laws.
• Rules set standards of conduct and are
much more specific than laws because
they determine how laws will be applied.
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or duplicated, or posted to a publicly accessible website, in whole or in part.
11
Regulation of NA Practice
• Omnibus Budget Reconciliation Act
(OBRA)
– 1987 federal law regulating the education
and certification of nurse aides
• Nurse Aide Competency Evaluation
Program (NACEP)
– Minimum training standards for nurse aides
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12
OBRA
• Gives nursing assistants recognition
through registration
• Helps define the scope of nursing
assistant practice
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or duplicated, or posted to a publicly accessible website, in whole or in part.
13
OBRA
• Provides better uniformity in care
provided by nursing assistants
• Promotes educational standards for
nursing assistants
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14
Nurse Practice Act
• A state board of nursing regulates
nursing practice and determines the
scope of practice, or skills the nursing
assistant is legally permitted to carry
out.
• Always stay within your state’s scope of
practice.
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15
Professionalism
• Professionalism is the grooming and
appearance, skill, good judgment, and
polite behavior that is expected from a
person who is trained to do a job well.
• Be neat and clean, and follow the dress
code.
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or duplicated, or posted to a publicly accessible website, in whole or in part.
16
Evidence-Based Practice (EBP)
• Evidence-based practice (EBP) guides
decision making by identifying evidence
for a practice, then rating the activity
according to the strength of the
evidence.
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17
Organization of Nursing Care
• Each facility selects a method of
providing nursing care and determines
job duties.
• The nursing assistant has a functional
role in each delivery system.
• The nursing care delivery system
describes how care is organized in the
facility.
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18
Organization of Nursing Care
•
•
•
•
•
Primary nursing
Functional nursing
Team nursing
Partners in practice
Nursing assistant has a functional role
in each
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19
Primary Nursing
• Care is given by an RN
– Responsible for a patient’s care during that
patient’s entire hospitalization
• Licensed staff and assistants help when
an RN is not on duty
• RN is responsible for six to eight
patients
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20
Functional Nursing
• Task-oriented way to organize care
service
• Charge nurse responsible for all
patients
• Others are assigned specific tasks
– Medications, administering treatments, or
providing hygienic care
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21
Team Nursing
• A team leader (usually an RN)
– Determines nursing needs of patients
• Team members receive assignments
– From and report to the team leader
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22
Team Nursing
• Team nursing is successful when
members:
– Understand the philosophy, purposes, and
goals of restorative nursing
– Understand their responsibilities
– Attend the care plan conference
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23
Partners in Practice
• RN or a primary nurse
– Partnered with a nursing assistant or other
team member
• Team members
– Work together to meet the needs of their
assigned patients
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24
Partners in Practice
• Method combines positive aspects of
team and primary nursing into the
partnership model
• In some facilities:
– Team members work on same schedule
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25
Case Management
• The case manager helps identify
services, providers, and facilities
needed by the patient and ensures that
resources are used in a timely and costeffective manner.
• The case manager advocates for the
patient and works to achieve the best
possible outcomes.
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26
Progressive Patient Care
• The patient moves from one unit to the
next as her health needs change.
• This system may be difficult and
confusing for the patient.
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27
Patient-Focused Care
• Patient is focus of service
• Goals
– Limit number of people involved in patient
care
– Contain costs
– Meet patients’ needs efficiently
• Staff members are cross-trained
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28
Teamwork
• Successful alternative models of care
are effective because they:
– Promote cooperation and teamwork
– Provide opportunities for growth
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29
Teamwork
• Learning to work with others as a
member of a team
– One of the most important skills to master
during your nursing assistant education
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30
Lines of Authority
• Learn your role and line of authority
within your facility
• Refer to Figure 2-4
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31
Lines of Authority
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32
Delegation
• Delegation is the transfer of
responsibility for carrying out a nursing
activity from a nurse to someone who
does not already have the authority.
• The nurse practice act describes how
nurses assign or delegate duties.
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33
5 Rights of Delegation
•
•
•
•
•
Right task
Right circumstances
Right person
Right direction and communication
Right supervision
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34
Delegation
• You may refuse the delegation:
– If you believe that a procedure is not within
your scope of practice
– If you have not been taught to do the task
– If you believe that the activity will harm the
patient
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35
Managing an Assignment
• Report
• Patients you are assigned to care for,
information, needs
• Make rounds, make a plan
• Organize time
• Continue making rounds throughout
your shift
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or duplicated, or posted to a publicly accessible website, in whole or in part.
36
Managing an Assignment
• Set priorities and deadlines
• Accept that priorities may change
• Help others
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37
Handoff Communication
• Occurs when responsibility for a patient
changes from one person to another.
• Vulnerable time for the patient and is
one of the places where errors are most
likely to occur.
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or duplicated, or posted to a publicly accessible website, in whole or in part.
38
Hand-off Communication
• Report:
– Situation and background
– Observations, findings, changes,
abnormalities
– Safety issues, high-risk conditions,
concerns
– Recommendations and special
orders
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or duplicated, or posted to a publicly accessible website, in whole or in part.
39
Guidelines for the Nursing
Assistant
• Only perform tasks you have been
trained to do
• Seek higher authority when necessary
• Know your scope of practice
– Live by it
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or duplicated, or posted to a publicly accessible website, in whole or in part.
40
Roles and Responsibilities
• Nursing assistant works directly with the
patient
– Provides physical care and emotional
support
• Nursing assistant’s specific duties
– Vary depending on his or her workplace
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or duplicated, or posted to a publicly accessible website, in whole or in part.
41
Personal Vocational Adjustments
• Nursing assistant must be:
–
–
–
–
Willing to learn and grow
Dependable
Respectful of his or her co-workers
Empathetic, patient, and tactful with others
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or duplicated, or posted to a publicly accessible website, in whole or in part.
42
Interpersonal Relationships
• Interactions between people
• Patients and staff
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43
Attitude
• Single most important characteristic you
bring to your job
• Developed throughout your lifetime
• Shaped by your experiences
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or duplicated, or posted to a publicly accessible website, in whole or in part.
44
Attitude
• Should reflect:
–
–
–
–
–
–
–
Caring
Courtesy
Cooperation
Emotional control
Empathy
Tact
Patience
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45
Patient Relationships
• All patients are different
• You should meet patients’ varying
needs
• You should meet families’ needs
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46
Adapting to Change
• Learn all you can about the change and
your responsibilities
• Try to understand the need for and
value of the change
• Find ways to adapt to and
accommodate the change
• Try to be open-minded and flexible
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47
Change
• Be a team player
• Adjust your attitude
– Look forward to the change
• Keep your sense of humor
– Make change fun
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48
Change
• Compensate for stress and pressure
– Make time for activities you enjoy when
you are off duty
• View change as an opportunity for
growth
• Change is inevitable
– But growth is optional
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49
Staff Relationships
• All health care workers share a single
goal:
– To help the patient
• There is much you can do to help
accomplish this goal
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50
Personal Health and Hygiene
• Your uniform should be appropriate,
clean, and neat
• You should wear an appropriate
identification tag
• Refer to Figure 2-10
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51
Personal Health and Hygiene
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52
Reducing Stress
•
•
•
•
Get sufficient rest
Practice good nutritional habits
Participate in satisfying leisure activities
Participate in stress-reducing activities
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or duplicated, or posted to a publicly accessible website, in whole or in part.
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