Personal Care Attendant - PowerPoint Presentation

1. Personal Care Attendant (PCA)Training Materials Developed By Ivy Tech Community College Per ISDH Course RequirementsTemporary Personal Care Attendant (Waiver Aide) Eight (8) Hour Course 5 Hour Classroom3 Hour Simulation/Competency Check-off

2. Implemented byIndiana State Department of Health (ISDH)Scope:The PCA position is temporary to address work increases and staffing shortages caused by the 2020 COVID-19 pandemicUnder the directives of Governor Eric Holcomb’s March 6, 2020 “Declaration of Public Health Emergency for Coronavirus Disease 2019 Outbreak” The PCA position will be authorized only while the Executive Order remains in effect, plus any additional time necessary to resume normal staffing

3. Personal RequirementsA candidate for training must be at least sixteen (16) years oldThere are no minimum educational requirements A PCA who completes training and is employed by a facility must satisfy the criminal history requirements

4. Training StandardsThe training/hiring facility is responsible for all training documentationThe PCA training course must be taught by a Nurse Aide Program Instructor for the ISDH Nurse Aide Program

5. Training StandardsAfter classroom training, PCA students must practice and demonstrate ability to safely perform all required care skillsThe instructor or licensed nurse must observe each student’s practice of required skills and document the student’s ability to perform skills safelyThe PCA shall report to the facility’s Charge Nurse/Manager

6. I. Resident Rights/HIPAA/Abuse & Neglect15 minutesResident Rights – OBRAOmnibus Budget Reconciliation Act (OBRA) – originated due to increased reports of abuse and neglect in nursing homes Purpose: to inform residents of rights and provide ethical code for healthcare workersWhat is ethics?

7. I. Resident Rights/HIPAA/Abuse & Neglect15 minutesResident rights include the right to:Choose a physician & participate in treatment decisions & care planningBe treated with dignity and respectDon’t call the resident ‘honey’ or ‘sweetie’ as this is disrespectfulCall the resident by their preferred name

8. I. Resident Rights/HIPAA/Abuse & Neglect15 minutesThe right to make his/her personal choices (resident-centered care)When to go to bed, when to get upWhen and what they wish to eatThey also have the right to refuse care (notify charge nurse)Resident has rights to have personal items in room – this is their homeMust be safeCannot interfere with rights of his/her roommate

9. I. Resident Rights/HIPAA/Abuse & Neglect15 minutesHave his/her culture/beliefs respectedPrayer time, spiritual advisors, dietary accommodations Have his/her protected health information treated as confidentialThe Health Insurance Portability and Accountability Act (HIPAA) Law to protect the privacy of protected health informationDo not give resident information to anyoneRespectfully explain confidentiality to families – refer to charge nurse

10. I. Resident Rights/HIPAA/Abuse & Neglect15 minutesThe resident has the right to be free of abuse and neglectPCA's are responsible for protecting residents & preventing abuse/neglectResponse to witnessed (or reported) abuse/neglect Must be reported if suspected or witnessedIf witnessed, call for the nurse, stay/protect with the residentImmediate reporting of abuse and neglect to nurse/manager

11. I. Resident Rights/HIPAA/Abuse & Neglect15 minutesTypes of abuse Physical SexualMental/psychological incudes leaving resident in an embarrassing situation as punishmentVerbalFinancial

12. I. Resident Rights/HIPAA/Abuse & Neglect15 minutesNeglect – what you do or don’t do causes harm/risk of harm example: not answering call lights as promptly as possibleInvoluntary seclusionMisappropriation (theft)Remember: Witnessed/suspicion of abuse/neglect MUST be reported to charge nurse

13. II. Infection Control30 minutesHow is infection spread?Infectious agent/pathogenReservoir/infected hostPortal of exitMode of transmissionPortal of entrySusceptible host

14. II. Infection Control30 minutesAccording to ISDH on March 23, 2020:Due to shortages of face masks:Only direct care providers should wear masks while in facilityThose essential providers should wear a surgical mask for the entire shiftMasks should be conserved Only a single mask should be worn by staff each shift

15. II. Infection Control30 minutesHand hygiene:Handwashing is the single most effective way healthcare providers can reduce the spread of infectionRequires a 20 second friction scrub on all surfaces of the hands/fingers Alcohol based hand rub – use a quarter sized amount; rub into all surfaces of the hands/fingers Requires at least 10 second friction rub … allow to dry to be most effective

