L. Ploom's chapter 1 and 2, quiz #1

1. Certified Nurse Aide Program

2. WELCOME TO MODULE ONE!

3. Chapter one • Understanding Healthcare Settings

4. Long Term Care (LTC) • Given in a nursing home or Long Term Care Facility (LTCF) for people who need 24 hour skilled care • Medical, nursing, dietary, recreational, rehab and social services are provided • Persons called residents • Typically older, disabled, living with CHRONIC illnesses or recovering from illness, surgery or injury • Chronic conditions that last a long period of time, even a lifetime- such as hypertension, arthritis, diabetes

5. skilled care provided by licensed professionals: therapists and nurses is medically necessary is available 24 hours a day

6. Hospice and terminal illness • Hospice care is given in facilities or homes for people who have approx. 6 months or less to live • Focus is on comfort and dying with dignity • A TERMINAL illness is one in which will eventually cause death

7. Assisted living residences (ALRs) • Personal care, support services, health care and activities in a home-like setting • Person has a room or apartment and help is given with meds, meals and personal care • Housekeeping, laundry, transportation and social services are met • Help with medication is offered • May be a part of a nursing home or a stand alone facility

8. Other types of healthcare settings • Adult day services- for those living in community, transported to a facility where meals are provided, social interaction is promoted • Home Health care • Acute care (hospital care) for ACUTE illnesses (a condition that comes on suddenly and last a short period of time, such as an asthma attack or a pneumonia • Subacute care-For persons who need less care than what is given in a hospital, but more than what is provided in LTCF; length of stay is shorter and person is discharged when stabilized or recovered • Rehab

9. The survey process • Inspections are done annually and anytime a need arises to ensure that a LTCF is following state and federal regulations • For approx. one week inspectors will observe day to day care, interview residents and staff, check documentation, observe meals, ensure that resident rights are being followed • If a problem is noted, a citation or deficiency is given and the facility must correct the problem in a timely manner; a fine may be levied

10. The Survey process • Do not be nervous when the surveyors are present, go about doing your job to the best of your abilities • If you do not have the answer to a question, be honest and tell the surveyor “I don’t know but I will find out right away” and follow up with the answer. • Always do your best; try to do the right thing everyday.

11. Paying for healthcare • Health maintenance organizations (HMOs) are managed care. Goal is to keep cost of healthcare down • Medicare (p. 7) is federal health insurance for those 65 and older and person living with certain disabilities • Medicaid is funded by government and each state; it is health care insurance for low income and people with disabilities • CMS (centers for Medicare and Medicaid) is a federal agency within the US Dept. of Health

12. POLICY VS PROCEDURE A POLICY IS A COURSE OF ACTION TAKEN EVERY TIME A CERTAIN SITUATION OCCURS SUCH AS CLOCKING IN AND OUT A PROCEDURE IS A METHOD OR WAY OF DOING SOMETHING SUCH AS HOW TO MAKE A BED EXAMPLES OF POLICIES INCLUDE FOLLOWING THE CARE PLAN, ONLY DOING WHAT IS APPROVED BY THE NURSE, REPORT OBSERVATIONS, DON’T ACCEPT TIPS, BE ON TIME

13. ORGANIZATIONAL CHART NURSING HOMES CAN BE PRIVATE OR A PART OF AN ORGANIZATION SUCH AS COMPLETE CARE OR GENESIS CAN BE OWNED BY NONPROFIT OR FOR-PROFIT COMPANIES THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, A FEDERAL AGENCY WITHIN THE DEPT OF HSS HELP TO PAY FOR HEALTHCARE. SEE PAGE 7

14. CHAIN OF COMMAND YOU CARRY OUT TASKS GIVEN TO YOU BY THE RN. THE NURSE IS ACTING ON INSTRUCTIONS GIVEN TO HER BY THE DOCTOR. THIS IS THE CHAIN OF COMMAND. IT DESCRIBES THE LINE OF AUTHORITY. IT PROTECTS YOU FROM LIABILITY (RESPONSIBILITY) SEE EXAMPLE, PAGE 7

15. Nursing department • DON is an RN • Nurse managers assist the DON • Shift managers or charge nurses coordinate resident care for a particular shift • Nurses also serve as staff development coordinator, infection control nurse and quality assurance nurse • Nurse educators oversee orientation of new hires, train NAs, provide in-services to meet state requirements and educate staff on new equipment and changing information

16. The nursing team • RN- 2 to 4 years of education; assess, make nursing diagnosis, plan and evaluate nursing care; carry out MD orders and delegate them to LPNs and Nas • LPN- 1 to 2 years of education; supervised by RN; may serve as treatment and medication nurse • NAs- minimum of 75 hours of education (90 hours in NJ); work giving basic nursing care under supervision of a licensed nurse

