Transcript TOC - Instructor`s Corner

Nurse Assistant Training
Introduction to the Course
Welcome
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Introductions
Facility policies and procedures
Facility layout
Emergency contact information
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Student Handout I-1: Find Someone Who…
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Has three children
Doodles when talking on the phone
Knows someone who uses a wheelchair
Has an older brother
Would like to be oldest
Would like to be youngest
Knows what range-of-motion exercises are
Sleeps with two pillows
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Student Handout I-1: Find Someone Who…
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Feels nervous about being a nurse assistant
Participated in natural childbirth
Knows first aid for choking
Has stayed in a hospital for several days
Knows someone over 80 years old
Has lost a parent
Likes to sing
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Course Overview and Materials
 Instructor’s role
 Textbook
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Goals and key terms
Case studies
Figures, boxes and tables
Special features
Skill sheets
Questions for review; questions to ask yourself
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Course Requirements
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Classroom instruction
Skills practice
Clinical practicum
Expectations of students
Ground rules
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Nurse Assistant Training
Unit 1: THE ART OF CAREGIVING
UNIT 1 CONTENTS
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Lesson 1: Being a Nurse Assistant
Lesson 2: Working in the Health Care System
Lesson 3: Understanding Legal and Ethical
Aspects of Health Care
Lesson 4: Understanding the People in Our Care
Lesson 5: Communicating with People
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LESSON
1
Being a Nurse Assistant
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What Is a Nurse Assistant?
 Works under the supervision of a licensed registered
nurse (RN) or licensed practical nurse (LPN)
 Provides basic nursing care
 Addresses the whole person
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Responsibilities
 Assisting with activities of daily
living
 Obtaining routine
measurements
 Assisting with admissions,
transfers and discharges
 Maintaining a safe, clean
environment
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Requirements
 Completion of state-approved training course
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Classroom learning
Hands-on skill practice
Clinical practicum
 Successful completion of state’s certification examination
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Multiple choice written examination
Skills test
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Health Care Team
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Person receiving care—“captain” of the team
Person’s family members
Staff members
Other professionals
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Health Care Team Continued
 Nursing team
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Licensed nurse
Nurse assistant
Other members, such as advanced practice nurse, nurse
practitioner
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Scope of Practice
 Tasks legally permitted to do
 State- and employer-defined
 Tasks usually outside the nurse assistant’s scope of
practice:
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Supervising/delegating nursing responsibilities to other nurse
assistants
Analyzing or interpreting data
Receiving verbal orders
Diagnosing illness
Administering medications and oxygen
Inserting/removing medical equipment
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The Art of Caregiving
 Skills performed with kindness, empathy and
compassion
 Getting the job done versus providing quality care
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The Art of Caregiving Continued
 Five principles of care
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Safety
Dignity
Independence
Privacy
Communication
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Professionalism
 Person with training and knowledge to perform a
certain role
 Positive attitude toward the job
 Performance to the best of one’s ability at all times
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Professionalism Continued
 Actions promoting professionalism:
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Dependability
Accountability
Integrity
Conscientiousness
Courtesy
Stewardship
Willingness to help
Ability to communicate
Ability to problem solve
 Professional appearance
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LESSON
Working in the
Health Care System
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Health Care Settings
 Acute care settings such
as hospitals
 Sub-acute care settings
Top image © Monkey Business Images 2012.
