1. Welcome to Medical Professions I Mrs. Nguyen MSN, RN CEN F-303
Welcome to Medical Professions I Mrs. Nguyen MSN, RN CEN F-303
Cleveland Clinic YouTube
Empathy: The Human Connection to Patient Care

2. Chapter 1
The Nursing Assistant in Long-Term Care

3. Health Care Agencies The person is always the focus of care.
Staff members have special talents, knowledge, and skills.
All work to meet the person’s needs.
Health care agencies offer services to persons needing health care.
Types of health care agencies include hospitals, long-term care centers, memory care facilities, home care agencies, home health care agencies, adult day-care centers, assisted living residences, board and care homes, rehabilitation and subacute care facilities, hospices, doctors’ offices, clinics, centers for persons with mental illnesses, centers for persons with developmental disabilities, drug and alcohol treatment centers, and crisis centers for rape, abuse, suicide, and other emergencies.

5. Agency Purposes The purposes of health care include: Health promotion
The goal is to reduce the risk of illnesses.
Disease prevention
Detection and treatment of disease
Rehabilitation and restorative care
Many agencies are learning sites for students.
The students assist in the purposes of health care.
Health promotion includes physical and mental health. People receive teaching and counseling about healthy living.
Risk factors and early warning signs of disease are identified. Measures are taken to reduce risk factors and prevent disease.
Detection and treatment of disease involve diagnostic tests, physical exams, surgery, emergency care, and drugs.
The goal of rehabilitation and restorative care is to return persons to their highest possible level of physical and mental functioning and to independence.

6. Types of Agencies Hospitals Rehabilitation and subacute care agencies
Long-term care centers (nursing homes, nursing facilities, nursing centers)
Skilled nursing facilities (SNFs)
Assisted living residences
Mental health centers
Home care agencies
Adult Day Care
Hospices
Health care systems
People need hospital care to have babies; for physical and mental health problems; for surgery, to heal broken bones, or to die; and for acute, chronic, or terminal illnesses.
A person needing rehabilitation or subacute care does not need hospital care but is too sick to go home.
Long-term care centers are for persons who cannot care for themselves at home but do not need hospital care.
SNFs are part of hospitals or nursing centers. They provide more complex care than nursing centers.
An assisted living residence provides housing, personal care, support services, health care, and social activities in a home-like setting.
Mental health centers are for persons with mental illnesses.
Home care agencies provide a wide range of services to people where they live.
A hospice is a health care agency or program for persons who are dying.
In a health care system, agencies join together as one provider of care.

7. Organization The goal is to provide quality care.
An agency has a governing body called the board of trustees or board of directors.
The board makes policies.
An administrator manages the agency.
Directors or department heads manage certain areas.
The health team (interdisciplinary health care team) involves the many health care workers whose skills and knowledge focus on the person’s total care.
The goal is to provide quality care.
The person is the focus of care.
Local, state, and federal laws are followed.
The administrator reports directly to the board.
Review Table 1-1 on pp. 5-6 in the Textbook.
Many team members are involved in the care of each person.

8. Organization (cont’d)
Nursing services
The director of nursing (DON) is an RN.
The DON is responsible for the entire nursing staff.
Nurse managers assist the DON.
Nursing areas usually have charge nurses for each shift.
Staff RNs report to the charge nurse.
LPNs/LVNs report to staff RNs or to the charge nurse.
You report to the nurse supervising your work.
Nursing education (staff development) is part of nursing services.
Director of nursing services, chief nurse executive, vice president of nursing, and vice president of patient services are some other titles used for DON.
Nursing supervisors and nurse managers manage and carry out nursing department functions.
Nurse managers are usually registered nurses (RNs).
The charge nurse is responsible for all nursing care and for the actions of nursing staff during that shift.
Nursing education staff:
plan and present educational programs (in-service programs).
provide the nursing team with new and changing information.
teach the nursing team how to use new equipment and supplies.
review key policies and procedures on a regular basis.
educate and train nursing assistants.
conduct new employee orientation.
provide programs that meet federal and state educational requirements.

9. The Nursing Team
The nursing team involves those who provide nursing care.
Registered nurses
Licensed practical nurses and licensed vocational nurses
Nursing assistants
All focus on the physical, social, emotional, and spiritual needs of the person and family.
RNs assess, make nursing diagnoses, plan, implement, and evaluate nursing care.
RNs can study to become clinical nurse specialists or nurse practitioners. These RNs have limited diagnosing and prescribing functions.
RNs work as staff nurses, nurse supervisors or managers, DONs, agency administrators, and instructors.
Licensed practical nurses (LPNs)/licensed vocational nurses (LVNs) are supervised by RNs, licensed doctors, and licensed dentists. They have fewer responsibilities and functions than RNs do.
Nursing assistants perform delegated nursing tasks under the supervision of a licensed nurse.

10. Nursing Care Patterns
The pattern used depends on how many persons need care, the staff, and the cost.
Functional nursing focuses on tasks and jobs.
Team nursing involves a team of nursing staff led by an RN.
Primary nursing involves total care.
Case management is like primary nursing.
A case manager (an RN) coordinates a person’s care.
Patient-focused care is when services are moved from departments to the bedside.
Nursing care is given in many ways.
In functional nursing, each nursing team member has certain tasks and jobs to do.
In team nursing, the RN decides the amount and kind of care each person needs. The team leader delegates the care of certain persons to other nurses. Team members report observations and the care given to the team leader.
In primary nursing, the primary nurse (an RN) is responsible for the person’s total care and the nursing team assists as needed.
In case management, care is coordinated from admission through discharge by the case manager. The case manager also helps the health team work together.
In patient-focused care, the nursing team performs basic skills usually done by other health team members. The number of people caring for each person is reduced, which reduces care costs.