17. Therapists Physical- assists with mobility (movement) and use of muscles- give treatments, massages Occupational- assists with (re)learning Activites of Daily Living (or ADLs such as dressing, bathing, feeding, toileting, etc.) Speech- for talking and swallowing

18. Also…. • Dietician • Clergy • Social Worker • Pharmacist • Recreational Director • Resident (!)

19. Some of the doctors who may come to LTCF • Cardiologist- heart disease • Psychiatrist- mental health • Podiatrist- feet • Gerontologist- care of elderly (65 and older) 1

20. VIP of health care team • Resident • Resident’s family and significant others

21. Role of the Nursing Assistant • Bathing • Assisting with grooming • Ambulation • Assisting with exercises • Measuring vital signs • Transferring in and out of bed • Feeding • Keeping living areas neat and clean • Communication • Bedmaking

22. Professionalism • A professional behaves properly on the job • Has a positive attitude • Is polite and cheerful • Doesn’t discuss personal problems • Doesn’t use the phone for personal use while working • Doesn’t use profanity • Listens • Finishes tasks • Is neatly groomed and dressed • Is punctual • Is reliable • Is honest • Follows the chain of command

23. Some qualities of the NA • Compassion- caring, concerned, considerate • EMPATHY-able to identify with the feelings of others • Honest • Tactful- showing sensitivity and having a sense what it is appropriate when dealing with others to avoid offending • Conscientious- try to do your best and be guided by sense of right and wrong • Dependable • Patient • Respectful of other’s culture, race, religion

24. Personal grooming • Shower, use deodorant, brush teeth each day • Avoid heavy perfumes • Keep hair clean, off shoulders • Keep facial hair short • Clothes should fit well, shoes should be closed toe • No large jewelry • Wear ID badge and watch • Minimal makeup • Follow dress code of facility • Fingernails clean, short

25. VERY IMPORTANT YOUR GO TO PERSON IS THE NURSE DO NOT DISCUSS THE RESIDENT WITH CLERGY, DOCTORS, THERAPISTS, DIETICIAN SOCIAL WORKER, ETC UNLESS THEY ASK YOU SPECIFIC QUESTIONS IF A RESIDENT NEEDS TO SEE ONE OF THE TEAM MEMBERS, THE NURSE WILL MAKE THE REFERRAL!!!

26. SCOPE OF PRACTICE • Only do what is within your scope of practice, may vary from state to state • Always know and understand what you can and cannot do! • Cannot: • Give meds • Take orders from a doctor • Assist in sterile procedures, like surgery • Diagnose, prescribe treatment • Be in charge • Ignore a request • Tell a resident diagnosis (what is wrong with the person) • Insert or remove catheters or IV

27. The Care Plan • An individualized lists that team members should perform and how to carry them out • Developed by the RN who uses a process • There are 5 steps to the nursing process: ADPIE or • Assessment- what is the person’s health status • Diagnosis- what problems are noted • Planning-what are the goals for providing care • Implementation- how do we achieve the goals • Evaluation- did our implementations work?

28. THE NURSING PROCESS: ASSESSMENT NURSING DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION A-D-P-I-E

29. Care conferences • Held every 4 months • All team members invited as well as resident and family • Discuss how team can best meet the unique, individual needs of the resident

30. Delegation-to authorize another person to perform a nursing task in a certain situation • Only the RN can delegate • Five rights of delegation: • 1. right task • 2. right circumstances • 3. right person • 4. right directions and communications • 5. right supervision • ** ultimately, the person who delegated the task shares responsibility

31. A customer is the most important visitor on our premises, he is not dependent on us. We are dependent on him. He is not an interruption in our work. He is the purpose of it. He is not an outsider in our business. He is part of it. We are not doing him a favor by serving him. He is doing us a favor by giving us an opportunity to do so.Mahatma Gandhi

32. Legal and Ethical Issues • The resident rights are reviewed & signed during admission • If a person does not speak English, an interpreter must be made available • Residents have the right to information and can see their chart, bill, etc. • Can refuse treatment • Have the right to privacy- pull the curtain, close the door, cover the body • Have the right to confidentiality-don’t discuss with people not involved in resident’s care, in public settings, leave a chart open, walk away from an open computer screen • Personal choice • Personal possessions can be brought from home • Have the right to complain • To work or not (can clean, sew, make own bed)

33. Ethics • Knowing right and wrong • The ethical person has a sense of duty and responsibility toward others and tries to do right • Ethics tells a person what they SHOULD do • Laws tell a person what they MUST do