Used under license from Shutterstock.com
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Health Care Settings Continued
 Long-term care settings
such as nursing homes and
assisted-living facilities
 Home settings
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Payment for Health Care
 Personal earnings or savings
 Health insurance
 Government programs
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Medicare: people over age 65
Medicaid: people with low incomes
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Protection of Health Care Recipients
 Regulations and agencies in existence to define
standards of quality and ensure care provided meets
standards
 Patients, residents and clients have certain rights:
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Right to competent care delivered with respect
Right to know the kind of care they will receive and its cost
Right to participate in decisions made about care and who will
provide it
Right to confidentiality and privacy
Right to be free from restraints and abuse
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Protection of Health Care Recipients Continued
 Nurse assistant plays a major role in ensuring rights are
upheld
 Five principles of care: one way to ensure respect for the
person’s rights
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Protection of Health Care Recipients Continued
 OBRA legislation: standards for staffing and operations
for nursing homes receiving federal funding
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Comfortable and fulfilling lifestyle
Promotion of physical, mental, emotional and spiritual well-being
Training requirements for nurse assistants
Facility’s physical environment
Basic rights of nursing home residents
Routine inspections—surveys
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Protection of Health Care Recipients Continued
 Ombudsman programs:
volunteers advocating for
nursing home residents
and family members to
resolve problems related
to quality of care
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Protection of Health Care Recipients Continued
 Government oversight: federal, state and local
governments involved in establishing regulations and
monitoring quality of care; standard setting
 Accrediting organizations: professional organizations
and nongovernmental organizations working to ensure
quality health care; for example, The Joint Commission
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Protection of Health Care Workers
 Occupational Safety and Health Administration (OSHA):
government agency that protects workers in all industries
from on-the-job injuries
 Standards for employers to follow to protect employees
from hazards:
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Prevention of employee exposure to harmful substances and
chemicals
Provision of equipment and environmental standards for
employee safety
Training to ensure employee safety
Monitoring of hazards with record-keeping of workplace injuries
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Understanding Legal and Ethical
Aspects of Health Care
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LESSON
3
Introduction
 Decisions about behavior made every day
 Some behaviors guided by laws
 Others guided by ethics
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Patient Self-Determination Act
 The right of the person to make decisions about care
 Right to accept or refuse care
 Right to develop advance directives
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Patient Self-Determination Act Continued
 Informed consent required before any treatment or
procedure
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Thorough understanding of benefits and risks of proposed
treatment or procedure
Explanation of why treatment or procedure being done
Review of the risks
Explanation of risks if person decides not to have treatment or
procedure
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Patient Self-Determination Act Continued
 Signature on a document indicating consent
 Person has the right to withdraw consent at any time and
refuse treatment or procedure
 Nurse assistant responsible for obtaining verbal consent
before providing care, not written consent
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Patient Self-Determination Act Continued
 Advance directives: legal documents stating how person
wants health care decisions made if unable to make or
communicate decisions independently in the future
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Durable power of attorney—responsibility for decisions on
person’s behalf given to someone else
Living will—specific directions about steps to take or not take to
prolong a person’s life when death seems near
Health care facilities and agencies required to teach people
about the purpose of advance directives and assist in putting
them in place
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Health Insurance Portability and Accountability
Act (HIPAA)
 Legal right to have medical information kept secure and
private
 Specifies who can look at and receive information about
a person’s health status and care
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Health Insurance Portability and Accountability
Act (HIPAA) Continued
 Nurse assistants responsible for protecting this right
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Sharing information only with those needing to know or directly
involved in person’s care
Avoiding conversations in places where information can be
overheard
Never discussing person’s condition or care in casual
conversations with others
Securing tools used for documentation per employer’s policy
Following employer’s policies and procedures about handling
and securing private information
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Behaviors Resulting in Legal or Disciplinary
Action
 Certain behaviors could result in legal or disciplinary
action
 Consequences ranging from employer disciplinary action
to loss of job to criminal prosecution
 Consequences may be recorded on nurse assistant’s
record in state registry
 Negative impact on ability to get another job in health
care
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Behaviors Resulting in Legal or Disciplinary
Action Continued
 Abuse: willful infliction of injury or harm
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Many forms: actively doing something to harm another person or
failing to provide necessary care
• Physical abuse: deliberately hurting another person’s body
• Emotional abuse: degrading, belittling or threatening another
• Sexual abuse: forcing the person to take part in sexual activity of
any kind
• Financial exploitation: taking or misusing another person’s money or
assets
• Neglect: failing to provide for a dependent person’s basic needs
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Behaviors Resulting in Legal or Disciplinary
Action Continued
 Abuse continued
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Anyone can be a victim of abuse; anyone can be an abuser
Never acceptable behavior
 Nurse assistant legally responsible for reporting concern
of abuse to supervisor or another person based on
employer policy
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Behaviors Resulting in Legal or Disciplinary
Action Continued
 Assault and battery
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Assault: action causing a person to fear being touched in a
harmful or unwelcome way
Battery: actual touching of another in a harmful or unwelcome
way
• Hitting, pinching, slapping
• Inappropriate use of restraints
• Beginning a procedure without person’s verbal consent
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Behaviors Resulting in Legal or Disciplinary
Action Continued
 Negligence
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Failure to do what a “reasonable and careful” person would be
expected to do in a given situation
Example: nurse assistant performs a task not trained to do
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Behaviors Resulting in Legal or Disciplinary
Action Continued
 Fraud and larceny
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Fraud: lying to gain profit or advantage, such as Medicare fraud
Larceny: theft
 Accurate and honest documentation as a safeguard
against fraud
 Prompt reporting of a person’s missing items or of
seeing someone take a person’s belongings to help
prevent larceny
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Ethical Behavior
 Actions guided by knowledge of what is right or what is
good or moral
 Five ethical principles important in health care:
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Autonomy: right to make decisions
Justice: fair and equal treatment
Beneficence: actions to promote well-being
Nonmaleficence: avoidance of harm
Fidelity: truthfulness and trustworthiness
 Ethical dilemmas: situations involving more than one
good or moral solution
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Ethical Behavior Continued
 Guidelines
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Practice the five principles of care
Know the rights of people receiving care
Be aware of legislation protecting persons’ rights
Familiarize self with employer’s policies and procedures and
scope of practice
Avoid tasks or decisions outside the scope of practice
Refrain from accepting gifts or money
Seek help from supervisor if unsure
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Ethical Behavior Continued
Scenario 1
Miss A. needs to go to the bathroom three or four times
each night. She feels that if she tips the night staff, they will
answer her call signal faster and she won’t have to worry
about wetting the bed. Mr. W., a nurse assistant who has
just been hired, goes into Miss A.’s room for the first time to
help her to the bathroom. Miss A. offers him money. What
should he do?
