1. Understand residents’ rights, advocacy, and grievance procedures. Unit A Nurse Aide Workplace Fundamentals Essential Standard 1.00 Understand the range of function, legal and ethical responsibilities of the nurse aide within the healthcare system. Indicator 1.03 Understand residents’ rights, advocacy, and grievance procedures. 11.03Nursing Fundamentals

2. Warm up What are some basic human rights? Read Resident’s Rights and list the 16 rights a resident has when living in a long term care facility.

3. Residents’ Rights Nursing Fundamentals 724331.03

4. Nursing Fundamentals 72434 Basic Human Rights – Protected by Constitution – Laws clarify these rights: Right to be treated with respect Right to be treated with respect Right to live in dignity Right to live in dignity Right to pursue a meaningful life Right to pursue a meaningful life Right to be free of fear Right to be free of fear 1.03

5. Nursing Fundamentals 7243 5 Basic Human Rights Behaviors that infringe on human rights: addressing residents as children addressing residents as children using demeaning nicknames for residents using demeaning nicknames for residents leaving door open during bath leaving door open during bath threatening a resident with harm threatening a resident with harm 1.03

6. Nursing Fundamentals 72436 Ethical and legal basis Ethical and legal basis States have adopted or codified these rights into law States have adopted or codified these rights into law Posted in facility Posted in facility Distributed on admission in many facilities Distributed on admission in many facilities OBRA 1987 Residents’ Bill of Rights 1.03

7. Nursing Fundamentals 7243 7 Residents have the right to: 1.Be treated with consideration, respect, and full recognition of personal dignity. OBRA 1987 Residents’ Bill of Rights 1.03

8. Nursing Fundamentals 7243 8 Residents have the right to: 2.receive care, treatment, and services which are adequate and in compliance with rules OBRA 1987 Residents’ Bill of Rights 1.03

9. Nursing Fundamentals 7243 9 Residents have the right to: 3.receive a statement of services and charges OBRA 1987 Residents’ Bill of Rights 1.03

10. Nursing Fundamentals 7243 10 Residents have the right to: 4.have on file the attending physician’s proposed schedule of medical treatment. OBRA 1987 Residents’ Bill of Rights 1.03

11. Nursing Fundamentals 7243 11 Residents have the right to: 5.privacy OBRA 1987 Residents’ Bill of Rights 1.03

12. Nursing Fundamentals 7243 12 Residents have the right to: 6.Be free from mental and physical abuse, and free from restraint (except in an emergency) OBRA 1987 Residents’ Bill of Rights 1.03

13. Nursing Fundamentals 7243 13 Residents have the right to: 7.receive reasonable response to all requests OBRA 1987 Residents’ Bill of Rights 1.03

14. Nursing Fundamentals 7243 14 Residents have the right to: 8.associate and communicate privately OBRA 1987 Residents’ Bill of Rights 1.03

15. Nursing Fundamentals 7243 15 Residents have the right to: 9.manage financial affairs OBRA 1987 Residents’ Bill of Rights 1.03

16. Nursing Fundamentals 7243 16 Residents have the right to: 10.private visits from spouse OBRA 1987 Residents’ Bill of Rights 1.03

17. Nursing Fundamentals 7243 17 Residents have the right to: 11.privacy in the resident room. Personal items should not be searched. OBRA 1987 Residents’ Bill of Rights 1.03

18. Nursing Fundamentals 7243 18 Residents have the right to: 12.present grievances and recommend changes OBRA 1987 Residents’ Bill of Rights 1.03

19. Nursing Fundamentals 7243 19 Residents have the right NOT to: 13.perform services for the facility OBRA 1987 Residents’ Bill of Rights 1.03

20. Nursing Fundamentals 7243 20 Residents have the right to: 14.retain, store, and use personal clothing and possessions OBRA 1987 Residents’ Bill of Rights 1.03

21. Nursing Fundamentals 7243 21 Residents have the right NOT to: 15.be randomly discharged or transferred from the facility OBRA 1987 Residents’ Bill of Rights 1.03

22. Nursing Fundamentals 7243 22 Residents have the right to: 16.be notified if the facility is given a provisional license OBRA 1987 Residents’ Bill of Rights 1.03

23. Warm up Why would you use restraints on a resident? What are some restraints that you have seen before? Read- Restraint Reduction Success Story.