16. II. Infection Control30 minutesCover coughs and sneezes (cough etiquette)Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbowThrow used tissues in the trashImmediately wash your hands with soap and water for at least 20 secondsIf soap and water are not readily available, clean your hands with alcohol based hand rub

17. II. Infection Control30 minutesStandard PrecautionsConsider the blood and body fluids of every resident as potentially infectiousThe minimum infection prevention practices that apply to all patient carePersonal Protective Equipment (PPE)Gloves should be worn for contact with blood and/or body fluidsGown/Mask/Goggles should be worn during procedures and while giving personal care if splashing/spraying of blood, body fluids, etc. is likely or if there is a possibility of contact with any infectious material

18. II. Infection Control30 minutesTransmission-based PrecautionsAirborne Precautions: pathogens transmitted by the airborne routeStandard precautions + respiratory protectionDroplet precautions: pathogens transmitted by respiratory droplets Standard precautions + masks & gloves if working within 3 feet of the residentContact precautions: pathogens spread by direct or indirect contactStandard precautions + gowns if substantial contact with resident/surroundings

19. II. Infection Control30 minutesHandling of linensNever shake linensCarry both clean and dirty linens away from uniformIf linens are taken in to a resident’s room, they cannot go back to the linen closetNEVER throw soiled linen on the floor

20. II. Infection Control30 minutesClean areas in the room: Back of chairHead of bedOver bed tableTop of bedside cabinetDirty areas in the room:Seat of chairFoot of bedLaundry bag/plastic bagLaundry hamperNEVER ON THE FLOOR!

21. II. Infection Control30 minutesMiscellaneous infection control measuresHigh touch areas include side rails and hand rails in hallway – disinfect per policyCommon use items need disinfected between residentsThermometers, lifts, scales, shower chairs, etc.Don’t sit on the resident’s bed; don’t use anything that has been on the floorNote: The PCA will not be assigned to provide care or services to a resident in Isolation Precautions

22. II. Infection Control30 minutesAIDS/HIVDestroys the immune system; resident will be vulnerable to infectionTransmitted through infected blood or body fluid Vaginal/anal sexSharing needles/syringes, tattooing/piercing, transfusion, organ transplantMother to infant during pregnancy/childbirth/breastfeedingNOT possible to get from toilet seat, casual contact, kissing, or insects

23. II. Infection Control30 minutesClostridium Difficile (C-Diff)Caused by bacteria in the colonUsually due to antibiotic useCauses frequent watery stools with a distinct odorCannot use hand rub - not effective against C-diffMUST wash hands with soap and water

24. II. Infection Control30 minutesProcedures Review:Hand wash – when visibly soiled/prior to care, scrub at least 20 secondsHand rub – quarter size amount of product, rub at least 10 seconds Gloving – check fit/holes, remove without contaminating handsGowning – remove without touching outside of gownMasking – normally removed after 30 minutes; now wearing entire shift

25. III. Emergency Procedures15 minutesFirst two actions for all emergenciesCall for the nurseStay with the resident

26. III. Emergency Procedures15 minutesFallsPreventionAwareness of residents who are at risk for fallingSafety check of resident and environment before leaving roomAnswer call lights promptly, check resident frequently

27. III. Emergency Procedures15 minutesFallsInterventionIf resident begins to fall, never try to stop the fall … instead ease them to the floorCall nurse, stay with resident … then check to see if the resident is breathingSpeak calmly to resident – do not get them up until nurse has checked themAfter a fall, document, check resident frequently for remainder of shiftIf resident tells you he/she fell when no one was around, report to nurse promptly

28. III. Emergency Procedures15 minutesChoking - Partial or complete airway obstructionUniversal sign: holding neck, gasping noise or clutching throatAsk “Can you cough?”, “Can you speak?”If resident cannot cough or speak – airway is completely obstructedPerform the Heimlich maneuver until object is expelledDo NOT perform this maneuver if the resident can cough or speak Airway is only partially obstructed, the Heimlich may completely obstruct

29. III. Emergency Procedures15 minutesProcedures Review:Resident Observed Fallen or on the Floor (Falling/Fainting)Call for nurse, stay with resident, check breathing, do not move residentChoking – Heimlich ManeuverCan they cough or speak?If NOT, perform Heimlich until object expelled

30. IV. Activities of Daily Living120 minutesA. Initial Steps/Responding to a call light Procedure: Initial Steps – Applicable Every Time the Resident Room is EnteredAsk nurse about resident needs abilities, limitationsRemember: 1. Resident rights 2. Infection control 3. Safety!

