1. 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.

2. Introduction to Nursing Assistant/ Home Health Aide
Unit One
Introduction to Nursing Assistant/ Home Health Aide

3. 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

4. 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.

5. 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

6. 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

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

8. 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

9. 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.

10. 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

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

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

13. 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

14. 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

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

16. 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.

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

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

19. 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.

20. 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.

21. 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

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

23. 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.

24. 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

25. 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

26. 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

27. 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.

28. 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.

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

30. 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

31. 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.

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

33. 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

34. 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.

35. 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

36. 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

37. 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

38. 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,

39. 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.

40. 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,

41. 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

42. 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.

43. 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.

44. 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.

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

46. Patient Self Determination Act
This is a 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.

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

48. 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.

49. 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

50. HOME HEALTH AIDE
UNIT ONE

51. 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

52. 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

53. 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.

54. 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

55. 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

56. 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.

57. 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.

58. 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

59. 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.

60. 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.

61. 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.

62. 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

63. 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.

64. 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.

65. 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

66. 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.

67. 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.

68. 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

69. Qualities of HHA’s Good customer service attitude Adaptable
Good communication skills
Adaptable
Will have to adjust to using skills in the home environment
will have to use a variety of equipment

70. 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,