Introduction to the Role of the Nurse Aide Refer to Page 1 in Textbook Facilities A Long Term CareCertified Nursing Facilitiesreceives Medicaid Medicare andor private pay person doesnt ID: 569225
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Slide1
Lesson 1 Objectives:Introduction to the Role of the Nurse Aide
Refer to Page 1 in TextbookSlide2
Facilities
A. Long
Term Care/Certified Nursing Facilities-receives Medicaid, Medicare, and/or private pay
(person doesn't
need to be hospitalized, but can no longer live at home)
~Skilled Nursing Facilities (SNF): provide nursing services on a 24
hr
basis for chronic illnesses or conditions
AKA
: Nursing home, nursing center, nursing facility, care center, healthcare center
“Resident’s”-not always elderlySlide3
Facilities
B. Hospitals-Acute
Care (short term illnesses)
~Transitional Care Units-located within an acute care facility, accepts private pay and Medicare. Provides lower level care while needs are assessed and arrangements made to be discharged.
~Trauma Centers-Life threatening illnesses
~Emergency Department-conditions that occur suddenly and require immediate attention
~Intensive Care Units-Continuous care for
pts
with serious illnesses/injuries
~Cardiac Care Units-serious heart conditions
~General Units-ill, but don’t need high level of specialized care and continuous nursing care.
The Joint Commission of Health (JCOH)-accredits many types of health care facilities; private, nonprofit organizationSlide4
FacilitiesC. Skilled or Sub-acute Care: person does not need to be hospitalized, but cannot go home yet
(Rehabilitation/Convalescent Centers-services to help recover from significant injury)
-Found in hospitals or long-term care facilities on specialized unitsSlide5
FacilitiesD. Adult Day Care- to provide social and some health services outside the home to persons 18 years and older during the day
Allows for caregivers to still work and provides respite (a break) for caregiversSlide6
FacilitiesE. Assisted Living Center: Provide supervision or assistance with ADL, coordination of services with doctors, and monitoring activities that promote health and ensure safety.
Person needs some assistance and supervision, but not 24 hour medical care. Slide7
Facilities
F. Home
Health Care Providers-care provided in patient/client home (accepts Medicare, Medicaid, private pay, and other insurance)
G. Hospice-care
and support for dying patients and their families; accepts Medicare, Medicaid, and private
pay/insurance
(Life expectancy of 6 months or less)
H. Palliative Care-goal for comfort rather than measures to prolong lifeSlide8
FacilitiesAll that utilize CNA’s are licensed by ISDH
(Indiana State Department of Health)
Must meet state and federal requirements known as Code of Federal Regulations
Annual surveys conducted:
~Might observe care and ask questions
~Tell truth and answer to best of your ability
~Not breaking confidentiality with surveysSlide9
Who pays for Services?Medicare
-Financial assistance for the elderly
Medicaid
-Financial assistance for low income/disabled
Private
Pay-
out of own pocket
Insurance
- Various Companies
This is why we should be cost conscious and have to be sure to document effectively…
REGULATIONS, REGULATIONS, REGULATIONSSlide10
Scope of Practice
STANDARD 14: NURSE AIDE SCOPE OF PRACTICE
The nurse aide will perform only
the tasks in the course standards and
Resident Care Procedures
manual, unless trained appropriately by licensed staff of the facility with policies and procedures and a system for ongoing monitoring to assure compliance with the task, i.e., (see supplements for examples). This additional training would only apply for tasks, which are not prohibited by paragraphs 2 and 3 of this section and by current rule, which prohibits the giving of injections.
The nurse aide will not perform
any invasive procedures, including enemas and rectal temperatures, checking for and/or removing fecal impactions, instillation of any fluids, through any tubing, administering vaginal or rectal installations.
The nurse aide will not administer
any medications, perform treatment or apply or remove any dressings. Exception to the above would be the application of creams/ointments to intact skin, such as moisture barrier cream.Slide11
Role of CNAHygiene, safety, nutrition, exercise, and elimination needs of residents (Varies from state to state)
Help residents/patients with ADL’s (Activities of Daily Living)
Examples: bathing, dressing, eating, toileting, Slide12
Indiana Requirements
Criminal Background of candidates: Felonies in theft, battery, abuse, substance abuse within the previous 5 yeas are prohibited from employment and enrollment in a NA training program.
2. Physical/Health Screen
3. TB/
Mantoux
testing
4. Successfully completing approved training program and the state competency evaluationSlide13
Professionalism
Respect (do not be prejudice based on personal values)
Loyal/Dependable
Teamwork-resident focused
Helping any resident within the facility
Accountable
D
o Not accept or give money/gifts to residents
Appearance- Take Care of Yourself
Smile, leave personal problems at home.