24. Nursing Fundamentals 724324 Behaviors That Uphold Residents’ Rights 1.Address as Mr., Mrs., or Miss unless asked to use a specific name 1.Address as Mr., Mrs., or Miss unless asked to use a specific name 2. Never withhold social responsiveness 2. Never withhold social responsiveness 3. Never ignore residents 3. Never ignore residents 4. Make eye contact 4. Make eye contact 1.03

25. Nursing Fundamentals 724325 Behaviors That Uphold Residents’ Rights – 5. Make eye contact – 6. Allow to complete sentences prior to leaving room – 7. Don’t shut or slam door to quiet resident – 8. Never threaten or intentionally hurt 1.03

26. Nursing Fundamentals 724326 Behaviors That Uphold Residents’ Rights 9. Encourage socialization (meal-time) 9. Encourage socialization (meal-time) 10. Assist to activities/meetings/church 10. Assist to activities/meetings/church 11. Participate in planned activities 11. Participate in planned activities 12. Help with phone calls, cards, mail 12. Help with phone calls, cards, mail 1.03

27. Nursing Fundamentals 724327 Behaviors That Uphold Residents’ Rights 13. Explain care you plan to give 13. Explain care you plan to give 14. Observe safety precautions 14. Observe safety precautions 15. Obtain proper consent after identifying resident 15. Obtain proper consent after identifying resident 1.03

28. Nursing Fundamentals 724328 Behaviors That Uphold Residents’ Rights 16. Handle personal items carefully 16. Handle personal items carefully 17. Add new items to list of resident’s belongings 17. Add new items to list of resident’s belongings 18. Mark all items with resident’s name 18. Mark all items with resident’s name 1.03

29. Nursing Fundamentals 724329 Behaviors That Uphold Residents’ Rights 19. Sit when feeding a resident 19. Sit when feeding a resident 20. Offer a clothing protector; do NOT automatically place clothing protector on the resident prior to eating 20. Offer a clothing protector; do NOT automatically place clothing protector on the resident prior to eating 21. Give resident centered, not task centered care 21. Give resident centered, not task centered care 1.03

30. Nursing Fundamentals 724330 Behaviors That Uphold Residents’ Rights 22. Address resident in a dignified way 22. Address resident in a dignified way 23. Listen to what resident has to say 23. Listen to what resident has to say 24. Converse with resident in an adult manner 24. Converse with resident in an adult manner 25. Respect resident’s privacy 25. Respect resident’s privacy 1.03

31. Nursing Fundamentals 724331 Behaviors That Uphold Residents’ Rights 26. Adult residents must be treated as adults. Give age appropriate care. 26. Adult residents must be treated as adults. Give age appropriate care. 1.03

32. Nursing Fundamentals 724332 Behaviors That Uphold Residents’ Rights 27. Treat all residents equally 27. Treat all residents equally 28. Promote positive attitudes 28. Promote positive attitudes 29. Report errors to supervisor immediately 29. Report errors to supervisor immediately 1.03

33. Nursing Fundamentals 724333 Age Appropriate Care Guidelines Don’t ignore or humor resident Don’t ignore or humor resident Explain what care you are going to give Explain what care you are going to give Promote resident independence Promote resident independence Treat resident as you would want to be treated Treat resident as you would want to be treated Age-appropriate considerations: Age-appropriate considerations: – Style of dress – Hair style and grooming – Recreational activities – Social activities 1.03

34. Nursing Fundamentals 724334 Age Appropriate Care Guidelines Encourage resident to make choices: select clothing to wear select clothing to wear select books to read select books to read select television programs to watch select television programs to watch 1.03