31. IV. Activities of Daily Living120 minutesB. Obtaining a temperature (all routes other than rectal) Procedure: Oral Temperature (Electronic)NOT if resident is unconscious, on oxygen, or confused/disorientedProcedure: Axillary Temperature (axillary = armpit)Use this method if cannot take temperature orallyTake resident’s arm out of sleeve, dry armpit before placing sheathed thermometer

32. IV. Activities of Daily Living120 minutesC. Making an unoccupied bed/handling of linens Procedure: Unoccupied BedRemember clean and dirty areas in roomRemove soiled linens by rolling them from head to foot of bed, place in bag/hamperCompletely make bed on one side, including tucking/mitering cornersTHEN, make other side of bed and change pillowcase

33. IV. Activities of Daily Living120 minutesD. Turning and repositioning the Resident while in bed Procedure: Assist Resident to Move to Head of Bed Easiest with 2 caregivers/draw sheetProcedure: Assisting Resident to the Supine PositionBed flat, resident on back and alignedUsed for bedbath, changing incontinence brief, any time resident needs to be turned

34. IV. Activities of Daily Living120 minutesD. Turning and repositioning the Resident while in bed Procedure: Assisting Resident to the Lateral PositionTurning on either side, supported with 4 pillows (head, back, under arm, between knees)Used to get pressure off coccyx (tailbone)Procedure: Assisting Resident to the Fowler’s Position Head of bed elevated to 45-60 degreesUsed for ADL care, eating, etc.

35. IV. Activities of Daily Living120 minutesE. Making an occupied bed Procedure: Occupied bed Turn resident away from you (side rail up on other side of bed)Tuck soiled bottom sheet under resident, place clean bottom sheet, tuck under residentGo to other side, turn resident away (side rail up on other side of bed)Remove soiled linens, finish placing clean bottom sheetChange top sheet while keeping resident covers, tuck, miter corners, change pillowcase

36. IV. Activities of Daily Living120 minutesF. Transfer from bed to chair/wheelchair/Use of Gait belt- One person standby/transfer Procedure: Sit on Edge of Bed Prior to Transfer to Chair Place bed in position where resident’s feet can touch floor, raise head of bedAssist resident to sit on side of bed using count of 3, check for dizziness 10-15 secondsPut on resident’s shoes or non-skid socks/slippers, feet should be flat on floor

37. IV. Activities of Daily Living120 minutesF. Transfer from bed to chair/wheelchair/ Use of Gait belt- One person standby/transfer Think about this: Does the resident need ASSIST or TRANSFER?The resident may need a little help (ASSIST)Stand on resident’s affected side holding gait belt on side and backThe resident may need more than a little help (TRANSFER)Stand in front of resident, toe to toe, holding gait belt on both sides

38. IV. Activities of Daily Living120 minutesF. Transfer from bed to chair/wheelchair/Use of Gait belt- One person standby/transfer Procedure: Using a Gait Belt to Assist with Ambulation Place gait belt snugly around resident’s waist, over clothing, buckle in frontSince resident can ambulate (walk), they only need ASSIST to standStand on resident’s affected side, hold gait belt at side and backAssist to stand on count of three, check for dizziness 10-15 secondsHold gait belt/stand on affected side/slightly behind, walk at resident’s pace

39. IV. Activities of Daily Living120 minutesF. Transfer from bed to chair/wheelchair/Use of Gait belt- One person standby/transfer Procedure: Walking (Assist)Procedure is much the same as assist resident to ambulate with a gait beltResident may or may not need a gait beltStand to the side and slightly behind the resident, walk at resident’s pace

