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Nursing Assistant Course Upon completion of this course, students are eligible for the Minnesota Nursing Assistant Competency Exam. Completion of course.

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Presentation on theme: "Nursing Assistant Course Upon completion of this course, students are eligible for the Minnesota Nursing Assistant Competency Exam. Completion of course."— Presentation transcript:

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2 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.

3 Unit One Introduction to Nursing Assistant/ Home Health Aide

4 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

5 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.

6 List Personal Qualifications of Nursing Assistants Behavior: –Honest - will not lie –Patient- self controlled –Caring- feel concern –Courteous - polite/respectful –Dependable - reliable –Sensitive - responsive –Accountable for actions/manage assignments

7 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

8 Personal Health –good general health –free from back injury or problems with lifting –good personal hygiene, grooming –clean neat appearance –practice stress reducing exercises

9 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 Male and female nursing assistants care for both male and female residents Nursing assistants are expected to care for any resident in a facility

10 Define 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.

11 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

12 Describe Responsibilities of NAR’s Getting the job –Must complete NAR course –Must pass competency exam –Complete interview process including criminal background check.

13 Examining a job description A job description is a detailed listing of tasks and responsibilities expected of the nursing assistant. Review copy********

14 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

15 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. Practice attribute listed in personal qualifications

16 EMPLOYER EXPECTATIONS Focus on resident Be on time Be flexible Avoid absences No drug or alcohol use Prioritize duties

17 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.

18 Members of the Team Resident nursing assistant licensed nurses activity staff occupational therapist physical therapist housekeeping staff

19 Team members Licensed social workers family clergy doctor volunteers laundry staff maintenance staff

20 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.

21 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.

22 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

23 It’s YOUR Responsibility to: Report accurately Record information per facility policy Review copy of Care plan/ assignment sheet*********

24 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.

25 Ethics vs Etiquette Ethics is a moral code (knowing right/ wrong) which guides the behavior of health care workers. An ethical worker is one who: –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

26 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

27 The Ethical worker Maintains confidentiality Accepts no “tips” for service to the resident Accepts responsibility for job and own behavior and is willing to accept constructive criticism and suggestions graciously

28 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.

29 –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.

30 Values The standards that assist one to make decisions and guide ones behavior –Personal values include: –Culture, religion, education, rules, language, lifestyle, belief systems.

31 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

32 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.

33 THE BILL OF RIGHTS This Minnesota and Federal law provides nursing home residents with the same rights given to all citizens.

34 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

35 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.

36 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

37 Residents have the right to: Confidentiality maintained regarding their medical condition/care Be free from non- therapeutic 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

38 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

39 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,

40 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.

41 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,

42 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

43 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.

44 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.

45 ABUSE 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.

46 Facility responsibility Maintain written policies and procedures. Keep records of incidents of self injury or aggression between residents. Develop individual prevention plans

47 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.

48 Institutionalized Care Vs Individual Institutionalized care –Task oriented –Depersonalized –Fragmented –Schedule driven –One size fits alls –Little ivolvement in decisions by direct care staff

49 Institutionalized vs individual Individualized care ( resident centered) –Caregivers are consistent –Care is focused on resident choices, interests, needs, life style, preferences and abilities. –Food, mealtime, bed time, activities are resident decisions.

50 Terminology for resident centered 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

51 HOME HEALTH AIDE UNIT ONE

52 Introduction to HHA GOALS: –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

53 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

54 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.

55 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

56 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

57 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.

58 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.

59 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

60 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.

61 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.

62 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.

63 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

64 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.

65 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.

66 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

67 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.

68 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.

69 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

70 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

71 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,


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