35. Nursing Fundamentals 724335 Age Appropriate Care Guidelines Encourage resident to make choices: select food and nourishments select food and nourishments select activities of interest select activities of interest select friends select friends 1.03

36. Nursing Fundamentals 724336 Age Appropriate Care Guidelines Recognize value of past experience (validate the resident) Recognize value of past experience (validate the resident) Praise age appropriate accomplishments Praise age appropriate accomplishments Encourage adult behavior Encourage adult behavior 1.03

37. Nursing Fundamentals 724337 Right to be Free from Restraint Under Omnibus Budget Reconciliation Act 1987 (OBRA), Under Omnibus Budget Reconciliation Act 1987 (OBRA), residents have a right to be free from restraints. residents have a right to be free from restraints. 1.03

38. Resident Restraints Nursing Fundamentals 7243381.03

39. Nursing Fundamentals 724339 Facts Regarding Restraints RESTRAINTSrestrict voluntary movement or behavior CHEMICALPHYSICAL 1.03

40. Nursing Fundamentals 724340 Facts Regarding Restraints Physical Restraints a lso k nown a s postural supports postural supports protective devices protective devices 1.03

41. Nursing Fundamentals 724341 Facts Regarding Restraints 1.03 Restraint: Any manual method, physical or mechanical device, material, or equipment attached or next to the resident’s body that the individual cannot remove easily, which restricts freedom of movement or normal access to one’s body

42. Nursing Fundamentals 724342 Facts Regarding Restraints IN THE PAST! Restraints commonly used to safeguard residents who wander, prone to falls, are violet, at risk of hurting themselves, or pulling tubes out Restraints commonly used to safeguard residents who wander, prone to falls, are violet, at risk of hurting themselves, or pulling tubes out Abuse of restraints led to new restrictions and laws on use of restraints Abuse of restraints led to new restrictions and laws on use of restraints 1.03

43. Nursing Fundamentals 724343 Facts Regarding Restraints 1.03 Tucking in top sheet so tightly that resident cannot move NEVER

44. Nursing Fundamentals 724344 Facts Regarding Restraints 1.03 Placing wheelchair so close to a wall that the wall prevents resident from getting out of chair

45. Nursing Fundamentals 724345 Facts Regarding Restraints 1.03 Pulling up full side rails to prevent patient from voluntarily getting out of bed

46. Nursing Fundamentals 724346 Facts Regarding Restraints 1.03 Restraints MUST not be used for convenience or discipline

47. Nursing Fundamentals 724347 Facts Regarding Restraints 1.03 Unnecessary use of restraint is FALSEIMPRISONMENT

48. Nursing Fundamentals 724348 Facts Regarding Restraints 1.03 Acceptable Reasons for Use of Restraints: Temporarily for life threatening medical conditions Brief periods to allow medical treatment to proceed if there is documented evidence of resident or legal approval of treatment

49. Nursing Fundamentals 724349 Facts Regarding Restraints 1.03 Acceptable Reasons for Use of Restraints When alternatives to restraints are not effective, however, and the physician orders restraints, it becomes essential for the nurse aide to know the risks involved in caring for these residents.

50. Nursing Fundamentals 724350 Facts Regarding Restraints 1.03 Types of acceptable physical restraints if ordered appropriately Side rails on a bed Side rails on a bed Special chairs such as geriatric chairs Special chairs such as geriatric chairs Lap cushions or lap tray Lap cushions or lap tray Vests and jacket restraints Vests and jacket restraints Safety belt restraints Safety belt restraints Soft ties for wrist and ankles Soft ties for wrist and ankles

51. Nursing Fundamentals 724351 Facts Regarding Restraints 1.03 Restraint-free facility: Restraints are not used for any reason and not kept in the facility

52. Restraint Alternatives Nursing Fundamentals 7243521.03

53. Nursing Fundamentals 724353 Restraint Alternatives 1.03 Restraint alternative: Interventions used instead of using restraints