40. IV. Activities of Daily Living120 minutesF. Transfer from bed to chair/wheelchair/Use of Gait belt- One person standby/transfer Procedure: Assist with WalkerProcedure much the same as assisting resident to ambulate with a gait beltPlace walker in front of resident – as close to bed as possible, stand on affected sideBrace walker with your foot, place one hand on top of walker to secureHold side of gait belt, assist resident to stand on count of three – check for dizzinessAsk resident to move walker 1st, then weak leg, then strong leg (walker, weak, strong)

41. IV. Activities of Daily Living120 minutesF. Transfer from bed to chair/wheelchair/Use of Gait belt- One person standby/transfer Procedure: Transfer to Chair Place chair firmly against bed on resident’s strong sideStand in front of them toe to toe, place resident’s hands on your shouldersHold sides of gait belt, assist to stand on count of three, check for dizzinessBrace your feet and assist resident to turn to chair, lower resident into chairAlign resident, remove gait belt

42. IV. Activities of Daily Living120 minutesF. Transfer from bed to chair/wheelchair/Use of Gait belt- One person standby/transfer Procedure: Transfer to WheelchairProcedure is much the same as transfer to chairRemember to lock the brakes of the wheelchair and move footrests out of the wayTransport forward through open doors, backward through closed doorsRemember to lock brakes once resident is at destination, remove gait belt

43. IV. Activities of Daily Living120 minutesF. Transfer from bed to chair/wheelchair/Use of Gait belt- One person standby/transfer Note: For anything beyond a one-person transfer, the PCA may only assist and must be directed by a certified/licensed staff member

44. IV. Activities of Daily Living120 minutesG. Bed bath/partial bathProcedure: Bed Bath/Perineal Care Most important consideration during the bathing process; comfort, safety and privacyPartial bath; face, hands, underarms, and perineal area; at least dailyFull bath or shower; 2 times per weekPerineal care includes pubic area, inner thighs, groin, genitalia, and anusLinens: 6 washcloths, 4 towels, bath blanket, clean gown/clothes Catheter Care - clean tubing starting from the opening to the bladder and wipe outward 4 inches

45. IV. Activities of Daily Living120 minutesG. Bed bath/partial bathProcedure: Bed Bath/Perineal Care (continued)Start with warm water in basin, will be changing 3 times for total of 4 basins of waterWash head to toe EXCEPT perineal area ( 1 washcloth, 1 towel)Perineal area (2 washcloths, 1 towel) - away from the opening to the bladder – circular motion Anal area, buttocks (2 washcloths, 1 towel) – cleaning front to backBack (1 washcloth, 1 towel)Note: each time water is changes, wash hands, put on clean gloves, ask resident to check water temp

46. IV. Activities of Daily Living120 minutesH. Assistance with Dressing/Undressing Procedure: Dressing a Dependent ResidentGive resident a choice of clothingDress Affected side firstUndress Unaffected side first

47. IV. Activities of Daily Living120 minutesI. Incontinence/Perineal Care Procedure: Application of an Incontinence BriefPut on gloves before removing the dirty briefProvide perineal care (peri-care)Change gloves/wash hands before applying a clean briefPlace dirty brief in a bag and remove from room

48. IV. Activities of Daily Living120 minutesJ. Assist to Toilet/Use of urinal (only for a resident requiring one person/standby assist) Procedure: Assist to BathroomWhen finished – apply gloves, assist resident to wipe front to backRemove gloves, wash hands, assist resident to raise garments, help resident was handsProcedure: UrinalIf using in bed, raise head of bed to a sitting positionWhen finished, apply gloves, cover urinal, take to bathroom, check COCA, dispose, wash hands, assist resident to wash hands

49. IV. Activities of Daily Living120 minutesK. Oral Care - conscious residents only Procedure: Oral Care for the Alert and Oriented ResidentOral care should be done daily, place in Fowler’s positionPCA can NOT perform oral care on an unconscious resident Check MLTT Mouth, Lips, Tongue, TeethCheck for OCSBDL Odor, Cracks, Sores, Bleeding, Discoloration, Loose teethWhat is the phrase to help you remember what you are checking for? Oral Care Should Be Done Last

50. IV. Activities of Daily Living120 minutesL. Devices/Use/Storage (Hearing Aids, Eyeglasses, Dentures)Procedure: Assisting with Hearing AidsYou know it’s working if it amplifies soundAlways face resident when speakingStore hearing aids in the labeled case when not in resident’s ear, can use a clean labeled denture cupDo not get hearing aids wetClean according to manufacturer’s instructions