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Ethical Behavior Continued
Scenario 2
Mr. S. continually calls Ms. L., a nurse assistant, abusive
names. He tells her she can’t do anything right and he
wishes she would leave him alone to die. Ms. L. is tempted
to do just that. What should she do?
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Ethical Behavior Continued
Scenario 3
You and a few other nurse assistants are eating lunch
together in the dining room. You begin to tell your friends
about your unpleasant experience with Mrs. T. As you are
telling them about Mrs. T.’s angry outburst, the visitors at the
next table interrupt and ask whether you are talking about
that sweet little lady in Room 106. What should you do?
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Ethical Behavior Continued
Scenario 4
Mr. P.’s family has gathered in the waiting room. You
overhear them discussing whether or not to tell Mr. P. about
the car crash his grandson was in yesterday. They are
afraid that the shock of hearing his grandson is in a coma
will be too great and that his condition might get worse.
Later, as you are helping him get ready for bed, Mr. P.
begins talking to you about his grandson. You realize that
the family has not told him about the crash. You believe
that it’s not fair to withhold information like that. You
certainly would be upset if no one told you about something
so important. What should you do?
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LESSON
Understanding the People
in Our Care
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Introduction
 Each person is unique
 However, we all share some common experiences and
needs
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Human Growth and Development
 Human growth: physical changes
 Human development: social, emotional and cognitive
changes
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Human Growth and Development Continued
 Common stages
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Infancy (birth to 1 year)
Toddlerhood (1 to 3 years)
Preschool (3 to 5 years)
School age (5 to 12 years)
Adolescence (12 to 20 years)
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Human Growth and Development Continued
 Common stages
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Young adult years (20 to 45 years)
Middle adult years (45 to 65 years)
Young-old years (65 to 75 years)
Middle-old years (75 to 85 years)
Old-old years (85 years and beyond)
 Age as a common point of reference but important not to
confuse ages with stages
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Maslow’s Hierarchy of Human Needs
 Five levels of needs
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Physical: basic requirements
for life
Safety and security: being and
feeling safe
Social: feelings of being liked,
loved and accepted
Self-esteem: feeling good
about self and worthy of
others’ respect
Self-fulfillment: satisfaction
with self and with life
 Lower-level needs must be
met before meeting higherlevel needs
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Sexuality and Intimacy
 All persons as sexual beings with a need for sexual
expression
 Sexuality: perception and expression of self sexually
 Sexual behaviors: physical activities for obtaining sexual
pleasure and reproducing
 Gender identity: person's inner sense of being male or
female
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Transgender individuals
Transsexual individuals
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Sexuality and Intimacy Continued
 Sexual identity: person’s sexual orientation and
preferences for sexual partners
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Heterosexual individuals
Homosexual individuals
Bisexual individuals
 Intimacy: need and ability to feel emotionally close to
another human being and have that closeness returned
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Sexuality and Intimacy Continued
 Sexual behaviors: activities to derive sexual pleasure or
to reproduce
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Sexual intercourse
Masturbation
 Nurse assistant’s responsibilities
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Respect for the right of the person to engage in sexual behaviors
and provision of privacy
Protection of those in your care from unwanted sexual advances
Protection of self from unwanted sexual advances
Care not to misread something possibly looking like sexual
attraction
Nonjudgmental approach for people whose feelings and beliefs
differ from own
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Culture
 Shared set of beliefs, values, customs and practices
characterizing a group or society
 Influence on behavior and preferences such as:
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Food intake, preparation and serving
Personal care rituals
Acceptable caregivers
Acceptable types of touch
Acceptable eye contact
Social customs
Management and treatment of illnesses
Rituals before and after birth or death
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Culture Continued
 Nurse assistant responsible for respecting person’s
preferences based on culture
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Spirituality
 Belief in something greater than oneself that helps give
meaning and purpose to life
 Organized religion closely linked to spirituality
 Possible to be spiritual without participating in a formal,
organized religion
 Strong sense of spirituality as a means to strengthen
coping
 Nurse assistant’s role—support for and fostering of
person’s sense of spirituality
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LESSON
5
Communicating with People
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Introduction
 Communication: process of giving and receiving
information
 Essential for providing quality care
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Communication Basics
 Communication model
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Sender: providing information
Receiver: person to whom information is sent
Message: information
Confirmation: receiver's acknowledgment of receipt of message
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Communication Basics Continued
 Communication methods
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Verbal: spoken and written language
Nonverbal: body language
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Communication Basics Continued
 Strategies for effective communication
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Be clear in message.