54. Nursing Fundamentals 724354 Restraint Alternatives 1. Using friends, family, volunteers or resident directed care provider 1.03

55. Nursing Fundamentals 724355 Restraint Alternatives 2. Interesting activities and diversions such as games, movies or music distract residents 1.03

56. Nursing Fundamentals 724356 Restraint Alternatives 3. Answering call signal promptly 1.03

57. Nursing Fundamentals 724357 Restraint Alternatives 4. Exercise and outdoor activities 1.03

58. Nursing Fundamentals 724358 Restraint Alternatives 5. Consistent reality orientation or validation and staff assignments 1.03

59. Nursing Fundamentals 724359 Restraint Alternatives 6. Having resident’s room close to nurses’ station 1.03

60. Nursing Fundamentals 724360 Restraint Alternatives 7. Barriers such as STOP SIGNS posted on doors discourages confused residents from wandering into the area 1.03

61. Nursing Fundamentals 724361 Restraint Alternatives 8. Partial bed rails prevent residents from rolling out of bed while allowing them freedom to get up if they wish to 1.03

62. Nursing Fundamentals 724362 Restraint Alternatives 9. Positioning devices and wedges such as wedge cushions placed in wheelchairs to prevent forward sliding 1.03

63. Nursing Fundamentals 724363 Restraint Alternatives 10. Furniture such as low beds, rocking chairs, or recliners 1.03

64. Nursing Fundamentals 724364 Restraint Alternatives 11. Easy –release belts reminds resident of safety but the resident can release if desired 1.03

65. Nursing Fundamentals 724365 Restraint Alternatives 12. Floor cushion or pads next to the bed – decreases injuries if a resident does fall when getting out of bed 1.03

66. Nursing Fundamentals 724366 Restraint Alternatives 13. Electronic warning devices on beds, wheelchairs, and doors alert staff if patient gets up without help* 1.03

67. Processing Computer Lab- go to techforltc.org Read chair bed and toilet alarms/ fall detection. Go to posey.com and list the self releasing devices that are available

68. Warm up Review Skill 1.03A and 1.03B

69. Nursing Fundamentals 724369 The Last Resort! Occasionally, alternatives do not work and restraints are ordered. 1.03

70. Nursing Fundamentals 724370 Using Restraints Ordered by the physician… Ordered by the physician… when necessary to treat a medical symptom or provide emergency medical treatment when necessary to treat a medical symptom or provide emergency medical treatment choice of restraint based on multidisciplinary evaluation for the least restrictive measure choice of restraint based on multidisciplinary evaluation for the least restrictive measure 1.03

71. Nursing Fundamentals 724371 Using Restraints Safety Measures and Considerations When APPLYING Restraints 1.03

72. Nursing Fundamentals 724372 Using Restraints Safety measures and Considerations APPLYING Restraints: 1. Use reassurance in an attempt to calm agitated residents1. Use reassurance in an attempt to calm agitated residents 1.03

73. Nursing Fundamentals 724373 Using Restraints Safety measures and Considerations APPLYING Restraints: 2. Be sure there is a physician’s order for restraint use and that it is in the care plan before applying restraint 1.03

74. Nursing Fundamentals 724374 Using Restraints Safety measures and Considerations APPLYING Restraints: 3. Use the correct type of restraint and apply according to manufacturer’s directions and only after you have received instructions in its use 1.03

75. Nursing Fundamentals 724375 Using Restraints Safety measures and Considerations APPLYING Restraints: 4. Secure enough assistance to apply restraints quickly to avoid injury 1.03

76. Nursing Fundamentals 724376 Using Restraints Safety measures and Considerations APPLYING Restraints: 5. Attach restraints to bed frame (immovable part of bed), not to side rails or other parts of the bed Leave an 8 inch tail 1.03

77. Nursing Fundamentals 724377 Using Restraints Safety measures and Considerations APPLYING Restraints: 6. Use slip knot to tie restraint for quick release 1.03