51. IV. Activities of Daily Living120 minutesL. Devices/Use/Storage (Hearing Aids, Eyeglasses, Dentures)Procedure: DenturesStore in labeled denture cup with cool water overnightRemove uppers first – break seal then move up and down; lowers – lift one sided then the otherFill bathroom sink ½ full of water, place a towel in sink – protects dentures if you drop themCheck MLTT Mouth, Lips, Tongue, TeethCheck for OCSBDL Odor, Cracks, Sores, Bleeding, Discoloration, Loose teeth

52. IV. Activities of Daily Living120 minutesL. Devices/Use/Storage (Hearing Aids, Eyeglasses, Dentures)EyeglassesShould be clean and on the resident during waking hoursStored safely when the resident is not wearing themReport to nurse if glasses are damaged of resident reports of headaches/not seeing wellNote: Emphasis on orthotics and prosthetics must be placed by a CNA.

53. IV. Activities of Daily Living120 minutesM. Final Steps/Observations to report to the NurseProcedure:Final Steps – Observations to Report to the Nurse – Applicable Every Time the Resident Room is ExitedFinish everything in room, wash handsDo safety sweep – make sure you haven't forgotten anythingReport unexpected findings to nurse, document

54. V. Skin Care/Pressure Prevention15 minutesA. Basic care/interventions/devices Residents who cannot change positions must be repositioned at least every 2 hoursResidents at highest risk for skin breakdown:Those who are immobile, incontinent, obese, malnourished, previous breakdownEarly sign of decubitus/pressure ulcer (caused by pressure over a bony prominence)Redness that doesn’t go awayResident reporting burning sensation

55. V. Skin Care/Pressure Prevention15 minutesB. Offloading/floating heels Procedure: Float HeelsInspect skin, especially heelsPlace a pillow (not a rolled pillows or blankets) under resident’s calvesHeels should be “floating” in the air, free from pressure

56. V. Skin Care/Pressure Prevention15 minutesC. Observations to report to the Nurse/Manager 1. Open area or skin condition observed to be lacking a dressing a. Emphasis on no dressing applied by the PCA 2. Observed bruises, abrasions or skin tears

57. VI. Oxygen Use/Safety15 minutesA. Nasal cannula/tubing/storage/observing liter flow Procedures: Nasal Cannula CarePerform every shift, clean nostrils, clean nasal cannulaInspect skin for signs of irritation: nostrils, behind ears, on cheeks, under neckB. Potential hazards/safety PCA’s are NOT authorized to administer oxygen which includes adjusting the flow rateSafety precautions: No smoking; No electrical appliances near resident (fan, electric razor, hair dryer)

58. VII. Nutrition/Hydration15 minutesA. Mechanically Altered Diets/Thickened Liquids/Adherence to Diet Follow diet card to make sure resident is getting the correct diet, equipment, etc.Therapeutic diets (diabetic, low sodium, etc)Mechanically altered (mechanical soft, pureed)Thickened liquids – according to manufacturer’s directions, for residents with swallowing difficulty(nectar thick, honey thick, pudding thick)

59. VII. Nutrition/Hydration15 minutesA. Mechanically Altered Diets/Thickened Liquids/Adherence to Diet Meal consumption: Record meal intake in % (25%, 50%, 75%, 100%)Notify nurse if diabetics eat less than 50%, non-diabetics less than 25%Recording intake:Fluid intake and output recorded in cc’s or ml’s 1 ounce = 30 cc = 30 ml8 oz glass of milk (8oz X 30 cc/ml) = 240cc or 240 ml

60. VII. Nutrition/Hydration15 minutesB. Passing Trays/Retrieving Trays (set up/opening packages for residents who can consume meals independently) Procedure: Assist to EatWash hands/resident hands before mealCheck diet card/tray; confirm any adaptive equipment neededAssist to open packages, cut meat, season according to resident preferenceDocument

61. VII. Nutrition/Hydration15 minutesC. Passing ice water Procedure: Passing Fresh Ice WaterKeep ice scoop covered with a clean towel or plastic bag to prevent contaminationNote any fluid restrictions/NPO (nothing by mouth) prior to passingNote residents who require thickened liquids prior to passingKeep in mind: this procedure may be handled differently due to pandemicD. Food storage/safety