Never use Profanity
Personal Matters on Personal TimeSlide14
ProfessionalismNo solicitation at WorkControl Emotions (Remain calm and collected)
Confidentiality (HIPAA-Health Insurance Portability and Accountability Act): Taken Very Seriously, you could be SUED and Lose your Job indefinitely Slide15
Comprehensive Care PlanAKA- Plan of Care (POC)
-Written Plan of Action based on resident’s needs and limitations. Identifies short and long-term goals for the resident
-
Often based off of MDS (Minimum Data Set)- screening and an assessment tool for Long-Term Care Providers
OBRA
(
pg
8)-Omnibus Budget Reconciliation Act-Law passed to ensure safer/better care for residents in LTC due to high reports of abuseSlide16
Communication NA should be able to actively listen and talk with residents, family and other health care personnel.
Observe & Report:
Objective vs. Subjective Data Slide17
Observing & Reporting
Report-
verbally
inform the person in authority (often the nurse for CNA’s) about the care that has been given or observations made
Routine Report-end of each shift (every 8
hrs
)
Some observations require immediate reporting:
severe pain, falls/incidents, seizures, sudden or increased confusion, swelling, bleeding/drainage, change of LOC, behaviors, mood changes, SOB, skin issues, any change of conditionSlide18
Other Responsibilities
Participate in Care Conferences
Usually held quarterly or when there is a significant change in condition
Know the policies and procedures of the facility where you work
Policy
-written statement/rule
Procedure
-how to follow a particular rule/plan of actionSlide19
Healthcare TeamIDT-Interdisciplinary Team
Administrator, Director of Nursing (DON), Nurse Manager, Staff/Charge Nurse, Qualified Medication Aides (QMA), Certified Nursing Aide (CNA), Dietician, Speech Therapist, Occupational Therapist, Physical Therapist, Respiratory Therapy, Activity Director, Social Worker, Resident, Family Member, Responsible Party, Ombudsman,
House-keeping, Laundry, Maintenance, Information TechnologySlide20
Chain of CommandProper line of authority for reporting
*Protects
NA’s and their employers
from liability
*Nurse Aides always report to the nurse (staff nurse or charge nurse on your shift)
*Could also maybe be a unit manager or Director of Nursing (DON)
Bottom to Top=
CNA…Nurse…Nurse Manager…ADON…DON… Administrator…Executive DirectorSlide21
Communication/Interpersonal Skills
Formulate Message (Talker)
Receive Message (Active Listener)
Observe for Feedback
Communication is not always VERBAL words (written words=text, email, letter)
Also communication can be verbal and nonverbal
Body Language is HUGE (could be unintentionally sending a negative message to the receiver)Slide22
Barriers to Effective Communication
Cliches
-phrases that can be interpreted differently by people or where the meaning might not be clear.
ie
. “Opposites Attract,” “Everything will be fine/OK!”
Slang- word or phrase often used by certain generations with specific meaning, but not understood by all.
ie
. Oh Snap, LOL, OMG, TBT
Sensory Impairment-Visually Impaired, Hearing impaired (HOH), Cognitively impaired (confused or intellectual disability)
Unconscious- may not be able to communicate, but may still be able to hearSlide23
Barriers ContinuedEmotions: stress, tension, anxiety
Coping/Defense Mechanisms:
Denial- refuse the proven truth
Displacement- Transfer emotion(s) onto someone or something
Rationalization- Excuses
Regression- Revert to prior state
Repression-Block thoughts from mindSlide24
Call LightsThis is many patients/residents form of communication with staff to help meet their needs
Place on person’s unaffected side within reach at all times
Answer immediately
Never withhold as a means of punishment or retaliation=ABUSESlide25
Promote Resident Independence
Independent
- Requires minimal to limited assistance
Dependent
- Requires extensive to total assistance
Offer support, praise, encouragement
Be patient, understanding, compassionate
Out of bed at least 1-2
hrs
/day
Encourage their preferred attire, dining room for meals
Assistive Devices in working condition
Socialize-TV, activities, reading paper/magazine
Passive ROM at least 2xday
Bowel/Bladder retraining for incontinenceSlide26
Resident/Person Centered Care
Respects the voice of the resident as an individual to meet the persons specific needs and/or limitations and preferences based on lifestyle
Takes into consideration the persons Culture and/or Religious Values
**We should all do so without judgment and respect their choices regardless of our own personal beliefs!!Slide27
Review QuestionsPage 13 in your bookIf you cannot answer them, be sure to review!