78. Nursing Fundamentals 724378 Using Restraints Safety measures and Considerations APPLYING Restraints: 7. Protect bony areas and skin by padding them prior to applying restraint 1.03

79. Nursing Fundamentals 724379 Using Restraints Safety measures and Considerations APPLYING Restraints: 8. Adjust restraint so that it allows some movement, but is secure and comfortable – place open flat hand between the resident and the restraint for restraints around the torso. 1.03

80. Nursing Fundamentals 724380 Using Restraints Safety measures and Considerations APPLYING Restraints: 9. Make sure breasts or skin are not caught in the restraint. 1.03

81. Nursing Fundamentals 724381 Using Restraints Safety Measures and Considerations AFTER Restraints are applied 1.03

82. Nursing Fundamentals 724382 Using Restraints Safety measures and Considerations AFTER Applying Restraints: 1. Be sure resident NEEDS are MET 1.03

83. Nursing Fundamentals 724383 Using Restraints Safety measures and Considerations AFTER Applying Restraints: Special attention must be paid to basic needs Elimination- assist in toiletingElimination- assist in toileting Hydration – offer fluidsHydration – offer fluids 1.03

84. Nursing Fundamentals 724384 Using Restraints Safety measures and Considerations AFTER Applying Restraints: 2. Call signal must be in reach and the resident’s signal for help must be answered immediately (STAT) 1.03

85. Nursing Fundamentals 724385 Using Restraints Safety measures and Considerations AFTER Applying Restraints: 3. Check on resident every 15 minutes 1.03

86. Nursing Fundamentals 724386 Using Restraints Safety measures and Considerations AFTER Applying Restraints: Every 15 minutes: Pulse, color, and temperature of any restrained extremity Pulse, color, and temperature of any restrained extremity 1.03

87. Nursing Fundamentals 724387 Using Restraints Safety measures and Considerations AFTER Applying Restraints: Every 15 minutes: Breathing of resident with vest (torso) restraint Breathing of resident with vest (torso) restraint 1.03

88. Nursing Fundamentals 724388 Using Restraints Safety measures and Considerations AFTER Applying Restraints: 4. Every 2 hours: Remove restraint for 10 minutes and reposition resident Remove restraint for 10 minutes and reposition resident 1.03

89. Nursing Fundamentals 724389 Using Restraints Safety measures and Considerations AFTER Applying Restraints: 5. In an emergency, notify supervisor immediately via call bell, stay with the resident, and loosen restraint. 1.03

90. Nursing Fundamentals 724390 Using Restraints EMERGENCY EXAMPLES: 1. Unable to detect a pulse in extremity1. Unable to detect a pulse in extremity 2. Extremity cold, pale, blue-tinged, gray, red, purple in color2. Extremity cold, pale, blue-tinged, gray, red, purple in color 3. Resident complains of pain, discomfort, numbness, or tingling in restrained part3. Resident complains of pain, discomfort, numbness, or tingling in restrained part 4. Breathing is impaired with vest or safety belt restraint4. Breathing is impaired with vest or safety belt restraint URGENT!!! TAKE ACTIONURGENT!!! TAKE ACTION 1.03

91. Nursing Fundamentals 724391 Using Restraints Observations and reporting should include: 1. Color and condition of skin under restraint 1. Color and condition of skin under restraint 2. Pulse rate, color and temperature of skin in restrained extremity 2. Pulse rate, color and temperature of skin in restrained extremity 1.03

92. Nursing Fundamentals 724392 Using Restraints Observations and reporting should include (continued): 3. Any complaints about restrained part 3. Any complaints about restrained part 4. Red or injured skin areas under restraint 4. Red or injured skin areas under restraint 5. Respiratory rate and color of skin with vest and safety belt restraints 5. Respiratory rate and color of skin with vest and safety belt restraints 1.03