Provide and seek confirmation.
Actively participate in conversation.
Be aware of nonverbal messages.
Remember importance of touch.
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Communicating with Those Receiving Care
 Communicating with those who are visually impaired
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Knock first to avoid startling person.
Stand where person can see you.
Call person by name.
Describe person’s surroundings, people and/or events.
Describe each skill step while doing it, including equipment used.
Encourage person to hold your arm just above the elbow when
helping person move around.
Describe where you are going, including items in the path.
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Communicating with Those Receiving Care
Continued
 Communicating with those who are hearing impaired
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Learn what the person can and cannot hear.
Encourage use of hearing aid if the person has one. Check to
make sure it is working properly.
Approach person from the front, gently touching person on hand
or arm to gain attention.
Position self near ear that provides clearer hearing.
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Communicating with Those Receiving Care
Continued
 Communicating with those who are hearing impaired
continued
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Position self so person can see your mouth and facial
expressions.
Change words, not volume, if person seems not to understand.
Use gestures.
Ask for confirmation for important information.
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Communicating with Those Receiving Care
Continued
 Communicating about difficult topics
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Keep lines of communication open.
Show person you care about his or her feelings.
Stop what you are doing and pay full attention, making eye
contact.
Encourage person to talk by asking questions, focusing on what
person is telling you, or confirm the message by repeating it in
your own words.
Involve other health care team members if person needs
answers.
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Communicating with Those Receiving Care
Continued
 Teaching and reinforcing
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Reinforce information person has already been given.
Teach the person how to do things within your scope of practice.
Report person’s need for more information to the nurse.
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Communicating with Family Members
 Nurse assistants often the first member of the health
care team that family members ask for information
 Manner of communicating with family members
contributes to the overall impression of care their loved
one is receiving
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Explain your role in providing care.
Build a relationship with the family.
Welcome their input and feedback.
If family voices a concern or complaint, respond professionally
and attempt to see a solution.
• Avoid becoming angry or defensive.
• Use communication skills to gain a full understanding of their
concern.
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Communicating with Other Health Care Team
Members
 Effective communication among members of the health
care team necessary for coordinated, high-quality care
 Knowledge of how to report and record information a
necessity
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Communicating with Other Health Care Team
Members Continued
 Medical words and abbreviations important in
communicating with other health care team members
 Medical words often long and complex; breaking words
into smaller parts often easier
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Root: foundation of the word
Prefix: before the word to make it specific
Suffix: at the end of the word to make it specific
Combining vowel: between root and suffix to ease pronunciation
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Communicating with Other Health Care Team
Members Continued
 Use of abbreviations for more efficient communication
(saving time and space)
 Only use abbreviations approved by employer
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Communicating with Other Health Care Team
Members Continued
 Reporting: verbal exchange of information between team
members
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Routinely at change of shift
Throughout the shift when person’s condition changes
 Reporting to the supervising nurse before and after care
is provided and any time nurse assistant determines it is
necessary
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Communicating with Other Health Care Team
Members Continued
 Reporting of observations
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Objective: directly obtained using one of five senses
Subjective: not detected by one of five senses or measured with
equipment, such as person stating he did not sleep well
 Decision as to what to report: any time there is a change
 Rule of thumb: when in doubt, report
 Accurate details with a focus on the facts is important
when reporting observations
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Communicating with Other Health Care Team
Members Continued
 Recording: written exchange of information between
team members
 Use of various forms within the person’s medical record
 Three important forms:
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Care plan
Flow sheet
Nursing notes
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Communicating with Other Health Care Team
Members Continued
 Accuracy essential
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Medical record a legal document that could be used if a legal
problem arises
Other health care team members relying on documentation to
evaluate person’s condition and make decisions
Required for facility to receive payment for services provided
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Communicating with Other Health Care Team
Members Continued
 Guidelines for recording
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Date, time, initials or signature for every entry
Information recorded in the correct person’s medical record
Proper terminology and abbreviations
Facts
Black ink
Employer’s policy for correcting mistakes—NO erasures
Only care provided or observations made
 Key to remember: care not recorded is considered care
not provided
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Communicating with Other Health Care Team
Members Continued
 Telephone use
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Be professional
Identify self on answering
Be courteous, speaking slowly and clearly in a pleasant tone
Take accurate messages
Respect privacy
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