15. Paying for Health Care
Private insurance is bought by individuals and families.
Group insurance is bought by groups or organizations for individuals.
Health care is a major focus in society.
The goals are to provide health care to everyone and to reduce the high cost of care.
Health care bills cause worry, fear, and emotional upset.
These programs help pay for health care:
Private insurance companies pay for some or all health care costs.
Group insurance is often an employee benefit.

16. Paying for Health Care (cont’d)
Medicare is a federal health insurance program for persons 65 years of age or older.
Some younger people with certain disabilities are covered.
Part A
Part B
Medicaid is a health care payment program sponsored by the federal government and operated by the states.
Medicare Part A pays for some hospital, skilled nursing facility (SNF), hospice, and home care costs.
Medicare Part B helps pay for doctors’ services, out-patient hospital care, physical and occupational therapists, some home care, and many other services. It is voluntary. The person pays a monthly premium.
People who qualify for Medicaid usually include those with low incomes, some children, and some older, blind, and disabled persons. There is no insurance premium. The amount paid for covered services is limited.

21. Paying for Health Care (cont’d)
Prospective payment systems limit the amount paid by insurers, Medicare, and Medicaid. Length of Stay (LOS) is also a factor.
Diagnosis-Related Groups (DRGs) are for hospital costs.
Resource Utilization Groups (RUGs) are for SNF payments.
Case Mix Groups (CMGs) are used for rehabilitation centers.
Home Health Resource Groups (HHRGs) are used for home health care.
Length of stay and treatment costs are determined for each group.
If costs are less than the amount paid, the agency keeps the extra money. If costs are greater, the agency takes the loss.

22. Paying for Health Care (cont’d)
Managed care
Managed care deals with health care delivery and payment.
Managed care limits:
The choice of where to go for health care
The care that doctors provide
Managed care as pre-approval for services.
Many insurers must approve the need for health care services.
If the need is approved, the insurer pays for the services.
If the need is not approved, the person pays the costs.
The insurer decides what to pay. With HMOs and PPOs, the insurer may decide where the person goes for services.
Insurers contract with doctors and hospitals for reduced rates or discounts. The insured person uses doctors and agencies that provide lower rates. If not, care is covered in part or not at all. The person pays for costs not covered by insurance.
Many states require managed care for Medicaid and Medicare coverage.
This pre-approval process is also called managed care. It includes monitoring care. The purpose is to reduce unneeded services and procedures.

28. Meeting Standards AZ SBON / AZ MB Standards are set by:
The federal and state governments
Accrediting agencies
An agency must meet standards for:
Licensure
Certification
Accreditation
AZ SBON / AZ MB
Standards relate to policies and procedures, budget and finances, and quality of care.
A license is issued by the state. An agency must have a license to operate and provide care.
Certification is required to receive Medicare and Medicaid funds.
Accreditation is voluntary. It signals quality and excellence.

33. AZ SBON LNA Credentialing (Endorsement Process) Process 2016

34. AZ SBON LNA Exam Process 2016

35. AZ SBON LNA Renewal Process 2016

36. Scope of Practice (Standards of conduct)
RN – R
LVN/LPN – R
LNA- R

50. Kouzes & Posner

55. Omnibus Budget reconciliation act (OBRA)
Omnibus Budget Reconciliation Act of 1987
On December 22, 1987, President Ronald Reagan signed the Omnibus Budget Reconciliation Act of 1987 (OBRA-87) also known as the Federal Nursing Home Reform Act. While not all components have to do with drugs and pharmacology, there are a few points you should be aware of. OBRA-87 was enacted to protect the rights of patients in long- term care facilities such as nursing homes, skilled nursing facilities, and assisted living homes.
It sets forth regulations for Medicare and Medicaid Conditions of Participation in long-term care facilities. It states that residents should not be given unnecessary medications, and that antipsychotic drugs can only be given to patients who have a condition that necessitates them. These patients must have documentation stating that they have a condition requiring antipsychotic drugs. For those who do receive it, doses must be gradually tapered off, and behavior modification and “drug holidays” (a drug-free period) can be used to see if the medication can be stopped completely.
In addition, long-term care residents should not have any significant medication errors, and all necessary drugs, both routine and emergency, must be given as required. The facility itself is required to have a consultant pharmacist, and medications must be labeled and stored according to federal and state laws.

56. Informed consent & Advanced Directive
Advance Directives
Do Not Resuscitate (DNR)
Living Will
Medical Power of Attorney (MPOA)

57. Meeting Standards (cont’d)
Surveys are done to see if the agency meets set standards.
If standards are met, the agency receives a license, certification, or accreditation.
When problems (deficiencies) are found, the agency:
Is given time to correct them
Can be fined for uncorrected or serious deficiencies
Can lose its license, certification, or accreditation
A survey team will:
review policies and procedures.
review medical records.
interview staff, patients and residents, and families.
observe how care is given.
observe if dignity and privacy are promoted.
check for cleanliness and safety.
review budgets and finances.
make sure staff meets state requirements (Are doctors and nurses licensed? Are nursing assistants on the state registry?).

61. Meeting Standards (cont’d)
You have an important role in meeting standards and in the survey process.
Providing quality care
Protecting the person’s rights
Providing for the person’s and your own safety
Helping to keep the agency clean and safe
Conducting yourself in a professional manner
Having good work ethics
Following agency policies and procedures
Answering questions honestly and completely