93. Nursing Fundamentals 724393 SKILL 1.03A SKILL 1.03A Apply Personal Electronic Warning Device Training Lab Assignment Engage in the Skill Acquisition Process for:

94. 1.03Nursing Fundamentals 724394 SKILL 1.03B SKILL 1.03B Apply Restraints Training Lab Assignment Engage in the Skill Acquisition Process for:

95. Processing Skills Lab- Skill 1.03A and 1.03B

96. Warm up Into Aging

97. Resident Advocates Nursing Fundamentals 7243971.03

98. Nursing Fundamentals 724398 Resident Advocates 1.03 What does an advocate do? Plead cause of another Plead cause of another Resolve grievances Resolve grievances Protect resident’s rights Protect resident’s rights

99. Nursing Fundamentals 724399 Resident Advocates 1.03 Advocates can be: You and your co-workers You and your co-workers Member of resident’s family/support system Member of resident’s family/support system Resident’s guardian Resident’s guardian Ombudsman Ombudsman

100. Nursing Fundamentals 7243100 Resident Advocates 1.03 Ombudsman Program - History The national network of long term care ombudsman programs was established in response to the many problems found in nursing homes. The program was first introduced in 1971 as part of President Nixon’s eight-point plan to improve nursing home conditions. This plan established several demonstration ombudsman projects, funded and supervised in the beginning through the U.S. Public Health Service. In 1973, administration responsibility for these projects was transferred within the Department of Health, Education and Welfare to the Administration on Aging, within the Office of Human Development Services. By 1975, all state agencies on aging were invited to submit proposals to promote effective statewide ombudsman programs. Money was then made available for this voluntary state program. The Long Term Care Ombudsman Program has been in existence in North Carolina since 1976.

101. A favorable response to the ombudsman program led to its formal adoption in the 1978 Amendments to the Older Americans Act. The Older Americans Act (federal law) requires that each state establish and maintain a Long Term Care Ombudsman Program to advocate on behalf of residents in nursing and adult care homes (rest homes, assisted living). In 1989, the North Carolina General Assembly enacted legislation for the Long Term Care Ombudsman Program (G.S. 143B-181.15-25) which incorporated federal mandates in the Older Americans Act for the Program and clearly define the roles and responsibilities of the state and regional long term care ombudsmen. In North Carolina, the State Long Term Care Ombudsman Program is located in the Department of Health and Human Services, Division of Aging and Adult Services. The Regional Long Term Care Ombudsman Programs are housed in the 17 Area Agencies on Aging. Last updated June 2, 2010 LTC Ombudsman Program Nursing Fundamentals 72431011.03

102. Nursing Fundamentals 7243102 Resident Right to Voice Grievances 1.03 Regarding services furnished Regarding services furnished Regarding services not furnished Regarding services not furnished With respect to behavior of others With respect to behavior of others Nurse aide must report grievances to supervisor Nurse aide must report grievances to supervisor

103. Nursing Fundamentals 7243103 Facility policy components for resident grievance 1.03 1.Acknowledgment 2.Prompt attempt to resolve 3.Resident kept apprised

104. Nursing Fundamentals 7243104 Resident Council: Advisory Group 1.03

105. Nursing Fundamentals 7243105 Resident Council: Advisory Group 1.03 Provides opportunity for discussion Recommendations may be made for: Facility policies Facility policies Decisions regarding activities Decisions regarding activities Exploration of concerns Exploration of concerns Resolving grievances Resolving grievances

106. Nursing Fundamentals 7243106 Resident Council: Advisory Group 1.03 Gives residents a voice in facility operations Gives residents a voice in facility operations Members Members – residents – facility staff members to include Nurse Aides – representatives from community

107. The Bottom Line Nursing Fundamentals 72431073.01 Resident has a right to voice grievances without fear of retaliation or discrimination!

108. Processing Review Exam tomorrow on 1.0

109. Understand resident’s rights, advocacy, and grievance procedures. 109  END  1.03 1.03Nursing Fundamentals