62. VII. Nutrition/Hydration15 minutesSafety precautions: Tube feedings Keep head of bed elevated at least 30 degrees when the tube feeding is runningAspiration pneumonia may result if the tube feeding mixture enters the lungsRisk of aspiration – inhaling fluids into lungs = aspiration pneumoniaResidents at risk of choking/aspiration should sit up/bed elevated for 30 min after mealsSigns of aspiration: coughing, gurgling, regurgitationSTOP feeding, notify nurse, stay with resident

63. VIII. Dementia Care30 minutesA. Stages of Dementia/OverviewImpairment of mental function, inability to think, concentrate, reason, remember clearlyCommon BehaviorsPacing: wanders aimlessly; may have forgotten the location of their roomHoarding – collecting, hiding, and storing items in a guarded manner; keeping more than neededPillage – taking items that belong to anotherSundowning – increased confusion in the evening with improvement during the day; Elopement – increased risk, report a missing resident immediately

64. Quick Reference for Stages of Alzheimer’s Disease Stage 1 – No impairmentNormal functioningNo memory lossStage 2 – Very MildMay feel memory lapsesForgets familiar words or objectsStage 3 – MildNoticeable problems coming up with right wordsForgetting material just readTrouble planning/organizingLosing or misplacing itemsStage 4 -- ModerateForgetfulness of recent eventsDifficulty performing task, dinner, bills Forgets own historyStage 5 – Moderately SevereUnable to recall own address or phone #Forgets name of HS or collegeConfuses daysStage 6 – SevereTends to wander and get lostDresses inappropriatelyIncontinentUnable to recognize familyStage 7 – Most SevereNeeds maximum assistance with ADLAbnormal reflexes 

65. VIII. Dementia Care30 minutesB. Tips on communicating with cognitively impaired Residents Reality OrientationUse Person, Place and Time in the conversation at every opportunity, use clocks, calendars, and signs Validation TherapyAllows residents to believe they live in the past or imaginary circumstances; join them where they areReminiscence Therapy Talk about pleasant memories of the past - ‘Life Review’; resident is aware they are in the present

66. VIII. Dementia Care30 minutesB. Tips on communicating with cognitively impaired Residents Challenging behaviorRemove trigger, if knowDecrease stimulationAvoid arguing with the residentRedirect and try to engage the resident in other activities

67. VIII. Dementia Care30 minutesC. Recognition of when to seek additional staff assistance Examples:No matter what you try, the resident is not receptive to careYou find yourself getting frustratedThe resident is getting more and more agitatedCan you think of an example?

68. IX. Mental Health/Challenging Behaviors30 minutesA. Responding to challenging behavior Remain calm, don’t overreactRegardless of the behavior, always treat the resident with dignity and respectDon’t take anger actions personally B. Recognition of when to seek additional staff assistance C. Reporting a challenging behavior to Nurse/Manager on duty

69. X. Review Of Resident Rights, Abuse & Neglect Reporting, and Reporting to Nurse15 minutesA. Sample scenarios of situations involving Resident Rights, abuse and neglect Abuse: willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguishAbuse is NOT accidentalNeglect: failure to provide reasonable caution or care, resulting in harm/risk of harm to a residentCan be accidentalIncludes abandonment of a resident

70. X. Review Of Resident Rights, Abuse & Neglect Reporting, and Reporting to Nurse15 minutesB. Review of immediate protection of Resident until assistance arrives, if abuse is in process IMMEDIATE reporting requiredAny mistreatment, abuse, neglect, misappropriation of resident’s property or injuries of unknown origin occursThis mistreatment could come from visitors, family members, contractors, residents or a member of the staffC. Review of duty to immediately report to the Nurse/Manager on Duty

71. Scope of Practice Notes for PCACANNOT be assigned or provide care or services to a resident in Isolation Precautions CANNOT go beyond a one-person transfer without the assistance/direction of a certified/licensed staff memberCANNOT place orthotics or prosthetics – these must be placed by a CNACANNOT provide oral care to an unconscious resident CANNOT apply any type of dressingCANNOT feed a resident – CAN pass trays, set up/opening packages for residents who can consume meals independently