34. Some good ethical practices…. • Be honest • Protect residents’ privacy and confidentiality • Report any wrongdoing- abuse, neglect • Follow the care plan • Admit mistakes • Follow scope of practice guidelines • Follow rules of safety and infection control • Say no to gifts and tips • Don’t get personally involved with resident or his/her family

35. Omnibus Budget Reconciliation Act of 1987 • OBRA is a federal law that serves to improve the quality of life of nursing center residents • Sets minimum training and competency evaluation requirements at least 75 hours • Requires that CNAs be listed in nurse aide registry- includes addresses, aliases, DOB, last known employer (date of hire and termination), date competency test passed • Requires CNAs complete 12 hours of education programs/year

36. Resident rights • Have the right to be free from abuse, neglect and mistreatment • Have the right to a clean, safe environment • Have the right to send and receive unopened mail • Have the right to share a room if married • Have the right to be free from restraints • Have the right to participate in groups (form resident’s council, to discuss their life in facility) • Have the right to practice religion • Have the right to be treated with dignity and respect

37. Rights, continued…. • Have the right to private phone calls and visits • To exercise rights as a citizen • To choose his doctor • To be informed of roommate changes or room changes • to leave or to stay • To work or not to work in the home • To complain without fear • To choice • Right to refuse care

38. RESIDENTS CAN SEE THEIR CHART, THEIR BILL, BE GIVEN A WRITTEN COPY OF RIGHTS, BE INFORMED OF ROOM CHANGES, CONTINUE TO SEE OWN DOCTORS, HAVE PERSONAL POSSESSIONS, HAVE ACCESS TO SOCIAL SERVICES AND MANAGE THEIR OWN MONEY, HAVE THE RIGHT TO PARTICIPATE IN C INFORMED CONSENT: DOCTOR TELLS RESIDENT NAME OF CONDITION, WHAT CARE IS NEEDED- CAN REFUSE TREATMENT AND PARTICIPATION IN EXPERIMENTAL TREATMENTS

39. Protecting resident rights • Report abuse and neglect • Call resident by name, not honey or dear • Always explain what you are going to do FIRST • Don’t unnecessarily expose a resident during care • Knock, pause, enter • Protect resident property • Report observations to nurse • Allow resident choices • Respect refusal of care

40. Legal aspects • Torts: a wrong committed against a person or their property; can be intentional or unintentional • Negligence- unintentional- failing to do what is proper and expected- can be active or passive • Malpractice-neglect by a professional • Slander-making false statements orally that injure a person’s name and reputation • Libel- making false statements in print or with pictures

41. Legal offenses cont…. • False imprisonment- restraining without a MD order • Battery- touching without permission • Assault- threatening or attempting to touch without permission • Involuntary seclusion- separating a resident from others

42. Abuse • Intentional harm to another • Can be physical, verbal, mental, sexual, financial • If you see it, stop it then report • If you suspect it, report it to your nurse

43. Ombudsman • A person who supports or promotes the needs of residents • Advocates on their behalf to solve grievances and disputes • Monitors nursing home conditions • May report to DOH • Name, address, and phone number is posted in facility • NOT AN EMPLOYEE OF FACILITY, IN NJ A VOLUNTEER POSITION

44. Confidentiality vs Privacy • Confidentiality protect the residents’ personal information • The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires that healthcare providers only discuss resident care with those directly involved in the care • Protected health info includes health and mental conditions, address, phone, email, medical record number • HITECH (p. 31) was created to protect electronically transmitted info • IF YOU SEE A RESIDENT OR FAMILY OUTSIDE OF WORK, BE CAREFUL HOW YOU GREET • USE CONFIDENTIAL ROOMS FOR REPORT

45. Privacy • Protects the body from exposure • Only expose the area you are bathing during a bath • Close privacy curtain and door • Knock even if the door is open • Never give personal care in a common area

46. Advance directives • Legal document that allows person to decide what medical kind of care they wish to receive in the event they cannot make decisions themselves

47. Do Not Resuscitate (DNR) • A legal document that helps the doctor honor a person’s wishes regarding healthcare • If a DNR is in effect and the heart stops or breathing stops, no CPR will be performed

48. Harrassment • Troubling, tormenting someone with behavior or comments • Be careful what you say, even innocent comments can be taken the wrong way • Report to HR, Unit manager

49. Wills • Legal document of how a person wants property distributed after death • Do not witness, politely refuse • Report request to the RN

50. The chart Legal document- can be viewed by insurance, lawyers. Use black ink document after care (immediately) Date, time, sign all entries If an error is made- draw one line and initial the mistake only document the care you have given know 24 hour clock